VCU Department of Surgery

A wide breadth of out-patient clinic experience is available to the General Surgery resident to build skills, in assessment, clinical decision-making and the development of treatment plans.

The following is a list of the out-patient clinics with descriptions for each.

Ambulatory Care Center (ACC), Nelson, Children’s Pavilion, and Gateway Clinics (General Surgery, Vascular, Trauma, Pediatrics, Transplant, and CT Surgery):

Residents are involved in pre-operative evaluation of patients with diagnoses falling within the principal components of general surgery as well as the secondary components of general surgery. Most of the elective surgery patients are not admitted to the hospital until the day of the scheduled operation, therefore the outpatient clinics are organized to include an opportunity for the resident staff to perform complete evaluations on all patients prior to hospital admission during the weekly history and physical clinic in the outpatient clinic. This provides continuity of care in that residents do the initial evaluation pre-operatively, assist with the case in the operating room and follow the patient in out-patient clinics on follow-up visits. A critical part of the training program allows residents to provide the initial evaluation on patients referred to the surgical clinics, with input and guidance from chief residents and supervising faculty. The volume and variety of diseases seen in clinics, which may or may not require surgical intervention, gives residents’ exposure to a broad spectrum of diseases in general surgery. Residents have the opportunity to demonstrate their ability to evaluate patient disease, write operative plans, present their management and treatment plans exhibiting their knowledge of pertinent scientific information. Residents are given graduated levels of responsibility throughout their training. Through feedback from the supervising faculty, residents have the opportunity to evaluate their own patient care appraisals and improve in their delivery of patient care. Since many patients are referred from other hospital services, residents develop communication skills that result in effective exchange of information and collaborate with other health care professionals in the care of their patients. Because of the diverse group of patients seen in the clinics, residents demonstrate their professionalism as seen through their commitment to carrying out professional responsibilities. The VCUHS has many system-wide resources available and residents routinely utilize these resources to provide optimal care. The General, Trauma, Vascular, and CT clinics see an average of 200 patients weekly in these clinics. The Transplant clinic sees about 70 patients each week, and the Pediatric clinic see an average of 25 patients each week in their clinic in the Children’s Pavilion.

A.D. Williams Clinic (General Surgery):

VCUHS provides health care for the underprivileged citizens of Virginia . The A. D. Williams Clinic at the VCU Medical Center is an indigent clinic, and also takes care of incarcerated patients. Residents see an average of 50 patients weekly in the A. D. Williams General Surgery Clinic (30 return patients and 20 new patients). The A. D. Williams General Surgery clinic is supervised by faculty from the Division of General Surgery. Trauma clinic is on Thursday morning and the residents see about 20 patients each week. The Trauma Clinic is supervised by the trauma faculty. Vascular surgery has a clinic on Tuesday morning once a month to take care of the incarcerated patients. Residents see about 10 patients. The Vascular Clinic is supervised by the Vascular faculty. All patients are evaluated in the clinic pre-operatively by the residents. Residents participate in the operation and see patients in the clinic post-operatively. The faculty member assigned to cover the clinic discusses the pre-operative evaluation and the operative plan with the resident. Continuity of care is enhanced by resident involvement from the onset in the initial evaluation, participating in the operation, and follow up post-operatively.

Dalton Oncology Clinic of the MCV Massey Cancer Center (Oncology):

