The first two and one-half months are served in a didactic session where international and national leaders in their respective fields of surgical/medical expertise provide lectures. Also, BLS and ACLS certification are acquired. All state requirements for licensure are met including infection control, OSHA, child abuse and HIPPA instruction.
There are also scheduled sessions in the Montefiore Institute for Minimally Invasive Surgery (MIMIS). MIMIS is a center of excellence to instruct surgeons, surgical residents (physician and PAs) in established laparoscopic techniques and to develop new techniques and instrumentation. For the PA and physician residents there are dry lab sessions available throughout their tenure where computer based exercises sharpen skills and record progress over time as well as mechanical trainers to practice intracorporeal suturing techniques in a three dimensional trainer viewed on a two-dimensional video screen (just as in the OR). The last three weeks of the didactic session are spent on the surgical service the PA resident will be assigned for his or her first month of the clinical session.
The clinical session is composed of eleven one-month rotations through three major urban hospitals. At the Jacobi Medical Center, a member of the New York City Health and Hospitals Corporation, PA residents serve in the area's largest and best-known Level One trauma center. They participate as surgical interns on the in-patient service learning to manage patients with both penetrating and blunt trauma.
In conjunction with their trauma experience the PAs spend an additional month at Jacobi as the surgical intern in the SICU. This combination of trauma and the SICU at a Level One urban Trauma Center truly sharpens skills needed to assess, diagnose and treat critically injured and fragile patients.
From Jacobi, the PA residents usually travel to the Weiler Division of the Montefiore Medical Center, a close geographic neighbor to Jacobi. At Weiler, the PA residents serve on the specialty care surgical service This service has varied in-patient population from pediatric (neonatal) to geriatric. Emphasis, as in all the surgical rotations, is on the preoperative care, inrtaoperative first assisting and postoperative management with appropriate in-patient care on the general floors or intensive care units. Participation at surgical clinics and follow-up office visits are also required.
Crossing the Bronx, the PA residents receive the majority of their surgical experience at the Moses Division of the Montefiore Medical Center. Here the PA residents serve for one month each on the Vascular Surgery Service, Pediatric Surgery, the Acute Care Service (covering patients admitted through the Emergency Department who need surgical care), the Adult Specialty Care Service (general surgery, endocrine surgery, bariatric surgery, liver/pancreatic surgery, oncologic surgery), Cardiothoracic Surgery and as the surgical PA intern in the Emergency Medicine Department. They also spend one month in the Surgical Intensive Care Unit (SICU).
There is also an elective month where a PA resident can spend time on a previously experienced surgical service or on a surgical sub-specialty such as:
The chart above represents a typical schedule for 5 PA interns - one row for each intern, one month for each rotation except vacation/elective.
Finally there is also a most appreciated full, one-month's vacation that is split into two week segments with the elective month; thus, the resident will have two weeks of vacation and two weeks of an elective. All this experience is complemented by a competitive salary, full benefits with a variety of enrollment options and a newly instituted graduation bonus paid once the entire 15-month residency is completed.
Montefiore's Postgraduate Residency in Surgery is not only the first postgraduate training program but has stayed the test of time, continually graduating surgical physician assistants who rise to the challenges of surgical practice and remain involved on the national, state and local scene directing the role of the surgical PA. Taking the lead again, there has been a substantial increase in base salary ($50K per year over 14.5 months is approx $60K) as well as the institution of a "Graduation Bonus ($5K)" to be given to each member of the class upon completion of the full residency.