General Surgery Residency

Mission

Our mission is to cultivate a dynamic learning environment where academic rigor meets compassionate, patient centered, community care. We shape future surgical leaders who uphold the highest standards of surgical excellence.

Values

The surgical residency supports the MaineHealth values and is committed to achieving:

• Personal and professional balance
  • Personal - To celebrate diversity and prioritize resident well-being, mental health, and work-life balance, which in turn enhances education and patient care.
  • Professional - To provide our residents with the academic and clinical balance to support the career they choose ranging from tertiary care to rural practice.
• Exceptional patient care - To recruit and develop physicians whom are dedicated, independent, collegial, and flexible who will thrive in a high-volume healthcare system and be comfortable caring for diverse and vulnerable patient populations.
• Outstanding surgical education - To maintain and enhance our long tradition of a surgical education by promoting academic inquiry and technical prowess. To develop practice-ready surgeons with a deep understanding of anatomy, physiology, and evidence-based practices who will be leaders in their communities.

Introduction to Program

Almost all of our residents’ experience occurs at our large University Affiliated Academic Medical Center. MaineHealth Maine Medical Center is a full tertiary care center with services including the only level 1 trauma center in the state, ECMO, transplant, pediatric surgery, and burn care. There are no outside electives that our residents need to do to round out their education. We feel this environment captures the best of both worlds between a large university hospital and a community environment. 

We have the benefits of a university program including Tufts Maine Track students that are present from years 2-4 of their medical school, research opportunities with MaineHealth Institute for Research (MHIR), an innovation center, an institute for teaching excellence (MITE) and recent residency tracks offered through GME for all residents in research, education/leadership or informatics. Four of our residents are taking advantages of these research tracks in their first year. 

At the same time, we maintain the benefits of a community program including early autonomy in an environment with few surgical fellows (only Surgical Critical Care), a close relationship between faculty and residents, and early operative experience. We are a high volume center where residents learn by seeing a lot of patients and doing many operations. Our new tower at MaineHealth Maine Medical Center- Portland features state-of-the-art operating rooms. We value residents that have a passion for general surgery and thrive in a high volume environment.

We received ACGME approval for an expansion of the categorical surgical residency in 2024 from 4 to 6 categorical residents per year.  We recruited 6 residents through the NRMP match to start in July of 2024. As part of this expansion, we are eliminating our preliminary internship position. In considering residency expansion, we have plenty of volume and uncovered cases at MHMMC. We anticipate the additional residents will mostly stay at MHMMC to help appropriately staff services and cover cases for the initial several years of expansion.

Rural Focus Position

One of our 6 positions will be a rural focus that will do essentially one year of their residency predominately at MaineHealth Pen Bay Hospital in Rockport, ME. This rural experience will be broken down into blocks approximately 3 months each year from PGY 1-4 at rural sites and the entire PGY-5 year being at MaineHealth Maine Medical Center. Starting with the recruitment for interns in July 2025, there will be one separately matched position for the rural focus and 5 positions for MHMMC.

For all residents, experience is provided in the broad range of general surgery as defined by the American Board of Surgery as well as in all other surgical subspecialties. The educational program is supervised by the Chairman of the Department of Surgery and the Program Director. There are 3 Associate Program directors focused on areas of curriculum, research, and simulation. Education is provided by a diverse group of over 35 surgeons that actively participate as the teaching faculty.

Appointments are made at the PGY-1 level only through the National Resident Matching Program. In addition to the 6 categorical general surgery residents, there are two preliminary positions for urology that spend 6 months on general surgery, one is a designated preliminary position for interventional radiology, and an integrated vascular surgery residency that spends approximately 18 months on general surgery rotations across their first 3 years. The program is non pyramidal with annual reappointment based on demonstrated competency and professional maturation as judged by the staff.

In addition to receiving a broad and intense clinical experience, residents are expected to carry out clinical investigation; historically they have presented these results both at regional and national meetings. Please see the separate research section for additional information. 

