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May 13, 2019
9
1
Status
MD/PhD Student
Hey everyone,

I'm an ortho res who is really dedicated to learning the art. Unfortunately, I am starting to get the feeling that they don't really start operating until their third year (which was not what they said at the interview). I know I am early on in my training, and there's a lot I have to learn, but I'm worried that their curriculum is going to really affect my ability to be a well-trained surgeon. The residents here operate at a noticeably lower skill level than my home program and I feel like I need to look for outside advice on how to navigate this situation. I do the typical stuff - come prepared knowing steps, indications, anatomy, etc. I jot down small nuances in a surgery log for tips in tricks. I study every night. But the problem is I still feel like I'm going to be screwed if I don't have good people training me... A lot of the attendings don't actively teach, it's like pulling teeth, and as I mentioned, I don't think I'm going to see much knife time until 3rd year... Please help.

Thank you,
 

DarkHorizon

Probationary Status
10+ Year Member
Mar 20, 2008
745
887
Status
Attending Physician
Hey everyone,

I'm an ortho res who is really dedicated to learning the art. Unfortunately, I am starting to get the feeling that they don't really start operating until their third year (which was not what they said at the interview). I know I am early on in my training, and there's a lot I have to learn, but I'm worried that their curriculum is going to really affect my ability to be a well-trained surgeon. The residents here operate at a noticeably lower skill level than my home program and I feel like I need to look for outside advice on how to navigate this situation. I do the typical stuff - come prepared knowing steps, indications, anatomy, etc. I jot down small nuances in a surgery log for tips in tricks. I study every night. But the problem is I still feel like I'm going to be screwed if I don't have good people training me... A lot of the attendings don't actively teach, it's like pulling teeth, and as I mentioned, I don't think I'm going to see much knife time until 3rd year... Please help.

Thank you,

Are you an intern?
 
Dec 22, 2016
3,006
10,963
Status
Attending Physician
Hey everyone,

I'm an ortho res who is really dedicated to learning the art. Unfortunately, I am starting to get the feeling that they don't really start operating until their third year (which was not what they said at the interview). I know I am early on in my training, and there's a lot I have to learn, but I'm worried that their curriculum is going to really affect my ability to be a well-trained surgeon. The residents here operate at a noticeably lower skill level than my home program and I feel like I need to look for outside advice on how to navigate this situation. I do the typical stuff - come prepared knowing steps, indications, anatomy, etc. I jot down small nuances in a surgery log for tips in tricks. I study every night. But the problem is I still feel like I'm going to be screwed if I don't have good people training me... A lot of the attendings don't actively teach, it's like pulling teeth, and as I mentioned, I don't think I'm going to see much knife time until 3rd year... Please help.

Thank you,
Make the best of it.
I never did a surgery completely on my own in residency. Not one. I still learned and then made up for it when I started practice.
Any ortho program will teach you the things you need.
 
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May 13, 2019
9
1
Status
MD/PhD Student
Make the best of it.
I never did a surgery completely on my own in residency. Not one. I still learned and then made up for it when I started practice.
Any ortho program will teach you the things you need.
That is comforting to hear. What do you mean made up for it in practice? You mean, you just operate a lot now?

Thanks,

AN
 

Miles Gloriosus

“ME-lace” not “Miles”
10+ Year Member
May 6, 2008
48
89
Status
Attending Physician
Pretty typical for programs to wait until pgy3 for residents to be active in the OR. Don't be discouraged. Pgy2 is mostly on focused on learning the information before applying it. Have to learn how to close reduce and splint/cast fracture first before learning how to fix in the OR.
 
Last edited:

Miles Gloriosus

“ME-lace” not “Miles”
10+ Year Member
May 6, 2008
48
89
Status
Attending Physician
That is comforting to hear. What do you mean made up for it in practice? You mean, you just operate a lot now?

Thanks,

AN
I would say most programs don't let you have pure 100% autonomy (like the attending never scrubs/not there and lets you do the entire the operation with no supervision). Even then, most of the time the attending is immediately available if you run into trouble. So for most people, the first time you do the surgery without any supervision is probably when you are in practice. When I was a resident, our department got pressure from the hospital leadership to cut back on resident autonomy/running concurrent rooms after the MGH/Boston Globe fiasco got published. Our department chair told us there was even legislation being introduced by a few state representatives. I heard from residents of other programs that their hospitals had made similar policies (for example, next patient can't roll back to OR1 until OR2 is closing, etc...).

One attending told me you'll experience the "green wall effect" early in practice. You'll get in a bind in the OR for the first time and look up. Instead of seeing an attending across from you, you'll stare into the emptiness of the green wall of the OR. At the end of residency you'll feel super confident. But at some level, you can't replicate pure 100% unsupervised autonomy. Hence, you learn by doing.
 
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