Best general surgery programs for matching plastics fellowship

[MD3829]

If you're already applying to all of the integrated plastics programs, which are the 10 best general surgery programs to rank as a solid backup that will place you in a plastics fellowship 5 years later (no 7 year programs)? Here are a few to start:

1. Emory
2. Vandy
3. Oregon
4. UF
5. Louisville
6. Mayo
7. Beth Israel

Thanks for any input.

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[mosfet]

SUNY Buffalo consistently matches their residents into plastics. Last year, they matched 4 out of their 9 residents into plastics. This year, they matched 3. So they have a pretty good track record.

 

[JayDoc06]

Great general surgery program. Louisville has placed those who want plastics into those fellowships. However, Dr Polk and his disciples loathe spending five years training a general surgeon to then have them "waste it" on plastics. But some graduates have done it.

Hope this helps...

 

[filling]

How many years of general surgery do you have to have completed prior to applying for these fellowships in plastic?

I have heard some say the entire 5 years while others say 3 years?????

How do you apply to good general surgery programs, not be insincere about your intentions, and still have plastic surgery as your final goal in mind?

How much less difficult is it to gain acceptance into a fellowship rather than the integrated programs??? do they still look at your step 1, AOA, step 2, class rank...or do they weigh your general surgery program and your recommendations from that program more heavily???

If most general surgery programs are not very fond of their applicants applying to Plastic fellowships...then how do you apply and not risk being black balled by the program...lets say if you are applying after 3 years of general surgery and you do not match will you be the guy who really wanted to be something else???

Final question...I promise...does that two extra years of general surgery that you do not complete in the integrated program make you a less competent surgeon than one who completes 5 years of general surgery??

In advance I want to thank all who will respond to this post.

 

[Microhabitats]

How many years of general surgery do you have to have completed prior to applying for these fellowships in plastic?

I have heard some say the entire 5 years while others say 3 years?????

How do you apply to good general surgery programs, not be insincere about your intentions, and still have plastic surgery as your final goal in mind?

How much less difficult is it to gain acceptance into a fellowship rather than the integrated programs??? do they still look at your step 1, AOA, step 2, class rank...or do they weigh your general surgery program and your recommendations from that program more heavily???

If most general surgery programs are not very fond of their applicants applying to Plastic fellowships...then how do you apply and not risk being black balled by the program...lets say if you are applying after 3 years of general surgery and you do not match will you be the guy who really wanted to be something else???

Final question...I promise...does that two extra years of general surgery that you do not complete in the integrated program make you a less competent surgeon than one who completes 5 years of general surgery??

In advance I want to thank all who will respond to this post.

According to what I have read, you can no longer apply for PRS after 3 years of general surgery unless the PRS program is at your home institution.

In addition to your performance at your general surgery residency, the PRS fellowship programs will still look at your medical school stuff, including step I and II.

Don't really know the answers to the rest of your questions.

 

[DrDre311]

How many years of general surgery do you have to have completed prior to applying for these fellowships in plastic?

I have heard some say the entire 5 years while others say 3 years?????

How do you apply to good general surgery programs, not be insincere about your intentions, and still have plastic surgery as your final goal in mind?

How much less difficult is it to gain acceptance into a fellowship rather than the integrated programs??? do they still look at your step 1, AOA, step 2, class rank...or do they weigh your general surgery program and your recommendations from that program more heavily???

If most general surgery programs are not very fond of their applicants applying to Plastic fellowships...then how do you apply and not risk being black balled by the program...lets say if you are applying after 3 years of general surgery and you do not match will you be the guy who really wanted to be something else???

Final question...I promise...does that two extra years of general surgery that you do not complete in the integrated program make you a less competent surgeon than one who completes 5 years of general surgery??

In advance I want to thank all who will respond to this post.

You can no longer apply for independent PRS residencies unless you anticipate completing the entire residency (i.e. board eligibility in GS/OtoHNS/Uro/Ortho/NSG). Also good integrated residencies get their grads anywhere from 3-4 years of dedicated plastics along with plastics-specific rotations in their junior years. So we get a lot more plastics, and I
don't think 2 more years of butts and guts/trauma/MIS/ICU **** makes you any better in the OR; as a junior PRS guy I've got better hands than most of the GS guys I've operated with in addition to a deep plastics knowledge base.