The residency consists of a system small, discrete experiences with a close attending-resident relationship. In addition to the resident components of these services, there are over 45 NPs and PAs who work on the services shoulder to shoulder with the residents. The typical resident rotation schedule is described separately in the curriculum section. The residency is structured with the following major services:

Emergency General Surgery

The emergency general surgery service cares for patients entering the hospital through the emergency room or through interhospital transfer with emergent general surgery problems. The complexity of these problems ranges from straightforward appendicitis, to multiorgan failure requiring complex general surgery procedures and ICU care. There are two residents (one senior and one junior) on the service coupled with 1-2 attendings who rotates on a weekly basis, and 1-2 APPs daily.

Elective General Surgery

The elective general surgery service is typically a two resident service that cares for patients with elective general surgery problems ranging from inguinal hernias to Upper gastrointestinal reflux. Oncology is usually not part of this service. There are 7 core attendings, and a number of other subspecialty attendings who do occasional elective general surgery cases. There is also some exposure to endocrine surgery on this rotation as well as transplant surgery.

Colorectal Surgery

Typically another two resident Senior-Junior team Colorectal Surgery provides residents with a focused experience treating all types of colorectal diseases including from colorectal cancer, IBD, and anorectal pathologies. There are 4 attendings on this service. The service has a mixture of open, laparoscopic and robotic surgeries.

Bariatric/MIS/Endoscopy

This service provides a focused endoscopy experience that follows the American Board of Surgery flexible endoscopy curriculum. Many PGY 1s will leave the service with their upper endoscopy competency completed. Again, usually this is a two resident Senior-Junior pairing and in addition to endoscopy, this service provides an experience in advanced laparoscopy including complex hernias, Nissens, inguinal hernias and morbid obesity surgery. There are usually 2 residents one junior and one senior on the team. Heavy robotic exposure is offered in addition to laparoscopic and open operations.

Surgical Critical Care

The intensive care unit at MHMMC is a semi-closed unit and critically ill surgical patients are typically managed by the surgical critical care team. Interns and second-year residents throughout the year with an Emergency Medicine resident and Anesthesiology residents. Residents learn ventilator management, bedside procedures ranging from central venous access to bronchoscopy, management of patients with ruptured aortic aneurysms, major trauma, sepsis and more. There is a recently added surgical critical care fellow that has been a great resource for resident education on service.

Surgical Oncology/ Endocrine Surgery

The Surgical Oncology service is comprised of resident senior and a junior working closely with 3 attending surgical onocologists. These attendings have various areas of focus including high volume endocrine surgery, pancreas/liver/spleen, HIPEC, and melanoma/ skin malignancies. This service always has a chief resident or late PGY 4 reflecting the case mix of liver and pancreatic resections. There are multiple APPs that work closely with the residents on service.
 
Trauma Surgery

Residents on the trauma service are a mixed team of Surgery and Emergency Department interns led by a third- or fourth-year Surgery chief resident. The service is busy, caring for the large majority of the trauma patients admitted to this level I trauma center with 4200 admissions per year. Much of the floor work is handled by a large team of APPs, over 5 per day and overnight, that work closely with the residents. There is a robust chest wall reconstruction program including open and thoracoscpic approaches, in addition to VATs for trauma. There are also regular opportunities for learning bedside procedures such as chest tube placement and tracheostomy. Our patient population is predominately blunt trauma but there are frequent needs for operative trauma including damage control operations.

Nightfloat Coverage

The nightfloat team consists of 4 residents in the following roles:

• Nightfloat Floor- PGY-1 that covers floor patients primarily.
• Nightfloat ICU- is a PGY-2 or late year PGY-1 resident responsible for the surgical ICU. Often there is a critical care APP on duty overnight to assist.
• Nightfloat Consult is a PGY-3 or late PGY-2 responsible for most consultations from the ER and floor
• Nightfloat Chief is a PGY4 or late PGY-3 that provides oversight for the entire team and covers most operative procedures overnight.

