scrappy said:
a continuation of discussion from ROL 2006 by alexrusso and robotsonic.
what do you think about early v. late (i.e. "top heavy") operative experiences in academic programs? now, i know we've all been told that it doesn't really matter, that both types produce excellent surgeons, and usually you can see that graduating chiefs everywhere are pretty facile.
anyway, i asked one of my interviewers who was from a less top heavy program whether she thought it made a difference, and she said it had. when she started her fellowship she could see that she was a lot more comfortable in the OR and was quite an advantage.
i don't want to include community programs in this debate because the argument always devolves to something like "community surgeons don't have to deal with complicated patients," or "community surgeons deal with hernias all day," etc.
top heavy programs are neither top nor heavy: discuss.
**Disclaimer--In the following long-winded reply, I am not trying to piss off any non-surgery residents/applicants or suggest that they aren't as intelligent or skilled in treating sick patients. Its just that where I come from, the sickest patients in the hospital will 9/10 times be managed by the surgical team...this probably isn't universal.
I battled with the same issue posed by Scrappy myself as evidenced in my thread "UAB, Vandy, Louisville" (thanks for the posts and pm's by the way, they were helpful right up to the minute before list certification!).
Coming from UT Memphis where there is an almost scary amount of autonomy and relatively early operative exposure, I originally set out to find the best academic program with the same type of experience. Some of the programs I really thought I'd like...and tried hard to like either due to reputation or research/fellowship opportunities, I came away wondering if I'd really be happy, since many of the residents commented on how "top heavy" the program was and that they were okay with not seeing the OR till PGY-III (Emory for example).
When I was making my decision, it came down to a program like Louisville, notorious for excellent operative experience, even interns performing "upper-level cases", but less well endowed from a research standpoint versus UAB, one of the research meccas, but supposedly with a more "Halstedian" approach to operating. I knew graduating from Louisville I'd be one of the best technically trained surgeons, from what I'd heard. But graduating from UAB, I'd have a launching pad into any number of fellowship spots, while also hopefully being trained well.
In the end, I'd like to think it really wouldn't matter that much where I trained. If attendings/residents alike have the same vision, which is to teach/learn general surgery, while holding the patient's best interest as the utmost priority, then everyone would win, whether at Cornell, UAB, Louisville, or BFE. Everyone (even myself) gets so caught up in the numbers game and the little ins and outs of trying to get into what he or she feels is the "best" program for surgical training (whatever details they hold as most important) that we sometimes lose sight of whats really important...that the patient is getting the best possible treatment, no matter what.
Residents have to learn to operate and have to be cut loose to make appropriate surgical decisions without an attending watching over their every move. At the same time, you can't expect an intern to step in and knock out their first whipple and suggest that this has the patient's best interest in mind. Even at the most "top heavy" programs, I'd imagine there are still cases that interns will, at some time or another, get to step in, grab the scalpel, and cut like hell.
Just remember, that being a surgeon gives you the opportunity to do something outside of the OR that the other docs can't...take care of the sickest patients in the hospital. This in itself is one of the biggest aspects that led me into general surgery. The fact that anytime a really sick "medical" patient comes in, you can likely count on the Medicine team consulting the surgeon for advice...Be forewarned, if you come to UT Memphis for general surgery and you even consider consulting Medicine for a "medicine" issue on your surgical patient, you will catch hell. The surgeon is to manage the toughest medical patients as well as have the unique ability to operate...the best of both worlds. This is why during interviews you asked the question "do surgeons manage your ICU's in a closed environment?"
As an intern or even PGY-II in the ICU, you may not be in the OR cutting, but you can certainly do a great service to your current and future patients by making the best of your "non-OR" years by mastering bedside procedures and critical care issues. Last time I checked, a subclavian stick for central line placement wasn't the most benign thing you could do to a patient. Yet, as surgery residents, we will do so many of them, they will become second nature. Remember to respect the invasiveness of every single procedure you perform on your patients, because the minute you don't, something bad will happen. In the end, its the patients that suffer.
