Your Path to General Surgery Residency Success

The Best General Surgery Residency Programs in the US

1. Mayo Clinic College of Medicine and Science
2. University of Alabama School of Medicine
3. Ichann School of Medicine at Mount Sinai
4. Montefiore/Albert Einstein College of Medicine
5. Vanderbilt University School of Medicine

What are the most competitive and least competitive residencies? Check out this video:

The Best General Surgery Residency Programs in Canada

1. University of Toronto
2. University of Alberta Faculty of Medicine
3. Michael G. DeGroote School of Medicine at McMaster University 
4. Northern Ontario School of Medicine
5. Dalhousie University School of Medicine

What is a General Surgery Residency?

A general surgery residency is where you build upon the preliminary skills you learned in medical school to learn more about how surgery relates to all other aspects of health. In a general surgery residency, you also become more familiar with the particular skill-set (hard and soft skills) that successful surgeons need to excel in their careers, from communicating with patients and other residents to learning technical, specialized surgical skills that every surgeon should have.

In a general surgery residency, you may learn more about:

• The definition and application of various surgical procedures
• How to properly assess and diagnose when someone needs surgery
• Possible alternatives to surgery
• The drugs or medicines most useful to surgery patients, before, during and after their operation

But there is much more involved.

You got a glimpse of what being a surgeon is like during your two-or-three-month rotation in surgery during medical school. Even though you were well-acquainted with how to prepare for clinical rotations, many of the graduates we have worked with found their surgery rotation was among the toughest, and left it out when they were deciding how to choose a medical specialty. Why? Well, think about it. Surgery is the most invasive, and maybe, most severe, type of medical intervention there is, which requires knowledge of various systems of the body and a particular set of finely-tuned technical skills.

The stakes can range from removing a small mole on a patch of skin to giving someone a new heart or lungs, and everything in between, which is usually what graduates either love or hate about surgery – its unpredictability. A “general” surgery residency is the right name for this type of residency, as it opens the door to other specialities within the field of surgery, but is also vital to treating a range of different conditions from trauma and cancer patients to gastrointestinal issues and repairing injuries to extremities.

There is a surgery sub-speciality for every part and system of the body, and you will most likely choose from among the most popular ones, such as orthopedic and thoracic, depending on your interests and goals. However, general surgery is a popular field in itself precisely for its versatility and variety. But being a qualified surgeon requires a lot.

The grueling training regimen and long hours (up to 80 hours a week) have seen applications for general residency positions in Canada decline over a ten-year period. However, surgery remains a popular specialty in the US, and there are only slight variations between the number of applicants every year with an average of 6550 applicants over five years.

Medical school graduates now pay more attention to whether they will be able to achieve a work-life balance in the future, and surgery is, generally, not viewed as “lifestyle-friendly” as other specialities, such as an internal medicine residency or family medicine residency. However, if becoming a surgeon was and is your reason for going to medical school, you must be willing to put in the work, and stomach the crushing defeats from being a general surgery resident (and there will be many, not only in relation to patients, but more in terms of your training and practice), then, hopefully, by the end of this article, you’ll come away more determined.

We’ll lay out the various paths to joining a general surgery residency in both the US and Canada, and what you will need most to get into any of the programs listed here and beyond.

What’s Involved in a General Surgery Residency (US)

One thing that general surgery residencies in the US share with their Canadian counterparts is the length of most programs, which is five years. Add another year or two to learn more about a subspecialty and you’re looking anywhere between five and seven years of additional training, so be cognizant of that.

But the average length of the program is where the comparison usually ends, as there is much more involved in applying for a general surgery residency in the US than in Canada. For one, you have to meet a whole different set of criteria and admission standards for US programs. Second, the location and type of your residency (urban v rural residency, for example) plays an important role in the types of qualifications you must have to enter that program.

