Residents in General Surgery will not operate independently. All cases taken to the operating room have been discussed with the attending physician and all operations are performed under the supervision of the attending physician. In addition, JACHO requires that all hospital nurses be able to determine whether a physician, including a resident, is capable of performing a given procedure in the ER or on the ward without direct physician supervision.

The GME office has instituted a system (the "MSO") allowing nurses and staff to track resident capabilities to perform procedures without direct attending supervision.

The resident’s profile is updated as progression through the program and acquisition of skills is acquired. In addition, the residency program has just implemented a program to monitor the interns in the acquisition of skills for invasive procedures. Once a predetermined number of specific procedures have been completed satisfactorily, the resident may then perform such procedures with attending approval, but without direct supervision.

The first year of training emphasizes surgical diagnosis, pathophysiology and pre- and postoperative care. The intern, along with the more senior residents, are involved in the daily presentation of the patient to the attending surgeon where treatment decisions are finalized. The intern follows the patient to surgery where he acts as one of the surgical assistants. In less complicated cases, such as hernia or appendectomy, the intern often performs the operation as directed by the attending surgeon.

Residents who perform well can be given responsibility for independent judgment and surgical decision-making with continued attending supervision. By the third year, residents are also given more responsibility for evaluating surgical patients in the emergency room, initiating preoperative treatment and arranging for further surgical care. In addition, they are more involved with the technical aspects of the surgery in the operating room.

During the fourth and fifth years of residency, residents are considered the senior/chief of the service and supervise junior residents and medical students. Senior residents are expected to exercise increasing degrees of independent responsibility for surgical decision- making and perform more advanced surgical procedures while attending surgeons monitor their progress and continue to supervise the service. Senior residents are allowed and encouraged to exercise independent surgical judgment to the degree that is consistent with good patient care.

In every rotation at all hospitals participating in the Surgery Residency Program, the attending physician must document supervision in daily progress notes.

Residents must be aware of the supervisory lines of responsibility .  If there is a serious concern related to supervision or any other aspect of the training, any resident can bypass the supervisory lines and communicate directly with the Program Director or the Chairman of the Department of Surgery.