You and I got in an argument a while back about a similar topic. I guess what frustrates me is that people in the Northeast have a certain amount of tunnel vision, and tend to assume that their experience is "the way it is," when in fact there are plenty of programs in other areas of the country that are quite different.
Quite possible. And that's why I wrote what I wrote. I understand that resident autonomy in General Surgery can vary quite a bit from program to program and, moreso, from region to region. My friends in the South say it's great. My friends up here in the Northeast (New England/Mid Atlantic states) generally say it sucks mooseballs. I happen to think my own program is pretty good with resident autonomy, but it certainly isn't the norm for the New York area programs and not generally for the lovely Northeast.
You guys often assume that anything other than what you're used to is either inaccurate or inferior, when in fact you couldn't be more wrong. Of course, I don't completely blame you for that, as you're a product of your environment, and are basically regurgitating what you've been told since the first day of med school.
Hmmm... I don't quite understand why you believe you are the clearinghouse on opinion in this forum.
Now I have a question for both you and WS: You have stated that the "coolest cases" the interns have just described were really glorified first assistant roles, and yet you also admit you lacked autonomy as residents. When you participated in these cases as juniors residents, did you count them as surgeon junior or first assist?
Perhaps your general dislike for my posts is the root cause of all this.
I don't believe I accused any of the interns posting that they were glorified first assistants. I just found it "hard to imagine" that an intern would be doing an ALND. Now, if you believe that that excludes the realm of possibility in my mind, then I'm sorry, but you should read the post more carefully.
In answer to your question, as Winged Scapula noted, I listed myself as Surgeon Junior when I performed 50% or more of the case. If I believed I got nothing from the case, held hook, became the Bovie scraper, or the sucker man, then I didn't log the case at all. My PD also did not want us to code too many First Assists.
So I didn't log the lap choles that I "did" as an intern when it was the attending who splayed the gall bladder out for me and I hooked it with my right, while watching it with the camera in my left. That's NOT doing a lap chole, in my opinion.
As I've stated in the past with regard to my program, it has a little more autonomy than the typical program that I know here in New York. Chief Residents can start cases. Chief Residents can do cases without attending supervision. Attendings must be present for the "critical portion" of the case. Chief Residents have operating room privileges in trauma and emergent situations. In my program common, bread-and-butter cases are done by a Chief Resident and an intern who wants someone to "take him (or her) through it."
Prior to the Chief year all residents, even R4s, need an attending opposite them in the OR. In those cases sometimes even an R4 will be muscled out of doing the case because it's Friday afternoon/evening or the attending has to rush out to get to the office. It sucks, but that's life in the Northeast.
