Does anybody know the ideal total case number for an academic program and also the number of chief cases? Also, where can I find the number of min cases for specific procedures (ie. Lap basic, liver). Couldn't find all the info I needed on acgme. Thanks.
IDEAL Total number of cases and chief cases
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Ideal based on what?
I'd like to have around a thousand cases, and I suppose 250-300 as a chief would be a good ratio.
I'd like to have around a thousand cases, and I suppose 250-300 as a chief would be a good ratio.
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I think Prowler has hinted at the issue with your question. It is really a balance of quantity of quality operative experience/training. PDs will often hold up case log numbers of chiefs. They might even list these numbers on their website, i.e. "come to our program cause our chiefs on average log a gazillion cases...".
The issue is the honesty factor. It has been raised in other threads. The ABS specifically talks about logging a case as "surgeon" or "chief". Residents can fight and resist for only so long until the time remaining is too short and so they suck it up and start logging so they get numbers sufficient to graduate AND convince an employer they have high volume experience.
I can only tell you from anectdote, community programs traditionally have a reputation for actual early operative experience and operative advancement. Academic programs traditionally have a reputation for more observation then full operation. This has been attributed to:
1. institution fame/prestige, i.e. "the patient came here to be operated on by me not a resident" mentality.
2. Academic centers plan for you to get "finished" through fellowship and thus focus on the cerebral as opposed to the technical.
All of the above may be untrue, hence, anecdote caveat. The point is that the numbers depend on what a resident's criteria for listing. I have seen chiefs refuse to log a whipple or similar case because the attending took the "surgeon side" during the case. On the otherhand, I have seen interns try to log as surgeon for a whipple or similar cause they got to put an anastamosis stitch! So take these numbers with plenty of salt.
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In the stickied FAQ you will find a link to the page on ACGME which lists the required number of cases.
As others have noted, I would not put too much stock in this while you are interviewing.
The way people log cases is highly circumspect and almost means nothing. You will have no way of knowing whether that Chief who brags about graduating with 1400 cases was really doing those cases or just logging anything he scrubbed into. You may find that programs with lower numbers are actually reflecting true values.
I can tell you personally that there were cases that I was told I had to log as SJ and Chief even though the attendings double scrubbed and I did very little.
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This is an important question, but as Kim touched on, the numbers don't tell you the whole story. What's perhaps more important is how much of the operation are you going to get to do? Will you start learning how to dissect and setup an operation as an intern or will you Bovie between the attending's right angle as a chief? The question of getting to operate is perhaps the most frustrating part of the interview season. Another important consideration, and one that's hard to figure out, is how many of the cases are good, complex cases versus the bread and butter. The difference between a program whose graduates finish with 900 versus 1200 cases might be 300 run-of-the-mill gallbladders and hernias. You might finish with 1200 cases at one program and 4 of those pancreas resection versus another with 900 operations and 30 pancreas cases.
I agree with what all of you say but thus far, I haven't been able to assess the operative experience of residents who are in their 4-5th year. There's so much bull**** that goes around when residents vouch for their residency. Everybody pretty much says the same **** on the interview trail so I've been using the total case number as a poor man's measure. Even though there is a lot subjectivity, I try to go by the averages so that I don't get fooled by the chief who said he did 1400 cases or the one who said 800.
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Yep, its all a crapshoot and residents do lie to applicants.
Sometimes what helps is that many programs will list their grads on line. Google some of those grads, see if you can find an email for them (or just guess at it - pretty easy to do with most .edu addys), and shoot them an email asking their thoughts about their former program. In most cases, they have nothing to lose and you might get some bites. You'll want to focus on young attendings because they are going to have a fresher memory of residency.
Of course, residents can lie about their level of participation just as fast as they can lie about their OR numbers.
I agree with the above comments that the threshold for counting a surgery as "surgeon junior" is different for everyone. Hopefully, by the time you are logging cases as "surgeon chief" you are doing enough of the case where there is rarely a question about it. Chiefs assisting on general surgery cases is just unacceptable.
As for whipples and esophagectomies, while those big cases are important, there are a lot of places where the big cases are way more common than the "bread and butter" cases, and the resident has an imbalance of experience.
I think balance is the most important thing when it comes to numbers, and the resident should log at least 1,000. Anything less than that, and the resident may be more inclined to count something he/she shouldn't.
Ask for a resident to show you their ACGME printout where cases are broken down by category....and, just talking to the residents and senior students.