There are pros and cons to both training models. One is not necessarily better than the other. Plastics is really competitive at the moment and it's not a great deal "easier" to get into independent PRS residencies than integrated ones--it's super competitive, just in a different way than the integrated match.

 

[maxheadroom]

As I understand it, board eligibility is not required for a General Surgery trained applicant if their GenSurg training is completed at the same institution as PRS. Simply put, it's the combined program.

 

[GSresident]

I would second what was said about Louisville being good for plastics. I think the best thing you can do if you want to match into an independent (fellowship) model program is to do general surgery at a place that has an independent program.

The other good thing about Louisville is Wilhelmi is the chair. Wilhelmi goes out of his way to help people who are genuinely interested in plastics. If you were to do general surgery there and (on the sly) get ingratiated with the plastics department by going to grand rounds, sticking around after breast recon cases to help, trying to get to the journal clubs, trying to get to our fresh tissue dissection labs etc. then you would likely have a serious leg up. I know of at least 3 GS residents in the last 7 years who have gone into plastics from Louisville. As pointed out above, I wouldn't advertise your interest to the GS department until it was clear (mid 4th year) that you were going to finish general surgery.

Besides all that the goal is to end up a well trained and competent surgeon. It isn't always best to go to a cush program. I was extremely impressed with the finishing chief residents in general surgery both years that I was at Louisville.

 

[medfriend]

Dr. Dre, You mentioned that you have better hands than most of the gs guys you have operated with. Is that because of the different kind of training you have received in plastics or do you think that on average gs is attracting less talented applicants than plastics?

 

[maxheadroom]

While Dre's comment sounds a little arrogant, I've found it to be true. As a chief resident on PRS, I've noticed that my 2nd year residents seem to be smoother in the OR than the 2nd year GS guys who rotate with us. Most of that is seen in suturing, which doesn't surprise me. Our juniors spend lots of time double-scrubbing breast reductions, body contouring cases, and other cases with lots of sewing. Also, our junior residents spend lots of time in the OR on our service compared to lots of floor-work time on the GS services.

 

[DrDre311]

While Dre's comment sounds a little arrogant, I've found it to be true. As a chief resident on PRS, I've noticed that my 2nd year residents seem to be smoother in the OR than the 2nd year GS guys who rotate with us. Most of that is seen in suturing, which doesn't surprise me. Our juniors spend lots of time double-scrubbing breast reductions, body contouring cases, and other cases with lots of sewing. Also, our junior residents spend lots of time in the OR on our service compared to lots of floor-work time on the GS services.

I didn't mean to sound arrogant, but I wouldn't have gone into plastic surgery if I didn't have some aptitude for being meticulous and making things look pretty. I do think that integrated plastic surgery attracts, for the most part, more talented applicants than general surgery or other surgical subspecialties. Most of the OtoHNS guys at my residency program are pretty good too, though. As far as the differences in training, the reality is that plastic surgery requires a very different skill set than general surgery; a lot of GS stuff is laparoscopic, and thankfully plastic surgery doesn't involve that. Working through those ports--while it does require skill--provides a fulcrum that completely neutralizes any tremor, and I think laparoscopic work doesn't require the surgeon to train the intrinsic muscles of the hand for delicate tissue handling. Plus general surgeons aren't all that concerned with actually closing layers in the proper fashion or making a nice scar--they just want to cut out whatever they're cutting out and then finish the case as fast as possible. The upshot is that I've spent a great deal of time getting my hands to be good at making fine movements without twitching all over the place, whereas my GS colleagues have spent a lot of time poking sticks into people's bellies and running scopes up people's butts.

 

[medfriend]

Would you say, Dr Dre, that the prs people who go the GS and then fellowship route are by and large the most talented GS grads? And would you say that they are more talented only with their hands, or would they have higher average absite scores than other GS people?

