SURGICAL INTERN (PGY-I)

     During the first year (PGY-I), emphasis is placed on the development of basic surgical skills and pre- and postoperative care.  Services covered are general surgery and the surgical sub-specialties, including thoracic surgery, vascular surgery, pediatric surgery, orthopedics, urology, neurosurgery, ENT, and plastic surgery, both wards and clinics.  Interns are under the direction and teaching of the senior residents and the attending staff.

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SECOND-YEAR RESIDENT (PGY-II)

     The second-year resident (PGY-II) is responsible for overall supervision of the inpatient service to which they are assigned.  The residents are expected to see all patients on admission, to elicit a history and perform the physical examination.  The residents make daily rounds on their service and discuss the patients with both the attending surgeons and the senior residents.  They assume a graduated responsibility for the therapeutic and diagnostic procedures in the hospital, under the direction of the senior resident and attending staff.

     The residents assist at operations and carry out procedures, under supervision, which are commensurate with their level of training and experience; assist on other cases from their service; and attend the surgical clinics.  The surgical residents are expected to understand surgical anatomy, pathology, operative techniques and procedures, and the use of instruments related to specific surgical procedures so that they may concentrate on developing the basic surgical skills which give a firm foundation for sound surgical practice.

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THIRD-YEAR RESIDENT (PGY-III)

     The third-year resident (PGY-III) has increasing responsibilities.  He/She provides supervision to the junior house staff in the pre- and postoperative management of patients and in the surgical outpatient department.  In addition, he/she performs the less complex surgical procedures, acquiring the dexterity needed for a career in surgery. Operative responsibility is determined by the resident's training and ability.  During this time, he/she rotates through the San Joaquin General Hospital,  the University of California, Davis, Medical Center and St. Joseph's Medical Center.

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FOURTH-YEAR RESIDENT (PGY-IV)

     In the fourth year, the resident has increasing responsibility in the clinics and on the ward.  In this year, he/she performs surgical procedures of greater magnitude.  He/She provides senior resident responsibility in general surgery, pediatric and thoracic surgery at the San Joaquin General Hospital, St. Joseph's Medical Center, and the University of California, Davis, Medical Center.  The fourth year surgery resident functions as Acting Chief Resident in Surgery at St. Joseph's Medical Center for a period of four to six months.  During the last quarter of the year, a gradual transition toward responsibility of the Chief Resident is made. Teaching remains a major component of the program.

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FIFTH-YEAR RESIDENT (PGY-V) CHIEF RESIDENT

     The Chief Resident (PGY-V) spends his/her entire last 12 months at the San Joaquin General Hospital on the surgical services.  During this time, he/she has complete responsibility for the management and the supervision of all services.  He/She schedules operations and notifies the attending staff of their assignments.  He/She directs treatment and maintains discipline over  all surgical interns and residents.  He/She conducts daily rounds, which are attended by the surgical interns and residents.  The Chief Resident assists in assigning journals and topics to the residents and interns for the Journal Club.  He/She is responsible for maintaining minutes of this meeting as well as the Surgical Staff meetings.  The Chief Surgical Resident organizes and conducts the weekly surgical conferences and panel discussions.  He/She collects monthly statistics of operative procedures, complications, deaths and autopsies.  With consultation, under the guidance of the Chief of Surgery, the Director of Surgical Education and attending faculty, he/she is responsible for the supervision of all major and minor surgical procedures.

     During the fifth year, he/she will perform approximately 300 to 500 major surgical procedures and will supervise many additional procedures.  During the total five-year program, a finishing resident will have performed between 1,000 and 1,200 surgical procedures.  These surgical procedures are done under the direct supervision of the attending staff.  In the last months of the residency, the Chief Surgical Resident is given more individual discretion in the care of his/her patients.

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EMERGENCY DEPARTMENT

     San Joaquin General Hospital is the major emergency center of the San Joaquin County.  All PGY-I house staff rotate through this service.  A proper mix of responsibility and supervision makes this an extremely valuable rotation.  A full-time director supervises the training program. The Emergency Department is the focus for the County Paramedic Training Program and serves as the Primary Base Station Hospital for this effort. 

     The Emergency Department sees an average of 3,000 patients monthly and 40,000 annually in all disease categories.

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OUTPATIENT CLINICS

     Over 95,000 patient visits are made each year.  Clinics are held regularly in all major and sub-specialty services.  House staff rotate through these clinics on a regular basis.

     Hospital outpatient clinics include:  Anesthesiology, Pulmonary, Endocrinology, Rheumatology, Hematology/Oncology, Gastroenterology, Nephrology, Neurology, Cardiology, General Surgery, Vascular Surgery, Orthopedic Surgery, Plastic Surgery, ENT, Urology, Ophthalmology, and PM&R.
Additionally, there are clinics for Audiology, Pain, and Addiction.

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INTENSIVE CARE UNITS

     The Intensive Care and Coronary Care Units are jointly supervised by a full-time Director.  Each house officer follows his/her own patients in the Intensive Care Units.

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SURGICAL RESIDENCY TEACHING PROGRAM

     The Surgical Department has specialty services in General Surgery, Thoracic Surgery, Vascular Surgery, Neurosurgery, Urology, Orthopedics, Plastic Surgery, Otorhinolaryngology and Ophthalmology.  Residents have increasing responsibility as they rotate through each service.  They participate actively in the teaching of interns and residents below their level on the respective services.

     The surgical residents and interns are also assigned to each of the surgical clinics, and the assigned surgical resident supervises the conduct of the clinics.  Attending staff surgeons are assigned to the respective clinics for teaching and consultation.  As in private practice, surgical clinics are popular with the house staff because it is from these clinics that majority of patients are admitted to the hospital for elective surgical care.

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