What You Need to Get into a General Surgery Residency (US)

In a survey of many of the most and least competitive residencies in the US, the American College of Surgeons said that academic performance is the number one deciding factor for admittance. But there are others that you should know, such as:

• Being a member of the Alpha Omega Alpha (AOA) Honors Society in the US
• Being within the top 10% of your class
•  Having a USMLE Step 2 CK score of 220 or higher
• Having published or be involved in research
• Have exceptional letters of recommendation from surgeons

But you should not view this as a comprehensive list of requirements. These are more “nice-to-haves" and not necessarily “must-haves”. The program you want to enter may not ask or require you to be elected to the AOA or the Gold Humanism Honor Society, which is another non-profit honors foundation for medical professionals in the US. Depending on the program, being in the top 25% of your graduating class may be enough, if other aspects of your application stand out, such as your residency personal statements or letters of recommendation.

Applying to a General Surgery Residency (US)

The application process is similar to any other residency program – reviewing programs through the FREIDA online catalog; applying through the Electronic Residency Application Service (ERAS); surgery residency interviews; ranking your programs on your rank order list for the National Residency Matching Program; waiting for Match Day.

How General Surgery Residencies are Structured (US)

The five years you spend in a general surgery residency are sometimes broken up into two sections similar to how medical school is divided between pre-clinical and clinical years. But usually, a program integrates in-class training into hands-on, clinical experience and vice-versa, while others (like the Mayo Clinic) divide clinical rotations and team-based-learning into separate blocks.

 But every program has its unique features, attributes, and curriculum that will eventually help you decide which program is right for you. We say this a lot, but it bears repeating; you need to look at each program carefully to understand its application requirements and whether its mission, research and values are in line with yours.

Let’s us the Mayo Clinic example as an illustration. Remember not all programs are like this, so each will have a different curriculum, electives, rotation schedule and research opportunities.

Mayo Clinic General Residency Program

The Mayo Clinic has many different locations in Minnesota, Florida, and Arizona, but the General Surgery Residency in Phoenix is well-known for its expertise in minimally invasive surgery among other reasons. Each year of the program (five years) is divided between blocks, or rotations, within different surgical specialities, such as acute, vascular or trauma and critical care surgery. You must also perform off-site rotations in various satellite clinics and clinical partners as part of the program requirements.

But the program also has didactic rotations, or conferences, where you go in-class with other residents to learn more about diseases that require surgery and “non-technical surgical skills”, while performing basic surgeries during your rotations, such as how to take biopsy samples or hernia repair. This curriculum format continues for the rest of your five years, more or less.

However, in the fifth year, you graduate from a resident to a chief resident, with all the attendant responsibilities, such as scheduling and assigning surgeries, mentoring and instructing junior residents, and handling all the administrative duties associated with a general surgery department. This chief resident program at the Mayo Clinic is designed to prepare you to assume more senior roles at others hospitals, unless you decide to pursue a medical fellowship afterward.

But before you complete the general surgery residency at the Mayo Clinic, you also have to pass board-licensing exams, specifically for the field of surgery. The two exams are the American Board of Surgery In-Training Examination (ABSITE), which is specifically for surgery residents, and the General Surgery Qualifying Examination, which is the board licensing exam, both of which are administered by the American Board of Surgery.

This is just a snapshot of what a general surgery residency entails at the Mayo Clinic, which is a popular program, but your choices will have different curriculums, teaching models, research opportunities and other tangibles that you need to research to make your decision. 

Now we’ll look at the system to become a general surgeon in Canada.

What’s Involved in a General Surgery Residency (Canada)

The path to becoming a general surgeon in Canada is not that different from the path in the US. All general surgery residencies in Canada must train for a minimum of five years, while some general surgery residency programs run for up to six years. But, in Canada, new residents do not usually start performing surgeries until their third year with the first two years spent in-class. Again, your program may have a different teaching curriculum, but this is a standard organization for most programs.

But, in any case, when you enter a general surgery residency program in Canada you also have a division of your rotations, which are hospital-based but can include off-site rotations to community hospitals in or near your main location. But the general surgery rotations do not start (clinical experience) until the third year. Your first years are taken up by learning about the various surgical subspecialities, which you can specialize in during your final years or pursue additional training after the general residency ends.

