The Cardiothoracic Surgery Division offers exposure to the full gamut of adult cardiac and general thoracic surgery, as well as a more limited exposure to congenital heart surgery. Heart and lung transplantation is not offered at this time. Approximately 800 surgical procedures are performed annually. Since the medical center is a level one trauma center, there is ample exposure to chest trauma. Residents rotate through the division for one month as a junior resident, and for three months as a senior resident. The resident's primary responsibility is the care of the general thoracic surgical patients including preoperative evaluation, participation in surgery, and postoperative care. Residents do have an opportunity to participate in the care of cardiac surgical patients depending on their level of interest. The Division of Cardiothoracic Surgery participates in an active lung cancer registry. An active chest clinic, which attracts patients from a wide referral area, is available to the residents. There is an excellent weekly chest conference where cases are presented to a multidisciplinary group including pulmonologists, surgeons, radiologists, pathologists, and oncologists. There is also a weekly cardiology conference. There is ample case material available for the interested resident to perform a clinical research project. The division is staffed by four full-time faculty surgeons all of whom are certified by the American Board of Thoracic Surgery.
The Division of General Surgery has full-time and clinical faculty. There are two general surgical services: orange and white. Each general surgical service has one senior or chief resident, one mid-level resident, and one first year resident. Medical students also rotate on the services throughout the year. Residents are exposed to a range of general surgical procedures and are actively involved in direct patient care throughout the patient's clinical course. They see patients in the general surgery offices on the office hour days of their services. Thus, residents have the opportunity to evaluate patients pre-operatively, scrub on the patient's surgical procedure, manage them in the post-operative period, and follow them in the outpatient setting. There are a large number of ambulatory surgical cases (outpatient) performed each year and the resident staff is actively involved in these cases as well.
The general surgical services offer ample opportunity for residents to be exposed to the broad discipline of general surgery, including alimentary and biliary tract surgery, laparoendoscopic surgery, colon and rectal surgery, endocrine surgery, and breast and oncologic surgery.
The neurosurgical faculty consists of a division chief and seven clinical faculty members. The faculty represent diversified backgrounds and interests. Approximately 1200 major neurosurgical operations are performed at the University of Tennessee Medical Center each year. Since there are no neurosurgical residents on the service, the surgery resident has firsthand exposure to a large number and variety of neurosurgical problems, both cranial and spinal, from a mix of trauma and non-trauma patients.
Junior surgery residents may rotate on the neurosurgical service and experience a one-on-one relationship with individual neurosurgical faculty members. This permits individual case discussions as well as opportunity to see, as first assistant, the varieties of surgical procedures and techniques. As the surgical house officer progresses through the residency program, close association with the neurosurgical faculty is continuous, especially in the management of patients with central nervous system injuries.
Neurosurgical faculty members present monthly lectures to surgical residents covering the broad spectrum of neurosurgical topics. Faculty also actively participate in morbidity and mortality conference and other resident teaching activities. Surgical residents are afforded the opportunity to participate in neurosurgical research.
The Ophthalmology Division contributes to the department's mission through teaching, consultation, and surgical expertise. The division consists of comprehensive ophthalmologists as well as subspecialists in retina/vitreous, glaucoma, oculoplastics, pediatric opthalmology, cornea/external disease, and refractive surgery. Because of the medical center's regional role as a trauma center, all ophthalmology division members have particular expertise in the diagnosis and treatment of ocular trauma and the rehabilitation of the injured eye. Approximately 3,000 ophthalmic laser and surgical procedures are performed yearly. The East Tennessee Lion's Eye Bank, located on campus, provides ready access to ocular tissue for corneal transplants and research.
The ophthalmology faculty have busy practices with surgical emphasis and are regional consultants in their respective fields. Many publish regularly in the opthalmic literature.
Orthopedic Surgery is an extremely busy division in the Department of Surgery, with seven full-time University of Tennessee clinical faculty members. The service is broadly based and includes all the major areas of orthopedic surgery: trauma, adult reconstruction, pediatric, spine, orthoscopy, and hand. In the past year, some 2,000 orthopedic surgical cases were performed by division members. Since there are no orthopedic surgery residents on this campus, a direct, hands-on experience in orthopedic surgery is available for general surgery residents.
The Division of Otolaryngology-Head and Neck Surgery consists of five full-time clinical faculty members and several part-time faculty. All subspecialty areas of otolaryngology are represented, including facial and reconstructive surgery, head and neck oncologic surgery, general otolaryngology, and otology.
