Back to Top Skip to main content

Surgeons share secrets of residency success

Surgeons in the operating room at Madigan Army Medical Center. (U.S. Army photo by John Wayne Liston) Surgeons in the operating room at Madigan Army Medical Center. (U.S. Army photo by John Wayne Liston)

Recommended Content:

Access, Cost, Quality, and Safety | Military Hospitals and Clinics

JOINT BASE LEWIS-MCCHORD, Wash. – Over the last 15 years, residents graduating from Madigan Army Medical Center's general surgery residency program have passed the exam for board certification on their first attempt at a nation-topping rate of 97.6 percent.

The American Journal of Surgery recently published a long-term study that ranks 231 general surgery residency programs across the country by this measure. By nearly two percentage points over the next ranked program, Madigan's residents taking exam over the 15-year duration of the study put the program in the number one spot. The pass rate that Madigan scored is well above the mean of 72.9 percent. 

To become a board-certified general surgeon, passing a combination of a computerized multiple choice qualifying exam and an oral certifying exam is required. 

Because of its value in the surgical field, this pass rate is seen as a significant measure of the success of a residency program. The study makes the overall success of military programs in achieving board certification apparent. 

"I think we attract a special breed of residents," said Army Lt. Col. (Dr.) Vance Sohn, the residency program director and chief of general surgery. "That's the type of person that we recruit and retain — the people who don't shy away from challenges. We want to be in the action," he added.

Of the 231 programs evaluated, eight were military, with six of those being Army. All of the military programs were ranked in the top half. Five of the six Army residencies were in the top third and two scored in the top three. Brooke Army Medical Center at Fort Sam Houston, Texas, occupies the third spot on the list. 

Selecting Character and Promise 

"The article divides it into military programs, academic programs, and civilian programs. The military programs were statistically better overall than any of the other two. And I think it has a lot to do with our selection process. They signed up for a military career and all the trappings that go with that — the responsibilities and things. You're getting a different level of committed individual. That's part of it," explained Dr. Joseph Homann, a surgeon and key member of the faculty. 

Sheer numbers also allow Madigan to be choosy when selecting its residents. 

"You have more people that want to do general surgery than the Army has places to train people so you really get the best of the best," agreed Army Capt. (Dr.) Michael Lallemand, a chief resident currently in his sixth year in the program.

"If you get an 89 percentile in the nation, you're in the bottom quarter of Madigan in our annual in-training exam. That's unheard of in any program. In any other program, you get an 89 percentile in the nation, you are doing very well," Sohn said.

More than simply the supply and demand aspect is the vast difference between the selection process within the military and the civilian side. 

As civilians apply to 1 of the 200+ programs, they submit their transcripts and possibly spend a day visiting a facility. That's the extent of visibility either candidate or faculty gets in determining whether the fit is right or not for the next five to six years.

In the military, a medical student does a full four-week rotation working within their prospective program. That makes the selection process much more informed, on both sides. The resident gets to interact with the faculty and staff within the program who, in turn, get to see the candidate in action. 

"You get to work with them professionally. See how they work in clinic, see how they work on the wards," said Lallemand. "You get that time to figure out — do we think this person is going to be successful or not," he said.

The military programs seem to have an advantage from the start. But, Madigan stands out even beyond that. A number of possible reasons come to the fore. 

The Madigan Approach

When he attends meetings and conferences off base, Sohn gets asked the same question again and again. "'What is it that you guys do that makes you so different?' We don't have a separate book that only we study out of," he said. 

Yet, there are things that are unique to Madigan's way of training general surgeons. 

Every Thursday is dedicated to training. Every single one. There is also a full year dedicated to research. That is now common Army-wide, but wasn't when Madigan started doing it. It is not common in the typical civilian residency program.

Residents here also get some good preparation for that oral exam. As they work on-call in their second and third years, they are required to present in a morning conference on all their patients and activities. Then, during their last three years of residency, they work with a hospital in Seattle to do rounds of mock oral exams twice a year. 

Being able to answer the questions of what to do in the oral exam situation is vital, but developing the surgical skills to perform in the operating room is clearly paramount. 

