How "hands on" are most FM Residencies?

[Mike59]

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Hi all,

I've noticed at my medical school that unless you are a resident in a surgical field, you don't get much hands-on opportunity in fields like surgery, OB/GYN etc. The FP residents for instance, do alot of the managment pre/post op but don't even get to scrub in most times on the actual surgery (usually because the surg residents get priority). Even when we scrub in as med students, we're second assist and just hold retractors for hours on end.

I was curious how it works at most Family Medicine residencies- are you allowed to be first-assist on surgeries during your block? Is this why opposed FM residencies are so unpopular? (Even though I won't become a surgeon, I would like to go somewhere where I can develop some solid skills during residency)

 

[gwyn779]

Hi all,

I've noticed at my medical school that unless you are a resident in a surgical field, you don't get much hands-on opportunity in fields like surgery, OB/GYN etc. The FP residents for instance, do alot of the managment pre/post op but don't even get to scrub in most times on the actual surgery (usually because the surg residents get priority). Even when we scrub in as med students, we're second assist and just hold retractors for hours on end.

I was curious how it works at most Family Medicine residencies- are you allowed to be first-assist on surgeries during your block? Is this why opposed FM residencies are so unpopular? (Even though I won't become a surgeon, I would like to go somewhere where I can develop some solid skills during residency)

Several of the places I looked did surgery at a separate community hospital if they were opposed.

 

[lowbudget]

I looked at unopposed places and for the majority of them, surgery is actually the easiest rotation. For the other programs though, it's the hardest... so it's really polarized.

In places where it's the easiest, the attending does not expect you to run the service like a surgery resident would. The attendings will do floor work themselves. They expect you to go to clinic, take consults, and assist in the OR. In clinic, you do a lot of assessment and maybe some office procedures. Of course, you do preop/postop. Assisting in the OR varies. Your experience may be something like starting a line and intubating the patient before the attending gets there, help retract/first assist, and closing. Depending on the rotation, you may get a chance to put in chest tubes.

In places where it's the hardest rotation, you hardly get time to get in the OR because you're running the floor. Some residents I talked to say they only go into the OR if the cases are interesting provided that the work on the floor has been done. They also take consults in the hospital. The attending at these programs leave the floor work to the residents (FM/Surg).

The amount of "hands on" will depend on program and attending and it'll be hard to determine what is what until you interview and ask the residents. Typically, opposed residencies will relegate floor work to the Surg and FM interns while senior residents and fellows get OR time. At some programs, surgery residents are the code runners and line starters. At others, surgery residents perform EGD and colonoscopies because there aren't enough GI specialists in the community. Alternatively, unopposed residencies may or may not relegate floor work to the FM resident; it'll depend on the program's philosophy and expectations of their FM residents. The majority will leave the surgery experience up to the resident. That said, it takes time for surgeons to have trust in you to perform in the OR, and other times attending surgeons will try to zoom through the case without giving you a chance to learn a procedure. On the other hand, if you prove you can do the procedure, you can help the surgeon move so much faster.

 

[Geronimo]

I have an "off topic" question. What is Family Medicine - ART? I have never heard of the ART and I was curious what it is?