Advice Needed: Limited Surgical Experience in 6-Year OMFS Program

[JawlineArchitecture]

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Hi everyone,

Currently a resident in a 6-year OMFS program. Lately, been feeling concerned about the level and breadth of experience I’m gaining in my program, and I’d appreciate some advice from this community.

Our program has a strong focus on head-and-neck, with 2+ fellows, which seems to limit the surgical opportunities for residents. Here are some of the challenges I've noticed:

• Chief residents are often retracting and suturing, with minimal cutting experience during head and neck cases. Secondly, our orthognathic case numbers have decreased, although I believe they've met the graduation requirements already. (probably the bare minimum)
• 5th-year residents haven’t had opportunities to cut, and are also taking primary call. Even on their H&N months, they're basically retracting/suturing.
• 4th-year residents function as interns, mainly seeing clinic consults, doing basic local extractions, limited IV sedation experience, which doesn't happen much until 6th year.
• Implant experience is extremely limited
• Not many TMJ or cleft/craniofacial cases, and the attending is doing most/all of the case.
• Also, it feels like we don't get to do much in the OR, in terms of cutting at least half of the case until our final year.

Some of us feel frustrated because we worry we won’t graduate with the surgical skills expected from a 6-year program.
To those who’ve experienced similar challenges or have insights:

1. How can I maximize my surgical experience in a program where case opportunities are so limited?
2. Is transferring programs even an option at this stage, or should I focus on supplemental ways to gain experience?
3. How do you stay motivated and make the most of a program that isn’t meeting your expectations?

Thank you so much for any advice or perspective you can share. I value the input of this community.

 

[yurpking]

Where is this at?

 

[amali]

This is becoming more and more common place and its sad. Ultimately, you should just try and finish up there. Keep an eye out for open spots to see if you can jump ship...but its difficult

As a four youre probably off service most of the year. Then just two more years. Hang in there. You'll probably need to hone your skills in private practice with some CE. You'll be an OMFS and be able manage complications. You're not the only one going through this.

 

[LurkingOMFS]

Sounds like UMich

 

[toothnumber32]

Hi everyone,

Currently a 4th-year resident in a 6-year OMFS program. Lately, been feeling concerned about the level and breadth of experience I’m gaining in my program, and I’d appreciate some advice from this community.

Our program has a strong focus on head-and-neck, with 2+ fellows, which seems to limit the surgical opportunities for residents. Here are some of the challenges I've noticed:

• Chief residents are often retracting and suturing, with minimal cutting experience during head and neck cases. Secondly, our orthognathic case numbers have decreased, although I believe they've met the graduation requirements already. (probably the bare minimum)
• 5th-year residents haven’t had opportunities to cut, and are also taking primary call. Even on their H&N months, they're basically retracting/suturing.
• 4th-year residents function as interns, mainly seeing clinic consults, doing basic local extractions, limited IV sedation experience, which doesn't happen much until 6th year.
• Implant experience is extremely limited
• Not many TMJ or cleft/craniofacial cases, and the attending is doing most/all of the case.
• Also, it feels like we don't get to do much in the OR, in terms of cutting at least half of the case until our final year.

Some of us feel frustrated because we worry we won’t graduate with the surgical skills expected from a 6-year program.
To those who’ve experienced similar challenges or have insights:

1. How can I maximize my surgical experience in a program where case opportunities are so limited?
2. Is transferring programs even an option at this stage, or should I focus on supplemental ways to gain experience?
3. How do you stay motivated and make the most of a program that isn’t meeting your expectations?

Thank you so much for any advice or perspective you can share. I value the input of this community.

First of all - thank you for positing this.

At this point just continue being positive and work hard. I know the circumstances are not ideal, but you have to make the best with what you have.

Oral and Maxillofacial Fellowship | Oral Facial Surgery Institute

This accredited opportunity is one year of hospital based Oral and Maxillofacial Surgery at Mercy, a level one trauma center in St. Louis.

ofsinstitute.com

Dr. John Griffin Columbus MS, Griffin Center for Oral and Maxillofacial Surgery

Griffin Center for Oral and Maxillofacial Surgery & Oral Surgeon John, DMD, FACS or Ryane, DMD in Columbus MS offers Oral Surgery, 662-327-2100

www.griffincenterfororalandmaxillofacialsurgery.com

I personally know of two colleagues that had very good things to say about these two fellowships and they did a very heavy caseload.
They are both wildly successful in private practice.