"I think one of the big advantages to our program, especially compared to some of the civilian programs," commented Lallemand, "is that literally day one of intern year, the interns were in the operating room." 

He noted that those initial procedures are minor things like draining an abscess, and are accompanied by intensive, over-the-shoulder supervision by faculty. Jumping right in and getting comfortable in the operating room is important, though.

"That's not necessarily the experience interns get everywhere in the country. That's one of the big strengths of our program is you get in the operating room right away and you get that experience." 

As focused as faculty is on perpetuating the areas of strength in the program, they are also addressing weaknesses. 

"Each year there are little incremental changes. We have discussions and we identify areas that are perhaps a little weak," said Homann.

Lallemand points to one area that has some room for improvement. "Anyone who's being honest isn't going to look at our program and say there's a lot of diversity. I think that's a weakness of our program," he said. In specific reference to the number of women in the program, he noted that, "the demographics are changing." The program has heard this concern from medical students doing their rotation and has added female faculty. 

Stability and Sustainment

A number of the faculty, both current and throughout the study's length, did their residency here to include Sohn and Army Lt. Col. (Dr.) Matt Eckert, the trauma medical director and associate residency program director. 

In addition to long-term dedication to the program by active duty surgeons, there is a contingent of former Madigan colonels who now work as civilian faculty. 

"I came here in 2004 when most of the active duty people were deployed and they just needed help from people who were used to the system. That's 15 years ago. That covers the spectrum of this report," said Homann. 

"I think having a stable staff really helps with the educational process," Homann said. Madigan was his last duty station before retiring from active duty.

"We've had a long-standing focus and intentional development of the faculty and the residency because we had a program that worked and we wanted to stick with it. That's a little unique in the military because typically even among surgical residencies in the military there's still a lot of movement among staff," said Eckert. 

The Mission at Hand

"I really try to impress upon them what the mission for our training is," said Sohn. "We have a very defined role in that we are going to deploy to the most remote and austere environments. We're going to be given the least amount of resources and we're going to say, 'you have to succeed,'" he added.

Having been deployed numerous times himself, Sohn knows the skills and knowledge his residents will need in that situation. He works to nurture a drive in them. 

"It's a long six years and they work very, very hard for six years. Our bar, our standards are very high because again, it's not something artificial; they will deploy," he said. 

Lallemand, though he has not yet deployed, has clearly taken this mission awareness to heart. 

"It's a very real possibility that six years from now when you're just finishing your residency and I've been out for six years and we deploy together and, you know, some Soldier's life depends on how well we can perform that day. To be able to perform your best, I have to rely on you to have gotten everything you can out of your residency," he said.

Culture of Excellence

Ultimately, the aspect faculty and residents bring forward as a key factor in the success of the program is that high-potential residents come into a program that is accustomed to success and, therefore, has very high expectations for them. 

"We have a hard-wired culture of excellence here and I think that's really what sustains us," said Sohn.

High expectations exist for residents from the start of their first, or intern, year and they merely build from there. 

Lallemand finds the expectation both intimidating and inspiring. By the final, or chief resident, year they are part of the mechanism that insists the bar is met. 

"You have a team of medical students and residents looking up to you now. You have to be able to lead your people and get your people to want to be better for you because the people that were ahead of you made you better," said Lallemand. "You're always expected to be a teacher."

The staff and chief residents push until a resident doesn't know an answer. "Then, when you don't know the answer, that's where the opportunity to learn comes from. If you don't get to the point where you don't know something every day, I kind of get the sense that the faculty and the senior residents have failed the junior residents because we haven't taught them anything," said Lallemand.

Lallemand makes clear that all this pushing is borne of a passion for the craft, the program and those within it. "The faculty really care," he said. 

"Being a surgeon is one of the greatest jobs in the world," concluded Homann. "And it's still fun, especially," he noted, "seeing the young people come along."

Disclaimer: Re-published content may have been edited for length and clarity. Read original post.

You also may be interested in...