The Massey Cancer Center is one of the 61 NCI designated Clinical Cancer Centers in the US . Patients are referred from all of Virginia as well as many surrounding states. The faculty sees private patients, as well as indigent patients in the center. Residents participate in the initial evaluation, develop treatment plans appropriate for the residents’ level of training, consult with the attending surgeon regarding operative care, assist with operations, and participate in the immediate post-operative care until the patient is discharged from the facility. Residents will see post surgical patients in follow-up visits in the outpatient clinic. The Dalton Oncology Clinic has a multi-disciplinary approach to patient care. The multi-disciplinary approach allows residents to collaborate with other health care professionals in effective information exchange. Residents also gain exposure to the larger context and systems of health care and access system wide resources to provide optimal care. Patients are referred for consultation and evaluated by residents working side-by-side with the assigned surgical oncology faculty member. Faculty provide immediate feedback and discuss the resident’s treatment plan for patient care and/or surgical intervention. Residents work closely with other hospital services such as physical and occupational therapy, patient and family counseling, genetic counseling, and home health care agencies learning how to integrate these services for the overall well being of the patient. Residents gain progressively more independent decision making as they advance in the training program. Residents take care of patients that may or may not require surgical intervention and develop skills in non-operative management. About 400 patients are seen in the Dalton Oncology Clinic each month, many of whom require the collaboration of physicians from multiple specialties which provides resident interaction with other health care providers and collaboration with referring physicians from other specialties. Faculty closely supervise the residents; however, supervision does not conflict with the resident’s capability to formulate independent treatment plans and patient care for these patients.

The educational goals with learning objectives for each rotation at the VAMC clinical sites are clearly outlined and are essentially the same as for services at VCUHS in general surgery, surgical oncology, plastic surgery and vascular surgery. The VAMC is the fifth largest VA in the US , and has one of the largest spinal cord services in the VA Health System. Further, it is well known for providing complex surgical care including heart and lung transplantation. Therefore, the VAMC serves as a regional referral center with complex surgical cases referred from several VA hospitals, including those located in Salem and Hampton , Virginia , and Beckley , West Virginia . The in-patient and out-patient surgical services at the VAMC are covered by eight surgery residents each month. The cardiothoracic service is covered by one PGY-1 general surgery resident; the general surgery service has two PGY-1’s, one PGY-2, or PGY-3, and one PGY-5; the vascular surgery service has two PGY-1’s, and one PGY-5 assigned on a monthly basis. Residents staff the surgery clinics which are supervised by the chief resident on that service with additional supervision by the assigned faculty member. The PGY-5 resident on the General Surgery service at the VAMC manages the general surgical patients, and surgical oncology patients. Patients referred to the outpatient clinics may not require surgical intervention but clearly have surgical related problems. The general surgery and vascular surgery services have an extremely busy consult service (an average of 20 to 40 patients per week) which is run by the chief residents on those services. About 10% to 15% of the operative cases come from these two consult services. The diversity of diseases and the operative experience ensures a sufficient number and distribution of complex cases for the achievement of adequate operative skills, balance, and experience in general surgery and vascular surgery. There is greater autonomy in decision making by the chief residents closely supervised by the faculty. They also direct the post-operative care and provide sufficient follow-up for hospitalized patients and those seen for follow-up in the outpatient clinic. This environment provides for an excellent learning experience and prepares the resident to make clinical decisions independently pre-operatively, intra-operatively and in post-operative care. There is a large geriatric patient population offering extensive experiences for residents in caring for the elderly patient with surgical needs. The general surgery service which includes surgical oncology averages about 600 cases per year and the vascular service averages about 400 surgical cases per year.

Residents assigned to the VAMC are required to attend the weekly general surgery conference on Friday mornings which includes discussions of complications and deaths (D&C). In addition to the D&C held at the hospital, the chief resident on the general surgery and the vascular surgery service at the VAMC present complications and deaths at the departmental D&C on Thursday afternoon at VCUHS.

VAMC Outpatient Clinics:

General surgery residents, during rotations at the VAMC, are involved with a number of outpatient clinical responsibilities depending upon the service to which they are assigned. Residents assigned to general surgery cover the general surgery clinic on Thursday and the surgical oncology clinic on Wednesday afternoon; residents assigned to vascular surgery cover clinic on Tuesday.

