General Surgery Program Goals and Objectives
Program Director: Marc Melcher, MD, PhD
Assistnat Program Directors: Jim Lau, MD; Natalie Kirilcuk, MD
The overarching goal of the Stanford General Surgery Program is to produce outstanding
clinicians and technically superior surgeons who will become leaders in their hospitals and
academic centers. To accomplish this we provide residents with training and guidance not only in
the fundamentals of evidence-based clinical practice, but the basic science principles that
underlie the primary components of general surgery. In addition, technical skill is fundamental to
the successful training of a general surgeon and will be taught both in the operating room, in the
surgical skills curriculum and the Goodman Center for Surgical Simulation. Every resident in the
General Surgery Training Program at Stanford is expected to receive the same level of training
from the same services and the same faculty. This aspect of our program will give them clinical
and technical skills, experience in self evaluation, systems based practice, teaching and
professionalism.
To accomplish the goal of training leaders in surgery, we have developed a program which we
have called Professional Development. This period usually occurs after the second clinical year
and will last two to three years. Residents may choose basic science research or applied surgical
research. In addition, we have begun a Professional Development curriculum which allows
residents to obtain advanced degrees in education, public health, law, business, international
medicine and surgical simulation.
The following describes these goals in detail, how we accomplish them, and how we assess our
success.
1. Patient Care
Goals

to train residents who perform appropriate and effective treatments of surgical diseases

to teach residents to communicate effectively, caringly and professionally with patients,
families and colleagues

to teach residents to make evidence based decisions about diagnostic and therapeutic
interventions, utilizing up-to-date scientific evidence and clinical judgment

to teach residents to use information technology to support patient care decisions and
patient education and to train residents to work with healthcare professionals including
those from other disciplines to provide multidisciplinary patient-focused care
Objectives
The residents partake in the teaching activities developed by our program. Both level dependent
and level independent teaching is provided. Early in the year new interns are provided with basic
guidance on dealing with on-call emergencies, working with the computer systems etc.
By taking on the clinical care of the patients with graduated responsibilities the residents develop
their communication and surgical skills and apply their medical knowledge to the surgical
diseases of their patients. Residents take on a graduated level of responsibility of patient care
culminating in the Chief Residency year.
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PGY 1: are expected to learn how to collect data, synthesize it, and accurately report it in a
meaningful way to others on the surgical team. Finally the year will be an important venue to the
introduction to the Surgical ICU.
PGY 2 & 3: are expected to perform the above tasks at a higher level, with more efficiency and
accuracy. PGY2 residents begin to take consult call and learn how to develop care plans that
they review with their senior residents. In addition, these residents learn ICU care by working in
the ICU.
PGY 4: Begin to take on leadership positions on some services where they are the most senior
resident. For example, they are responsible for running the Trauma Service.
Chief Residents receive the patient care data, validate it, discuss treatment options, and enact a
treatment plan with the guidance of the attending.
Residents must develop the manual dexterity appropriate at each level. Therefore, residents are
expected to perform a wide breath of procedures in sufficient numbers to achieve this. OR data
are reviewed semi-annually to assure compliance. Technical skills are evaluated in the OR
supplemented by simulation exercises in the Goodman Simulation Center.
Teaching Activities
Teaching activities include the following; Core Course, Morbidity and Mortality Conference, Daily
Rounds, Attending Rounds, Pre-op Conferences, Clinical Care Conference, Mock Orals, Surgical
Skills Course and Surgical Boot Camp.
Assessment
Residents are evaluated and receive feedback in formal setting such as attending rounds and
Morbidity and Mortality Conference.
The faculty provides written assessments of their
performance on each rotation using the “Medhub” global evaluation program. Written feedback is
given to the residents after partaking in the mock orals.
Residents are expected to log all their surgical cases in the internet based ACGME Case Log
Software. They are given immediate feedback by attendings during cases and documented
feedback through Medhub at the end of each rotation.
2. Medical Knowledge
Goals

to train residents to develop the knowledge of established and evolving biomedical and
clinical science, as well as the application of this knowledge to patient care

to give residents an understanding of the basic science that is the foundation for surgical
practice and have a clinical knowledge necessary to treat the broad range of surgical
diseases
Objectives

every two years residents should review a complete surgical curriculum

residents need to go to and actively participate in the core course

junior and senior residents should present portions of the curriculum to their colleagues to
facilitate their own deeper understanding of the materials
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Teaching Activities
We have developed a core curriculum that is based on the curriculum put forth by the American
College of Surgery. This curriculum is completely presented every two years in Core Course.
Core Course consists of 1.5 hours per week of lectures and Socratic method of teaching following
a structured curriculum. Chapters from surgical textbooks covering the topic of the week are
required reading.
The teaching activities consist of the following; Morbidity and Mortality Conference, weekly Grand
Rounds, Daily Rounds, Attending Rounds, Pre-op Conferences, Clinical Care Conference and
Surgical Skills Laboratory.
Assessment
Evaluation by the Program Director, the service attendings (documented in MedHub), and chief
residents (documented in MedHub).

