Operating as a resident

[curiousjorge]

What have peoples' experiences been in terms of hands-on training in the OR vs observing an attending perform the majority of a case? In my program -- which I consider strong and am quite satisfied with overall -- there is a small subset of attendings (a distinct minority) who don't let residents do a whole lot in their cases. Is this common? On some level, there is a definite benefit to watching an attending perform something at a high level and then trying to emulate that. However, I think that the best learning occurs when an attending demonstrates something as much as is necessary and then allows a resident to perform it with their own hands. My favorite attendings demonstrate something well, then allow us to do as much as is appropriate to our level, then either give our performance a seal of approval or touch up things after we have done our part, to ensure that the result is optimal. Thoughts on this? What do people think is the appropriate amount of attending-level operating vs resident-level operating?

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[neutropeniaboy]

The appropriate level of operating is whatever the attending feels is appropriate based on these factors:

1. Complexity of the case
2. Impact of Surgery on the outcome of disease
3. Educational benefit (what are the long term realities here)
4. Competence of the resident
5. Preparedness of the resident
6. How much time the attending wants to spend in the OR.


Many factors.

Some of my surgeries can have a huge positive or negative impact on patient quality of life, and I'm not willing in many cases to let a resident do the critical parts because the technique is so critical. These are typically things I learned I fellowship.

If you're not prepared, you're not going to do anything.

Some residents think they are better than they are or that they are prepared more than they are.

I'm getting older and have young kids. Staying in the OR until 8pm isn't fun anymore.

It's hard to say what the right balance is. This will vary from specialty to specialty and from resident to resident.

I think it's quite normal to have a range of attendings in a program - some who let you do everything to those who let you do very little. All appropriate in my book.

I think one of the issues is when residents feel like they should be given freedom to operate commensurate with their experience - "appropriate to our level" as you call it. Who defines that? You? The attending? Often these two definitions don't match and the resident is left wondering why he isn't doing more. Maybe your not there yet. Possibly the attending likes more control than you would like him to have.

You have to work in those systems.



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[OtoHNS]

A good mix of both teaching styles is ideal in my experience. It's always somewhat annoying as a resident (particularly a more senior resident) to watch an attending operate, but use it as an opportunity to learn. If the attending is a really technically skilled surgeon, you can get a whole lot of benefit from watching. On the other hand, if the attending is a mediocre surgeon, it's pretty miserable.

The only time where it really becomes an issue is in smaller programs where there is only one of a certain subspecialty. For example, if your program only has one otologist who does all the ear cases and he doesn't really let the resident do anything, you're not going to graduate as a competent ear surgeon.

It sounds like your program is larger, so hopefully this is not an issue.