Beth Israel Surgical Residency Program
About the Department of Surgery
Clinical Divisions
Surgical Facilities
Department Programs/Services
Curriculum Overview
General Information
Application Procedures

THE DEPARTMENT OF SURGERY

The Department of Surgery at Beth Israel Medical Center is a major provider of tertiary and quaternary surgical care for the New York metropolitan area. The department consists of nearly 110 surgeons representing general surgery and all surgical subspecialties. Full time and voluntary faculty members hold faculty appointments at the most prestigious medical schools in the metropolitan area, including The Albert Einstein School of Medicine, The Weill-Cornell College of Medicine, Columbia College of Physicians and Surgeons, The Mount Sinai School of Medicine and New York University. Beth Israel Medical Center is over 100 years old with a long and proud history of service, and academic and clinical achievement. Academic diversity, devotion to quality and cutting edge clinical skill remain institutional hallmarks. The leadership of the Department of Surgery demonstrates an impressive history of progressive and innovative care. Notable former Chairmen include:

Leon Ginzburg, MD
One of the three co-authors of the original and seminal paper on Regional Enteritis, this paper is recognized as one of the Landmark Articles of the 20th Century in Colon and Rectal Surgery. Dr. Ginzburg was a technically gifted surgeon, clinical researcher, and stressed innovation in educational endeavors. Dr. Ginzburg was Director of Beth Israel's Department of surgery from 1947 to 1970.

William Wolff, MD
Drs. Wolff and Shinya, introduced colonoscopy and colonoscopic polypectomy to the United States. Their original study proved the value of colonoscopy and established the procedure as the gold standard of clinical care. Their article was also listed as a Landmark Article of the 20th Century in Colon and Rectal Surgery. Beth Israel is the only institution with two such achievements. A beloved surgeon, colleague and teacher, Dr. Wolff still attends many surgical Grand Rounds and teaching conferences. Dr. Wolff was Director of Beth Israel's Department of surgery from 1970-1977.

Charles K. McSherry, MD
Dr. McSherry was an internationally recognized authority on diseases of the biliary system, and revolutionized the department with recruitment and programmatic development. The late Dr. McSherry was director of surgery from 1977 to 1991.

Moses Nussbaum, MD
Dr. Nussbaum is the current Chief of the Division of Head and Neck Surgery and Co-Director of the Head & Neck Cancer Institute. He is an authority on head and neck surgery, and has published and lectured widely on thyroid and parathyroid diseases, especially modern techniques in head and neck surgery. Dr. Nussbaum served as acting Chairman from 1991 to 1993, and as Chairman from 1993 to 2000.

Anthony C. Antonacci, MD, FACS
Dr. Antonacci, served as the Chairman of the Department of Surgery from 2000 to 2005. He also served as Associate Chairman of Surgery from 1996 to 2000, and has been an attending surgeon at Beth Israel since 1990. He is widely published and is the recipient of numerous academic and research awards, including the National Institutes of Health, the Smith, Kline & French Fellowship, the George T. Heuer Scholar in Academic Surgery Award, the Calder Foundation Award and the President’s Award from the American College of Surgeons.

George Todd, MD, FACS
Dr. Todd is Interim Chairman of Surgery since 2005. He is a well known and innovative vascular and endovascular surgeon. He is Professor of Surgery at Columbia University and Chairman of Surgery at St. Luke’s and Roosevelt Hospitals. Through our alliance in Continuum Health Partners he is the interim Chairman. .

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CLINICAL DIVISIONS
The Department of Surgery consists of ten clinical divisions (noted below) and a surgical intensive care unit and two ancillary departments.

Bariatric Surgery
Cardiac Surgery
Colorectal Surgery
Head and Neck Surgery
Pediatric Surgery
Plastic and Reconstructive Surgery
Surgical Endoscopy
Oncological Surgery
Minimally Invasive Surgery/Advanced Medical Technology Institute
Thoracic Surgery
Vascular Surgery
Surgical Intensive Care Unit

Beth Israel Medical Center also has active departments of gynecology, urology, orthopedics, neurosurgery, neurology and ENT.

