Program Description
	General Surgery
	Neurosurgery
	Ophthalmolology
	Orthopaedic Surgery
	Otolaryngology
	Pediatric Surgery
	Plastic & Reconstructive Surgery
	Surgical Oncology
	Thoracic & Cardiovascular Surgery
	Transplant Surgery
	Critical Care
	Colon & Rectal Surgery
Postgraduate Surgical Education Program
	Goals and Objectives
	Affiliate Institutions
	Departmental Organization

Program Description

The Department of Surgery at Howard University Hospital with its affiliated hospitals gives our residents a rich and varied experience by exposure to a broad spectrum of patients for resident education. There are excellent inter-disciplinary efforts between the various divisions and sections of the department. During their residency, the trainees rotate through General Surgery, Neurosurgery, Orthopaedic Surgery, Pediatric Surgery, Surgical Oncology, Thoracic and Cardiovascular Surgery, Trauma and Critical Care, The Burn Unit, Colon and Rectal Surgery, Laparoscopic Surgery and Transplant Surgery services. Rotations in these various specialties provide a broad based education not only in general surgery, but also in all surgical subspecialties. Several teaching conferences are held in all the major participating hospitals throughout the week. Each division also holds a weekly academic conference.

Appointments to the training program are for one year and residents are re-evaluated by the Surgical Education Committee on an annual basis to determine whether they should be advanced to the next level of training. Evaluations are primarily based on clinical competence. However, academic performance measured by the Resident in--training examination, and the departmental examinations, as well as technical skill, moral character and overall professional growth. Residents are given increasing responsibilities with supervisory help being continuously available in the diagnosis and treatment of surgical patients.

There are two types of first year residency positions which are offered, Categorical surgery and Preliminary surgery. A person applying for the Categorical surgery position will be expected to complete ten months on the surgery wards and in the surgical specialties, one month in the Emergency Medicine. Applicants selecting the Preliminary surgery positions are required to spend one month on Internal Medicine, one month in Emergency Medicine, one month on OB or GYN, two months electives and seven months on Surgery.

The program is approved for the training of five categorical and four preliminary residents per year. Candidates who are planning to continue in surgical specialties such as Otolaryngology, Urology, and Orthopaedics are encouraged to apply for preliminary spots. The five categorical residents are expected to finish the program. This program is not pyramidal

General Surgery
Chief: Debra H. Ford, M.D.

Surgical residents will encounter and treat a broad spectrum of general surgical problems at Howard University Hospital and its affiliated hospitals (District of Columbia General Hospital, Providence Hospital, Greater Southeast Community Hospital, Washington Hospital Center, and Children's National Medical Center).

Residency training is afforded through a variety of mechanisms. Supervision by full-time attendings, a chief resident, and a variable number of junior residents, interns, third and fourth year medical students and support personnel make up this service. Mortality and morbidity conferences, and grand rounds are held weekly. Board-review type lecture series are presented each Saturday jointly by a faculty member and an assigned resident. Journal Club meets monthly.

Neurosurgery
Chief: Gary C. Dennis, M.D.

The Division of Neurosurgery provides quality care for its patients at Howard University Hospital and the District of Columbia General Hospital where over 380 neurosurgical procedures are performed each year. Its faculty provide daily teaching rounds and weekly neurosurgical conferences for its house staff and students. Monthly neuropathological and mortality and morbidity conferences allow for thorough investigation of each disease process. Emphasis is placed on the management of acute head and spinal cord injuries, critical care, disc disease, subarachnoid hemorrhage, peripheral nerve injuries and the management of increased intracranial pressure. Neurosurgery Clinics allow the residents generous exposure to diagnostic analysis, management and follow-up of patients who present with a wide variety of neurological diseases.

Ophthalmology
Chief: Robert C. Copeland, Jr., M.D.