Surgery residents rotating on this service enjoy a one-to-one relationship with clinical faculty members, and depending on their level of expertise, will usually first assist or be the primary surgeon on operative cases.
The Division of Pediatric Surgery provides the resident with a basic educational experience in pediatric surgery designed to familiarize the non-pediatric surgical specialist with the basic principles of the care of the child. If provides him/her with the ability to recognize the significant surgical problems of childhood, with emphasis upon providing proper evaluation, resuscitation, stabilization and appropriate referral.
Under the close supervision of full-time faculty members, residents will perform those procedures appropriately managed by non-pediatric surgical specialists. The resident also will assist in more complex reconstructive procedures. Operative experience will also include significant exposure to airway and upper gastrointestinal endoscopy. Since trauma is the most significant cause of death and disability in children, the resident will also have exposure to the severely-injured child with the whole array of multisystem critical care issues exhibited by the traumatized child.
The residents work in a close individual relationship with the faculty surgeons and benefit from small group teaching conferences at which such topics as fluid and electrolyte management, airway problems, individual congenital anomalies, common tumors of childhood, and basic principles of pediatric care are explored in depth.
The Division of Plastic Surgery is an integral, busy and growing part of the Department of Surgery. Since there are no plastic surgery residents, the general surgery house staff is afforded firsthand experience with a variety of problems including cleft lip and palate repair, breast reconstruction, maxillofacial trauma, lower extremity reconstruction, micro-surgery, surgery of the hand, burn reconstruction, aesthetic surgery, and complex reconstruction surgery.
The service is attended by three full-time surgeons. The objectives of the plastic surgery rotation are to teach proper surgical technique, tissue handling, and wound management. It provides an exposure to the field of plastic and reconstructive surgery for those who may wish to further pursue a plastic surgery residency upon completion of the general surgery program.
The Division of Surgical Oncology provides opportunities for resident participation in the diagnosis, evaluation, staging and multimodal treatment planning for a broad spectrum of benign and malignant diseases. The division consists of four full-time, fellowship-trained surgical oncologists and is supported by an accredited Tumor Registry and the full support of the University of Tennessee Cancer Institute and Department of Surgery. Through specialized surgery for cancer, cutting edge adjuvant biological and chemotherapeutic protocols, and innovative technology in radiation therapy, the residents are exposed to the same educational cancer opportunities offered at larger oncology centers. Residents and faculty participate in weekly multidisciplinary oncology conferences (All-Site, Breast, Pulmonary, and Head & Neck) to obtain multiple "expert" opinions, and then tailor an evidence-based treatment algorithm for each patient.
In 2012, there were nearly 500 surgical cancer inpatient admissions and approximately 1,300 operative procedures. Residents participate in all major operative procedures for benign and malignant tumors of the breast, skin and soft tissue, upper gastrointestinal tract, liver and biliary tract, pancreas, colon and rectum, retroperitoneum, head and neck and adrenal gland. Residents receive significant exposure to evolving technologies in oncologic surgery, including minimally invasive approaches to all gastrointestinal malignances, isolated limb infusion, peritoneal tumor debulking and heated intraperitoneal chemotherapy, and oncoplastic reconstruction.
The surgical oncology division offers residents opportunities to gain expertise in advanced surgical management of complex surgical techniques such as: sentinel lymph node mapping for breast cancer and melanoma, liver surgery for primary and metastatic tumors, intraoperative hepatopancreaticobiliary ultrsound, radio-frequency ablation for unresectable liver cancers, pylorus-preserving pancreas surgery, total mesorectal excision for rectal cancers, sphincter-sparing surgery for low-lying rectal cancer, and advanced laparoscopy for colectomy, hepatobiliary resection, pancreatectomy, adrenalectomy, splenectomy, feeding access, and palliative oncologic surgery. Residents are also encouraged to work with faculty on oncology-focused basic science, translational and clinical research projects; treatment protocols and clinical trials. For those who may be interested in pursuing a surgical oncology career, a one-year research fellowship is available after completion of the second postgraduate year.
The mission of the Division of Surgical Rehabilitation is to optimize physical medicine and rehabilitative care through the advancement of knowledge on the University of Tennessee Medical Center campus. The division's current research projects include: shoulder pain in hemiplegia, osteoporosis in spinal cord injury, and sleep apnea in disability. Future research projects include: chemodenervation with Botulinum Toxin B to improve ROM and function of finger flexors and shoulder after brain injury. The role of chemodenervation with Botulinum Toxin combined with aggressive therapy, to restore function of the hemiparetic limb by reversal of reciprocal inhibition.
