Maggie McKay (Host): Today, I'm joined by Dr. Javier Romero, Dr. T'Keyah Gray, and Dr. Diego Monasterio to discuss General Surgery residency at Community Memorial Healthcare.

Welcome to Wise and Well presented by Community Memorial Healthcare. I'm your host, Maggie McKay. Thank you all for being here today. Let's start off with you introducing yourself. Dr. Romero?

Dr. Javier Romero: Good afternoon and thank you for taking the time to interview us. My name is Javier Romero. I'm the Program Director for the Community Memorial General Surgery Program in beautiful Ventura, California. I have a background in Trauma and Critical Care and General Surgery. Thank you.

Host: Dr. Gray?

Dr. T'Keyah Gray: Hey, again, thank you so much for having us. We really appreciate that. I'm T'Keyah Gray. I'm a PGY-2 here at Community Memorial General Surgery.

Host: And Dr. Monasterio?

Dr. Diego Monasterio: My name is Diego Monasterio. I'm a fourth year General Surgery resident, originally from Puerto Rico and I'm here pursuing my General Surgery residency, and then I'm applying for Vascular Surgery as we speak.

Host: Dr. Romero, let's start with you. Would you please describe the philosophy of your residency program? What sets it apart from other programs across the country?

Dr. Javier Romero: It's very germane to this new and expanding program. We've been in existence now for 10 years, and we're an ACGME-accredited program. The philosophy is quite simple. We're a residency that focuses on residents. So when they ask me what I do, I'm not a Residency Director, I'm actually a Resident Director. And so, we really tailored the program to the needs and the expectations of the residents. Because there's different definitions of success and we really hold that to be valuable for each and every one of our residents. So, we try to tailor this program to meet their needs and their definition of success. That's essentially our philosophy here.

Host: And Dr. Monasterio, let's talk about the role of community involvement in your residency program. How do residents contribute to the health and wellbeing of the community?

Dr. Diego Monasterio: Since our program is relatively small, our attendings and our residents are very involved with the community. We're actually working on a research project where we're creating customized videos for consents for people based on the exact procedure that they're getting, and we've heard really good results.

The videos are made both in English and Spanish, and I'm overseeing the Spanish translations to make sure they're fairly easy to understand for people who are not really well-versed in the medical literature. We're hoping that's going to help people understand what it is that we're actually going to do for them in surgery.

Dr. Javier Romero: And I'd like to add to Diego's comment there, because we also have a platform of data, particularly in quality as well as population health. And we encourage the residents to look at that data and say to themselves, "How can we better serve the community with quality or with community outreach?" We have one physician here who does incredible work in the fall prevention, and he does a lot of research with that, Dr. Thomas Duncan. And he encourages the residents to join him with his research to better help the community, particularly for elderly falls in the Ventura County area.

Host: Dr. Romero, could you give us some details about the surgical case volume and the types of procedures residents typically handle at Community Memorial Hospital Ventura?

Dr. Javier Romero: We're fortunate to have two hospitals that we work in, and Community Memorial Hospital, which is a non-profit community hospital. And we also have the luxury of working at a county hospital, which is a couple blocks away. So, we have two patient populations that we serve there.

That's given us a large footprint on different types of cases, particularly in Trauma, Critical Care, Surgical-Oncology. And at the Community Memorial Hospital, we have a large volume of General Surgery cases, to the point that our chief residents are graduating with 90 to 99 percentile in their operative volume with a large breadth of cases as well.

And to meet the demands of a quaternary center, we send them to Cedars Sinai for their transplant experience. We send them to Children's Hospital of Orange County for their pediatric experience. And we also send them to City of Hope, which is a world famous oncological center so they can experience really a quaternary type of Surgical-Oncology experience. And we just added a Burn rotation at the USC Burn Center, the busiest burn center in Los Angeles, so they can also get that experience as well. It's important for us to have the general surgeons that graduate from this program be very well grounded in multiple specialties, and also understand the pathophysiology of many disease processes.

Host: It's going to be ideal being in Ventura in Southern California because like you just mentioned, just a few, there's so many choices of hospitals here, and they're not that far away from you. Dr. Gray, how does the program help residents explore different career paths within general surgery?

Dr. T'Keyah Gray: Here at Community Memorial, we are fully supported. I think those two words are the main thing that I can say. We have a mentor program from the start of residency, and we can tailor who our mentor is based off of the type of specialty that we want to go into. And with that mentor, we can set up a plan and figure out Where we want to go or do an elective rotation or a fellowship during our residency as well.

We have two residents that left for a fellowship during their residency. One, her name is Richa. She did a fellowship last year in New York for an ECMO fellowship, and then she's now a chief. And then, we have Zoe and she is currently doing a Pediatric fellowship over at Children's Hospital of Orange County. So, we're fully supported. We come up with a plan and we present it to Dr. Romero, and he literally does everything he can in his power to allow us to get to where we need to get to.

