Elective Information – General Surgery at Mount Desert Island Hospital

Pre-requisite: General Surgery Residents PGY2 level or above

Duration for Elective: 2 or 4 weeks

Rotation Director: Joseph Dougherty, MD

Educational Objective

This rotation will provide the General Surgery resident an opportunity to experience rural surgery practice, spanning the full array of elective and emergent general surgery, including trauma, in the resource limited environment of a critical access hospital (CAH) in rural Maine. Surgeons in this setting manage a wide spectrum of patients presenting with both common and uncommon diagnoses, varying in acuity from preventative care to chronic conditions to acutely critically ill, without immediate access to subspecialty consultation on site or the typical resuscitation capabilities of a major trauma center. Trainees will gain a first-hand appreciation of the breadth and depth of comprehensive surgical knowledge and skills the rural surgeon must maintain, including those typically abdicated to subspecialties in larger population centers, and exposure to the mind-set needed in a resource limited setting. Trainees will hone their ability to adapt and improvise within the parameters of safe surgical patient care, learning to triage those patients that must be offered intervention in the CAH setting versus those who can be temporized for transfer to higher-levels of care as appropriate. In this particular community, we see patients from all over the world and all socioeconomic strata, providing trainees the opportunity to further develop their skillsets for treating patients of diverse backgrounds.

Experiences and Procedures

The resident’s primary responsibility is to spend as much time as possible in the OR or endoscopy suite. Operative duties will be assigned commensurate with the resident’s level of training and demonstrated capabilities, up to and including performing endoscopies and surgeries with direct attending surgeon oversight. The resident must keep a log of all surgeries and endoscopies performed during the rotation and is expected to make substantive progress toward completion of the ACGME endoscopy requirements during the rotation.
If the resident is free of OR duties, see patients in the General Surgery clinic in conjunction with the attending surgeon.
Take surgical call, in conjunction with the on-call surgeon. Call is taken from home, with a 20 minute response time to the hospital required in emergencies. Emergency call-backs are uncommon. Resident schedules are flexible.
Round daily on surgical inpatients (typical inpatient census of 1 to 4 patients) in cooperation with the attending surgeon. Manage surgical patients on the inpatient medical-surgical unit and well as in our ICU (3-bed).
Perform admissions, daily rounding, discharges, documenting in our EHR (Cerner). Provide surgical consultation for Medicine inpatients as requested.
Work cooperatively and collaboratively with ED providers when called upon for a surgical patient evaluation.

Housing

Mount Desert Island Hospital has recently built the Kogod Center, a new on-site housing facility. The building provides an extended learning experience with living and eating spaces alongside organized seminars in the evening. Learners each have their own bedroom and bathroom with shared cooking and living spaces. MERGE learners are billed a discounted rate of $375/week for lodging. Reimbursement may be available through the MERGE Collaborative per the MERGE Housing Reimbursement Policy.

Additional Information

The American Board of Surgery defines rural hospitals (RH) as those that serve a population of fewer than 50,000 people. Rural surgeons must have a toolbox of vast procedural capabilities, covering the full range of “bread and butter” general surgery operations from breast care to colectomies, as well as all manner of rural traumatic injuries, from farm accidents to hunting misadventures and everything in between. The rural surgeon’s role often encompasses the primary care needs of their patients, including colonoscopies, medical management of bowel disease, and procedures outside the scope of modern general surgery such as vascular access and cesarean section. All of these opportunities and more are available during this elective rotation.

The wide spectrum of care provided by rural surgeons highlights the great importance of rural surgeon availability for the care of dispersed populations. However, a shortage of more than 23,000 rural surgeons is expected in the coming years (Mercier, 2019). The benefits of surgery training in resource-scarce settings are supported by research. Trainees in rural hospitals report more operative confidence, hands-on experience, and patient care continuity(Hao, 2020). During this rotation, surgical residents have the freedom to concentrate their time and efforts where they feel the greatest benefit is to be gained, whether in the OR, the endoscopy suite, or learning to manage the expectations and experiences of the elective patient population. Our teaching staff is here to help residents achieve their rotation goals.

Mercier PJ, Skube SJ, Leonard SL, McElroy AN, Goettl TG, Najarian MM, Termuhlen PM, Chipman JG. Creating a rural surgery track and a review of rural surgery training programs. J Surg Educ. 2019 Mar-Apr;76(2):459-468. https://doi.org/10.1016/j.jsurg.2018.09.004
Hao S, Johnson HM, Celio A, Frye L, Bayouth L, Joseph J, Walsh DS. Rural general surgery experience as a valuable adjunct to an academic based general surgery residency. J Surg Educ. 2020 May-Jun;77(3):598-605. https://doi.org/10.1016/j.jsurg.2019.11.007

Conditions treated by General Surgery at MDIH:

Abdomen

Abdominal Abscess
Abdominal Hernias (umbilical, ventral, diaphragmatic, hiatal, incisional, internal, inguinal, Spigelian, femoral, obturator, paraesophageal, etc.)
Abdominal Trauma
Acute Abdomen and Pregnancy
Acute Appendicitis