# of operations during residency

[Simppu]

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Just out of intrest, about how many operations/month does an surgical resident do/assist during the first 3 years ? And how quickly are they allowed to operate without a senior behind their back watching ?

J

 

[Castro Viejo]

Just out of intrest, about how many operations/month does an surgical resident do/assist during the first 3 years ? And how quickly are they allowed to operate without a senior behind their back watching ?

J

It's program dependent and junior dependent, really. There's no generalization I can make.

In my first three years in resideny I did (gotta pull up my logs...)

Year 1: 115 (or 9.6 cases/month)
Year 2: 126 (or 10.5 cases/month)
Year 3: 388 (or 32.3 cases/month)

Most General Surgery programs in the United States have some level of supervision for all residents, including Chief Residents. In my program, just as an example, attending surgeons must work with all residents directly in the operating room other than a Chief Resident. So the interns through the R4s have to be scrubbed with an attending on the other side of the table at all times. As Chief Residents we have "independent" privileges in cases of emergency, where what can be done in the operating room is potentially life-saving, and so we don't need to ask an attending for approval (I'll often do after the fact just as a show of respect to the attending -- after all, he should know if his patient is going to the OR). Just pack the patient up and go. For elective cases we have a little less supervision than an R4, where the attendings don't have to be scrubbed with us and we can do the case with a more junior resident (for me that would be an R3 or higher -- no R2s. Most of ours can't tie for crap), but the attending must at least be in the room during the "critical" portion of the case (i.e., prior to resection of a bowel segment, prior to doing the hookup, prior to closing to make sure all the sponge and instrument counts are correct, etc.) but not necessarily during the dissection.

This is by no means typical, rare, better, or worse. It's just how it is where I am.

 

[Winged Scapula]

I don't have my cases by year at hand, but by way of showing you how different things can be:

at my program Chief residents did not have independent operating privileges. We could not start a case, even an emergency one, without the attending being there. If we were lucky we could make an incision and start setting up the Bookwalter (if needed) before the attending scrubbed.

The attendings were present and scrubbed for almost the entire case. If we had a student on service, or a junior resident who happened to be scrubbed in, they would leave once the anastomosis was done and we would close with the student or intern. But often times they were there, skin to skin.

I thought it was just me, but my fellow Chiefs confirmed it was that way for them as well.

 

[Castro Viejo]

Ugh... Were Bookwalters pretty standard where you were? Did everyone use them?

I don't like them. They seem too cumbersome to me. I like the Omni or just an intern from the floor. 🙂

 

[Winged Scapula]

Ugh... Were Bookwalters pretty standard where you were? Did everyone use them?

Most did.

I don't like them. They seem too cumbersome to me.

I used them so often that I was fine with the Bookie.

I like the Omni or just an intern from the floor. 🙂

One of our surg onc foregut guys used the Omni as I recall but I didn't care for operating with him so didn't use it very often. And our Colorectal guys tended to favor it for the APRs and LARs.

Interns? Why they've got floor work to do! Ocassionally they would get paged to come in for the LARs to hold a bladder blade for hours!

 

[Arch Guillotti]

I don't have my cases by year at hand, but by way of showing you how different things can be:

at my program Chief residents did not have independent operating privileges. We could not start a case, even an emergency one, without the attending being there. If we were lucky we could make an incision and start setting up the Bookwalter (if needed) before the attending scrubbed.

The attendings were present and scrubbed for almost the entire case. If we had a student on service, or a junior resident who happened to be scrubbed in, they would leave once the anastomosis was done and we would close with the student or intern. But often times they were there, skin to skin.

I thought it was just me, but my fellow Chiefs confirmed it was that way for them as well.

Some nights I never even see the attending surgeon, even w/multiple operations going on.

 

[Winged Scapula]

Some nights I never even see the attending surgeon, even w/multiple operations going on.

Yep, its very different...I have friends at other programs that had no independence and others like you, that seemed to run the show, even at a PGY3 level.

 

[Blade28]

I think he's in Anesthesia.

 

[Winged Scapula]

I think he's in Anesthesia.

Yep, you're right...missed the "CA-3".

OK, so make it independence like the surgery residents at his program have.

 

[Simppu]

Thanks for the answers and sorry for the late reply, they have been keeping me busy at the hospital. 😀 I guess the system is different between countries and even hospitals. My first year is about to end, we don't have a log we fill in, but we get a printout of all our operations every half year. For the first 7 months I participated in 184 operations (included as an assistan and my own 57). I have a feeling that this is not a very high number around here, but the speed has picked up a bit lately and I'm not complaining because it's basicly a 7:45 - 16 scedule. Our boss warned though that next year the # could drop a bit as the operations get more advanced and longer. 😡

J