Host: What is the program's approach to robotic surgery or minimally invasive surgery?

Dr. T'Keyah Gray: So for that, we have a structured program for robotics that has a dedicated curriculum, and this is from the start of residency as well in term year. With that curriculum, we work specifically with Dr. Carden. He's one of the attendings at County Program, and he helps us get everything set up and do modules early on to help us succeed in Robotic Surgery. And from the start we're bedside, but we have graduated autonomy to eventually the console. And the attendings here are absolutely wonderful, and they allow you to do a lot. I'm only a second year, and we were doing a bilateral inguinal hernia repair on the robot, and Dr. Carden said, "I'll do the left side, you do the right side." and that's exactly what he did, and it was exciting and fun.

Host: Dr. Monasterio, let's talk about the different rotations offered to general surgery residents. Where do residents go for rotations in Trauma, Pediatric Surgery, and Transplant?

Dr. Diego Monasterio: Dr. Romero kind of alluded to this prior, but we spent the majority of our time at Community Memorial Hospital doing our bread and butter, General Surgery, Minimally Invasive, and also a large breadth of Vascular Surgery. We have eight vascular attendings here, so we do operate a lot with them. For our trauma, we spend about 30% our time across the street at Ventura County Medical Center where we get all of our trauma exposure.

And now, for our elective rotations, on our second year, we will go to Children's Hospital Orange County. We'll be there for two months. Third year, we go to Cedars Sinai for a transplant, that'll be one month. And then, fourth year will be our final away rotation with City of Hope. We'll be with them for one month for our Surgical-Oncology. Dr. Romero also was gracious enough in having us get a burn ICU rotation at USC, which is just starting this year, so we'll see how that goes, but we're really excited for it. 

Host: Dr. Gray, what advice would you give to medical students who are interested in applying to your program? 

Dr. T'Keyah Gray: Well, if you're interested in a community-driven program, as well as a family-focused program, a diverse program, here is the best place for you. And if you want to operate and spend lots of hours in the OR, this is a place for you. Because we're a diverse program, we're able to experience each other's different cultural backgrounds, and it allows us to grow together and understand those different cultures and not just like help us grow together as residents, but it allows us to understand our patients a lot better, and to, you know, be able to understand their thought process as well as why they make the decisions that they make.

Host: At Ventura, LA, the whole Southern California, it's such a melting pot and to have different cultures working there, has got to be a benefit to the patients.

Dr. T'Keyah Gray: And not just being in the hospital, but outside and going to the beach and going surfing, that's great as well.

Host: Dr. Monasterio, did you want to add anything to that?

Dr. Diego Monasterio: To add to T'Keyah's point, I think if you like a smaller town vibe, but still want to be close enough to the city to explore what LA has to offer, this is a great place for you. Jokingly, we're called a very food-driven program. We go to LA a lot as a group. We're very close with each other and we aren't only just co-workers, we're friends outside of work. 

Dr. T'Keyah Gray: Dr. Gray, how does the program support work-life balance for residents?  

I am a single mother. I have an 11-year-old boy. And being in residency and being a mom is difficult. But this program is extraordinary with that. I mean, it was a huge reason why I chose to come here, because I wanted a family-oriented program that understood that I am a single mom. We work a lot of hours, but at the same time, the residents are understanding to my needs, my son's needs. And if I need to urgently take off to go handle business with my son, there's full coverage. They're telling me, "Hey, Kia, go ahead, go handle what you need to do." Not only that, we're able to take days off, our PTO, as well as resident wellness days to handle things as well. The work-life balance is phenomenal. I don't have anything to complain about. Yes, I'm at the hospital and I freaking love it. But at the same time, I have enough time to be at home with my son, and do what I need to do with him.

Host: How ideal is that, because that's not the case at most places, you know?

Dr. T'Keyah Gray: It's definitely not. And I was at another program prior to coming here. I did the preliminary year somewhere else. And that was a little bit tougher for me and my son, but here it's a whole different story. And just the other day, my son needed to go to basketball practice and I had a case to go to. And one of the residents was like, "Hey, I got you. I'll go take your son to basketball practice." And he dropped him off. He missed the bus one day, and I texted in our group chat, "Hey, who can take--" my son's name is Cayden-- "who can take him to school?" And sure enough, three of them replied, "I got you, let me know when and where, send me your address." And he got to school.

Host: That's amazing. I love that. Well, thank you all for being here today, and sharing your insight. This has been really interesting and a lot of fun.

Dr. T'Keyah Gray: Yeah, it was a great time. Thank you for having us.

Host: Again, that's Dr. Romero, Dr. Gray, and Dr. Monasterio. To find out more, please visit mycmh.org/general-surgery, mycmh.org/general-surgery. And if you found this podcast helpful, please share it on your social channels. And check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Wise and Well, presented by Community Memorial Healthcare.