Howard University Hospital serves as the principal teaching site for the residency program. Here, nearly 700 patient visits per month provide a wide variety of clinical experiences. In addition to the general ophthalmology service, subspecialty clinics in glaucoma, pediatrics and retina are held on a weekly basis. The Eye Clinic is equipped to handle a full range of diagnostic services including ultrasonography, fundus and slit lamp photography, electro-diagnostic testing (ERG, EOG, etc.) and automated perimetry. In addition, a modern minor surgery area along with our 3 lasers allows us to provide convenient outpatient laser surgical services.

The Division of Ophthalmology has clinical affiliations with the District of Columbia General Hospital. Our affiliation with the Armed Forces Institute of Pathology has provided our trainees with an unequaled opportunity to become familiar with the histologic features of many ocular disorders.

The Division of Ophthalmology is involved in a wide spectrum of research activities including glaucoma, ocular disease in sarcoidosis, diabetes, vitiligo and sickle cell disease. The residents are encouraged to participate in these research areas and to develop their own interests. The program is approved for the training of three residents per year.

Orthopaedic Surgery
Terry Thompson, M.D., Chief

This Program offers four years of training that provide the resident broad experiences in orthopaedic surgery. There are five principal hospitals with over 200 orthopaedic beds and 2,923 admissions yearly--Howard University Hospital, District of Columbia General Hospital (including the Handicapped and Crippled Children's Service), Providence Hospital, the Veterans Administration Hospital, Sinai Hospital of Baltimore, and Children's Hospital National Medical Center. These hospitals have large outpatient clinics, which afford an opportunity for follow-up and ambulatory care. The rotations are for periods of three months and each hospital has junior and senior resident positions. These hospitals provide a spectrum of experiences ranging from municipal, Federal and private community hospitals to a university hospital setting. Residents are rotated through these hospitals to complete their training in adult orthopaedics, trauma and children's orthopaedic surgery.

The attending staff are extensively involved in teaching. Each participating hospital holds regular conferences. Combined clinical and basic sciences teaching conferences are held three times weekly at Howard University Hospital.

Otolaryngology
Chief: Ernest M. Myers, M.D.

This division provides audiology and aural rehabilitation, oncology, otology and adult/ pediatric/ neonatal airway management problems. Presently, head and neck oncology is the most active service. This is managed in a multidisciplinary manner, with involvement from medical oncology, radiation oncology, oral surgery, neurosurgery, speech rehabilitation, plastic surgery and surgical oncology.

The division staffs Howard University Hospital's ambulatory service 2 mornings and 2 afternoons per week. Tuesday morning is devoted to HUMED, a satellite office clinic of Howard University Hospital. The division consists of two full-time and two part-time otolaryngologists, one full-time and one part-time audiologist, an office manager, a third year surgical resident, and an intern.

Pediatric Surgery
Chief: Samuel Rosser, M.D.

Pediatric Surgery is dedicated to patient care, teaching and clinical research. We see and care for a representative number of infants, children and adolescents with surgical problems. The program provides an environment that will prepare each trainee to recognize and competently treat surgical problems in these age groups. Pediatric Surgery is also available as an elective rotation in the senior year of medical school and for residents in the Department of Pediatrics and Surgery.

Plastic and Recontructive Surgery
Chief: Robert Dennis, M.D.

This division offers resident exposure in general reconstructive plastic surgery, management of difficult wounds, reconstruction and management of cutaneous and osseous malignancies, hand surgery, reconstructive breast surgery, oculoplastic surgery, maxillo-facial surgery, craniofacial surgery, microvascular surgery and cosmetic surgery. The division consists of three full-time and two part--time attending plastic surgeons.

Surgical Oncology
Chief: LaSalle D. Leffall, Jr., M.D.

This division was formed in 1985. It provides surgical residents and medical students the opportunity to participate in the comprehensive management of cancer patients. This multi-disciplinary management not only encompasses the pre-operative, operative, and post-operative management of these patients but also emphasizes rehabilitative support and the psychological support needed by the patient with incurable disease. The multi-disciplinary approach utilizes participation from the divisions of medical oncology, surgical oncology, radiation oncology, nutritional support services and rehabilitative services.

