Goals & Principles of the General Surgery Residency

  1. One of the guiding principles of the program is that we strive for heterodoxy. Our faculty have diverse backgrounds and have been educated in different parts of the world. Consequently, we do not believe that a "UCSD way" of doing things exists, whether we are talking about the correction of metabolic acidosis or the specific techniques involved in a bowel anastomosis. There are many training programs around the country which claim to teach the way of doing things. Instead, we prefer an educational program that exposes our residents to as broad a spectrum of acceptable alternatives as is possible; thus enabling them to begin to evolve their way of doing things. Consequently, we expect you to graduate, not as clones nor mimics of anyone of our faculty, but as independent thinkers with the beginnings of your own personal style. A style that will continue to evolve throughout your career. The end result of all of this is a sense of knowing where the residents are: they will not only know strengths but also be aware of weaknesses and, particularly, will know where ignorance is prevalent and where further growth must take place. So, the only programming we aim to do is to program surgeons to continue to grow.
  2. This second guiding principle is very simple. If you come to UC San Diego for your education, from the day you join us until the day you leave us, you will be expected to teach. Part of the rationale for this emphasis is to repay the debt which we all have incurred during our education. More importantly, however, it is aimed at the residents themselves. We learn more and we learn differently when we have to teach and answer questions. We insist on this requirement, which enhances the quality and depth of our surgical knowledge.
  3. The third matter is not really a requirement. It is more a statement of principle and philosophy. General Surgery is being invaded from above by the head and neck surgeons and endoscopists, from below by the colorectal surgeons, endoscopists, and gyn/ oncologists, and from the surface by the joint forces of interventional radiologists and plastic surgeons. In this setting, broad training becomes difficult, but increasingly critical. We have consistently made an effort to retain as broad an interpretation of our discipline as possible. We have avoided establishing fellowships in vascular surgery, oncology, or gastrointestinal, hepatobiliary, and pancreatic surgery in order to retain the experience in these important fields for the general surgical resident. We feel that a thoracic experience is of great value to the general surgeon whether or not he or she ever does pulmonary resections. He or she will be taking care of patients with thoracic trauma, esophageal disease, hiatal hernias, or parathyroid problems, and competence in the chest is critical. 
  4. The faculty realizes that there is no one single program which should be imposed on every general surgical resident; goals differ amongst those headed into cardiothoracic vs. pediatric vs. plastic or old-fashioned general surgery, and the same experience is not what they all require. Therefore, a certain amount of "tracking" will be possible from the internship on up, allowing people to customize part of the program, namely the one that extends beyond the true core experience. The research experiences available are multiple and vary from basic science work to clinical investigation. The facilities of the department, the entire medical school, as well as those of the adjacent Scripps Clinic and Research Foundation and the Salk Institute, are all available to our residents/fellows. The time allocated to research is not fixed. Many of our residents have taken two years in continuity, and the ocasional one even three. Several have obtained graduate degrees in the process. We will try to help with the latter, but it certainly is not a requirement. Major strengths of the department and medical school concern gastrointestinal physiology, cardiopulmonary physiology, tissue and organ culture, monoclonal antibodies and genetic engineering, bioengineering, and the broad field of immunology, both humoral and cellular. Clinical research strengths are in trauma and burn care, intensive care and monitoring, and the various aspects of gastrointestinal and hepatobiliary pancreatic surgery, as well as endocrinology and surgical oncology. All of these and many others will be available to residents and fellows. Projects have been and can be undertaken at other institutions by special arrangement. It is our hope that by the combination of elective opportunities and research experiences, the broadest possible foundation can be built for practice or future fellowship training. In addition to the direct learning experiences that take place during this year, there is another important benefit. The elective year, by removing the resident from hour-by-hour patient care, takes him or her off the assembly line. This decompression allows both thinking and learning to occur in a different fashion than it does during the remainder of the residency. By being out from under the gun, the resident is allowed more time to read on the basis of long-felt needs rather than to fill immediate voids. The growth which results from such unpressured thinking and learning is invaluable, and contributes to the development of surgical judgment in a unique fashion.
  5. Last, but not least, the majority of operations are performed, at least in part, by the resident, depending on the nature and complexity of the case and the individual resident's level of training. The development of surgical expertise depends on a gradual increase in responsibility, and its rate varies from resident to resident. Ultimately, the faculty member is always responsible for the patient. Taking care of a patient is a privilege, not a right. Residents are required to adhere to surgical discipline in an ethical fashion. Commitment to a patient's care does not simply entail an operative procedure. Preoperative evaluation and postoperative management are equally important.