Changes to military health care system aimed at readiness

Article
12/6/2019
Speaking before the House Armed Services subcommittee on personnel during a Dec. 5 hearing on Capitol Hill, Assistant Secretary of Defense for Health Affairs Thomas McCaffrey (left), Army Lt. Gen. (Dr.) Ronald Place (second from left), director of the DHA, the service Surgeons General, and Joint Staff Surgeon outlined the necessity for the health care system to change in order to support warfighter readiness. (MHS photo)

Merger of all hospitals and clinics to DHA a key step

Recommended Content:

MHS Transformation | Military Hospitals and Clinics

Keesler renovates cardiac cath lab to provide better, safer care

Article
12/5/2019
Air Force Staff Sgt. Matthew Slaven (right), 81st Medical Operations Squadron cardiopulmonary technician, briefs 81st Medical Group staff and guests on cath lab capabilities during the cardiac catheterization laboratory ribbon cutting ceremony inside Keesler Medical Center at Keesler Air Force Base, Mississippi. The lab was upgraded with an entire suite of technology to provide better and safer care for patients and the surgical team. (U.S. Air Force photo by Senior Airman Suzie Plotnikov)

The clinic also has a joint DoD – VA partnership

Recommended Content:

Military Hospitals and Clinics

Military hospital transformation – introducing the market construct

Article
12/5/2019
Barclay Butler, Ph.D., MBA, assistant director of management at DHA, explains the market concept to an audience of active-duty and civilian conference attendees at the 2019 AMSUS Annual Meeting in National Harbor, Maryland, Dec. 4. (Photo by MHS Communications)

Markets will manage hospital and clinic needs within a geographic region

Recommended Content:

Military Hospitals and Clinics | MHS Transformation

Tri-Service surgeons perform the first surgeries at new hospital

Article
12/3/2019
The Army, Navy and Air Force surgeons and physician assistant met with the hospital command team. (Left to right) Army Col. Alfonso Alarcon, orthopedic surgeon at BDAACH; Army Maj. Harry Aubin, general surgeon at BDAACH; Army Command Sgt. Maj. Nicole Haines, the hospital senior enlisted advisor; Air Force Capt. Christopher Ng, Air Force general surgeon with 51st MDG; Army Maj. Eric de la Cruz, chief of general surgery at BDAACH; Navy Lt. Cmdr. Paul Lewis and Lt. Cmdr. Dan Sanford, general surgeons with 3rd Medical Battalion; Army Maj. John Fletcher, general surgeon at BDAACH; Army Col. Andrew L. Landers, hospital commander, and Air Force Capt. Steven Maya, physician assistant with 51st MDG. (U.S. Army photo by Inkyeong Yun)

This event showcased the collaboration amongst the tri-service general surgeons

Recommended Content:

Military Hospitals and Clinics | MHS Transformation

NMCP hosts ‘The Future of Military Medicine’ discussion panel

Article
12/3/2019
Navy Capt. Joel Schofer, deputy chief of the Medical Corps at the Navy Bureau of Medicine and Surgery, talks about the Defense Health Agency transition during Naval Medical Center Portsmouth’s Future of Military Medicine panel. The panel participants were (left to right) Schofer, deputy chief of the Medical Corps at the Navy Bureau of Medicine and Surgery, Navy Capt. Lisa Mulligan, NMCP’s commanding officer and Capt. Guido Valdes, Navy Medicine East deputy commander (U.S. Navy photo by Seaman Imani N. Daniels)

The readiness of the Navy Medicine team is paramount to combat survival in the future

Recommended Content:

MHS Transformation | Military Hospitals and Clinics

Keesler Medical Center receives national recognition

Article
11/27/2019
Keesler was one of 56 participating hospitals to be recognized in both patient care categories – all patients and high risk patients. (U.S. Air Force photo)

The ACS National Surgical Quality Improvement Program recognized Keesler Medical Center

Recommended Content:

Military Hospitals and Clinics

Award-winning Navy team successfully improves care for women, infants

Article
11/26/2019
Labor and Delivery providers were the front-line adopters of the Induction of Labor care pathway at Naval Medical Center San Diego. As of July 2019, over 80 percent of the hospital’s providers were using the pathway. (U.S. Navy photo by Mass Communication Specialist Seaman Joseph A. Boomhower)