It's not easy, because so many residents are full of crap, which we all seem to agree on.
I guess the best thing to have is a good bulls@#t meter. If the student is a good judge of character, and can pick up on body language and inflection well, that's probably better than any list of numbers.
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Just want to point out that if you get a resident to print out their acgme log that:
1. you need to remember that the year of the resident makes a difference and you can't base the number and balance on this. A current PGY3 is not going to have 1000 cases since they are only halfway through training, and many programs are top-heavy (which may mean 75% of cases are in the last 2-3 years, as a subjective guess).
2. remember also that depending on which part of the log is printed, especially for PGY1and 2s, some things are not shown in the numbers (i.e. central lines and minor procedures, critical care cases, etc.). While most people want all the 'big stuff', doing a lot of the 'little stuff' early on in residency is also a very good thing.
3. it doesn't tell you how much a junior resident is in the OR (watching/participating with more senior residents who are actually taking credit). If my service wasn't busy, any junior resident was welcome to scrub in on a cool case like an esophagectomy, big retroperitoneal sarcoma whack, etc....they'd get to do some stuff, learn some technique but couldn't take credit...sometimes they had to leave and come back if a really long case. I had an intern who would do this all the time and by the end of the year had developed mad skills despite not logging a ton of cases on paper.
4. Always ask about seniors taking juniors through cases. If attendings let chiefs take younger residents through cases, it is a good sign of a. chiefs having sufficient knowledge and experience to do so and b. some resident autonomy. For example, I took juniors through a bizillion lap choles, hernias as well as some trauma GSWs, bowel resections, open choles, colon resections....But you can't see this in the 'numbers', you have to ask. [you can log stuff as a TA, but only up to 50 cases count...many don't even think to log them]
My advice with case log volume is to not quibble over numbers around the average (say 900-1200 or so, depending on program type). Worry more about the programs with barely enough (< 800) or a ton (> 13-1400) of PRIMARY cases. These are places where you really have to ask questions like "how much do you get to do vs how much are you just bovie-ing between the attending's clamp", "how do you count whether to log a case?", etc. As others have said, you don't want to be somewhere that you may not get enough cases, but you also don't want to go somewhere that counts any case regardless of how much you get to do.
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Agreed. I ask those questions. There are definitely some places where attendings would rather teach the jr resident rather than the chief resident (ie strong academic institutes). As far as how much they do, that has some utility. Most will spit out something like, "yah, i got to do 'a lot' during my whipple last week, etc." so that's a tough read so I've started asking, "What are you comfortable doing as the main surgeon at the beginning of ur 2nd and 3rd year of residency." Most will still bull**** their way into a reasonable answer but it's much easier to see through that.
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One thing I think has been helpful so far is seeing if any of their grads go on to private practice as a general surgeon
I know it's far from an objective observation but generally I've found that a healthy mix, or at the very least the presence of a small few, that stay with GS has been a helpful approximation of comfortable case volume that gave them sufficient operative experience. A big plus too if they went to practice in areas outside of major cities on the tenet that they'd likely have to work on cases where subspcialists may not immediately be available. Anecdotal for me, and I might be using a misguided guideline, but has helped me get a feel of their case volumes.
I know it's far from an objective observation but generally I've found that a healthy mix, or at the very least the presence of a small few, that stay with GS has been a helpful approximation of comfortable case volume that gave them sufficient operative experience. A big plus too if they went to practice in areas outside of major cities on the tenet that they'd likely have to work on cases where subspcialists may not immediately be available. Anecdotal for me, and I might be using a misguided guideline, but has helped me get a feel of their case volumes.
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I would ask what the senior resident felt comfortable doing on their own (or taking a junior through). Lap chole? Open hernia? Open colectomy? Lap colectomy? Trauma laparotomy? Etc.
Agree 100%.
Lap choles are no problem for interns since they do so many, trauma laps I can walk a 2 or 3 through because I have a system.....but inguinal hernias are tough....it's just hard to show them what to do. Colons are tough, too, because I'm still learning how to be a good assistant and pack the bowel away perfectly.
I walked a PGY1 through a right colon, and it was awkward but went okay. I tried walking the same tern through a sigmoid and I had to take over....talked to a trusted attending about how to teach/expose, and the next sigmoid went a lot smoother...it's the little things we should probably pay more attention to when we are 3s and 4s....
Lap Colons I've never walked a junior through before. I've had them mobilize the colon a few times, but we don't do those cases without the attending.
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