How does trauma surgery training work?

[moyoshix2o]

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Hey guys, I'm a soon to be MS2 and right now I'm dabbling with the notion of trauma surgery. Problem is that I don't really know how the training in that works. Anyone know? I'd like to know residency options and fellowship and what not. Thanks so much.

 

[smq123]

Hey guys, I'm a soon to be MS2 and right now I'm dabbling with the notion of trauma surgery. Problem is that I don't really know how the training in that works. Anyone know? I'd like to know residency options and fellowship and what not. Thanks so much.

There is no formal "trauma surgery" residency. You will do trauma rotations as a general surgery resident.

Trauma gets called to anything that happened suddenly, which can range from the flashy and exciting (gun shot wounds) to the somewhat boring and mundane (old lady slipped on a patch of ice outside of her house).

There is also a large non-surgical aspect to trauma, in that trauma surgeons frequently are in charge of the surgical ICU, in conjunction with anesthesiologists.

There are a few places with trauma fellowships, although those are fairly new. They're usually labeled "Surgical Critical Care/Acute Care Surgery" fellowships. These help you hone your ICU management skills, as well as a few other procedures.

Trauma is not particularly popular - not as popular as, say, Vascular surgery. Traumas tend to happen in the late hours of the morning (when most people would rather be asleep), and most victims who end up on the trauma service are not, shall we say, always the "salt of the earth" type people. I mean, who else would be standing on a street corner at 2 AM in an interaction where guns are involved? Not rabbis or kindly old ladies, usually. These types of patients can sometimes end up being social work nightmares (i.e. don't have a real home to go to, don't want to leave the hospital because they know that someone has a vendetta against them and that they're not safe, etc.).

The surgery resident in charge of the trauma service when I was a 4th year med student was actually assaulted while in the ER - the guy who tried to shoot her patient came looking for her because he was angry that she saved the patient's life. He threatened to kill/rape her and punched her in the face, if I recall. Another guy got into a fight and got stabbed in the cheek. When he rolled into the ER, the ER nurse tried to put an IV in him (standard for most trauma patients). He was so pissed at her for this that he started spitting blood into her face on purpose.

 

[Smurfette]

5 year general surgery residency (if no research)
then 3 options:
1. a 1 year trauma fellowship
2. a 1 year trauma fellowship plus a one year critical care fellowship (increases marketability, especially at "big name" trauma places).
3. a 2 year acute care surgery fellowship (which is basically like option 2 with a more integrated approach). This is a new, emerging fellowship option in the last couple years due to the fact that much trauma is blunt and non-operative and they are trying to boost ways to get cases and keep skills up---i.e. trauma and critical care PLUS emergency general surgery stuff (appys, choles, perf diverticulitis, perf DUs, etc.)

You can always just do a residency and then look for a GS job that covers trauma....but it depends on your goals (some places only want trauma fellowship trained individuals) and residency trauma experience.

 

[45408]

5 year general surgery residency (if no research)
then 3 options:
1. a 1 year trauma fellowship
2. a 1 year trauma fellowship plus a one year critical care fellowship (increases marketability, especially at "big name" trauma places).
3. a 2 year acute care surgery fellowship (which is basically like option 2 with a more integrated approach). This is a new, emerging fellowship option in the last couple years due to the fact that much trauma is blunt and non-operative and they are trying to boost ways to get cases and keep skills up---i.e. trauma and critical care PLUS emergency general surgery stuff (appys, choles, perf diverticulitis, perf DUs, etc.)

You can always just do a residency and then look for a GS job that covers trauma....but it depends on your goals (some places only want trauma fellowship trained individuals) and residency trauma experience.

I've seen several "Trauma/Critical Care" fellowships that are just one year.

 

[Smurfette]

I've seen several "Trauma/Critical Care" fellowships that are just one year.

To sit for the surgical critical care boards, you need a minimum number of months dedicated to critical care. Only 20% of your time (maximum) is allowed to be outside of critical care (i.e. operative)...which is not enough time to do a true trauma fellowship.

