GS vs Integrated PRS

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Pothos

Full Member
10+ Year Member
Joined
May 16, 2012
Messages
18
Reaction score
0
So people here have previously criticized or praised lvl of GS involvement in PRS integrated training programs. Right now I believe it's always 3+3 with some programs a little 'wishy washy' on the first 3 so it ends up more 2-hybrid 1-3, I'm sure there's a spectrum.

Getting real: by the time you get out of GS into PRS, what 'level' of GS competency do you actually have? Not talking credentialing thinking international relief wise. Are you basically useless w/any critical care/trauma/GS if you're a PRS out in the field, well supplied but are working alone with a nurse anesthetist? Or, can you actually take care of a fair amount of pathology a GS could take care of as long as you're not taking on something that *probably* even a GS wouldn't (I'm thinking equipment/facility limitations, no robotic laproscopy available so that training would be useless in relief field for the GS anyway, you get my point).

I predict it will be a spectrum and would be interested in what you feel about the 'spread' of different programs' GS endowment in integrated PRS's... maybe what to ask about in programs if I want to be GS competent but don't want to dual-board unless it actually is really vital on a day to day basis w/international work. Should I continue to be interested in pursuing it, that is. Again, not talking boarding, we're talking practical competency in a strained situation. Thank you all.

Members don't see this ad.
 
So a few of things:

1. The 3+3 model, to my understanding, no longer exists.

2. When you're a medical student it's hard to get an idea of what residency is really like so your question is a reasonable one.

As a junior resident (PGY1-2) you're not going to learn how to be a "competent" general surgeon. The majority of the first two years at most academic places (which would have integrated PRS) are heavy on floor work but not so much quality OR time. You're experience takes off during your third year, but it's unreasonable to think you'll be comfortable doing GS cases after one year of operating under close supervision.

3. PRS is a long road even if you land an integrated spot and I would imagine part of why you're asking this question is because you don't want to go through 5 years of GS just to do 3 more of PRS +/- a 1 year fellowship.

I'm currently in GS resident pursuing an independent position. Would I have liked to rock a 270 on step 1 and land an integrated spot? Sure. It would have saved me a couple years of training, but I'm not unhappy as a GS resident. In fact, I actually really like it. I've been primary surgeon on everything from lap choles to kidney transplant and even sewn a few proximals during CABG. And, although this will prob make attendings cringe, the hours really aren't all that terrible. Overall, I enjoy my life quite a bit.

So to summarize,

No, you will not be competent after three years of GS. If that was the case, the residency wouldn't take 5. But if you like it, I wouldn't worry about the extra couple years of training. I even added a year of research and I have absolutely no regrets.
 
I think it all depends on how the integrated program is set up. While the 3+3 program no longer exists, some programs are still tailored after that fashion. My program is a 2+4 module. The first 2 yrs are exclusively with GS. In our GS yrs we learn to care for everything from basic blunt/penetrating trauma to complex transplant pts. I know for a fact (because we have to rotate w/ them in 3rd yr) I am much more comfortable managing post op complex pt then my friends in ortho/ent/urology who only did an intern yr with GVS.

As far a surgical skill competence a lot of it depends on good you are and how much u can work your way to the OR. By the end of my second yr I felt fairly comfortable doing basic things like lap chole, appys, bowel resections, I&Ds, bariatric procedures by myself, under the supervision of the attending of course, but I know this was not the case w/ all the PGY-2s from my GS program. I never saw a CABG/heart/lung txpl/whipple, but also didn't care to. Do I ever think i'll do a chole out in practice...I certainly hope not. BUT those laparoscopic skills are useful for things such as endoscopic flap harvest
The opposite was true of my friend at a different institution that did mostly floor scut work his first 2 yrs. Best is to just talk to the residents from the programs you interview at.
 
Last edited:
Members don't see this ad :)
I think it all depends on how the integrated program is set up. While the 3+3 program no longer exists, some programs are still tailored after that fashion. My program is a 2+4 module. The first 2 yrs are exclusively with GS. In our GS yrs we learn to care for everything from basic blunt/penetrating trauma to complex transplant pts. I know for a fact (because we have to rotate w/ them in 3rd yr) I am much more comfortable managing post op complex pt then my friends in ortho/ent/urology who only did an intern yr with GVS.

As far a surgical skill competence a lot of it depends on good you are and how much u can work your way to the OR. By the end of my second yr I felt fairly comfortable doing basic things like lap chole, appys, bowel resections, I&Ds, bariatric procedures by myself, under the supervision of the attending of course, but I know this was not the case w/ all the PGY-2s from my GS program. I never saw a CABG/heart/lung txpl/whipple, but also didn't care to. Do I ever think i'll do a chole out in practice...I certainly hope not. BUT those laparoscopic skills are useful for things such as endoscopic flap harvest
The opposite was true of my friend at a different institution that did mostly floor scut work his first 2 yrs. Best is to just talk to the residents from the programs you interview at.

Since I'm not an integrated resident, I would have to defer to FacePlates on the details. I do, however, find it very difficult to believe that after two years of operating under close supervision someone would be "comfortable" functioning independently and even more difficult to believe they could handle complications appropriately. While I do acknowledge integrated PRS residents are very intelligent people and admit had I been given the option I'd be in an integrated program, saying one is comfortable doing basic things while being directly supervised is a bit different than performing relief work on your own with minimal support (which was the OPs original question).
 
By the end of my second yr I felt fairly comfortable doing basic things like lap chole, appys, bowel resections, I&Ds, bariatric procedures by myself, under the supervision of the attending of course

That's correct....with attending supervision. I want you to look back on this when you're doing your first case as an attending and see if you still feel the same way. Residency is a safe place and it's easy to kid yourself into thinking you're better than you are. It happened to me and I see it in my residents today. Residency is not reality. Stay humble. Learn lots. Don't let your ass get too far ahead of your brain.
 
Last edited:
  • Like
Reactions: 1 users
That's correct....with attending supervision. I want you to look back on this when your doing your first case as an attending and see if you still feel the same way. Residency is a safe place and it's easy to kid yourself into thinking you're better than you are. It happened to me and I see it in my residents today. Residency is not reality. Stay humble. Learn lots. Don't let your ass get too far ahead of your brain.

Yep.
 
That's correct....with attending supervision. I want you to look back on this when your doing your first case as an attending and see if you still feel the same way. Residency is a safe place and it's easy to kid yourself into thinking you're better than you are. It happened to me and I see it in my residents today. Residency is not reality. Stay humble. Learn lots. Don't let your ass get too far ahead of your brain.

Absolutely.

Its a world of difference doing an easy case as a resident with attending supervision and being out on your own doing it yourself. Even easy cases change dramatically in that scenario. Complications become much more difficult to manage when they're not just a question on the ABSITE.
 
Top