 

[DrDre311]

I've got no proof of that. The best and brightest GS grads tend to do whatever they want; some of them do plastics, some of them do CT or colorectal/MIS/whatever. I haven't seen a breakdown of ABSite scores with respect to fellowship choice. Some people would say that CT surgeons actually have the best hands in the hospital, but the absolute best surgeon I've ever seen is a plastic surgeon (of course, I'm biased).

 

[Celiac Plexus]

Would you say, Dr Dre, that the prs people who go the GS and then fellowship route are by and large the most talented GS grads? And would you say that they are more talented only with their hands, or would they have higher average absite scores than other GS people?

As a general surgery chief resident who will be starting a traditional plastic surgery training program next July, I believe that surgical talent as described by letters of recommendation, or in telephone conversations with a PD are important. Precision is important to plastic surgeons. However, most letter writers will overhype you somewhat, and a PD wants his/her trainees to do as well as possible in the match so they probably overhype you as well.

In the integrated/combined match I would guess that surgical ability is not a factor at all since medical students have no surgical ability.

I would say that students/residents interested in plastic surgery are in general more pre-occupied with the fine details of an operation (and the way the scar looks) than other specialties. This preoccupation with precision may lend itself to the development of superior technical ability. Though, I'm only speculating.

At this time in my development, I think that technical expertise is the easiest part of learning to be an excellent surgeon. The more taxing, and at times painful, things to learn are judgement, management, and administrative skills.

 

[DrDre311]

As a general surgery chief resident who will be starting a traditional plastic surgery training program next July, I believe that surgical talent as described by letters of recommendation, or in telephone conversations with a PD are important. Precision is important to plastic surgeons. However, most letter writers will overhype you somewhat, and a PD wants his/her trainees to do as well as possible in the match so they probably overhype you as well.

In the integrated/combined match I would guess that surgical ability is not a factor at all since medical students have no surgical ability.

I would say that students/residents interested in plastic surgery are in general more pre-occupied with the fine details of an operation (and the way the scar looks) than other specialties. This preoccupation with precision may lend itself to the development of superior technical ability. Though, I'm only speculating.

At this time in my development, I think that technical expertise is the easiest part of learning to be an excellent surgeon. The more taxing, and at times painful, things to learn are judgement, management, and administrative skills.

I disagree. Most medical students don't have extensive surgical experience, but experience and intrinsic ability are 2 very different things. When I was interviewing there were several programs that would have interviewees perform certain tasks related to hand-eye and fine motor coordination--while it isn't the same as operating, it's reasonable to assess fine motor coordination as a surrogate endpoint. And as far as GS-trained applicants being proven commodities in the OR, a lot of GS stuff is laparoscopic, which I don't think translates well into the skill set needed for plastic surgery; also, how much can an interviewer know about someone's operative skills without actually operating with that person? How can you know whether somebody who's spent 5 years in the belly will be worth a crap under the microscope or doing delicate stuff around the eye? I'd say interviewers don't know much more about GS-trained applicants' operative abilities with respect to plastic surgery than they do about potential operative skill in integrated applicants.

 

[CattleprodSurg]

Are you kidding me?
Are you telling us that a plastic surgeon really is technically more able than a liver transplant surgeon, thoracic surgeon, or vascular surgeon?

You obviously have little or no experience in the OR with these guys. Go sew some skin buddy or better yet inject some botox you technical wizard.

 

[GSresident]

Here are a couple observations on technical ability and challenges. I did all 5 years of general surgery and I am board certified. I also did a 2 year plastic surgery fellowship. I am now a plastic surgery attending in solo private practice.

Technically excellent general surgeons will make technically excellent plastic surgeons. I would say that the average operation in plastic surgery requires more attention to delicate technique than the average operation in general surgery. All of the surgeries that I learned as a general surgery resident had elements that were transferable to plastic surgery. Yes, even the laparoscopic cases helped me in plastic surgery. I found operating under a microscope extremely similar to operating through a laparoscope. Maybe that transition was unique to me but I doubt it.

