Curriculum & Clinical Rotations

Our residency program leaders work closely with residents to define topical, engaging, and valuable didactic education and skills training.

Dr. Varban instructing trainees
General Surgery Trainees
General Surgery trainees

Comprehensive Surgical Training

The General Surgery Residency program aims to provide an innovative training experience for the future leaders in surgery by focusing on the following areas of focus:

  • Developing outstanding technical skills and mature clinical judgment by combining simulation training, broad operative exposure, formative feedback, and a deliberate focus on the development of autonomy.
  • Provide the opportunity, training, and mentorship to launch an academic career grounded in effective collaborations and substantive research contributions.
  • Develop residents as highly-professional leaders of health care teams and other organizations.
  • Use preparation, opportunity, and feedback to develop outstanding educators of all learners (including peers, patients, and self) over the arc of their career.
  • Promote a culture of constant quality improvement for health care systems.
  • Encourage work/life balance, personal insight, and wellness to sustain a career in surgery characterized by genuine compassion and service to patients.
  • Support all individuals to reach their highest potential within an inclusive and collaborative community.

Clinical Rotations & Objectives

PGY-1

Goals & Objectives

The first year of residency training consists of core general surgery rotations designed to provide a broad introduction to general surgery operations, as well as the pre-operative, post-operative, outpatient, and intensive care of surgical patients. First-year residents:

  • Take an active part in patient evaluation and management appropriate for their level.
  • Actively participate in operative procedures, both as first assistant and as surgeon (junior role).
  • Take on a prominent role in the delivery of post-operative care.
  • Progress through a period of being supervised directly by senior residents and attending surgeons, to being supervised indirectly.
  • Complete a rigorous, structured, and detailed curriculum for the development of surgical skills in the U-M Clinical Simulation Center.

One-Month Rotations

  • General & Vascular Surgery at Ann Arbor Veteran’s Administration Hospital
  • Trauma and Acute Care Surgery at University of Michigan Hospitals
  • Burn Intensive Care Unit at University of Michigan Hospitals
  • Endocrine Surgery and Minimally Invasive Surgery at University of Michigan Hospitals
  • Colorectal Surgery at University of Michigan Hospitals
  • Pediatric Surgery at University of Michigan Hospitals
  • Plastic Surgery at University of Michigan Hospitals
  • Vascular Surgery at University of Michigan Hospitals
  • Surgical Intensive Care Unit at University of Michigan Hospitals
  • Transplant Surgery at University of Michigan Hospitals
  • Hepatopancreaticobiliary Surgery & Surgical Oncology at University of Michigan Hospitals
  • Float at University of Michigan Hospitals

Float covers junior resident vacations on relevant services.

PGY-2

Goals & Objectives

In your second year, you’ll gain more opportunities for graduated responsibility, both in the operating room and in clinical management. Second-year residents:

  • Function more autonomously by seeing consults on the emergency general surgery service, and function as the emergency consult resident on trauma, assisting senior residents in the care of patients during trauma resuscitations.
  • Assist with the supervision and education of junior residents and collaborate with the critical care fellow during rotations in the surgical intensive care unit.

Rotations

  • General & Vascular Surgery at Ann Arbor Veteran’s Administration Hospital (1 month)
  • Acute Care Surgery Emergency Consult at University of Michigan Hospitals (2 months)
  • Endocrine Surgery and Minimally Invasive Surgery at University of Michigan Hospitals (2 months)
  • Colorectal Surgery at University of Michigan Hospitals (2 months)
  • Minimally Invasive Surgery at St. Joseph Mercy Chelsea and Brighton Center for Specialty Care (1 month)
  • Pediatric Surgery at University of Michigan Hospitals (1 month)
  • Hepatopancreaticobiliary Surgery & Surgical Oncology at University of Michigan Hospitals (1 month)
  • Float at University of Michigan Hospitals (1 month)
  • Surgical Intensive Care Unit at University of Michigan Hospitals (1 month)

Float covers junior resident vacations on relevant services.

PGY-3

Goals & Objectives

In your third year, you’ll function as the second senior resident on most rotations. Opportunities for independent responsibility increase substantially. Third-year residents: 

  • Function as the primary consult resident on most services, and staff consults with the chief resident or directly with the attending.
  • Share the responsibility of running the service with the chief resident on days off or over vacations.
  • Take on operative cases of increased complexity. Operative volume increases significantly.

