Are all physicians trained to do basic surgery?

[Pablo94]

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In medical school do you learn surgical skills and basic procedures or only in surgical residency? If you are in a third world country for instance, and are the only trained physician nearby, could you perform surgical procedures?

 

[pseud0]

You would definitely not be able to perform a real surgery by yourself. Youll learn how to assist in m3/4 as far as i know but leading you wont know what youre doing.

 

[darkjedi]

You would need to complete a surgical residency if you expect to operate, third world or not. Even then you should only operate in the scope of your training. You wouldn't expect an orthopaedic surgeon to do an appendectomy, despite it's relative simplicity. They just are never trained to do them.

 

[neoevolution]

I've heard stuff about rural FM doing things like C-sections and vasectomies, I can only find anecdotal threads on it when I google though

 

[LucidSplash]

I've heard stuff about rural FM doing things like C-sections and vasectomies, I can only find anecdotal threads on it when I google though

There are a few fellowships for FM (a very few) with OBGyn training that includes basic csection. From what FM colleagues tell me, it is a struggle for most to get the numbers in training to feel comfortable. I certainly wouldn't feel comfortable letting an FM operate on me, but I'm a surgeon. The OBgyns that are trained do enough damage on their own it seems.

 

[sliceofbread136]

You learn how to suture, that's pretty much it

 

[LucidSplash]

But most FM will burn off skin lesions, do punch biopsies, or do basic abscess I&Ds. Nothing that requires an OR or that should be considered operations. Those are procedures, a different ball of wax.

 

[seeinghowitgoes]

You learn how to suture, that's pretty much it

Seconded. You learn how to be sterile in the OR, how to properly hold some instruments, and how to suture. That's really about it.

Heck, some gen surg residents I've talked to have said they don't even feel comfortable after residency and that's why fellowship is so important for them.

 

[Mad Jack]

Even surgeons often aren't performing their own surgeries until third year of residency at some programs...

 

[mimelim]

Even surgeons often aren't performing their own surgeries until third year of residency at some programs...

That isn't true no matter how you take it.

PGY1/2s are operating. They would have ACGME crawling all over them if they didn't at all. Now, certainly not all programs follow all the rules and skirt others, but the number of, "interns don't operate" programs are vanishingly small. It is all about level appropriate cases. They may not operate a ton, but even at the most malignant programs, they will do something.

And, no residents are performing "their own surgeries". You are always operating under an attending.



I should clarify that I know nothing about DO residencies and am only talking about what I know, which is ACGME.


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Regarding the premise of performing surgery earlier. Surgery is not 'hard'. There are plenty of operations (procedures as well, but real operations) in every discipline that are technically easy to perform. Yes, those with more experience are going to be faster and better, but with good success rate? There are plenty of cases that can be done by someone with minimal experience. The hard part of surgery is everything else. Who to operate on, who NOT to operate on. When to operate, which operation to perform, etc. If all you get out of your MS3 surgery rotation is how to scrub and suture, your school is shafting you. That is the bare minimum they should be teaching you from a technical standpoint, but the lion's share of the education should be in patient/service management.

There is a large dividing line between what you could do and what you SHOULD do. Should you be doing something that you don't have training in or comfortable with? No. Could you figure out and perform some simple procedures? Yes. In an emergency, sometimes you simply have to figure things out or draw on theory. No different than me as a vascular surgeon delivering a baby on an airplane.

 

[Chillbo Baggins]

I've heard stuff about rural FM doing things like C-sections and vasectomies, I can only find anecdotal threads on it when I google though

I believe cesareans, as a part of obstetrical training, are a component of a lot of FM residencies. I know several FM residents and attendings here have performed c-sections. There is an AAFP position paper that says outcomes are not substantially different, albeit with more limited data.

 

[Mad Jack]

That isn't true no matter how you take it.

