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Case load question

Discussion in 'Surgery and Surgical Subspecialties' started by Dr. Dukes, Mar 12, 2007.

  1. Dr. Dukes

    2+ Year Member

    Sep 24, 2006
    Likes Received:
    Medical Student
    I have a question about how much surgical case load during residency matters. I am considering going to USUHS and then going into an Army surgical residency, but I am conserned about the operative case load during residency. Everyone I've talked to (Army or Civilian) stipulates that Army residencies aren't super intensive caseload wise. However, all their graduates leave and pass their boards (so they meet the minimum requirements). What I am confused about is how much caseload matters. Both Army and Civilian docs I've spoken to say it doesn't matter that much. Their reasoning is this: what matters, assuming you learned during residency, and are a competent surgeon, is where you do your fellowship, as that is where you really learn how to do whatever it is you choose to do. Since the Army sends all (well, except for Vascular @ Walter Reed) their surgeons to civilian hospitals for fellowship, I'm not worried about that aspect.
    So, my questions is this: Since I know I will get boarded after Army surgical residency, how much do I care about the operative caseload (I understand it to be ~60th percentile nationally)?

  2. Winged Scapula

    Winged Scapula Cougariffic!
    Staff Member Administrator Physician Faculty Lifetime Donor Verified Expert Verified Account 15+ Year Member

    Apr 9, 2000
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    Attending Physician
    Good question.

    While the ACS requires that you do a minimum number of cases, it is true that most surgery residents log at least twice the number required. And bear in mind that many "cases" which require a fair deal of technique simply do not "count" toward the ACS total. So you are operating more than it appears.

    I think there are other factors beyond just the number which are important:

    1) how technically skilled are you? Some are able to perform certain procedures easily and others take lots of practice.

    2) how easily do you learn? Obviously related to the above; some need more than others.

    3) how comfortable do the Army surgeons feel when they graduate?

    4) how about those who DON'T go onto fellowships? Are they working competently as general surgeons?

    Remember while the ACSA requires a minimum, this is spread out amongst a lot of different cases. So while you might get pretty proficient at lap choles, it is unlikely that you'll be so at pancreatic cases. I did more than the national average, and would say that I do not feel comfortable with them. Therefore, it is important to recognize that further training - whether in a fellowship or as an attending is generally necessary to hone your skills, or you may need to realize that you don't have the skills to do some of the procedures on the list.

    If the Army residencies are doing cases at the 60% percentile, that's better than the average, right? I'm not sure it makes a significant difference, especially when YOU are the most important factor, the teaching you get and any further trainng you undergo.

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