Regardless of whether of not you do any fellowships, it will not hold any bearing on your success in private practice, which is what you most likely will end up doing.

Feel free to PM me at any time if you have any questions of the next stage (following residency).

 

[GimmeTheScalpel]

Sounds like UMich

No sir. We don’t have 2+ HN fellows. And we have among the highest orthognathic and cleft volumes in the country (one of our attendings is booking past summer 2026 to give you an idea of his volume). We also do TJR cases and scopes weekly. 5th years and chiefs cut a lot, although 4th years are the most junior on service because of our curriculum set up. Happy to have you for an externship.

I know what program OP is referring to but no need to name drop if I’m not training there.

 

[omgomfs]

Buffalo?

 

[omfsing]

This is a lot of programs unfortunately. Not just in OS but lots of other surgical subspecialties.

I did 2 implants during residency and my first year working I did around 200

Though it may not seem you’re doing much during residency, you’re being much better trained than you think. You’re gaining fundamental surgical and medical knowledge whether you like it or not haha.

Have faith in yourself and your abilities, you’ll learn the most your first year working

Good luck.

 

[LurkingOMFS]

No sir. We don’t have 2+ HN fellows. And we have among the highest orthognathic and cleft volumes in the country (one of our attendings is booking past summer 2026 to give you an idea of his volume). We also do TJR cases and scopes weekly. 5th years and chiefs cut a lot, although 4th years are the most junior on service because of our curriculum set up. Happy to have you for an externship.

I know what program OP is referring to but no need to name drop if I’m not training there.

Can't be that busy with the amount of time you spend on SDN

 

[JawlineArchitecture]

Can't be that busy with the amount of time you spend on SDN

No need to be catty, or name-drop programs. If you've got actual input, feel free to share, but so far your replies haven't been particularly useful.

 

[nade0016]

Hi everyone,

Currently a resident in a 6-year OMFS program. Lately, been feeling concerned about the level and breadth of experience I’m gaining in my program, and I’d appreciate some advice from this community.

Our program has a strong focus on head-and-neck, with 2+ fellows, which seems to limit the surgical opportunities for residents. Here are some of the challenges I've noticed:

• Chief residents are often retracting and suturing, with minimal cutting experience during head and neck cases. Secondly, our orthognathic case numbers have decreased, although I believe they've met the graduation requirements already. (probably the bare minimum)
• 5th-year residents haven’t had opportunities to cut, and are also taking primary call. Even on their H&N months, they're basically retracting/suturing.
• 4th-year residents function as interns, mainly seeing clinic consults, doing basic local extractions, limited IV sedation experience, which doesn't happen much until 6th year.
• Implant experience is extremely limited
• Not many TMJ or cleft/craniofacial cases, and the attending is doing most/all of the case.
• Also, it feels like we don't get to do much in the OR, in terms of cutting at least half of the case until our final year.

Some of us feel frustrated because we worry we won’t graduate with the surgical skills expected from a 6-year program.
To those who’ve experienced similar challenges or have insights:

1. How can I maximize my surgical experience in a program where case opportunities are so limited?
2. Is transferring programs even an option at this stage, or should I focus on supplemental ways to gain experience?
3. How do you stay motivated and make the most of a program that isn’t meeting your expectations?

Thank you so much for any advice or perspective you can share. I value the input of this community.

From a PD/Chair perspective:
Two ways to address this.
1. Get the residents together and discuss if many feel this is an issue. You might not be the only one and there is strength in numbers. Then if the majority agree that this is an issue. Bring it to the PD in a calm and succinct manner and be sure you have solutions, don't just bring problems. PD's and Chairman will/should take this seriously. And then ask for quarterly meetings to update staff.

2. Transfer if possible but remember that grass is not always greener on the other side. There are always programs in need. In fact I posted an open position recently on SDN for a PGY3 spot. They are out there but not always public.

Lastly, I want to make this very clear. The trend recently I have experienced is that residents think cutting = education. This is very far from the truth. Patient care is all patient care, meaning that patient care = consultation, workup, pre-op, surgery, rounding, post op, etc. The last thing a resident should become competent with is the surgery. Residents should master all the other aspects of patient care prior to operating on a patient. My chairman and program director in training often stated that he can tell how good of a surgeon a resident will be can be seen in how well they manage a flap in a third molar surgery. I agree with this sentiment and I think many other faculty would agree. As a resident, get good at taking out teeth and the rest will follow.