PGY1/2s are operating. They would have ACGME crawling all over them if they didn't at all. Now, certainly not all programs follow all the rules and skirt others, but the number of, "interns don't operate" programs are vanishingly small. It is all about level appropriate cases. They may not operate a ton, but even at the most malignant programs, they will do something.

And, no residents are performing "their own surgeries". You are always operating under an attending.



I should clarify that I know nothing about DO residencies and am only talking about what I know, which is ACGME.


-----------------------------------

Regarding the premise of performing surgery earlier. Surgery is not 'hard'. There are plenty of operations (procedures as well, but real operations) in every discipline that are technically easy to perform. Yes, those with more experience are going to be faster and better, but with good success rate? There are plenty of cases that can be done by someone with minimal experience. The hard part of surgery is everything else. Who to operate on, who NOT to operate on. When to operate, which operation to perform, etc. If all you get out of your MS3 surgery rotation is how to scrub and suture, your school is shafting you. That is the bare minimum they should be teaching you from a technical standpoint, but the lion's share of the education should be in patient/service management.

There is a large dividing line between what you could do and what you SHOULD do. Should you be doing something that you don't have training in or comfortable with? No. Could you figure out and perform some simple procedures? Yes. In an emergency, sometimes you simply have to figure things out or draw on theory. No different than me as a vascular surgeon delivering a baby on an airplane.

I wasn't saying they'd done zero operating, but that they'd done no start-to-finish operations without substantial attending involvement as they started their third year. I have worked with zero AOA-trained surgeons in my life, so these are all ACGME people. Perhaps they were just poor surgeons so the attendings didn't trust them to do everything, perhaps they were slow and the attendings just wanted to speed them along, I really can't say. But I've heard several residents lament that they felt completely inadequately trained to perform even many basic surgeries on their own entering their third year of surgical residency, and many residents that didn't feel comfortable as they moved to attending roles from residency as they felt poorly prepared for independent practice (and those were from a big name ACGME place in the Northeast).

 

[Lawpy]

You would need to complete a surgical residency if you expect to operate, third world or not. Even then you should only operate in the scope of your training. You wouldn't expect an orthopaedic surgeon to do an appendectomy, despite it's relative simplicity. They just are never trained to do them.

And that's a good thing. Otherwise, we'll end up with this:

 

[AnatomyGrey12]

I've heard stuff about rural FM doing things like C-sections and vasectomies, I can only find anecdotal threads on it when I google though

The number of FM docs doing C-sections is low. A vasectomy however is a procedure and not a true surgery, and it is common for FM docs to do them. A few I've talked to said they can actually be a cash cow because they are an elective procedure.

 

[Chillbo Baggins]

I wasn't saying they'd done zero operating, but that they'd done no start-to-finish operations without substantial attending involvement as they started their third year. I have worked with zero AOA-trained surgeons in my life, so these are all ACGME people. Perhaps they were just poor surgeons so the attendings didn't trust them to do everything, perhaps they were slow and the attendings just wanted to speed them along, I really can't say. But I've heard several residents lament that they felt completely inadequately trained to perform even many basic surgeries on their own entering their third year of surgical residency, and many residents that didn't feel comfortable as they moved to attending roles from residency as they felt poorly prepared for independent practice (and those were from a big name ACGME place in the Northeast).

Question, are these programs more white or blue collar? Because that can make a big difference. For instance, I've read about some research-heavy ortho programs with a bunch of fellows where the 4's barely do much more than retract, while I was with a resident last fall who was only a few months into his second year, but did a TFN skin-to-skin with the attending just watching and giving some pointers, not scrubbed, since the program here is much more operative-focused.

 

[Mad Jack]

Question, are these programs more white or blue collar? Because that can make a big difference. For instance, I've read about some research-heavy ortho programs with a bunch of fellows where the 4's barely do much more than retract, while I was with a resident last fall who was only a few months into his second year, but did a TFN skin-to-skin with the attending just watching and giving some pointers, not scrubbed, since the program here is much more operative-focused.

Heavy research programs, very white collar.