It took an adjustment of my technique when I started my plastic surgery fellowship. The adjustment was not hard but it was needed. By the time I was in my second year I was walking junior residents through free flaps with no staff. By the end of the year, the junior residents were ready to teach the next class. I suspect that it would be very difficult to train an integrated plastic surgery intern to do free flaps at the end of the first year. So why is it easier to train a general surgeon in a year? The general surgery skills transfer.

The other thing - there is very little chance that a general surgery resident would make it to the 4th year with poor technical ability. They wash out. The 4th year is when you apply for plastic surgery fellowships. By that time, if you are still a resident, you are at least trainable in technique. When we were interviewing candidates for plastic surgery fellowships (yes the residents are a part of the process) it was taken as a given that they could operate or were at least trainable. If they were at the interview they had good absite scores so that really didn't separate highly ranked candidates from lower ranked ones. What made the difference was whether or not the candidate seemed to 'fit' with the program. Its a Gestalt thing. The bottom line is, don't make too much of small differences in technique between a general surgery resident and a plastic surgery resident. They'll both end up at the same level provided they are trainable.

Of course none of the above says anything about the life and death judgment that is acquired by full general surgery training. That is another topic entirely.

 

[droliver]

I suspect that it would be very difficult to train an integrated plastic surgery intern to do free flaps at the end of the first year. So why is it easier to train a general surgeon in a year? The general surgery skills transfer.

Agree 100%.

Particularly for burns, traditional reconstructive flaps, oncoplastic cases, and microsurgery cases. General surgery training at a place like I trained (Louisville) will blow integrated training out of the water in the transition to the skillsets for most of those kinds of cases. Particularly the abdominal wall cases & vascular surgery stuff. Prior to doing plastics I had done and assisted on a couple hundred vascular cases (in transplant, vascular, general, & trauma services)ranging from head to toe and diameters from the aorta to calcified 2-3 mm LE/pedal vessels.

Doing your first real vascular surgery under the microscope (like in integrated residencies) is a much harder way to learn then progressing from AV-shunts/fistulas (common junior level surgery cases) to fem-distals,etc... Particularly for the lower extremity trauma cases, the access for the pedicles and vessels is identical to common vascular surgery approaches. My PGY-5 year in surgery was often spent birddogging distal bypasses just to watch/learn these approaches better looking down the road. I pretty much felt like I could look at a book and go do most reonstructive cases (hand excepted) from the neck down on the first month of my plastics training.

I think ENT & Ortho both have their own particular areas where they bring superior backgrounds (nasal surgery & upper extremity/hand respectively) in more narrow ways. The integrateds split the difference on technical training at the gain of signifigantly more didactic exposure, which is almost now required to get some passing familiarity with the ridiculously broad base of our field. At least they finally dropped traditional plastics GU procedures like hypospadias & gender reassighnment surgery from the material covered on the written boards in 2005 when I took it!

It's a goofball conceit (that our field loves to propagate) to suggest that Plastics people have some superior tendancy to finness or precision just because we like to close the skin better. There is waaaaaay less margin for technical error for truly catastrophic disasters in things like transplant, CTVS, vascular, and even many general surgery cases then about 99.8% of what we do.

 

[Green Grass]

1. Emory
2. Vandy
3. Oregon
4. UF
5. Louisville
6. Mayo
7. Beth Israel
8. SUNY Buffalo

Is this list still accurate? Any others that we could add to this list?

 

[WentForitandWon]

I got into plastics from one of the programs on that list.

I would also add UCSF to the list. They place a TON of their chiefs in plastics.

 

[Green Grass]

I got into plastics from one of the programs on that list.

I would also add UCSF to the list. They place a TON of their chiefs in plastics.

Interestingly, as I look at more and more alumni lists from program websites I am finding quite a few schools that I would not have expected to place a high number of PRS residents. Oddly, these programs are never mentioned as "competitive GS programs" or ever talked about on SDN. In addition to the above programs, I think there are quite a few "hidden gems" for getting into PRS residencies post-GS.

 

[sperdoc]

so what are these hidden gems