What You Need to Get into a General Surgery Residency (Canada)

Getting into any of the best residency programs in Canada is done through the Canadian Resident Matching Service (CaRMS), which is similar to the ERAS in the US. The requirements for entering a specific program are not standard across most programs, which include submitting:

• Official transcripts
• Your MSPE
• Between 3-4 letters of recommendation
• Personal letter 
• A Relevant General Surgery Experience document outlining all your surgical experiences

This is not a comprehensive list, as some programs will ask for additional supporting documentation, or a different number of letters of recommendation with specific instructions on who should be the letter writers. Interviews also figure prominently in the application process, but many Canadian residency programs use MMI or other clinical assessment programs instead of a traditional, one-on-one or panel interview.

Applying to a General Surgery Residency (US)

If you are interested in applying to a general surgery residency in Canada you must submit an application via CaRMS. Each program has a description on the CaRMS website, which is not a definitive listing of all the program’s features, such as the electives or special tracks offered, but the CaRMS website does give you important information about application requirements. It also gives you all the specific program information such as the content and length of your CaRMS personal letters and other application materials.

Preparing for an interview with a general surgery residency program?

How General Surgery Residencies are Structured (Canada)

As we talked about, the path to becoming a general surgery takes the same amount of time as it does in the US, and there are only a few differences between the teaching methods, rotation schedules, and other roles and responsibilities. In Canada, surgery residents are put through the same number of rotations in all the most fundamental surgical specialities, such as pediatric, trauma, thoracic, and vascular surgery.

The second year consists of more rotations within more specialities such as critical care and endoscopy, while also giving residents the chance to choose from a series of electives that vary among all the different programs. If you are interested in becoming a researcher, the program at the University of Toronto offers a Surgical Scientist Training Program that you can apply for in your second year, which will expose you to more research opportunities at the university where you can earn either a Master’s or a PhD.

But each program in Canada has specific tracks or specializations based on its location. While the University of Toronto does feature a rural specialization through the Rural Ontario Medicine Training Program, the general surgery residency program at the Northern Ontario School of Medicine offers many more community-based rotations throughout Northern Ontario cities but also puts first-year residents directly into the OR accelerating their training.

Another similarity to the American general surgery residencies is that residents have teaching responsibilities, along with their ascension to chief resident status in their final year to prepare them for more administrative possibilities later in their career.

How to Get into a General Surgery Residency

Excellent Letters of Recommendation

A great letter of recommendation is a reflection of how unique you are as an applicant and the fact that surgery residencies can be extremely challenging means that programs want to hear about how resilient, determined and passionate you are about surgery. If those words come from a well-respected surgeon at your medical school, then it will look even better. To get one of those letters, though, you have to apply yourself in other ways.

Do the “Scut” Work

It may seem demeaning to some, but many surgery residents we’ve spoken to talk about their willingness to pick up the slack for others during their rounds. Meaning, you should not stop at what is required of you, but go further than that and find ways to be useful to your fellow residents, faculty, and most importantly, patients. During your clinical rotations in medical school, at the beginning of your shift, look for jobs that you can perform such as post-op check-ups or removing temporary medical implants. Showing this kind of initiative stays in the mind of your surgery faculty and will help you in the application process.

Get Published and Do Research

This step may apply more to US medical graduates than Canadian medical graduates, since in the US, having published research is a key indicator of success for general surgery residency applicants. Of course, having published research papers in Canada is an excellent achievement to put on your residency CV, but programs in Canada are also more interested in your soft skills, such as your interpersonal skills, self-motivation, and autonomy.

Above-Average Board Scores

Again, this applies more to graduates in the US, as those programs tend to have minimum scores for applicants for the USMLE Step 2 CK and other board-licensing exams. Canadian programs do not use USMLE or MCCQE Step 1 scores in their consideration, some, such as the University of Toronto even go so far as to penalize any applicant who submits board scores with their application, so make sure to put more effort into getting your letters of recommendation and writing your surgery residency personal statement that your board exam scores if you are applying in Canada.

Take Time off Before you Apply

If you choose a general surgery residency, to be as frank as possible, you will not have a life. You give everything to the program and will have to cut off or cut out the things you love to do most, whatever they may be, from seeing friends, and family or any of your other favorite hobbies. With that in mind, you should seriously consider taking time off before you apply, such as a gap year before residency, so you can have some semblance of a normal life before you are working 80 hours a day, as is the case with some programs.

FAQs 

To your success,

Your friends at BeMo

BeMo Academic Consulting

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