4th year GS resident case volume

[gerickson03m]

Just wondering how many cases other residents have. My numbers so far as a pgy4 (major)

SS&B 24
H&N 50
ALTR 51
AB 33
LV 8
Panc 0
Vasc 183
Endo 8
Traumop 13
Thor 30
Ped 21
Pla 9
Lap-b 32
Lap-c 21
Total major 668
Total cases 1001

I have not yet done my GS rotations this year so I hopefully my GS cases will increase. Just want to know what other resident's case number are like at other places.

---

Members don't see this ad.

 

[Pilot Doc]

Just wondering how many cases other residents have. My numbers so far as a pgy4 (major)

Total major 668
Total cases 1001

I have not yet done my GS rotations this year so I hopefully my GS cases will increase. Just want to know what other resident's case number are like at other places.

You're required to get 150 major cases as a chief. If you get another 100 over the remaining 2/3 of this year, that will put you in the low 900s. That's on the low end but not atypical for my program.

 

[david stern]

I come from a top heavy academic program. It's a prestigous program but not top 5 or anything. It was consistently listed without debate in that recent ridiculous thread listing the top 20 general surgery programs in the country.

My numbers are similar. I have logged about 610 major cases but probably have at least 50 more because I did not log diligently intern year and for the first half or so of second year.

Over the past 4 months, I have logged almost 240 cases- 40% of my total. This pace will not continue 4th year as I have 4 months of trauma coming up and then some lighter gen surg and vasc rotations at the VA. I will proabaly do another 150-200 cases over the next 34 weeks to bring me between 750 and 800 cases this year.

You have 50% more vascular cases than I have and double my head and neck caseload, but I have done several more abdominal, alimentary tract and breast cases than you have- reflecting our strong surg onc emphasis here. I have not done any livers yet.

Chief year will be good. I will easily do about 300 cases (including more liver and pancreas than anyone would want) to bring me close to 1100- the same numbers we had pre 80 hour work week.

But are we really DOING these cases? Could I do this case without the attending in the room? I think this is the real issue and not absolute numbers.
Does your program foster independence? One of our chiefs was recently suspended for starting and completing (successfully) an ileostomy takedown without an attending present. 15 years ago our chiefs did APRs with attendings available by telephone- NO LONGER.

 

[Winged Scapula]

The number of cases will vary significantly depending on where you are. I don't recall my numbers as a 4th year specifically, but had many more peds, abdominal and SSB cases and much fewer H&N. We had a large surg onc service so I graduated with lots of livers and pancreases.

david stern's post - particularly the last paragraph touched a cord with me, because I have found it to be painfully true as a fellow. I don't believe I really did the cases, even as a Chief and when asked to help an intern do a case during my fellowship, had to "confess" that since I really hadn't ever done the case by myself, didn't feel comfortable doing so.

During my 4th year as a resident on the Pediatric Surgery service I protested and refused to log any cases, feeling that if I wasn't doing the case, or at least 50% of it, or if the attendings were double-scrubbing, it just didn't count. Administration quickly denounced my activities, saying they "were aware" of the problems of lack of independence on that service, but felt unable to do anything about it - so I had to (fradulently) log cases in which sometimes I did little more than cut suture or hold hook.

We had one new attending who liked to give the residents independence - ie, not show up for awhile and tell you to start the case, or to leave in the middle, etc. Scary at first, exhilarating at best, and a wonderful learning opportunity...he was also sanctioned by administration. "We just don't do that here." I always found it curious that the private practice surgeons allowed the residents to do so much more, especially when their income was based on outcome, unlike the salaried university surgeons.

Thank goodness this doesn't occur everywhere and thank goodness I'm not the only one in this boat and it does occur elsewhere. I'm starting to understand perhaps why 100% of recent grads of my program do fellowships...perhaps none of them felt prepared to do general surgery either.

 

[supercut]

Your numbers jive fairly well, at least in terms of the total major cases, for what I've seen our PGY 4s have.

