SCC and ACS Fellowship – Second Year: Acute Care Surgery

Program Mission

The Acute Care Surgery (ACS) fellowship at the Brody School of Medicine at East Carolina University is an immersive and intense educational experience focusing on trauma and emergency general surgery (EGS) that builds upon the foundation of the Surgical Critical Care (SCC) year. The goals of the ACS fellowship are consistent with those of the SCC year, and include:

  • To prepare graduates for clinical excellence in the entire breadth and scope of trauma and emergency general surgery.
  • To prepare graduates for leadership positions in surgical critical care, emergency general surgery and trauma.
  • To model graduates in the attributes of the teaching faculty, including professionalism, collaboration, compassion and wellness.


The majority of training occurs at ECU Health Medical Center, the 1,000-bed Level I trauma center and tertiary care teaching affiliate of East Carolina University. As the sole tertiary care teaching institution in the largest trauma catchment area in the state of North Carolina, ECU Health Medical Center serves the entirety of eastern North Carolina and the Outer Banks. The Trauma Center at ECU Health Medical Center is an American College of Surgeons verified and state of North Carolina accredited Level I trauma center, evaluating nearly 4,000 injured patients annually, with 2,600 patients admitted to the trauma service. Unique features of the trauma center at ECU Health Medical Center include a relatively high penetrating trauma rate (15%), long transport times given the austere catchment area, and a large breadth of injury mechanisms. Due to the rural nature of the trauma system and proximity to military bases and the Outer Banks, injuries include agricultural, military, hunting and ocean-related trauma.

The Learning Experience

The curriculum follows the American Association of the Surgery of Trauma (AAST) curriculum. The learning experience produces graduating fellows that are intellectually and technically prepared for all aspects of trauma and emergency general surgery. The foundation of learning is at the bedside, with hands-on teaching by faculty. Morning report, which meets daily at 8 a.m., includes a rich combination of didactic and socratic education based upon overnight admissions and events in the TSICU. The foundation of the didactic component of the curriculum is the weekly Fellow’s Conference (FC). Topics at FC are based upon a rubric which includes the Scientific American SCC curriculum topics and landmark evidence based articles. The conference is divided each month into four distinct presentations:

  • Journal club
  • Curriculum fellow based lecture
  • Curriculum core faculty lecture
  • Curriculum expert lecture

Additional conferences include the monthly Multidisciplinary Critical Care Conference as well as Multidisciplinary Trauma and Acute Care Surgery Conference, which also meets monthly. A variety of formal teaching and research offerings are available through the Office of Graduate Medical Education and the Brody School of Medicine. For aspiring ICU directors, the fellowship includes a leadership pathway for surgical critical care.

We are committed to ensuring our fellows finish the SCC year facile in any component of surgical critical illness.


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. Based upon input from past fellows and re-defined case volume requirements by the AAST, we have refined the rotations, retaining some rotations as mandatory.

Mandatory Rotations

  • Emergency General Surgery: 2 months
  • Trauma Surgery: 2 months
  • Neurosurgery: 1 month
  • Orthopedic Surgery: 1 month

Elective Rotations

  • Burn Surgery: 1 month
  • Urology: 1 month
  • Thoracic Surgery: 1 month
  • Vascular and Interventional Surgery: 1 month
  • International Trauma Rotation (Cape Town South Africa): 1 month
  • Hepatobiliary Surgery: 1 month
  • Additional EGS or Trauma

Goals and Objectives

Specific goals and objectives (GO) exist for each rotation. Fellows meet with the program leadership and rotation liaisons to review GO prior to each rotation. Goals and objectives for the ACS year are available on this website, but the following descriptions provide a brief overview of each rotation.

Emergency General Surgery

The EGS rotation is an invaluable core of the program. The 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. All schedule cases, whether EGS or trauma, are performed by the EGS service.

Trauma Surgery

Trauma Surgery is another core rotation of the ACS year. Fellows are responsible for covering day trauma call (8am -4pm) and supervising rounds on the trauma floor. An alternative path for the rotation, opted for by past fellows, is covering trauma call in a “night float” fashion, Monday – Thursday to optimize exposure to trauma cases. Autonomy is conferred in a graded fashion, with faculty providing direct supervision of all high-level trauma activations and operative trauma for the first three months.

Subspecialty Rotations

When designing the ACS fellowship, the primary rationale by the AAST for vascular, thoracic and hepatobiliary 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 electives and attempt to have ACS fellows rotate when vascular and thoracic fellows and other senior trainees are on off service rotations. 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 elective that essentially all fellows complete. Again, with no trainees on the service other than ACS fellows, the operative experience is excellent.

Call Schedule

The program abides strictly by duty hours defined by the AAST. Within that goal, a standardized call schedule has been created that applies to the entire ACS year. Fellows are responsible for call Monday and Tuesday nights as well as Saturday. Typically, one fellow covers Monday/Saturday, the other fellow covers Tuesday and has the following weekend off. Call is in the role of junior faculty, and is one of the richest educational experiences of the ACS year. Fellows have the opportunity to cover trauma and EGS admissions and cases, as well as provide oversight for the SICU. Fellows do not provide call coverage for non-ACS services while rotating on those services. While on non-trauma rotations, fellows are excused at 4pm to begin call, and are excused at 8 am the following day.