Some of the combined 1 year fellowships are non-accredited...once again, depends on your goals (personally, I would want to be boarded if I did a fellowship in SCC).

 

[MarlyMarl]

I shadowed one of the best trauma surgeons in NYC and he told me that the best way to go is the gen surg res and #2 on Smurfette's list.

 

[phospho]

I met a dude who was an "orthopedic trauma surgeon". He said he did ortho, and then one year of ortho trauma fellowship after that. He fixed my broken calcaneous bone. This is by far the coolest specialty I've ever seen.

 

[ruiner]

It's always interesting to hear how the different hospitals do things because like the last poster said, where I'm at I think pretty much all the trauma is the ortho residents, not the gen surg.

 

[smq123]

It's always interesting to hear how the different hospitals do things because like the last poster said, where I'm at I think pretty much all the trauma is the ortho residents, not the gen surg.

It definitely varies. At some places, ortho and gen surg take turns taking traumas. At others, ortho and gen surg take turns taking regular traumas, while plastics, ENT, and OMFS take turns taking facial/head traumas.

 

[Raryn]

I met a dude who was an "orthopedic trauma surgeon". He said he did ortho, and then one year of ortho trauma fellowship after that. He fixed my broken calcaneous bone. This is by far the coolest specialty I've ever seen.

Why would ortho need a trauma fellowship? Except for hip replacements, almost everything else ortho does is a result of some traumatic injury.

 

[drizzt3117]

Why would ortho need a trauma fellowship? Except for hip replacements, almost everything else ortho does is a result of some traumatic injury.

A lot of orthopedics in a trauma situation now is focused on stabilization rather than repair... this is something that is relatively new due to evidence based medicine.

 

[hurdlepup]

I met a dude who was an "orthopedic trauma surgeon". He said he did ortho, and then one year of ortho trauma fellowship after that. He fixed my broken calcaneous bone. This is by far the coolest specialty I've ever seen.

Ouch! Did it swell up a lot? Did they put you in those inflatable leggings?

 

[phospho]

Ouch! Did it swell up a lot? Did they put you in those inflatable leggings?

haha, yup... inflatable legging... I've never seen anything swell like this before. There was this bad ass surgery called ORIF (open reduction internal fixation) which he did on me. He put screws under the calaneous to elevate it (since I squished my spongy bone beneath it and there was nothing left to support it). Now it's good as new. Definitely made me start thinking about ortho.

But the pain was pretty unbelievable. Unlike anything I've ever imagined. Good pain killers though. One second you wanna shoot yourself - the next second you feel like you're sitting on the beach drinking one badass Margarita.

It was the first time that I went under full anesthesia. It's one hell of an experience. Now I know what it's like to be dead I think.

 

[phospho]

Why would ortho need a trauma fellowship? Except for hip replacements, almost everything else ortho does is a result of some traumatic injury.

I don't know man. All I can tell you is that it seemed like that dude knew EXACTLY what he was doing every step of the way with me. It's like his specialty was made specifically for cases like mine. He kept calling his specialty a "happy specialty".

 

[SouthSideSteve]

I don't know man. All I can tell you is that it seemed like that dude knew EXACTLY what he was doing every step of the way with me. It's like his specialty was made specifically for cases like mine. He kept calling his specialty a "happy specialty".

i dont see ortho trauma as a happy specialty, especially when compared to some of the better ortho specialties.

Joint & Sports Med are 'happy' subspecialties

Trauma & Spine can be pretty malignant.

When you're spending your weekend on call fixing up the drunks & gangbangers of the city, id find it hard to be happy. Ortho trauma is lots of ORIFs, IMNs and Ex Fixs.

 

[lemontilt]

There is no BC for "trauma surgery" right? I guess you Critical Care is BC. Plus, I read some people trash-talking about trauma guys because they had to babysit the patients of the other specialities in the ICU and how they dont get to operate most of the time. Not my opinions but I know for a fact that many trauma patients do not require surgery and general approach is to trat them a non-surgically.
After all, I find trauma really appealing 😀