Since gastrointestinal malignancies constitute a significant percentage of the cancers seen at our hospital, gastrointestinal endoscopy is a major part of the experience on the surgical oncology service. The residents on the service become familiar with the techniques involved in both upper and lower endoscopy.

Thoracic and Cardiovascular Surgery
Chief: Oswald G. Warner, M.D.

The Division of Thoracic and Cardiovascular Surgery is an integral arm of general surgery. General surgery residents are encouraged to become intimately familiar with the performance of cardiac and non-cardiac thoracic surgery, surgery of chest and vascular trauma, peripheral vascular surgery, and other closely related disciplines. This includes understanding the role of invasive and non-invasive testing, doppler ultra-sound techniques and the expanding roles of angioplasty and thrombolysis.

The division has full-time and adjunct faculty to whom the residents are exposed at Howard and its affiliated hospitals.

Transplant Surgery
Chief: Clive O. Callender, M.D.

The Transplant Center began in July, 1973 and performed its first organ transplant in January, 1974. Since that time many kidney transplants have been carried out and over 40 clinical research papers published. It is anticipated that 25 kidney transplants and 10-14 livers transplants will be performed annually. In March, 1988, the Howard Transplant Center was authorized by the District of Columbia to be the sole site of liver transplantation in the District. It is anticipated that pancreatic and heart transplantation will be performed at this center by the late 1990's.

Medical students, interns, and residents that rotate on the transplant service play a major role in the management of the immunosuppressed patient. The Howard University Transplant Center remains the only minority run organ transplant center in the United States.

Critical Care
Chief: S. M. Siram, M.D.

Howard University Hospital is one of the major trauma centers in the District of Columbia. It is an accredited Level 1 Trauma Center with major trauma admissions exceeding 600 per year. The majority of Trauma victims in the District are admitted to D.C. General Hospital which is an integrated hospital with the Howard University Training program.

The trauma service at Howard University Hospital is managed by an in house "Code Yellow Trauma Team" under the leadership of a chief resident, with an attending back-up. There is also a full complement of highly trained and readily available specialists on-call 24 hours a day. After appropriate initial resuscitation and management, critically injured patients are admitted to a multidisciplinary 11 bed Surgical Intensive Care Unit (SICU). Surgical interns and residents are required to rotate through the SICU. Supervision and teaching are provided by two full-time surgical intensivists. There is also a complement of well trained nursing staff and other support personnel. Because of the multispecialty nature of the Surgical Intensive Care Unit's patient population, surgical residents have an excellent opportunity to learn the management of a wide range of surgical and medical problems.

This division also runs and coordinates the Nutritional Support Services for the hospital. This affords an excellent learning opportunity for surgical residents to become proficient in the evaluation and treatment of malnourished patients. Daily Nutritional Support rounds are conducted by surgical residents and surgical intensivists.

Daily, didactic bedside teaching is augmented by a monthly, hospital-wide conference on trauma and related issues. Recognized authorities in the field of trauma, critical care and nutritional support services are sponsored regularly.

Colon and Rectal Surgery
Chief: Debra H. Ford, M.D.

The Division of Colon and Rectal Surgery was formed in 1990. It provides surgical residents and medical students the opportunity to participate in the care of patients with diseases of the small intestine, colon, rectum, and anus. Special emphasis is placed on management of colorectal carcinoma, intestinal stomas (their complications), inflammatory bowel disease, incontinence, constipation, complex anal fistulae and anal sphincter preservation. Trainees are exposed to the pre-operative, operative and post-operative management of these patients. Lower gastrointestinal endoscopy is an integral part of this rotation.

An anorectal physiology laboratory, incorporating both anal manometry and electromyography, has been established for diagnostic and therapeutic applications and for research in anorectal physiology.