three multiple choice practice ABSITE exams

mock orals for PGY-3 through 5. Residents get written feedback that is placed in their
permanent record

ABSITE examination – Our goal is that all our residents score above the 50th percentile
3. Practice-Based Learning
Goals
Residents must demonstrate the ability to appraise and assimilate scientific evidence and to
continually improve patient care based on constant self-evaluation and life-long learning. They
are expected to develop skills and habits to meet the following goals:

identify strengths, deficiencies, limits in one’s knowledge and expertise and set learning
and improvement goals

identify and perform appropriate learning activities, and analyze practice using quality
improvement methods

residents must be able to locate, appraise and assimilate evidence from scientific studies
related to their patients’ health problems

residents must be able to use information technology to optimize learning and to
participate in the education of patients and families
Objectives

use information technology to organize and review published scientific data and develop
an understanding of factors such as demographics and insurance that influence their
patients’ health problems

take leadership roles in the teaching of students and more junior surgical residents

become involved in standardized simulations of surgical diseases to develop and assess
their surgical skills
Teaching Activities
Goodman Simulation Center: Each resident is required to attend surgical skills at our new
simulation center and they have protected time to attend their scheduled sessions. Our new
simulation facility gives our residents first chance to experience surgery without the high stakes of
a real operation. The Goodman Simulation Center will lead the way towards improved patient
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safety and quality of care by providing the best and most comprehensive learning for our
residents.
It emphasizes on; Standardized Patients, Part-task & Procedural Simulation, and Patient
Simulation for Individuals & Teams. These provide mannequin-based simulation drills to
assess decision-making, team collaboration skills and to enhance training, teamwork and skills
involving complex surgical cases, ICU patient care and trauma resuscitation
Morbidity and Mortality Conference: Senior residents are expected to present surgical
complications to the department. Their presentation includes a critical assessment of the event, a
review of the literature, and the development of a plan of action to reduce the chance of a
recurrence.
Assessment
4. Interpersonal and Communication Skills
Goals

residents must demonstrate interpersonal and communication skills that exchange
information and collaboration with patients and their families upon a broad-range of
socioeconomic and cultural backgrounds

residents must communicate effectively with physicians, other health professionals and
health related agencies and work effectively as a member or leader of a health care team

maintain comprehensive, timely, and legible medical records, if applicable.
Objectives

residents should be able to present clinical cases to others in a clear, concise, and
structured way to facilitate precise effective treatment of patients

residents should work well within a surgical team by facilitating communication between
members of the team and be able to communicate and coordinate care with other
medical specialties

senior residents should take an active role in the education of medical students and junior
residents
Teaching Activities
Presentation of patients on Chief Resident Rounds; presentation of patients on Attending
Rounds, Specific Core Course Lectures: 1) Lecture on Giving Bad News: Oncologist Beth Martin,
MD and 2) Lectures by Cardiology, Radiology, etc to facilitate resident communication with
consulting services.
Assessment
Chief residents and Attendings give regular feedback through the Medhub online system and 360
Degrees of feedback from patients in clinic and nurses on the wards.
5. Professionalism
Goals
Graduates of our program should be:

respectful of and responsive to the needs of diverse patient populations and be respectful
of patient privacy and autonomy
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
accountable and compassionate to patients and society

cognizant of when patient needs supersede self-interest
Objectives
Teaching Activities
Residents rotate through multiple styles of healthcare systems including a private hospital, a
county hospital, the Veterans Administration Hospital, and a managed care hospital. Each gives
exposure to overlapping diverse groups of patients with diverse backgrounds.
On daily rounds attendings and senior residents are expected to model professional behavior
when interacting with patients.
Assessment
Attendings and senior residents take on the responsibility of assessing the professionalism of the
residents. Their assessments are documented in Medhub. Problems are addressed face-to-face
with relevant attendings and/or the Program Director or Associate Program Director.
6. Systems-Based Practice
Goals
Residents must demonstrate an awareness of and a responsiveness to the larger system of
healthcare and the resources to provide optimal healthcare.

they must work effectively in a variety of healthcare delivery settings and coordinate
patient care within that health system relevant to their clinical specialty

they must incorporate considerations of cost and risk-benefit analysis in patient care
and/or population-based care as appropriate

residents must advocate for quality patient care, work in teams to enhance patient safety,
and improve patient care

identify system errors and implement potential systems solutions
Objectives
Residents will learn to function in a variety of healthcare systems including: private practice,
county, university, and VA hospitals.
Teaching Activities
Teaching activities should include the following; Core Course, Morbidity and Mortality
Conference, Daily Rounds, Attending Rounds, Pre-op Conferences, Clinical Care Conference.
Assessment
Attendings and senior residents assess the efficiency of the residents’ ability to navigate through
the multiple hospital systems.
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