Getting Handsy

[Stare Decisis]

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After touring a couple of well-known programs and talking to countless residents at a couple of meetings, I am surprised at how varied the educational experience in PRS is. It might be this way for most surgical specialties and I could just be betraying my lack of knowledge on surgical education in general. Although, there seems be a large disconnect between programs with reputations of being elite but offering a paucity of hands on surgical experience. Is it better to get a great name and improve surgical skills on the fellowship end or is it better to graduate with strong surgical skills and fight your way into an elite academic institution or fellowship?

On another note, our institution was visited by a very well-respected craniofacial/vascular anomalies surgeon who did nothing but rail against the current surgical competence of both general surgery PRS guys and integrated PRS guys. His thoughts were that most general surgery guys are only being taught to take care of sick patients and hold cameras; while the integrated guys are missing the basic principles of surgery which is evident in their handling of almost any PRS case. He finished by saying that it was okay because most of these guys will make their living with "fillers." Were his gripes legitimate? Or was it am instance of one of the Gods of PRS venting that surgery had become too soft with to much emphasis on lifestyle. I asked him if there was any way to escape surgical mediocrity, his response. "No, the system is set-up to deliver average."Curious as to what some of the vets on the forum think.

 

[rongeur]

After touring a couple of well-known programs and talking to countless residents at a couple of meetings, I am surprised at how varied the educational experience in PRS is. It might be this way for most surgical specialties and I could just be betraying my lack of knowledge on surgical education in general. Although, there seems be a large disconnect between programs with reputations of being elite but offering a paucity of hands on surgical experience. Is it better to get a great name and improve surgical skills on the fellowship end or is it better to graduate with strong surgical skills and fight your way into an elite academic institution or fellowship?

There probably is a wide range of training quality but it's not really a secret which programs give good training. Residents are obviously skewed but rotating students spread the word and everyone knows on the interview trail. The problem with "big name" programs is usually malignancy, not bad training. There are only a handful I can think of with "big names" that are very hands-off and everyone already agrees on which ones they are so they're easily avoided for less competitive programs if that's your thing.

 

[droliver]

His thoughts were that most general surgery guys are only being taught to take care of sick patients and hold cameras; while the integrated guys are missing the basic principles of surgery which is evident in their handling of almost any PRS case.

It sounds like that is someone who trained in another era without real insight into what contemporary general surgical residency is. Compared to someone who finished 20-30 years ago, today's graduates have a much more varied and often intense experience.

I think the biggest technical difference from years ago is that most GS graduates today get a lot less traditional vascular experience which is a nice complement for reconstructive and microsurgery techniques. Likewise, the integrated PS pathways give you more didactic time but short you a lot on operative technique and "crossover knowledge" you get from traditional surgery procedures of the breast, trunk, and head/neck. Orthopedics & ENT residents also bring their unique strengths/weaknesses when they train in PS.