The entire nightfloat team (including an overnight trauma APP) responds to trauma activations as they are able. These are demanding rotations but also where we see exponential resident growth. See also Duty Hour section below.

Vascular Surgery

There are 2 separate vascular surgery services that are staffed by general surgery residents in addition to a vascular residents and APPs. Each has a senior level and junior level resident. There is a separate vascular surgery integrated residency matching one resident per year. Both are busy vascular services with a variety of open and endovascular exposure. We are going to trial a midlevel flex operative role for both general and vascular surgery residents for 2024-2025. We anticipate increased operative volume for vascular surgery with the opening of Malone Tower in summer of 2024.

Pediatric Surgery

This surgical service is lead by a PGY-3 surgical resident as chief and most often a PGY 1 junior level resident. They perform more than 1,500 general pediatric and thoracic cases per year, ranging from neonates with congenital anomalies such as esophageal atresia, imperforate anus, biliary atresia, and gastroschisis, pediatric solid tumors of the chest and abdomen, and pediatric general surgical diseases including pyloric stenosis, intussusception, gastroesophageal reflux, hernias, IBD, cryptorchidism, Hirschsprung's, and appendicitis. The curriculum is structured to provide education regarding the unique features of caring for children with respect to preoperative assessment and resuscitation, surgical techniques, and postoperative recovery. The rotation includes coverage of pediatric trauma.

Burn and Soft Tissue Surgery

The Burn Soft Tissue Service has a single PGY1-2 level resident working closely with 1-2 APPs to care for patients with burns and complex soft tissue wounds including necrotizing fasciitis. There are opportunities to participate in the full spectrum of burn care as part of multidisciplinary team including initial management, ICU care, excision/ grafting, and delayed reconstruction. This a great rotation for junior resident to get early autonomy on the floor and in the operating room. The Burn team attends trauma morning report daily.

Breast Surgery

The Breast Surgery rotation involves a single resident on service as either a junior or senior level resident with focused exposure to benign and malignant breast pathology. The residents work closely with 4 breast surgeons through an organized curriculum. They participate in outpatient clinic, operative procedures and tumor boards.

Thoracic Surgery

The Thoracic experience is also moving to a rotation in the PGY-2 year and again as a PGY-4. There are 3 Thoracic Surgery attendings doing a range of operative procedures including esophagus, lung, mediastinum and hiatal hernia. Robotic, laparoscopic and open approaches are utilized.

Transplant Surgery

Third year residents do a month dedicated transplant elective with exposure to multidisciplinary care of the renal transplant patient, including cadaveric and living related transplantation.  This includes attending interdisciplinary rounds on Mondays, Wednesday and Fridays as well as transplant clinic and conferences. When there is not a dedicated transplant resident on service, these cases are covered by the elective general surgery service.

International Surgery

There is currently not a formal rotation in international surgery at MHMMC but an elective may be offered. There is a long tradition of supporting and providing those experiences for residents at MHMMC, one that we hope to keep and to build upon. Some of these efforts were made more complicated with COVID induced limitations. Faculty are involved in international surgery including Dr Laura Withers, Dr Kartik Pandya and Dr Heidi Miller. Mentorship is available. We are working toward reorganizing an elective rotation in International Surgery.

Duty Hours

The general surgery residency program utilizes a night float system. Our philosophy allows continuity of care and excellent learning but also emphasizes the need for growth and development outside of residency training. We take duty hours seriously and believe that adequate rest is integral to safe patient care and excellence in education.

Night float residents are on from 5:30 pm until 6 am Sunday through Friday. Night float averages 1 month in 4 until the chief year. Chiefs do not participate in night float. There is a Saturday day call team, a Saturday night call team and a Sunday day call team. Residents not on night float take call 2 weekends out of the month. MHMMC uses nurse practitioners to assist during transitional time and for protected educational time.

