Fellowship: ACS vs SCC/Trauma?

[Great Hambino]

Hello everyone. I am in the middle of applying for SCC/ACS fellowships. I am going to work in an academic system and want to pursue the two-year path. What are your thought on doing a single 2-year ACS fellowship vs doing a 1-year SCC fellowship followed by a 1-year trauma/ACS fellowship? Are there any benefits to doing one over the other (besides not having to move again)? Are the 1-year trauma/ACS fellowships difficult to get? I am mostly planning for a 2-year ACS fellowship but one of the strongest programs I've seen for pure critical care experience is a nonoperative 1-year SCC program. Now I am wondering if it would be better to do that for a year then go to another program for a trauma/ACS year. Thanks for any advice.

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[ACSurgeon]

Hello everyone. I am in the middle of applying for SCC/ACS fellowships. I am going to work in an academic system and want to pursue the two-year path. What are your thought on doing a single 2-year ACS fellowship vs doing a 1-year SCC fellowship followed by a 1-year trauma/ACS fellowship? Are there any benefits to doing one over the other (besides not having to move again)? Are the 1-year trauma/ACS fellowships difficult to get? I am mostly planning for a 2-year ACS fellowship but one of the strongest programs I've seen for pure critical care experience is a nonoperative 1-year SCC program. Now I am wondering if it would be better to do that for a year then go to another program for a trauma/ACS year. Thanks for any advice.

I did the one year critical care fellowship only. ACS was a new concept at the time.

I think a lot of level 1 trauma centers are moving towards a two year acute care/critical care/trauma fellowship. I’ve heard that the one year fellowships will become a thing of the past and so will isolated trauma fellowships. Not sure how accurate that is or when it’ll actually happen.

In the old days surgeons would do a one year critical care fellowship and become trauma surgeons. I think moving forward most academic and level 1 trauma centers will prefer or require folks with the official two year ACS fellowship for new grads.

 

[Lem0nz]

The actual ACS certificate/designation has not really taken off yet. That said, like ACSS said above, most programs have moved to a two year model. You generally do a year of ICU and will take some trauma call +/- general surgery call (not much) and then you do a year of trauma. The amount of acute care/EGS call is variable depending on how big the trauma program is.

Your comfort level with doing emergency surgery and trauma surgery is very pertinent here. If you come from an academic program in the suburbs you may not have seen a ton of gunshots and did 3000 hip fracture and concussion admissions and you need it. If you went to temple you can probably do an ED thoracotomy with your eyes closed and cross clamp the aorta using the force. Mileage of course varies. If you don't need the second year you can bounce out of the fellowship early (have heard of this happening ~10% of the time for the two year programs). It is one of the few fellowships with a bit of flexibility to actually address your needs. Most however want the two years for vascular exposure in all the body cavities which you either didn't see enough of in residency or saw enough of but didn't physically do enough of and spent more time watching because you sure as **** are going to get thrown into the deep end as a trauma attending on overnight call in a level 2 or level 1 trauma center.

The difference between 2 year combined vs 1 year + 1 year is that there is no difference except that there probably are not enough 1 year *trauma* fellowships, and most good trauma fellowships already have a 2 year program. The single year ACS fellowship is probably more geared towards people who didn't feel comfortable learning how to operate in residency and need help. If you have the choice, you should probably be choosing a 2 year program. They will be more established, have more exposure, and have a longer pedigree of training. That is not always the case but is true of the bulk of the trauma programs.

If you don't want to be a trauma surgeon then its not relevant. SCC alone is a wonderful addition to someone's practice if they don't live and breathe surgery and don't plan on being at a trauma center. While every trauma center has SCC, there are a great deal of places with SCC that are not trauma centers.

Relevant Experience: I applied to trauma in 2018, and my co-chief went into trauma.

 

[PandaBaer]

Slightly off-topic, what are some indicators of a gen surg program's trauma training?
i.e. what should a M3 be looking for in a program to provide broad trauma experience so that a 1yr SCC fellowship is sufficient for community ACS work?
If the goal is to work at a level 2, but not a level 1, is a 2 yr ACS/trauma fellowship still recommended/required?
Lastly, is there a list of community/hybrid GS programs, 5 yrs not 7, that are known for being trauma heavy?

 

[DOVinciRobot]

Slightly off-topic, what are some indicators of a gen surg program's trauma training?
i.e. what should a M3 be looking for in a program to provide broad trauma experience so that a 1yr SCC fellowship is sufficient for community ACS work?
If the goal is to work at a level 2, but not a level 1, is a 2 yr ACS/trauma fellowship still recommended/required?
Lastly, is there a list of community/hybrid GS programs, 5 yrs not 7, that are known for being trauma heavy?

Being "trauma heavy" isn't a good enough delineator. There are Level 1s in places that are "trauma heavy" but their penetrating rate is abysmal, while there are Level 2s out there in knife and gun club locations who actually get a decent amount of operative trauma. You'll have to ask residents directly and get a feel for what their breakdown is. Penetrating vs blunt rate is a decent quick and dirty way to break it down if you can get your hands on that info.

Personally I think doing an ACS year is pointless unless you didn't get very good operative experience in residency. From what I've seen with our graduates (have at least 1-2 do trauma every year), they do fellowship largely so they can work at large trauma programs who will only hire fellowship trained staff so they can also be in the SICU rotation for running the unit.

To be fair I have zero interest in trauma, but I am at a high volume knife and gun club program that does a lot of trauma since we don't have a fellowship here. There are others here with more experience than I who can give you more details and info.

 

[Valhallax]

Hello everyone. I am in the middle of applying for SCC/ACS fellowships. I am going to work in an academic system and want to pursue the two-year path. What are your thought on doing a single 2-year ACS fellowship vs doing a 1-year SCC fellowship followed by a 1-year trauma/ACS fellowship? Are there any benefits to doing one over the other (besides not having to move again)? Are the 1-year trauma/ACS fellowships difficult to get? I am mostly planning for a 2-year ACS fellowship but one of the strongest programs I've seen for pure critical care experience is a nonoperative 1-year SCC program. Now I am wondering if it would be better to do that for a year then go to another program for a trauma/ACS year. Thanks for any advice.

Here's my opinion as an academic acute care surgeon.

I personally think that most people do not need the 2nd ACS year. If you had good general surgeon training and feel comfortable doing trauma you will be able to successfully practice at 95% of hospitals in the US as an acute care surgeon with just the 1 SCC fellowship year. There are only a handful of hospitals (maybe 20ish) that you really need the 2nd ACS year (again my opinion) such as Houston, Denver, Emory, DMC, etc...

I also don't think the 2nd ACS year helps make you a better academic surgeon if that is your ultimate goal to become NIH/AHRQ/PCORI funded in trauma critical care. For example, I am both NIH and AHRQ funded in trauma and only did the 1 year SCC fellowship. Honestly, if your going to do a 2nd year it may be better to do a research year and get an MS, MPH or MHI from one of the bigger academic research programs (again just my opinion).

If you are going to do the 2 year, the programs themselves are very heterogenous. Some programs are very heavy on trauma/ACS (Houston, Emory, Denver) and others on critical care (Michigan, Minnesota, Penn). There are some hybrid programs that are good in both though (Pitt, Maryland, etc). I would think that it would be best to do 1 year of SCC at a top critical care program (best probably being Michigan) and then 1 year of ACS at a top trauma program (best probably being Houston).

Again this is totally just my opinion, feel free to fully disregard, just trying to help as I remember being in your shoes...