Postgraduate Surgical Education Program: Goals and Objectives

The surgeon produced by this program will be morally and ethically fit. He/She will have developed as a surgeon, with exposure to a comprehensive general surgery program with a detailed knowledge of gastrointestinal and other abdominal conditions, musculoskeletal trauma, endocrine surgery, peripheral vascular conditions, diseases of the breast, and of the head and neck region. He/She will understand the basic principles of management of the common problems in cardiothoracic, vascular, transplant, otolaryngologic, neurologic, orthopaedic, traumatic, pediatric, plastic and urologic surgery. This surgeon will have the opportunity under guidance and supervision to grow by progressive and successive stages of responsibility for patient care. This surgeon will have exposure to major operative experiences in the several hospitals which we use for postgraduate training.

The American Board of Surgery prepares residency-in-training as well as Board qualifying and certifying examinations. The surgeon produced by this program is expected to become eligible for and pass the ABS qualifying and certifying examinations the first time.

Objectives A. Postgraduate surgical residents for the first year are expected to:

1. Attend all major departmental conferences which include: surgical mortality and morbidity, surgical grand rounds, Trauma conference, Journal club, and board preparatory sessions
2. Contribute to morning rounds and study sessions and be punctual in attendance
3. Score above the 50th percentile on the surgical residency-in-training examination
4. Read one accepted general surgical textbook from cover to cover
5. Learn the safe practice of pre- and post-operative patient care and the early diagnosis and management of complications
6. Be knowledgeable of fluid and electrolyte balance and apply it to pre--and post-operative patient care
7. Learn the rudiments of surgical technique: to suture, to tie, to incise and to assist in surgery
8. Begin performing surgical procedures with supervision such as: skin grafts, incision and rainage of abscesses, the local examination and excision of breast masses, aspiration of cysts, varied surgical incisions and excisions, open and closed biopsies, sigmoidoscopy, appendectomy, herniorrhaphy, hemorrhoidectomy and tracheostomy
9. Must have obtained certification in ACLS

Objective B. Second year surgical residents are expected to:

1. Have read a general surgery textbook at least twice and begin supplementing this with the reading of one accepted surgical journal
2. Score above the 50th percentile on the surgical residency-in-training examination
3. Be confident in the diagnosis and pre- and post-operative management of surgical complications
4. Be able to make early diagnosis and institute prompt appropriate management of surgical complications
5. Become proficient in the rudiments of surgical technique, i.e., cutting, sewing and instrument handling
6. Become a confident and an able assistant and learn to perform operations such as: cholecystectomy, exploratory laparotomy, I&D of abscess, surgical excisions, herniorrhaphy hemorrhoidectomy, skin graft and appendectomy
7. Rotate through and learn the fundamentals of the major surgical subspecialties
8. Be knowledgeable enough to play a major role in the teaching of surgical fundamentals to subordinate residents and students on morning rounds, in the clinic and in the operating room
9. Attend all major conferences, study sessions and clinics
10. Be able to present and/or conduct case reviews of surgical problems at grand rounds
11. Acquire a District of Columbia Medical License by the end of the 2nd year as it is a requirement for promotion to the 3rd year
12. Must have obtained an ACLS certificate

Objective C. Third year surgical residents are expected to:

1. Assume responsibility in the daily rounds, i.e. teaching other residents and students the rudiments of pre- and post-operative surgical management and assume responsibility (with the Chief Resident) for admissions
2. Be the first surgical assistant or the surgeon with supervision on major general surgical cases such as: cholecystectomy, gastrectomy, thyroidectomy, A-V shunts and fistulae, esophagectomy, thoracotomy, exploratory laparotomy, pancreatic surgery, vascular, laparoscopic, orthopaedic and neurosurgical procedures
3. Develop confidence and technical skills in the craft of surgery
4. Complete subspecialty rotations
5. Work closely with the Chief Residents and Attendings in the presentation of cases and patient-care follow-up
6. Score above the 60th percentile on the residency-in-training examination
7. Lead the surgical team in the Chief Resident's absence
8. Play a major role in all surgical conferences and study sessions
9. Have completed a standard general textbook at least three times and supplement this reading by the regular review of accepted surgical journals
10. Handle night calls with confidence and decide with the Chief Resident when surgery is or is not necessary
11. Be proficient in the diagnosis and management of acute surgical problems and the pre-and Post-op management thereof
12. Attend all major surgical conferences, study sessions and clinics
13. Begin participation in hospital and medicine related committees
14. Obtain ATLS certification
15. Select 2 topics for research and publication

Objective D. Fourth and fifth year surgical residents are expected to:

1. Confidently diagnose the acute surgical abdomen and be able to handle all surgical emergencies with or without the presence of the attending physician
2. Know safe surgical approaches for all General and other surgical problems
3. Coordinate the schedule and rotation of junior residents and other Chief Residents
4. Handle (supervise) all surgical conferences, daily rounds, clinic and operating schedules and assign surgical assistants to all cases
5. Evaluate students, residents and attendings
6. Score above the 60th percentile on the residency-in-training examination
7. Be able to pass the American Board of Surgery examination
8. Participate in hospital committees
9. Be the surgeon or first assistant on all major cases
10. Attend all surgical conferences, study sessions and clinics
11. Present and defend all cases presented at the Surgical Grand Rounds and Morbidity and Mortality Conferences with or without the presence of the attending physician
12. Be a responsible, honest and safe surgeon
13. Chief Residents and 4th year residents are required to have produced 2 publication-quality papers as determined by the Surgical Education Committee

Residents at All Levels Are Expected to Rigidly Adhere to the Following:

1. To attend all major department conferences, clinics, and study sessions (the major department conferences are the surgical morbidity & mortality, journal club, surgical grand rounds, trauma conference, and weekly review session.)
2. To be punctual in attendance at morning rounds, study sessions and all major surgical conferences and the O.R.
3. Attend weekly basic science lectures

The Future of Howard University Surgical Residency Program

Currently the program in general surgery consists of five years of post graduate training with the residents rotating through the various specialties. Renewed emphasis is being placed on research, both clinical and bench. Faculty development is aimed at recruiting those who are not only clinically excellent, but also have a strong interest in research. Residents with strong interest in research are encouraged to spend two years in research after successful completion of the first two years of core general surgery.

Affiliate Institutions

• Inova Fairfax Hospital is an acute care level I trauma medical facility.
• Washington Adventist Hospital, is a reputed community hospital which gives exposure to a private surgical service with a large number of cases being performed annually.
• Providence Hospital in Washington, D.C. is a private hospital with a very active surgical department. Upwards of 7,000 cases a year are performed at the hospital.
• Washington Hospital Center has one Howard resident who rotates through the surgical oncology service. This rotation enriches the experience of our residents in the important components of surgery oncology.
• Children's National Medical Center has one Howard resident rotating. This rotation increases experiences in handling pediatric surgery cases.

By the time the residents have completed their postgraduate education, they have actively participated in the care of thousands of patients and have performed hundreds of major and minor operations in several specialties under the supervision of experienced surgeons. Residents will have also had the opportunity to teach medical students and to participate in research projects. In addition, each resident will have achieved our prime objectives of becoming safe and competent surgeons, ready to be certified by the American Board of Surgery.

Departmental Organization

Clive 0. Callender, M.D., F.A.C.S.
LaSalle D. Leffall Jr. Professor and Chairman

Robert H. Dennis, M.D.
Vice Chairman

Debra H. Ford, M.D., F.A.C.S.
Program Director, General Surgery

Mr. Kaushal Chauhan, M.B.A.
Administrative Director

Ms. Mary Harrell Mosby
Surgical Residency Program Coordinator