2nd assist in Gyn-Onc cases?

[ilovepubmed]

How common is it that at hospitals with fellowship's in Gyn-Onc the resident has to take 2nd assist, while the fellow and attending do the surgery? What's normal?

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[obgyn06]

How common is it that at hospitals with fellowship's in Gyn-Onc the resident has to take 2nd assist, while the fellow and attending do the surgery? What's normal?

It depends on the case and the hospital. At a lot of hospitals, it will be the resident is the primary surgeon and the fellow is the 1st assist (or vice versa). The attending often doesn't scrub or is the 2nd assist. If it is a big onc case (i.e. rad hyst) then it might be the attending and the fellow. It all depends.

 

[Oddmanout]

How common is it that at hospitals with fellowship's in Gyn-Onc the resident has to take 2nd assist, while the fellow and attending do the surgery? What's normal?

During my 3rd year clerkship, nearly every case I participated in had the attending scrubbed and operating, the fellow 1st assisting and the resident 2nd. The presence of the fellow clearly subtracted from resident opportunities in the OR. On the floors, though, the fellows were far more available, motivated and interested in teaching residents and students.

 

[Embryo2006]

It depends on the case and the hospital. At a lot of hospitals, it will be the resident is the primary surgeon and the fellow is the 1st assist (or vice versa). The attending often doesn't scrub or is the 2nd assist. If it is a big onc case (i.e. rad hyst) then it might be the attending and the fellow. It all depends.

At the institution where I did my gyn/onc sub I, the resident was normally the primary surgeon (dependent on case complexity). For example, the resident would typically be the primary surgeon on the usual TAH/BSO, but the fellow would do the lymph node dissection. For the most part, it seemed that the fellows added to the residents' learning.

 

[daisyduke]

I have definitely seen both scenarios. At my home institution there aren't any gyn onc fellows and the residents get to do their half of the TAH BSO and rad hyst. I did an away rotation at an institution with fellows and I mainly watched the residents retract while the fellow and attending did the case. I would be pretty pissed as a pgy 3 doing nothing but retracting...

It seems so hard to tell on the interview though!!! Of course all the residents say "oh our fellows are great and never take away from our operating experience!"

 

[Diane L. Evans]

Great insights. If you are interested in gyn onc mfm etc.. going to a program that has a fellowship will help you secure a spot as most institutions will interview and take their own graduates. However, if you are not interested in a fellowship going to a program that lets the residents interact in surgery is a valuable and skills enhancing experience. For gyn onc I think this is invaluable where else will you learn to do a hypogastric artery ligation? A tool that can save a c-hyst. Or learn how to ICU manage an unstable surgical patient.

 

[Global Disrobal]

I hope that they are not teaching hypogastric artery ligations anymore, especially since most in the community are now against it.

At our institution, we have a busy Gyn Onc service, and generally the OR dynamic is as above. The resident and the fellow perform the TAH/BSO, Cone, TVH, etc while the attending stands back and looks over the shoulders or retracts, and then positions are swapped and the attending/Fellow complete the staging, debulking, etc. There are some of us that are going for Gyn-Onc and in those circumstances (and depending on how motivated you are) you do more including inguinal node dissections, etc.

Diane is correct in that if you have any desire to do Onco, Urogyn, or REI you should go for a program w/a fellowship not only for the sake of getting in that same program, but also for the networking and letter of rec factor.