Bariatric Surgery
The department of surgery offers a multidisciplinary approach to the treatment of morbid obesity. Laparoscopic band surgery and gastric bypass surgery are performed at the Petrie campus. There are clinical research studies being performed by Drs. Elliot Goodman, Michael Leitman and James C. Rosser. top

Cardiac Surgery
The Cardiac Surgery program, began at the Medical Center in 1989 and offers a full range of cardiac surgery other than transplantation. The program has consistently achieved outstanding results in the New York State annual reporting system with the best risk three-year aggregate adjusted coronary bypass mortality rate in New York City for each of the years from 1991 to 2001. In the most recent three-year aggregate reporting for individual surgeons, Robert Tranbaugh, MD, had one of the best records in the state. Both pump and beating heart options are used. All vein and radial artery harvests are performed minimally invasively, reducing pain and complications dramatically. Full ranges of valve repair and replacement surgeries are undertaken and Paul Stelzer, MD has large experience with the Ross procedure. Particular expertise covers the area of arrhythmia management with outstanding results in pacemaker and AICD (defibrillator) implantation. Radiofrequency ablation for atrial fibrillation is performed as an adjunct to open heart surgery or as a stand-alone procedure via a minimally invasive approach. We obtained and used one of the first DiVinci robots in New York for the minimally invasive approach to the treatment of cardiac disease. The program is a leader in surgical implantation of biventricular devices and new investigational devices for the therapy of heart failure. The cardiac surgery suite consists of two fully equipped operating rooms, an adjacent 10-bed cardiac surgery intensive care unit, and a dedicated step down unit.
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Colorectal Surgery
The Division of Colorectal Surgery, begun in 1995, is both a clinical and investigative division in the department. Special attention is given to colorectal neoplasms and their multi-modality treatment, as well as anal incontinence. The Division of Colorectal Surgery is led by Dr. Warren Enker, an internationally recognized authority in surgery for rectal cancer, and the former Chief of the Colorectal Service at the Memorial Sloan-Kettering Cancer Center. Dr. Enker is also leader of the Surgical Oncology Cancer Service line across all Continuum hospitals. Dr. Joseph Martz has become recognized for his minimally invasive approach to treating benign and malignant diseases of the colon and rectum
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Head and Neck Surgery
The Head and Neck Division is engaged in cooperative studies with the Departments of Otolaryngology, Radiation Oncology and the Oncology Division of the Department of Medicine. Current research protocols address the management of patients with head and neck cancer in both early and advanced stages. Surgeons routinely perform extensive head and neck surgery with major soft tissue transfer and reconstruction. Dr. Moses Nussbaum (former Chairman of the Department of Surgery) leads the Division of Head and Neck Surgery. top

Pediatric Surgery
The Division of Pediatric Surgery continues to perform an array of surgical procedures, ranging from hernia repairs and appendectomies to rectal atresias, T-E fistulas and tumor resections. Laparoscopic surgery for intra-abdominal diseases is performed at the Petrie campus. The division provides 24-hour, seven-day-a-week coverage for pediatric surgical emergencies. top

Plastic and Reconstructive Surgery
The Division of Plastic and Reconstructive Surgery has a caseload consisting of general plastic surgical cases, cosmetic, general reconstructive, post-mastectomy reconstruction, facial and hand trauma and pediatric cases. The division also is involved in multi-specialty cases with other surgical subspecialists, offers a laser program, runs a cleft palate center and has an active pediatric plastic surgery service. Innovative therapies for reconstruction following ablative surgery for malignancy is an area of expertise. top

Surgical Endoscopy
Beth Israel was one of the first hospitals to introduce endoscopy and colonoscopy in the United States and is renowned for its pioneering efforts in the development of endoscopy and its continuing expertise and research into new applications of this technology. Most endoscopic procedures performed at the Medical Center are on an outpatient basis. In 1998, there were a total of 7.253 ambulatory and 2,483 inpatient gastrointestinal endoscopy procedures. The procedures included upper and lower endoscopy, gastrostomy tube insertion, ERCP, stent placement, percutaneous gastrostomy, endoscopic feeding tube placement, laser procedures and dilatations. top

Oncological Surgery
The division works and collaborates closely with Medical Oncology and Radiation Oncology to ensure a multidisciplinary approach that optimizes care of patients with complex liver, biliary and pancreatic malignancies. The division performs major hepatic resection, biliary reconstruction, pancreatic resections, radiofrequency ablation, and the placement of intra-arterial hepatic pumps. Alternatives including alcohol injection, embolization, chemoembolization, etc. are available and offered to appropriate patients. top