 

[Celiac Plexus]

I am in the 3rd clinical year of residency and I have roughly 170 major cases. I am not the best logger, so that number may actually be closer to 200-210. As an intern I only logged as first assist.

I will probably graduate with around 700-750 major cases which is on the low side for the average of all programs, but more than the minmum 500 set by the RRC.

I do feel that I will be comfortable operating alone when I am done with my residency. I am fortunate that I have had a few excellent operative technicians/teachers who let residents advance at their own pace. As a pgy-3 I have TA'ed amputations, trachs, inguinal hernias, mediports, and breast biopsies with the interns. And I have started many vascular, breast, and abdominal cases with the student, and closed with him/her as well. I have even done a few retroperitoneal exposures by myself before the attending has scrubbed in. So, I think it's less important how many actual cases you log, and more important how many cases you actually get to do.

For applicants who are interviewing now at surgery programs, I advise you not to get hung up on the actual numbers that program directors will flash before you. Instead, ask residents how much autonomy they have. Specifically, ask them what cases they have TA'ed, and if attendings scrub in for every case. The answers to those questions are imho the important ones.

 

[dry dre]

For applicants who are interviewing now at surgery programs, I advise you not to get hung up on the actual numbers that program directors will flash before you. Instead, ask residents how much autonomy they have. Specifically, ask them what cases they have TA'ed, and if attendings scrub in for every case. The answers to those questions are imho the important ones.

Ditto this. This thread (i.e. the info and ideas in the above responses) should be referenced any time the rediculous "Top X" program threads start. While I'm in ortho, the above applies to any surgical specialty. If you graduate and wouldn't feel comfortable operating alone, would you be happy training in that program?

My program isn't considered top shelf, but we are expected to be able to operate alone on most/all non-pelvis/spine by the end of 4th year. Many other types of cases are expected to be done independently even early.

I think we most benefit from an institutional environment where it is the norm for staff to not be in the room. We're probably not a "top shelf" program because we don't have a bunch of sub-specialists with their perceived "expertise to offer those in training" that may sound attractive to applicants. We also don't have their fellows taking cases. Do we offer the "best" care to every patient coming through the door since residents are learning on them instead of board certified surgeons? For the sake of argument, probably not. But you have to make your mistakes/learn somewhere...I'm glad that I'll be ~making my mistakes in an academic environment with others to get feedback from than as an attending at Podunk General without support. For the sake of full-disclosure, our inservice exam scores are not impressive by comparison; we reason that this is probably because we don't have all the specialists dropping pearls all the time...so there must be a balance somewhere.

This begs the question of why the trend has been to have staff around all the time? Historically I have always thought of surgey as trial by fire (especially general surgey). I recognize that even in my institution the gensurg staff tends to always be present in the room.

 

[tooshorttoolong]

What is TA'ed?

 

[SLUser11]

What is TA'ed?

Totally Awesome.

Maybe for some surgeons it would be Total A-hole.

Trans-Anal? If that's the case, I'm going to TA alot of cases this year.....

(Teaching Assistant, ie supervised a junior resident who logged the case as a surgeon junior.....I think.......)


Anyway, I assume these cases you guys listed are all logged as Surgeon Junior? I've always been curious how different residents decided whether or not they did 51%+ of the case, or whatever criteria they used for logging a case as surgeon junior. Personally, most of my cases I'm logging as First assistant right now, even though I'm performing alot of the case, since I couldn't really do it alone. For example, if I do MOST of a lap chole, but the attending performs the critical portion of dissecting out the duct and vessels, I'm not really DOING the case.

Hearing about the lack of autonomy at certain big academic institutions, I wonder if residents are forced to log cases as SJ that are really FA. I spoke with a physician in town recently whose son is a PGY3 at a big academic program in Texas, and just did his first Lap Chole.........