Residents rotating on general surgery have general surgery clinic on Thursday which begins at 9:30 am and goes until 2:00 pm . The general surgery clinic sees patients with a broad spectrum of general surgery problems exclusive of oncology problems. The clinic sees about 42 patients per week. Residents take care of patients with inguinal hernias, peptic ulcer disease, gall bladder disease, inflammatory bowel disease, and all other general surgery related problems. The volume and variety of the operative experiences ensures that residents have experiences in the principal components of surgery, as well as secondary components of surgery. Residents play a significant role in the management of patient care preoperatively, operatively, and postoperatively. Residents are responsible for making the diagnosis, select the appropriate operative procedure, present their management and/or treatment plan to the supervising attending for assessment. Residents follow their patient’s postoperative course, in outpatient visits in the clinic or as inpatients. Patients seen in clinic are referred from the primary care clinics, post-op follow-up, and patients on whom the service consulted while hospitalized on a medicine service that may need follow-up in surgery clinic. Dr. Jeannie Savas and Dr. Thomas Miller are the supervising attendings.

SurgicalOncology:

Residents on the general surgery service cover the surgical oncology clinic on Wednesday afternoon from 1:00 to 3:30 pm . The clinic is under the supervision of Dr. Walter Lawrence, Professor Emeritus of Surgical Oncology. The clinic sees new referrals with either presumed or recently diagnosed cancer that may benefit from surgical intervention. Residents also see postoperative patients who have undergone surgical procedures. The clinic gives residents extensive experience in caring for a very specialized group of patients allowing them to play a significant role in the preoperative, operative and postoperative care of these patients. Residents have the opportunity to determine the diagnosis, select the appropriate operative procedure, and direct postoperative care. They present their findings to the supervising attending for assessment and concurrence. Residents are considered to be the surgeon based on their role in the total care of the patient. The surgical oncology clinic sees about 15-20 patients each week.

Residents assigned to vascular surgery have one major clinic per week which is held every Tuesday from 9:30 to 3:00 pm . This clinic sees patients who have been referred from the primary care clinics with various presumed vascular problems, as well as follow-up of patients who have previously had vascular procedures or were inpatient consults subsequently discharged from the hospital and instructed to return to the vascular surgery clinic for follow-up. Residents have the opportunity to examine and evaluate patients preoperatively, formulate a diagnosis and/or treatment and management plan, which is presented to the supervising attending for assessment and concurrence. Residents perform the case with attending supervision and follow patients post-operatively in the clinic. There are about 58 patients seen in the vascular clinic weekly. There is a full-time faculty member supervising the residents in the outpatient clinic.

St. Mary’s Hospital:

Residents in the PGY-4 year spend eight weeks at St. Mary’s Hospital with community surgeons from Virginia Surgical Associates. These physicians hold an adjunct faculty appointment in the department of surgery. Residents have the opportunity to get “bread and butter” general surgery cases, as well as vascular surgery cases working with the private physicians. The patient evaluation is done by the private physician prior to surgery. Residents are expected to review the patient pre-op evaluation, laboratory values, and any radiologic reports related to the surgery. Residents participate in about 72 cases during the rotation, and see a broad range of general surgery diseases. Residents increase their mastery in formulating and implementing diagnostic and treatment plans for disease, injury or conditions amenable to surgical intervention. Residents broaden their medical knowledge and exercise interpersonal and communication skills through interactions with private physicians, patients, families and other health care professionals in a community hospital. Residents have exposure to surgery as a community private practice surgeon, and experience patient care outside the primary teaching hospital. The rotation provides a quality educational experience with clearly stated goals and objectives. Faculty supervise and evaluate residents on the service. A formal written evaluation of the resident’s performance is provided at the end of each rotation.

The Pediatric Surgery faculty cover the pediatric service at St. Mary’s Hospital. Residents assigned to pediatric surgery in the PGY-2 and PGY-4 years take care of patients at St. Mary’s Hospital supervised by the VCU faculty covering the service. Residents are expected to evaluate the patients in outpatient offices, participate in the operative procedure and follow-up in the outpatient clinic following discharge from the hospital. The PGY-4 resident is responsible for reporting deaths and complications at the weekly departmental D&C. Residents are supervised and evaluated by the VCU pediatric surgery faculty.