An award-winning team of nurses successfully implemented a treatment guide at Naval Medical Center San Diego that improves labor and delivery outcomes

Recommended Content:

Military Hospitals and Clinics | Children's Health | Women's Health

Ft. Bliss Hospital Replacement

Congressional Testimony
11/22/2019

H.R. 2998 HAC Milcon for FY 2018 115-188 Pg. 27-28

Recommended Content:

Military Hospitals and Clinics

Improvement of Administration of DHA And MTFs

Congressional Testimony
11/21/2019

H.R. 5516, NDAA for FY 2019, Section 711(c) (Defense Health Command)

Recommended Content:

Defense Health Agency | Military Hospitals and Clinics

Lending a helping, healing hand

Article
11/20/2019
Navy Capt. Johannes Bailey, Naval Hospital Bremerton Director for Nursing Services (left) and Navy Lt. Kaitlyn Harmon, NHB Multi Service Unit (right), flank Army 1st Lt. Lauren Odegaard, from Madigan Army Medical Center, for a photo op after thanking her for her assistance. Odegaard provided assistance for the month of October in NHB's MSU to help with staffing shortages. (U.S. Navy photo by Douglas H. Stutz)

Army nurse supports Navy hospital

Recommended Content:

Military Hospitals and Clinics | MHS GENESIS

Artificial intelligence makes its way to dermatology clinic

Article
11/18/2019
Air Force Maj. Thomas Beachkofsky, 6th Health Care Operations Squadron dermatologist, uses a body scanner microscope to take a picture of a spot on his arm at MacDill Air Force Base, Florida. A new software upgrade allows a complex algorithm to analyze an image captured with a camera and rate the severity of the spot for a dermatologist to review. (U.S. Air Force photo by Senior Airman Adam R. Shanks)

The software was able to correctly identify 95% of malignant skin tumors

Recommended Content:

Military Hospitals and Clinics | Technology

Nellis medical center celebrates 25 years

Article
11/13/2019
Air Force Col. Alfred Flowers, 99th Medical Group commander, and Army Staff Sgt. Michael O’Callaghan, (grandson of the former Gov. O’Callaghan) reveal a portrait of O’Callaghan during a ceremony celebrating the Mike O’Callaghan Military Medical Center’s 25th Anniversary on Nellis Air Force Base, Nevada, Nov. 12, 2019. The portrait will hang in the MOMMC to honor the center's namesake. (U.S. Air Force photo by Senior Airman Kevin Tanenbaum)

The Mike O’Callaghan Military Medical Center celebrated 25 years of operation Nov. 12

Recommended Content:

Military Hospitals and Clinics

Womack Army Medical Center named Level III trauma center

Article
11/12/2019
Local medical partners conduct a 'trace the trauma' tour Nov. 6 after Womack Army Medical Center celebrated their integration into the North Carolina American College of Surgeons Level III Trauma designation. (U.S. Army photo by Twana Atkinson)

Trauma is the leading cause of death for Americans age 45 and younger

Recommended Content:

Military Hospitals and Clinics

Air Force transitions all U.S. military treatment facilities to DHA administration, management

Article
10/31/2019
This October, U.S.-based Air Force military treatment facilities transferred administration and management to the Defense Health Agency. (U.S. Air Force illustration)

Congress directed this transfer in the fiscal year 2017 National Defense Authorization Act

Recommended Content:

MHS Transformation | Military Hospitals and Clinics

Joint Army-Air Force-Navy medical partnership saves lives downrange

Article
10/29/2019
Airmen work with members of the Extracorporeal Membrane Oxygenation team to save the life of a NATO troop at the Craig Joint-Theater Hospital on Bagram Airfield, Afghanistan. (U.S. Air Force photo by Tech. Sgt. Nicholas Rau)

More than 100 medics from the 59th Medical Wing deployed

Recommended Content:

Military Hospitals and Clinics
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 12

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing: Download a PDF Reader or learn more about PDFs.