 

[supercut]

For applicants who are interviewing now at surgery programs, I advise you not to get hung up on the actual numbers that program directors will flash before you. Instead, ask residents how much autonomy they have. Specifically, ask them what cases they have TA'ed, and if attendings scrub in for every case. The answers to those questions are imho the important ones.

A BIG amen to this! I made the critical error of focusing on total numbers. I wound up at a program with good numbers (some chiefs have had to slack off on logging cases so as not to exceed 1000 and get in trouble). But the vast majority of cases are not done independently. It is rare for a chief to start a case along (usually only happens on trauma when it gets busy enough to require doing 2 cases simultaneously). In fact, it is strictly forbidden for anybody except R5 to start a case without the attending in the room. (sometimes anesthesia won't put the pt to sleep until the surgery attending is in the room). I am very worried that I will not be able to operate independently when I graduate.

In fact, in retrospect, I would only look at 2 things: is there any category in which the program has a lot of difficulty making sure all chiefs get the minimum, and I would also look at the teaching assistant numbers. That will tell you a lot...if the chiefs are acting as teaching assistants, that means they can operate independently and are allowed to. If they are logging few TA numbers, you need to find out why. Realize that doing the case does NOT mean bovieing between the attendings clamp.

 

[FliteSurgn]

In fact, in retrospect, I would only look at 2 things: is there any category in which the program has a lot of difficulty making sure all chiefs get the minimum, and I would also look at the teaching assistant numbers. That will tell you a lot...if the chiefs are acting as teaching assistants, that means they can operate independently and are allowed to. If they are logging few TA numbers, you need to find out why. Realize that doing the case does NOT mean bovieing between the attendings clamp.

Good advice. As others have said, the ability for a residency to put out an INDEPENDENT surgeon is quite variable. I totally agree with Kimberli Cox that the lack of INDEPENDENT surgical skills during residency may be what fuels fellowships with such fervor. Resident autonomy is required to achieve this goal. You don't necessarily have to do cases without the attending to attain independence, but you do have to have attendings that allow you to direct the case, do the dissection, etc. In other words, the attending should be willing to stand there and "hold hooks" or Bovie between YOUR clamp.

Looking at the number of Teaching Assistant cases can be a very valuable thing. The acuity of those TA cases would also be nice to know, but that isn't reported. You should ask senior residents on the interview trail what kinds of cases they are logging as TAs. For example, I think that I ended with over 100 and probably didn't log all of them. Our residency was very good at allowing us autonomy. As a senior resident, I logged TA for lap choles, lap hernias, lap CBDEs, open/lap colons, lap Nissens, ventral hernias, etc. on a very frequent basis.

 

[toxic-megacolon]

On the ACGME case log system, what the heck does that checkbox next to CPT code that says "Credit" mean?

 

[SLUser11]

On the ACGME case log system, what the heck does that checkbox next to CPT code that says "Credit" mean?

You might want to start clicking on that........











......if you want credit for your cases.......



....are you being sarcastic/making a funny? Sometimes I can't tell.

 

[toxic-megacolon]

You might want to start clicking on that........











......if you want credit for your cases.......



....are you being sarcastic/making a funny? Sometimes I can't tell.

I figured as much, but why the hell would the checkbox even exist? Who would NOT want credit for their case? (I've been checking credit, of course!)

 

[SLUser11]

I figured as much, but why the hell would the checkbox even exist? Who would NOT want credit for their case? (I've been checking credit, of course!)

Well, you could hypothetically log multiple procedures/codes on one patient/OR experience, but you can only get CREDIT for one procedure.

 

[FliteSurgn]

Well, you could hypothetically log multiple procedures/codes on one patient/OR experience, but you can only get CREDIT for one procedure.

Exactly. I frequently entered all procedures that I did and took credit for the most significant one...for example, I did a distal pancreatectomy, splenectomy, left adrenalectomy/nephrectomy and partial colectomy for a large adrenocortical carcinoma. I would enter all of the cases and choose which one I wanted to take credit for. I'd still have a record of doing the other cases and could theoretically go back and switch which one I took credit for.