SCC and ACS Fellowship – Second Year: Acute Care Surgery

Rotations

The AAST curriculum has moved away from mandatory rotations, focusing now on an experiential year that requires achievement of specific case volume requirements. Accordingly, program directors have flexibility in curriculum and rotation design.

We have two primary rotational goals. First, we ensure that the program meets AAST case volume requirements. Second, we design rotations based upon the individual needs of each fellow, to achieve the established missions of the program.

Rotations include:

  • Emergency General Surgery (EGS) & Trauma Surgery: 8 blocks
    • Fellows alternate weeks on EGS and trauma meaning that for each block the fellow spends every other week on EGS and likewise for trauma.
  • Neurosurgery: 2 weeks
  • Orthopedic Surgery: 2 weeks
  • Urology: 1 block
  • Cardiac & Thoracic Surgery: 1 block
  • Vascular Surgery: 1 block
  • Elective Rotation: Options for this rotation include the following: burn surgery, hepatobiliary surgery, complex abdominal wall reconstruction and an international rotation.
    • If a fellow opts out of the elective rotation experience, they will complete an additional block of emergency general surgery & trauma surgery.
  • Note that the last two blocks will include two weeks of SICU as a re-introduction to prepare graduating fellows for attending practice.

Goals and Objectives

Specific goals and objectives exist for each rotation. Fellows meet with the program leadership and rotation liaisons to review them prior to each rotation.

Emergency General Surgery

The emergency general surgery service is high in both volume and acuity, and accordingly, two ACS faculty are dedicated to the service each week. ECU Health Medical Center is the sole tertiary care center in the entirety of eastern North Carolina, and referral volume is high and frequently of striking acuity.

Fellows rotating on the service serve as the “captain of the ship”, having complete oversight of the service, including operative decision making and case supervision. Faculty serve in a supervisory role, with the goal of providing appropriate supervision while optimizing the education to service ratio for fellows. For cases of significant complexity, faculty are available to assist fellows, while for less complex cases, fellows have the opportunity to operate autonomously and train general surgery residents on the service.

As a significant benefit, the EGS service has an operating room dedicated solely to the service 7 days a week. The service has grown in the last years to integrate robotic surgery as a key component of our emergency general surgery service line.

Trauma Surgery

On the trauma service, fellows are responsible for covering day trauma call and supervising rounds on the trauma floor. Autonomy is conferred in a graded fashion moving from direct supervision to supervision only over the course of the academic year.

Subspecialty Rotations

When designing the ACS fellowship, the primary rationale by the AAST for vascular, cardiac and thoracic rotations was for fellows to gain additional experience with exposures in controlled settings (e.g. thoracotomy, sternotomy) that may be of benefit when applied to trauma and emergency general surgery. We have retained these rotations as core rotations and make every effort to have ACS fellows rotate when vascular and cardiothoracic fellows are away and/or mature in their training.

We have continued with Neurosurgery and Orthopedic Surgery as mandatory rotations. There are no residents or fellows on these services, thus ACS fellows receive high volume, one-on-one operative experience, and the rotations have been highly regarded. Urology is a popular rotation that fellows embrace given exposure to anatomy, complex robotic experience and no opposing trainees.

Call Schedule

The program abides strictly by duty hours defined by the ACGME. Fellows take 24 hour call approximately every 5 days. There is no fellow on call on Wednesday nights to protect fellow education which occurs on Thursday afternoons. The 1st year fellow will cover the SICU and trauma services (including operative cases) when on call.

Supervision Policy

The Acute Care Surgery Fellowship has a supervision policy compliant with that of the AAST requirements.