Minimally Invasive Surgery/Advanced Medical Technology Institute
The Division of Minimally Invasive Surgery at the Beth Israel Medical Center was started in 2002 with the recruitment of James “Butch” Rosser, MD, the former head of Yale laparoscopy, Dr. Rosser is an internationally renowned laparoscopic surgeon and surgical educator, whose impact has already been felt throughout the institution. Dr. Rosser has introduced novel educational modules to enhance residency education in the field of minimally invasive surgery, established a Minimally Invasive Surgery Fellowship and developed the Advanced Medical Technology Institute as the forum for development of cutting edge technologies in minimally invasive surgery.top

Thoracic Surgery
The caseload of the Division of Thoracic Surgery consists primarily of lung, esophageal and hyperhidrosis cases. The David B. Kriser Lung Cancer Center, established in 1987, is staffed with a multidisciplinary team that provides a comprehensive approach to the treatment of lung cancer. This division currently has several research projects in progress in the areas of lung cancer, post-operative chest pain and brachytherapy techniques. The Division of Thoracic Surgery is under the leadership of Drs. Cliff Connery, Loren Harris and Angelo Reyes. top

Vascular Surgery
The Division of Vascular Surgery continues to treat a broad spectrum of peripheral vascular lesions. A newly equipped, non-invasive vascular laboratory treats both inpatients and ambulatory patients. Studies include arterial, carotid and venous vascular evaluations, as well as evaluation of vascular impotence. A full array of endovascular treatment options is available to patients, and Beth Israel Medical Center is an internationally recognized leader in the utilization of these techniques. Dr. Jonathan Deitch has been recently recruited to lead the Division of Vascular Surgery. top

Surgical Intensive Care Unit
Full-time intensivists certified in surgical critical care direct the Surgical Intensive Care Unit. This medical leadership is combined with a critical care nursing coordinator and a critical care nurse specialist, both of whom are critical care certified. The majority of registered nurses assigned to the SICU are also certified in critical care. There is a fully monitored 9 bed step-down unit. Each year the SICU admits approximately 886 patients from the various surgical divisions. Multidisciplinary critical care daily rounds include a comprehensive nursing review of the patient's prior 24-hour ICU course, followed by input from the critical care attending, resident intern, pulmonary medicine fellow and nutrition specialist. This information is incorporated into the clinical plan established by the patient's surgical attending and medical consultants.

The SICU's academic activities include publications and national lectures by the attending intensivists, as well as research activities initiated by nursing specialists. The SICU also has a critical care database/quality assurance software program for analysis of SICU care. Dr. Marvin McMillen in the current chief of the SICU.top

SURGICAL FACILITIES
Operating Rooms
The Petrie Division of Beth Israel Medical Center has 15 modern operating suites that are fully equipped and have had the air conditioning, electrical systems and medical gases upgraded for greater efficiency. The operating rooms serve all of the surgical specialties (as well as gynecology, otolaryngology, orthopaedics, the Spine Center, ophthalmology, urology and oral surgery) available at Beth Israel. Operating room time is allocated by service to specific days and rooms. The director of each service can assign surgeon-specific time. Currently, there is no defined end time, as long as the time during the day is used effectively.

Ambulatory Surgery Unit
Beth Israel Medical Center most proud of its newly completed Phillips Ambulatory Care Center (PACC). PACC is a state of the art ambulatory setting designed with the patient and family in mind. Complete with physician offices, and a fully functioning clinical lab, radiology suite (including MRI, CT, mammography, ultrasound, etc.), PACC is an attractive and novel patient care site. The ambulatory surgery unit at PACC consists of seven modern operating rooms and one procedure room. New waiting and exam rooms, as well as locker and gown areas make the delivery of care seamless.

Surgical Physician Assistant Program
The Department of Surgery employs physician assistants in the divisions of general surgery, thoracic surgery, cardiac surgery and plastic surgery. The physician assistants are fully integrated into the surgical teams, providing pre- and post-operative care to patients, and assisting attending physicians intra-operatively as first or second assistants. Physician assistants also are involved in performing histories and physicals for ambulatory surgery and surgical clinic patients. Nurse practitioners also are employed in the department and work as fully integrated members of the patient care team.

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DEPARTMENT PROGRAMS/SERVICES
Programs for Medical Students
Third-year medical students from the Albert Einstein College of Medicine rotate continuously through the general surgery services at Beth Israel during their surgical clerkship. Fourth year sub-internships are offered in general surgery, surgical intensive care, head and neck surgery, plastic and hand surgery, thoracic surgery and surgical endoscopy. A robust medical education program has been designed for the medical students. This program consists of didactic lectures, hands-on suture and laparoscopic skill courses, and the 1:1 mentoring relationships with residents and attendings. The students are integrated fully into the functioning of the surgical teams, and spend time in the SICU as well.

