The educational mission of the Division of General Surgery is to provide house officers with a sound, scientific understanding of the discipline of surgery so as to be able to practice the art of our field.  To meet that goal, a cadre of staff physicians has been assembled, each of  whom are foremost, practicing general surgeons-- although you will find that each has as well developed a defined area of clinical expertise.  As such, by the time you complete your rotations among the Surgery services at Henry Ford Hospital, you will have come away with a clear vision as to the role a general surgeon will play in the practice of medicine well into the new millennium.

Each of the Surgery services is organized to acquaint you with the diagnosis and management of patients whose illnesses are to be cared for under either elective, or more urgent, circumstances.  In regards to your participation in elective patient interactions, it must be first understood that the forum within which general surgeons now practice their trade has by and large moved from the inpatient, to an office, setting.  Since our outpatient clinics are attached to the hospital, an environment that fosters resident participation in  the process of bringing a patient through their entire care contract-- from initial assessment, through their operative procedure, to their final office evaluation-- is all but assured.  Moreover, the schedules of the attending surgeons on each of the Surgery services are coordinated so that each service conducts its elective operations on the same two days each week, while the outpatient clinics are attended to on different week days.  Therefore, the house staff assigned to a given service will have the greatest opportunity to work as a unit with the attending staff.

To address the management of patients with illnesses that mandate urgent attention, each of the four Surgery services has several attending staff who bear a special interest in emergency care, and who will therefore take in-hospital call with the residents assigned to their service on a rotating basis.  Since Henry Ford Hospital is a 650 bed institution that also houses an Emergency Department that handles over 100,000 visits annually, one can expect that the care of the critically ill will be a major part of your educational experience.  To emphasize our commitment to this concept, we have maintained our designation as a Level 1 Trauma Center under the direction of Dr. Pat Patton, Chief of Trauma Services.  The trauma team manages about 1400 patients annually, with a 7:3 blunt-to-penetrating mechanism of injury ratio.  Of the 25 operating suites available for all surgical services, there exists an immediate operating room access policy for the seriously injured, or critically ill, patient.  Dr. Mathilda Horst, Director of the Surgical Critical Care Service, manages a 40 bed Surgical Intensive Care Unit that is designed to assist you with the moment to moment care of such patients.

As you advance through this system, you will find your level of responsibility will increase in direct proportion to your level of competence.  We expect that, as junior level residents, you will focus upon mastering the concepts needed for effective perioperative management of your patients.   Among the specific goals of this process is to develop a sense of “trajectory” in your practice.  That is to say, you will learn that recovery from a given illness or operative procedure can be patterned along a fairly unique time curve, along which certain clinical events should occur with regularity as the patient recuperates.  Hence, deviation from an expected trajectory pattern should be considered an ominous sign that an untoward event lies ahead for the patient unless measures are taken to bring the patient back to the proper trajectory.  You will therefore be asked to hone your clinical skills, and to obtain assistance from ancillary tests only when you believe that the results of these examinations will appreciably alter the manner in which you are managing your patient.  As you move into the more senior years of residency, you will be increasingly exposed to the processes of: [1] making decisions relative to the indications and timing of a given operative procedure; [2] planning the conduct of an operation; and, [3] intraoperative decision making. As senior level residents, you are expected to take charge of the patients on your service, to learn proper delegation of responsibility to the junior residents and, of perhaps most import, to pass down your knowledge to your patients and to your junior staff.  Finally, throughout your tenure within our training program, you will be accorded operating room privileges in concert with the technical skills you bring to the table and with your understanding of the proper conduct of a given procedure.  As you gain familiarity with this patient management system, it is hoped that you will share our belief that continuity of patient care is, from both educational and practical viewpoints, crucial to the success of our discipline.

While assigned to each of the Surgery services, the patients are yours to manage on a 24/7 basis.  We feel patient care is best learned from this type of “hands-on” approach, guided by a self-imposed plan of directed reading on your patients’ illnesses, strengthened by a regular pattern of staff service teaching rounds, and unified by a series of interactive conferences designed to give the resident staff a complete overview of the relevant clinical and scientific literature over a three year time frame.  We remain confident that, if you take full advantage of this opportunity, you will leave our program well-equipped to progress to the next level of your career, be it the practice of general surgery or the participation in one of the surgical sub-specialties.