What to Expect in a Surgical Residency Program

Although the day-in-day-out grind of a surgical resident's life can vary depending on which specialty and which program you enter, there are some common features inherent in all surgical residents' daily schedules. One surgical resident at Baylor University Medical Center in Dallas, TX, reports that a typical three-day schedule looks like this:

A key element of a surgical resident's schedule is change. Every rotation brings different expectations and varying balances of consults, clinic, and operative time. Some programs use night float systems; others rely on 24-hour call without extended stretches of overnight shifts. 

As you evaluate programs and interview, ask specifically about call structure, scheduling expectations, and how residents feel about these arrangements. Whatever system a program uses, adaptability is essential. The ability to adjust to a new rotation's demands is one of the most valuable skills you can develop as a resident.

Work Hour Limitations

The ACGME adopted work hour protections in 2003 in response to concerns about resident fatigue and medical error. The current rules for all residency programs include:

• No more than 80 hours per week, averaged over four weeks (inclusive of in-house call and moonlighting)
• No more than 24 consecutive hours on duty (with additional transition time permitted for continuity of care and education)
• At least one day free from patient care and educational obligations per week, averaged over four weeks
• In-house call no more than once every three nights, averaged over four weeks

Electives

Value of Electives During Medical School

After completing your required clerkships, you will have the opportunity to take electives. While the beginning of your final year will focus on surgical sub-internships, including building knowledge and skills while obtaining letters of recommendation, you will have remaining time to pursue additional electives.

Most program directors agree that this remaining time should be spent gaining exposure to areas you will not encounter during surgical residency. Frequently recommended electives include anesthesia, radiology, intensive care, pathology, emergency medicine, and cardiology. Consult the American College of Surgeons' Prerequisite Objectives for Graduate Surgical Education to identify your gaps and arrange your electives accordingly.

An increasing number of medical schools conclude with a capstone experience or a preparatory curriculum for intern year, some tailored specifically to surgical interns. If your school offers one of these programs, take advantage of it.

"Away" or Audition Electives

Most general surgery programs do not require an away rotation, but many surgical subspecialties strongly recommend completing at least one audition rotation at an institution other than your home program. Talk with your advisor and mentors about whether this makes sense for you. Deadlines vary by institution, so explore opportunities early and apply where appropriate.

Audition rotations can be valuable for assessing whether a program is a good fit, but they come with real challenges. It is tough to learn a new system quickly, integrate into an unfamiliar team and culture, and perform at your best, often without established support structures. As with any rotation, your attitude and work ethic will be important components of your success.