Research Facilities
The Department of Surgery maintains many areas of active clinical investigation efforts. Animal laboratory and operating facilities are available at a variety of Continuum sites, and a “state of the art” 10,000 square foot Minimally Invasive Education Center with a classroom is being built. Attendings from nearly all divisions are either principal investigators or active participants in the clinical trials. As an institution we are affiliated with a variety of national and regional cooperative groups including NSABBP, ECOG, RTOG, ACSOG and BRANY. As a group we are committed to patient accrual in clinical trials as one of our missions as an academic medical center. In addition to opportunities available at Beth Israel Medical Center, we are affiliated with the Albert Einstein College of Medicine and Rockefeller University. We have recently made a strong department commitment to encouraging resident research time after the PGY-2 or PGY-3 year.

Department Library
The Department of Surgery maintains a separate surgical library and teaching center. Journals, textbooks and copying facilities are available for residents' use. There are computers available for medical database searching, Internet access, online literature searches, document scanning, Power Point presentation software, and other office applications. We are one of the few residency programs that have a designated librarian on site two mornings a week to assist only surgery residents with information searches and to conduct computer training sessions. A state of the art video display system is available for conferences. The main library located just across the street from the hospital and offers full access to information through both on-site and electronic resources, as well as an extensive document delivery service.

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CURRICULUM OVERVIEW
The Department of Surgery at he BIMC is committed to
· Providing word-class patient care;
· Being on the cutting edge of recent advances in technology and their application to patient care;
· Developing and participating in novel national, regional, and local clinical trials which advance the care of patients;
· Providing a comprehensive surgical education curriculum and program to prepare residents to pursue post-graduate fellowships or enter private practice (competent and confident)

The Department of Surgery offers both preliminary and categorical residency programs. The five-year categorical program is fully approved by the Accreditation Council for Graduate Medical Education and after year five, residents are eligible for examination by the American Board of Surgery.

The preliminary program is available for one to two years, depending on individual circumstances. Positions at the first-year through second-year level fulfill the needs of individuals who require training in general surgery as a qualifying requirement for the surgical specialties, such as plastic surgery, orthopedic surgery, urology, ophthalmology and ENT. This training also prepares residents for surgically related fields, such as emergency medicine, anesthesiology and radiology. During all phases of training, the resident is offered a broad range of educational and clinical experience, with both institutional and private patients drawn from a large urban population.

Surgical residents rotate at all the sites within Beth Israel Medical Center, including the Petrie Division and Phillips Ambulatory Care Center and the Kings Highway Division in Brooklyn. The Petrie Division is the Manhattan campus University Hospital for the Albert Einstein College of Medicine, and is the site of most rotations. The Petrie Division is a 500-bed tertiary care Level II trauma center located in the Lower East Side of Manhattan. All full-service surgical services are provided at Petrie.

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CLINICAL AFFILIATIONS & ROTATIONS
House staff rotations include Beth Israel Medical Center, Petrie and Kings Highway Division in Brooklyn; NYU Medical Center (Transplant); Lincoln Medical Center (Trauma); Jacobi Medical Center (Burns).

PGY-1 and PGY-2
During the first year, the residency training emphasizes pre- and post-operative care, diagnosis, surgical physiology and the fundamentals of surgical technique. The house officer has the opportunity to perform many surgical procedures under supervision, commensurate with his or her abilities and level of training. A team approach is used to provide continuity of patient care. During the second year, the resident is allowed to exercise more independent judgment and to provide in-patient and emergency room consultation. In addition PGY-2 spend considerable time caring for critically ill patients (SICU, Burn ICU, and Transplant) to fine-tune their diagnostic and treatment skills.

First-year rotations
· General Surgery (including Breast, and Colorectal , ~ 4 months)
· Vascular Surgery (~ 2 months)
· Thoracic Surgery ( ~ 1 month)· Anesthesia ( 1 Month)· Urology ( 1 Month)
· Head and neck Surgery (1 Month)
· SICU ( 1 – 2 months)· Vacation ( 1 month).

Trauma (1 month for categorical residents)

Second-year rotations
· General Surgery (~ 4 months)
Kings Highway Division (~ 2 months)

· Transplant Surgery ( ~ 1 month) NYU Medical Center
· SICU (~ 2 – 3 months)
· BURN Unit (~ 1 month) Saint Barnabus Medical Center, Livingston, NJ
· ER and Consultative Service ( ~ 2 – 3 months)

PGY-3 and PGY-4
In their third and fourth years, residents are encouraged to pursue clinical research. If desired, a year of traditional research can be added to the training program on an individual basis after the PGY 2 or PGY 3 year. All residents who complete the program are expected to complete a clinical research project and submit a paper for publication. Residents are reimbursed for travel to conferences at which they present the results of their research projects.

