The OHSU Department of Surgery was one of the first institutions in the country to offer the American College of Surgeons Mastery in General Surgery Program: an opportunity to transition directly from residency to independent surgical practice.
The Mastery Program supports the transition to independent practice in general surgery through:
- Building autonomy, decision-making, and clinical skills
- Developing experience in practice management, leadership, and quality improvement
- Learning the business of medicine
- Launching your career in general surgery
OHSU Program Description
During the first two months, the Junior Associate will share call with the faculty members and meet referring physicians. Direct supervision will progress to independent practice as skills are attained. Regular endoscopy clinics will also be scheduled throughout the year with opportunities for experience in gynecology, otolaryngology, urology, and orthopedic surgery. Monthly assessments will evaluate progress, review performance, and plan for the following month.
The Junior Associate will work in two Oregon hospitals: Adventist Health Portland, and Columbia Memorial Hospital in Astoria, OR. Upon arrival at the training site, the Junior Associate will undergo a baseline evaluation of a minimum of five supervised general surgical operations chosen from among the following: open or laparoscopic appendectomy, inguinal hernia repair, cholecystectomy, and/or incisional hernia repair. The intake assessment will be used to identify the level of performance of the Junior Associate and to plan his or her subsequent curriculum and experiences.
The Junior Associate will share call and procedures with the Mastery in General Surgery Program faculty members at the site for the first two months, including taking call for the Emergency Department, seeing patients in the ambulatory setting, performing operations and endoscopic procedures, rounding daily on inpatients, and taking consultations from the hospital, with the Junior Associate conferring with the Mastery in General Surgery Program faculty regarding management decisions. The Junior Associate will make rounds with a Mastery in General Surgery Program faculty member on all inpatients daily during the first two months and will have direct supervision for all operations. The Junior Associate will meet with the majority of the referring physicians during the first two months so that they can become familiar with the Junior Associate’s background and desire to be consulted for appropriate cases. The Junior Associate’s performance will be assessed at the end of each month and the Junior Associate will meet with the Senior Associate to decide at that time whether the Junior Associate is ready to enter the Emergency Call Schedule as an independent practitioner. The Mastery in General Surgery Program faculty will continue to be available to provide consultation and advice for any cases in which there are questions and a weekly case presentation conference will be held to discuss representative cases.
The degree of supervision required will be reviewed monthly. Every attempt will also be made to include patient care and operative experience with caesarean sections and other basic gynecologic conditions as well as basic emergency and elective conditions in the areas of otolaryngology, urology, and orthopedic surgery. In addition to basic general surgical procedures, gastrointestinal endoscopy will be a major feature of the Junior Associate’s curriculum, with regularly scheduled endoscopy clinics. The practice group will hold a regularly scheduled morbidity and mortality conference at which all deaths and complications are discussed using a root cause analysis format.
The Junior Associate will meet monthly with the Senior Associates for evaluation and feedback using a competency-based assessment tool. At this meeting the goals and objectives for the next month will be mutually discussed and decided upon.
A semiannual review will be scheduled to include the Junior Associate, the Senior Associate from each hospital, and the Mastery in General Surgery Program Chief to assess performance based on the goals and objectives that were established at the intake assessment. This will also be an opportunity to refine goals and objectives predicated on the performance and recognized needs to date.
The Junior Associate will learn about practice management issues including billing, collections, medical liability, contract negotiations, quality improvement, and patient safety initiatives from the primary faculty as well as from the practice manager of the surgical group.