1) i don't think L&D with c-sections constitutes true surgical management... cutting through the belly, the uterus, push baby out, deliver placenta, close uterus, massage uterus, close belly --- ain't no big surgical whoop, even FP residents can do it in a cinch...
Whether you think c-sections constitute "true surgical management" or not is irrelevant to this argument as there are still more than 12 months of surgical management (benign gyn, gyn onc) in a typical Gyn/OB residency. That is why I quoted separate numbers for L&D and the surgical Gyn rotations.
Your argument about the simplicity of surgical management of C-sections is on par with the argument that anesthesia is just throwing in a tube turning some dials and sittings on ass for the rest of the case documenting q 5 min vitals. I mean what could be simpler? Even a NURSE can do it in a pinch. That may be our bread and butter, but... When it comes to c-sections, a good OB, like a good anesthesiologist, makes even the tough cases look effortless.
In theater performance (by Gyn or other surgical specialty) constitutes approximately 1/4 of the overall surgical management. There is preop workup, making the decision when to cut and when not to, and postop management of the inevitable issues and complications.
2) benign and malign. gyn are the true surgical cases IMHO.... so add up the # of cases that most ob/gyn residents do on those services (beyond holding the retractors for the Gyn Onc fellow/attending)... and you will see what i mean... (i am of course comparing surgical exposure to gen. surg. residents)...
Even if you assume that the Gyn resident is doing half the number of "true surgical cases" per month, it is still more than 12 months of surgical experience, not the < 12 months that you claimed. This is of course a fallacious assumption.
I don't know how ONC is at other places, but at Hopkins the interns do a fair amount of the easier operative work (exposure, closure, port placement, occasional hysterectomies etc). The interns who do onc later in the year get more experience obviously. If you can break away from the floor you might have to retract for the more technically challenging cases/ portions of cases (retroperitoneal dissection, dissection of diffusely metastatic disease etc), but most of the retraction is done by the different contraptions that have been invented to make manual retraction passe. Mostly you just watch the technically challenging portions.
Before you go there, I am not arguing that surgical training in the average gyn residency is equivalent to surgical training in the average surgical residency. It is not. I am only arguing that your statement that there is less than 12 months of operative time is erroneus.
- pod
