Choosing a High surgical volume vs a High Teaching-research residency program.

[kardon93]

Hello everyone, I am about to start my ophthalmology residency and I was wondering if anyone could give me advice on which kind of hospital to choose for my training. I am not from the US so unfortunately teaching in hospital is not that regulated on my country, so residency spots divide into two poles:
- Public Hospitals: A lot of patients, high surgical volume (200 cataracts, 300 Pterygiums, 40 corneal trasplant etc. fully done by residents) after 3 years of training. The disadvantage at public hospitals is due to patient volume theres few classes, teaching is usually not regulated, you are always either on clinic or in the OR so you learn what you can on your time outside the hospital.
- Private Hospitals: Surgical volume is much lower (30-60 cataracts, 60-70 Pterygiums) after the 3 years of training. The advantage is theres more teaching and they do a lot of research, and theres actual teaching programs which are followed by each ophthalmology subspecialty with an asigned mentor.
-Medium Spectrum: Theres a few very limited number of hospitals that work like both private and public hospitals, but these are very few, less than 5% of spots and they fall on middle ground.

What would you recommend?
Is the surgical volume really an overkill in ophthalmology?
Is learning a lot of theory about each subspecialty really that important?

---

Members don't see this ad.

 

[Bronze Medal]

Ideally you want good surgical volume AND good teaching. If you have to choose between the two I would say surgical volume is more important.

 

[dantt]

I can't imagine trusting a doctor to do my cataract surgery having just done 30-60 cases.

 

[kardon93]

Ideally you want good surgical volume AND good teaching. If you have to choose between the two I would say surgical volume is more important.

Thanks a lot for answering. Unfortunately here in Mexico you have to choose beetwen the 2 options, theres maybe 2 hospitals in the country that have the best of both worlds but its pretty hard to match. (9 spots out of 189).

 

[kardon93]

I can't imagine trusting a doctor to do my cataract surgery having just done 30-60 cases.

Usually ophthalmologist trained in those hospitals don´t do surgery unless they do a Fellowship.

 

[LightBox]

Definitely the higher surgical volume residency. You can always read a book to learn stuff. You cant learn the muscle memory required for surgery by reading.

 

[Twoeyes2020]

That's not true. There is no minimum surgical numbers in the US to graduate. The ACGME does have a minimum number for residency programs to have so one resident might be a little short in one category, be it cataracts, strabismus, orbit, etc. but the average number for all the residents will be ok.

This is not a simple question, volume with no supervision versus low volume with good teaching. The worse is low volume with bad teaching. Often a residency will have one very good teacher but the other faculty might not be.

I would tend to choose a higher volume program because you might encounter a senior resident or faculty member who is a good teacher. If not, you might learn from your mistakes. Then if one does a Mexican fellowship, maybe the fellow can learn finer teaching points or better cataract techniques.

 

[Twoeyes2020]

The original poster is from Mexico and is asking about which Mexican ophthalmology residency to choose. There is a mention of many graduates doing a Mexican fellowship after residency for increased cataract surgery experience.

I stand by what I wrote. The ACGME numbers are for US programs to continue accreditation. If one particular resident does not meet all the numbers, they are not prohibited from graduating. It is merely the residency program who may be cited (but not necessarily put on probation).

 

[kardon93]

The original poster is from Mexico and is asking about which Mexican ophthalmology residency to choose. There is a mention of many graduates doing a Mexican fellowship after residency for increased cataract surgery experience.

I stand by what I wrote. The ACGME numbers are for US programs to continue accreditation. If one particular resident does not meet all the numbers, they are not prohibited from graduating. It is merely the residency program who may be cited (but not necessarily put on probation).

Thanks for replying. Indeed most mexican ophthalmologist must do a fellowship due to the low surgical volume in many residency programs because most of the surgerys are done by fellowships and residents end with low numbers. Usually fellowships in Mexico provide excellent training, in example most cornea & refractive surgery offer a minium of 500 cataracts in that year of training but its hard to match.

 

[kardon93]

Definitely the higher surgical volume residency. You can always read a book to learn stuff. You cant learn the muscle memory required for surgery by reading.

Thanks for replying. Thats what I been thinking about. I guess it is also a plus in ophthalmology that theres more time to study outside the hospital and review resources like surgerys teaching videos; if we compare the hospital hours with other programs like general surgery where they spend more than 100 hours a week on the hospital.

 

[MstaKing10]

Part of the decision has to include future plans. If you plan on heading to an academic institution where research, teaching and administrative duties will be more important then perhaps the private institution might be the best option. If however you are headed to a private practice where operating efficiently and in high volume are more important then perhaps the public hospital is your best choice. If you’re not sure which way you will go after training always go for more volume. As others have mentioned you can always teach yourself the books aspect as you go along. Go where you will be busier. Work hard and study a lot on your down time.