The David Adam Hecht Memorial Young Hope Fund and the Division of Surgical Rehabilitation Gift Fund has been established by faculty, friends and alumni of the Department of Surgery. The goal of the gift fund is to provide the Chairman, faculty and residents with additional resources to insure continued excellence in patient care, education and research. Gifts made to the fund may be utilized for the following:
For further information, call the Office of Development and Alumni Relations at 865-305-6111.
Educating Families of the Head Injured: A Guide to Medical, Cognitive, and Social Issues by Dana S. DeBoskey, PhD, Jeffrey S. Hecht, MD, and Connie J. Calub
Stroke Rehabilitation by Jeffrey S. Hecht, MD
Division of Transplant Faculty
The Division of Transplantation provides opportunities for resident participation in the diagnosis, evaluation, and surgical management of patients with end stage renal disease in need for kidney transplantation. The division consists of three full-time transplant surgeons. Â In addition there are three minimally invasive surgeons from the divisions of General Surgery and Urology that also participate in the living donor procedures. The transplant residents are supported by a very involved nursing, pharmacy and other allied health care staff, in addition to the full support of the University of Tennessee Transplant Center and the Department of Surgery. Residents participate in all surgical aspects associated with organ donation and transplantation. Residents and faculty participate in a weekly multidisciplinary transplant conference, where the residents will become familiar with the evaluation process of the potential kidney transplant recipient as well as the practical details of tissue typing, immunosuppression protocols and live donor selection processes. The Transplant Center at UT Medical Center in Knoxville performs approximately fifty kidney transplants a year, and actively participates with UNOS in the Scientific Registry of Transplant Recipients. Residents rotate twice through the division for one month as a middle level residents. The resident’s primary responsibility is the care of the kidney transplant recipients, to lead the multidisciplinary transplant rounds and to participate in deceased donor, live donor and transplant recipient surgeries. Residents also perfom vascular access procedures while on the rotation.
The Division of Trauma/Critical Care has been organized to provide continuous care for the critically injured and seriously ill surgical patient and maximum educational benefits for the surgical house staff.
The University of Tennessee Medical Center provides Level I trauma care for a 17-county area in East Tennessee and adjacent portions of Kentucky and North Carolina. In 2009, there were 3,846 trauma admissions. Thirty-two percent of these patients required admission to a critical care unit. Approximately 19 percent of these patients arrived via helicopter. Trauma services members take primary care of patients on the trauma service and help coordinate specialty consultants such as neurosurgery, orthopedics, plastic surgery, oral surgery and other services whose help may be necessary.
Six surgical attendings who have a special interest in the care of the trauma patients currently staff the trauma service. All of these faculty are fellowship-trained in trauma and surgical critical care. Residents on the trauma service include a senior resident, mid-level residents, and a first year resident. Mid-level providers are also a part of the service. Mid-level residents also spend three months on the surgical critical care service. There is an active educational program in trauma including multidisciplinary trauma conferences. Research in the basic science and clinical aspects of trauma and critical care is ongoing.
The Vascular and Endovascular Surgery Division is staffed by five full-time vascular surgeons. In addition, it has a full service noninvasive vascular laboratory. Over 800 major vascular cases are performed each year, in addition to 1300 endovascular procedures performed in a dedicated endovascular suite. The case mix includes peripheral arterial, carotid, aortic, renovascular, vascular access, and venous disease. Forty-five to 50 kidney transplants are performed each year.
The service is staffed by one fellow, one chief resident, one mid-level resident, and one first year resident. Attendings are divided into "sub-services" to preserve operative and patient care prerogatives of the general surgery chief resident. General surgery residents typically complete over 100 major vascular cases during their training. In-depth experience in noninvasive technology, as it pertains to the vascular patient, is available to the resident. There is ongoing basic research in vascular wall biology and biomechanical properties of aneurysm formation.
Simulation is the imitation of real-life experience including the use of task and virtual reality trainers, as well as standardized patients to refine technical and clinical skills of healthcare professionals. At the UT Center for Advanced Medical Simulation, the goal is continual improvement in quality of patient care and safety through education, practice, and assessment. Simulation can replicate almost any diagnostic or therapeutic situation, from simple IV insertions using low-fidelity task technology to complicated surgeries using high-fidelity, computerized manikins or virtual reality modules.
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