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Life as a General Surgery Resident at Bassett

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A Day in the Life of a General Surgery Resident at Bassett Medical Center (BMC)

At our program, residents primarily take care of surgical patients at BMC in Cooperstown. We are split into three teams, each consisting of three to five residents (interns, juniors, and seniors). Regarding continuity of care, patients are placed onto the team of the operative-resident or admitting senior resident if the patient did not have an operation.

Below you’ll find a typical outline of what our residents do on most days. We cover a wide variety of cases from day-to-day, ranging from head-to-toe (endoscopy, abdominal, endocrine, breast, plastic, vascular, thoracic, etc.); this truly approximates the practice of rural general surgery. When time allows, we cover cases in orthopedics and sometimes in neurosurgery.

There will be times throughout the year when residents will be on electives either at BMC, at one of the Bassett Healthcare Network hospitals, or at the University of Rochester Medical Center, where the schedule will deviate from the one below. Electives allow residents to focus on various disciplines, including but not limited to endoscopy, plastic surgery, vascular surgery, pediatric surgery, transplant, surgical critical care, cardiothoracic surgery, OB-GYN, urology, ultrasound, oncology, and pathology. Most electives are predetermined, and all residents have time in these electives. However, several electives are of the resident’s choosing, and any elective that can be justified as a valuable learning opportunity will be considered for approval.

A Typical Day at Bassett Medical Center:

0545: The day starts with arriving to the team room. To get ready for rounds, interns will obtain sign-out from the overnight intern regarding floor patients. If there are any ICU patients under the team’s care, the junior coming on for the day will obtain sign-out from the overnight team – which includes the overnight residents and ICU nurse.

0600: Discovery rounds begin with the whole team comprised of the seniors, juniors, interns, and medical student(s); most students are from Columbia University, with which Bassett is affiliated. Before seeing each patient as a team, the intern and junior will relay any relevant information and overnight events. This discussion before, during, and after seeing the patient allows for valuable teaching time and collaboration in determining the care plan for the day. This process takes roughly an hour.

0700: After rounds, all teams will attend morning conference. Each day is a different conference and lasts about an hour. We have conferences most (but not all) mornings. As social distancing becomes more relaxed, many conferences are moving from Zoom to in-person. Regular skills labs are, of course, done in person. The conference schedule varies each week, but includes Grand Rounds, a dedicated didactic session, and specific teaching sessions in Trauma, Vascular, and others.

0800 / 0830 : After conference, the team disperses to their assigned roles for the day, which may be on the floor, in the ICU, the OR, or in the clinic. As an intern, you will average one to three full days in the OR per week. Intern cases usually include bread-and-butter general surgery, plastics, hand, and breast cases. Residents who are out of the operating room or in-between cases will continue to work on completing patient care tasks. The team generally keeps in close contact with each other throughout the day when tasks are completed by “running the list” or by TigerText (encrypted text messaging).

If there is extra time, residents are strongly encouraged to double scrub cases, practice their laparoscopic skills in the learning center, and attend clinic. Clinic is required for at least half a day per week with an attending of the resident’s choosing.

1500 – 1700: The team will conduct afternoon rounds. This allows time to check on our patients’ progress and formulate a plan for the overnight team. After afternoon rounds, the team will complete progress notes, orders, and any incomplete discharge summaries.

1800: Each team’s intern signs-out to the night intern. If a team has completed all tasks prior to 1700, it is acceptable for a team’s intern to sign-out to the intern on-call during the day, and then leave; the intern on-call will then hand off to the night intern. Juniors and seniors perform ICU patient handoff to the on-call junior and senior. Day team will go home while the night intern stays approximately 12 – 13 hours from 1800 – 0700 with the on-call junior and senior, who work a 24 hour shift (0600 – 0600), plus time for handoff.

Call Shifts:

Interns have a night float system. They take “long-call” during the day every three to four days. On their call day, the intern is usually out of the OR during the day to help respond to traumas and help with new admits. Interns will generally be on call one to two weekends per month during the day. The “long-call” shift ends at 1800 when the night intern takes over.

The night intern works from 1800 until about 0700 – 0800 the following day. Their responsibilities include caring for the surgery floor patients, responding to traumas, and helping with new admissions.

Juniors and seniors are generally on-call every five to six days, and do 24-hour call shifts. This means they are post-call the day after. Juniors on-call see new consults and admissions with the senior resident. Both will respond to traumas. While at BMC, the junior resident will run the trauma while the senior resident supervises with the attending physician and helps with the primary and secondary survey.

We strictly adhere to ACGME and New York State duty hour regulations, including having at least one day off per week (defined as Sunday through Saturday), and working fewer than 80 hours per week, averaged over four weeks. While rare, whenever a resident is approaching the limit of 80 hours per week over four weeks, they are encouraged to speak up in order to be appropriately released from duties, and are never penalized.