Rotations

  • General & Vascular Surgery at Ann Arbor Veteran’s Administration Hospital (1 month)
  • Trauma and Acute Care Surgery at University of Michigan Hospitals (3 months)
  • Cardiac Surgery at University of Michigan Hospitals (1 month)
  • Endocrine Surgery and Minimally Invasive Surgery at University of Michigan Hospitals (1 month)
  • Vascular Surgery at University of Michigan Hospitals (1 month)
  • Surgical Intensive Care Unit at University of Michigan Hospitals (1 month)
  • Burn Surgery at University of Michigan Hospitals (1 month)
  • Transplant Surgery at University of Michigan Hospitals (1 month)
  • General Thoracic Surgery at University of Michigan Hospitals (1 month)
  • Pediatric Surgery at University of Michigan Hospitals (1 month)

PGY-4

Goals & Objectives

Fourth-year residents are responsible for all aspects of clinical management of the service, as well as team leadership. Your responsibilities increase substantially both in the operating room and on the service. Fourth-year residents:

  • Function as the chief of the Acute Care Surgery service (SA-2), leading and managing all areas of the trauma service independently. They also direct and supervise all care delivered during trauma resuscitations under the supervision of the trauma attendings.
  • Gain a month of time for electives so they can pursue specific clinical interests.

Rotations

  • Trauma and Acute Care Surgery at Hurley Medical Center in Flint, MI (1 month)
  • Trauma and Acute Care Surgery at University of Michigan Hospitals (3 months)
  • Endocrine Surgery and Minimally Invasive Surgery at University of Michigan Hospitals (2 months)
  • Colorectal Surgery at University of Michigan Hospitals (1 month)
  • Transplant Surgery at University of Michigan Hospitals (1 month)
  • Surgical Oncology at University of Michigan Hospitals (1 month)
  • Float at University of Michigan Hospitals (1 month)

Float covers vacations on relevant service, PGY 4 in ACS call pool at University Hospital.

PGY-5

Goals & Objectives

Fifth-year residents act as chief on all services, leading the team in every aspect. Fifth-year residents: 

  • Direct every aspect of clinical care, including pre- and post-operative management, and staff patients with attendings on a daily basis.
  • Fulfill all administrative responsibilities of the service to ensure the team functions smoothly by coordinating schedules to ensure all clinics and operating rooms are staffed, while guaranteeing that all ACGME and duty-hour restrictions are met.
  • Coordinate and lead the clinical education of fellow residents and medical students on the team.
  • Take the lead in the technical aspects of operations and direct operative decision-making under the direct supervision of attending surgeons, refining their surgical skills and judgment to prepare for a life of independent practice.

Rotations

  • General Surgery at Ann Arbor Veteran’s Administration Hospital (2 months)
  • Vascular Surgery at Ann Arbor Veteran’s Administration Hospital (1 month)
  • Acute Care Surgery at University of Michigan Hospitals (2 months)
  • Endocrine Surgery and Minimally Invasive Surgery at University of Michigan Hospitals (2 months)
  • Hepatopancreaticobiliary Surgery at University of Michigan Hospitals (2 months)
  • Colorectal Surgery at University of Michigan Hospitals (2 months)
  • General Thoracic Surgery at University of Michigan Hospitals (1 month)

Academic Development Time

Residents typically have 2 years of Academic Development Time (ADT) between the PGY-3 and PGY-4 clinical years of training. Your first three years of residency provide an opportunity to become familiar with the research being done in the department, develop relationships with primary investigators, and finalize a proposal for your own research.

Didactics

Weekly educational conferences are held each week during a dedicated 3-hour morning block, with residents excused from clinical duties in order to participate. Residents participate in setting the schedule and choosing topics based on educational goals.

A typical conference schedule would include:

  • Death and Complications conference: Held weekly and attended by all residents and faculty.
  • Teaching conferences: Held weekly, which are collaboratively prepared and led by a resident and a faculty member for small group interactive discussions.
  • Basic Science Curriculum: Held monthly and attended by all residents. Concentrates on basic science principles underlying surgical disease and treatment.
  • Surgical Grand Rounds: Held twice per month. Attended by all residents and faculty.
  • Quality Improvement / TAPS Curriculum: Team Action Projects (TAPS) are resident quality improvement projects that draw on Lean principles and methodology.
  • ABSITE review: Conferences held during the months prior to the exam.
  • Surgical Ethics: Quarterly case-based discussion sessions led by the chair of the Adult Ethics Committee.
  • Rotation-specific conferences: Examples include multidisciplinary tumor boards and weekly case conferences during which residents present and discuss patients, as well as service-specific Morbidity and Mortality conferences (pediatric surgery and thoracic surgery). The services at the University Hospital and the VA each conduct their own weekly teaching conferences, as well.

Other learning activities include a monthly journal club, where residents select the topics and faculty host the club in their home.

Feedback & Evaluation

Feedback and evaluation are major areas of focus for our training program. We follow the ACGME Milestones, and every 6 months, residents receive formative feedback from the Clinical Competency Committee to help them track their progress and development. Trainees are also evaluated monthly in a Clinical Performance Evaluation.

Residents receive separate and frequent evaluations on their professionalism, and global assessment of their technical skills. Each year, mid-level and senior residents undergo a mock oral examination to prepare for the American Board of Surgery Certifying examination with specific formative and summative feedback. Chief residents also receive specific evaluations on their operative performance in key areas.

We work closely with residents to continually refine the methods and contexts in which we provide feedback on their growth. We also use aggregate results from the annual American Board of Surgery In Service Training Exam (ABSITE) to identify programmatic areas for improvement for the next year.