Our integrated hospitals provide that variety: There are five major teaching hospitals through which our residents will rotate throughout their training period at the University of Louisville. Much is to be gained from experience on a busy private surgical service. One sees patients and a spectrum of diseases not ordinarily prevalent on the ward service at ULH, VAMC, and Kosair Children's Hospitals. The surgical trainee is exposed to a variety of diagnostic preferences, technical variations, and overall clinical diversity because the attending staff members come from diverse schools of surgery.

UNIVERSITY OF LOUISVILLE HOSPITAL
University of Louisville Hospital is the primary teaching hospital for the University of Louisville School of Medicine. It is a 404-bed acute care, tertiary medical center providing a full range of diagnostic, therapeutic, emergency, and surgical services. Over 500 of the area's physicians are on the medical staff. Dr. Kelly McMasters, Professor and Chairman, is Chief of Surgery and Dr. Glen Franklin is director of surgical education. Dr. J.David Richardson is Chief of Emergency Surgical Services, and Dr. Susan Galandiuk has a busy private practice in colorectal surgery there as well. Private patients of other faculty are regularly hospitalized here. Three separate surgical services including two emergency general surgery, trauma, and burn services, and an elective general and thoracic surgical service are staffed by a full complement of residents and each directed by a chief resident.

The hospital is part of a four-building complex that also includes an Ambulatory Care Building housing University Physicians Group, James Graham Brown Cancer Center, and Institutional Services Center. All are operated by University Medical Center, Inc., a partnership of the University of Louisville, Jewish Hospital Health Care Services, and Norton Health Systems. U of L Healthcare is a growingly recognized emblem of these mutual efforts.

VETERAN'S ADMINISTRATION HOSPITAL
The VA is located about 3.5 miles from the downtown medical center. Dr. Earl Gaar is Chief of the Surgical Service and several attending surgeons are either part or full time there. The hospital has about 100 filled beds and there are two resident surgical services, where a chief resident directs each service. The spectrum of disease seen is typical of any VA and includes vascular disease, cancer, hernias, complex intra-abdominal cases, and complicated wounds. There is a busy endoscopic service at he VA that is staffed by surgeons with expertise in endoscopy. The surgery clinics are particularly efficient and include two general surgery clinics, vascular clinic, and thoracic clinic. The electronic medical record is state of the art.

NORTON HOSPITAL
Surgical residents cover all of the surgical disciplines at the Norton Hospital. Five to six residents are assigned to the adult general surgical service. There are two senior residents (PGY IV), and an additional 3 to 4 junior residents. Several junior medical students are assigned to the service. The surgical subspecialties, including otolaryngology, cardiothoracic surgery, and plastic surgery, all have house officer coverage provided by rotating general surgical house officers or residents within their own discipline.

The Norton Hospital rotation has grown to one of the most attractive and productive rotations for our residents. This rotation affords the residents a large volume of routine as well as referral type of general surgical procedures. Additionally, the resident staff will have supervised operative responsibility for selected patients. The junior resident is on in-house call every third night, and the senior residents alternate call from home as backup.

A Tuesday afternoon teaching conference covers selected cases of interesting patients who are being cared for by the service. In addition to faculty, resident and student participation from Norton Hospital, attending staff and residents from Jewish Hospital join for this conference. Dr. Robert Cacchione is director of surgical education at Norton Hospital.

Also at Norton Hospital is the CAST program. This is an acronym for the Center for Advanced Surgical Technologies and is a joint program between the University of Louisville and Norton Hospital. One senior resident each month, either a PGY-4 or PGY-5, is designated the CAST resident. This resident has the benefit of learning the newest surgical techniques: sentinel lymph node therapy, laparoscopy and minimally invasive surgery, radio-guided parathyroidectomy, image-guided breast biopsy, and countless others. The CAST resident does not participate in the in-house call schedule. This unique program was the subject of the cover article in the Bulletin of the American College of Surgeons 2001; 86:11-15.

KOSAIR CHILDREN'S HOSPITAL
The Kosair Children's Hospital rotation is a busy one with responsibilities for newborn surgery, children's trauma, care of patients on the Oncology Service, the Burn Service, and consultation in an active Emergency Room and Surgical Clinic.

The senior resident functions as the chief resident on the Service and is supported by three to four junior residents. While on the Children's Service, the residents work closely with the attending pediatric surgeons in the care of a wide range of surgical illness from the newborn period to teenage years. The chief surgical resident is responsible for maintaining the call schedule in which he takes calls at home, while the junior residents have in-hospital coverage every second or third night. While at Kosair Children's, the residents participate in a weekly scheduled residents' teaching conference, student rounds presentations, and attend the Pediatric Grand Rounds as part of their total exposure to children's surgical care. Dr. Mary Fallat is Surgeon-in-Chief at Kosair Children's Hospital.

JEWISH HOSPITAL
There are separate services of general surgery, thoracic and vascular surgery, transplantation, and cardiac surgery at this large teaching hospital. Residents are assigned to each of these services and all are under the supervision of the surgical staff members who are clinical faculty members of this Department. Three surgical residents participate in the private general surgical service under the direction of Dr. Martha McCoy, who is overall Director of the University Surgical Services at Jewish Hospital. In addition, there will be a large experience with general thoracic surgical patients on Thoracic and Vascular Associates' private service, and one resident will be assigned to this service. Two surgical house officers also participate in the transplantation service. The hospital is home to all solid organ transplants, and this service is under the supervision of Dr. Frederick Bentley. PGY-I house officers will be assigned full-time to the Jewish Hospital rotation in cardiovascular surgery. These house officers will be on the full-time University Service directed by Dr. Laman Gray, Jr.

COMMUNITY SURGICAL EXPERIENCE
A private general surgical rotation is offered to mid-level residents in south Louisville. This rotation is primarily at Caritas and Southwest Hospital. The rotation is a preceptorship with the surgical group including Drs. Rodney McMillian, Joseph Blandford, Joel Garman, John Olsolfka, Vincent Lusco, and Bryce Schuster. This rotation has offered a tremendous opportunity for our residents to view a different kind of practice within the confines of Jefferson County.