We monitor resident duty hours weekly in order to achieve compliance with the ACGME's duty hour’s requirements. We support these requirements wholeheartedly.

Read the commentary published in the Archives of Surgery by Dr. James Whiting, former Surgical Residency Program Director entitled "Of Puppies and Dinosaurs: Why the 80-Hour Work Week Is the Best Thing That Ever Happened in American Surgery"

Sincerely,

Jaswin Sawhney MD
Program Director General Surgery Residency

“I owe so much to the experience and guidance that I received at MHMMC. The faculty still reach out to me to check in and I have a network of peers in my co-residents forever. You leave the residency as a skillful surgeon and a well-rounded doctor. “

Adria Johnson, MD
MHMMC Surgical Resident, Class of 2023

“I had a great experience during my five years of surgical training at MHMMC.  There was early and often exposure to the operating room as a junior and appropriate graduated autonomy as I moved through residency.  The size of the program enabled me to have strong mentorship and support from my seniors, co residents and faculty. Plus, you can’t beat the location with all Maine has to offer.   I liked the place so much I decided to come back as an attending after fellowship! “

Jennifer Bolton, MD
MHMMC Surgical Resident, Class of 2022

“Surgical residency is an extremely arduous life experience. I feel fortunate to have that experience at MHMMC where I met and worked with some of the most talented and exceptional people I know.”

Astrid Gleaton, MD
MHMMC Surgical Resident, Class of 2023

Portland and the Maine General Hospital had a distinguished surgical history long before the initiation of a formal surgical residency. After World War II, hospitals were encouraged to provide opportunities for specialty training to meet the growing medical needs in this country. Dr. Carl Robinson, Dr. Isaac Webber, and others at the Maine General organized a Residency in Surgery, which received its final approval from the American College of Surgeons in 1947. Originally, the Residency was three years in duration in addition to surgical specialties in order to prepare the graduate for rural practice. The resident case experience came from clinics and emergency cases, as well as observing the practices of experienced surgeons. Medicare legislation in 1965 made this system inadequate, and thus private patients were gradually integrated into the teaching program under the guidance of Drs. Emerson Drake and Richard Britton.

By the 1970s, Maine General had become the Maine Medical Center in Portland and both surgical volume and sophistication was on the rise, and as a result, the residency program began to attract applicants from beyond the local area. The hospital had originally been affiliated with the Medical School of Maine at Bowdoin College until that school closed in 1920, leaving the hospital without a university affiliation until 1971 when it reestablished an academic linkage, this time with Tufts University School of Medicine in Boston, Massachusetts. During that same time period, affiliations with Mercy Hospital, a local community hospital in Portland, and the Togus Veterans Hospital in Togus, Maine were developed but eventually lapsed as the volume and variety of case experience at Maine Medical Center itself continued to expand. In 1980, the medical center changed its university affiliation from Tufts to the University of Vermont in Burlington and the department has actively engaged in the surgical education of medical students from that institution ever since.

In 2008, Maine Medical Center reentered into an affiliation with Tufts University, this time in a unique partnership to provide a full medical program experience in Maine. As opposed to previous affiliation models, students are accepted into a "Maine Track" at Tufts, selected by a Maine based admissions committee and all of their clinical rotations are at MaineHealth Maine Medical Center or affiliated hospitals and medical practices in Maine.

The MaineHealth Maine Medical Center surgical residency is a classic example of a "hybrid" surgical program. Originally established as a community program, trainees receive an extensive background in "bread and butter" general surgery. The residency has retained the benefits of a community program in terms of relatively small resident-to-attending ratio and tremendous operative experience; at the same time the academic commitment of both faculty and residents has been steadily growing. Not surprisingly, as MaineHealth Maine Medical Center evolved into a tertiary referral center and cemented academic affiliations, more and more residents have chosen to enter fellowships and academics after finishing their training. Although the initial intent of the program was to train graduates from New England medical schools, the general surgery residency program now draws residents from schools throughout the country and has graduates in all regions of the United States.