In addition to general surgery rotations during the PGY 3 and PGY 4 years, a considerable amount of time is spent in learning the art and science of trauma evaluation and treatment, and in the ambulatory surgery setting. These rotations are most suitable for the PGY-3 and PGY-4 level, during which time the resident possesses the core knowledge base necessary to exercise independent clinical judgment. Significant exposure to endoscopy is provided throughout the 3rd and 4th year. Beth Israel Medical Center has long stressed surgical competence in endoscopy, and a large portion of the faculty is involved in this educational component.

PGY-5 (Chief YEAR)
In their final year, the chief surgical residents are assigned to surgical teams for which they assume full responsibility. This includes performing all service procedures other than those they delegate to a senior or junior resident. In addition to gaining considerable experience in complex abdominal surgery, the resident performs many major thoracic, vascular, pediatric, and head and neck procedures. Surgical residents perform an average of 250 to 300 progressively complex operations per year. The chief surgical resident is responsible for conducting teaching rounds with junior house officers and medical students and for the preparation of staff conference programs.

Surgical & Clinical Responsibilities
Under attending physician supervision, residents run active clinics in the following areas:
· General and vascular surgery
· Pediatric surgery
· Proctology
· Breast surgery
· Head and neck surgery
· Surgical oncology
· Plastic Surgery
· Neurosurgery

Didactic Programs
The teaching program in the General Surgery residency is robust, energetic and dynamic. It is specifically designed to ensure that residents acquire the core basic science and clinical knowledge necessary to expert care of patients. While it is impossible to list the details of each lecture and lecture series a brief synopsis is included below.
· Weekly Morbidity and Mortality conference
· Bi-weekly Grand Rounds
· Weekly Attending Team Walk Rounds
· Weekly Basic Science Core Curriculum lecture (2 lectures each week)
· Monthly Journal Club
· Monthly Laparoscopic Skills Laboratory
· Monthly Resident Presentations
· Biannual Mock Oral Board
· Mid-year ABSITE Mock Test
· Annual NYC Wide ABSITE Review Course
· Weekly Head and Neck Tumor Board
· Weekly Gastrointestinal Tumor Board
· Weekly Breast Tumor Board

Web-based learning modules and self-assessment programs

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GENERAL INFORMATION
House Staff Operative Log DocumentationBased on the requirements of the ACGME's Residency Review Committee, each resident keeps a record of all cases in which he or she participates. At present we participate in the ACGME web based recording keeping program. Recording of the residents' operative experience is kept up-to-date with the help of the house staff coordinator. Each house staff officer's experience is periodically reviewed to ensure a complete and balanced exposure to the components of general surgery is obtained.

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APPLICATION PROCEDURES
All PGY-1 positions are filled through the National Resident March Program with the electronic residency application service (ERAS). All application will be reviewed through ERAS. Applicants with minimum USMLE scores 80-85% will be considered. We will sponsor the J-1 Visas, but it is the applicant’s responsibility to aggressively follow through on the application process and be ready to start work on June 25, 2007, with all papers finalized. One year, prior US experience is preferred. You must apply for your USMLE's ECFMG certificate before December 2006 in order to get your ECFMG certificate on time. Our application deadline is November 3, 2006.

On occasion, advanced positions at the PGY-2 or PGY-3 level become available for residents desiring one or two years of surgical training.

For Further Information
Inquiries concerning the form, content or philosophy of the program are welcomed and should be forwarded to the director of the residency program: :

I. Michael Leitman, MD,
Vice Chairman and Program Director Department of Surgery
Beth Israel Medical CenterFirst Avenue at 16th Street
New York, NY 10003
(212) 844-8570 (212) 844-8440 (FAX)
Mleitman@chpnet.org

Burton G. Surick, MD
Associate Program DirectorDepartment of Surgery
Beth Israel Medical Center1st Avenue @ 16th Street
New York, NY 10003
212-420-4520212-420-2035 (FAX)
bsurick@chpnet.org

Carol Polanish
Program Manager
Department of Surgery
Beth Israel Medical Center
First Avenue at 16th Street
New York, NY 10003
212-420-4340
212-844-1939 (FAX)
cpolanish@chpnet.org

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