General Surgery - LHSC


Contact person: Christine Ward, Program Administrator,
University Hospital, Rm C8-114,
339 Windermere Road,
London, ON N6A 5A5


TEAM STRUCTURE

University Hospital
There are 5 general surgery teams. Each team usually has 1 senior resident, 1 or 2 junior residents, 1 medical student and possibly 1 elective student.

Victoria Hospital
There are 3 general surgery teams, 1 ACCESS team (acute care emergency surgical service), 1 combined adult general surgery and pediatric general surgery team. Each team usually has 1 senior resident, 1 or 2 junior residents, 1 medical student and possibly 1 elective student.

Call Requirements
On call ratio is 1 in 4 for senior residents "at home." Junior residents take 1 in 4 to 1 in 6 "in house" calls at Victoria Hospital and University Hospital.

Ward Rounds
As the junior resident, you will be responsible for accompanying the senior resident on daily ward rounds and supervising the medical students and others on your service. As you become more comfortable with pre and postoperative care, the senior resident will give you more responsibility. You are expected to answer directly to the senior resident and if that person is not available then directly to the consultant.

Outpatient Clinic
You are expected to attend the outpatient clinic for at least ½ day per week. Attendance is MANDATORY. Attendance in the clinic is mandated by the Royal College, and is essential to your understanding of the assessment of new patients and review patients who are having problems. In this day of same day admit procedures, this is your opportunity to assess patients in the elective situation and become experienced in decision-making.

Emergency Department
It is important to stand on your own two feet, assess the patient, make a diagnosis, and then check with the senior resident or consultant as your experience dictates. You are expected to become experienced in basic resuscitation of GI bleeds, bowel obstructions, and all types of shock. You are expected to learn the basic steps in trauma resuscitation.

Responsibility
As a resident, you will be a role model for those working with you, particularly the medical students working on the service. Keep in mind that you have a responsibility to your patients and their proper management, and also to continuity of care. The students working with you will closely watch your behavior and attitudes.

Operating Room
In the operating room, we expect you to learn the basics. That involves patient positioning, lighting, appropriate x-ray availability, prepping, draping and basic incision making, closing of wounds, and laparotomy techniques. By the end of the rotation we expect that you would have conducted these basic procedures and probably have done uncomplicated appendectomies and hernia repairs under supervision.

Pre & Postoperative Care
We expect that you will be able to assess surgical risk in patients preoperatively and anticipate problems, which may arise and prevent them with appropriate intervention. Continuity of care in post-op patient management is crucial. When puzzling postoperative situations arise, ask questions and ask for help.

Teaching Rounds
There are weekly teaching rounds conducted at both University Hospital and Victoria Hospital. You will be expected to attend these rounds at the site you are doing your rotation.

Attitude & Behavior
You should demonstrate the appropriate attitude and behavior expected of a competent physician. You must effectively interact and communicate with other members of the health care team and with patients and their families.

Advocating
We also expect you to develop basic skills in advocating what is right for patients who can’t speak for themselves, and also become involved in difficult ethical decision-making such as withdrawal of care in patients in the ICU and in organ donation.

Collaboration
We expect you to become comfortable in collaborating with other members of the health care team. On Wednesday afternoons there are interdisciplinary rounds for patient planning. The junior or senior resident is expected to meet with members of the nursing staff, psychologists, nutritionists, social workers, and physiotherapists and so forth to plan patient care and discharge.

Confidence
It is important that you develop a sense of self-confidence and responsibility along the way but never be afraid to ask questions when you are unsure as to what should be done.

Evaluation
You will be evaluated mid way through your rotation and at the end. We expect to give you daily feedback as to your performance as well. Evaluations are now being done on line and it is imperative that you complete these in a timely fashion. Evaluations are strictly confidential and are a very useful tool in improving the quality of our service.

It is the resident's responsibility to ensure that the final in-training evaluation is completed prior to leaving the service.