Operative exp. as a resident

Discussion in 'Surgery and Surgical Subspecialties' started by Sarcophageal, May 11, 2008.

  1. Sarcophageal

    Sarcophageal Intern

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    I am currently an M3 interested in surgery. Alot of what I hear from our residents is "Stay here, our residents get to do alot of surgery, and they start early." I hear stories from residents saying at "other schools," interns barely see the inside of an OR. Whereas, at our program, interns are doing lap appys, hernia repairs, lumpectomies, and mastectomies. We had a whipple done the other day and it was the attending, R4, and M3. The resident did a majority of the anastomoses.

    Is the operative experience of our interns the rule or the exception? Because I honestly don't have any idea about other schools.
     
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  3. Castro Viejo

    Castro Viejo Papa Clot Buster

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    Well at the risk of being reprimanded (yet again) by SLUser, I'll tell you that what you're describing as the typical operative experience for interns at your program is not the norm for most programs I know, including my own. And I'll be the first to say that I think my program is quite generous with the interns in the OR too.
    Then there's always the question of whether those reporting to you actually have an understanding of what it means to "do a case." As we've seen here plenty of times it seems to mean slightly different things to different people.

    Regardless if what you're describing is true, then it sounds like a good program. Let me warn you however it's not always about the volume of cases. Sometimes just having someone actually care about your education is way more important than throwing a couple of stitches. Even if it's the pancreaticojejunostomy.

    How much did your R3 understand about the actual operation? Was the attending saying things like "put the stitch there... No, there?"
     
  4. jubb

    jubb Tern

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    I'd have to agree and say it really depends on the faculty's devotion to teaching. I've seen plenty of operations where the resident appears to "do" the majority of the case because he or she is holding the bovie, but the attending is the one really doing the case because they are grabbing everything and holding it (basically indicating where to bovie). I'm usually impressed when I see attendings not scrub in at all and just look over the shoulder, or wait a while to scrub in or scrub out early(other than just for closure). The fact that the interns have enough time to be in the OR during the day is a good indicator that the scutwork is manageable.

    I think a lot of programs try to get you to drink the kool-aid of the home program, but I'd still apply broadly and see what else is out there.
     
  5. Pir8DeacDoc

    Pir8DeacDoc Cerumen Extractor

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    What is your feel for the program? Do you like the other residents? Do you feel as though the attendings are approachable and want to teach?

    Truth be told almost all programs will get your plenty of #'s to become competent. It's really the overall environment that I would be looking at as well. What are your career goals and does your home program meet those goals? Do you like living in the area and do you want to spend 5-7 years more there?

    There is a lot that goes into choosing a program and more cases and early exposure to the OR might seem a nice quantitiative way to look at a program but there is more to it than that.
     
  6. MacGyver

    MacGyver Banned
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    Dont go to any surgical residency program where there are lots of attendings that have long term "pet" midlevels that they use as their assistants. Because when push comes to shove, those attendings are going to shun you for their midlevels.

    Its all relative. If its just one attending with that setup, then no big deal, but when you hear about half a dozen or more attendings who are not interested in training residents and prefer to use their pets, then run away. These attendings should not be affiliated with residency training programs.
     
  7. Sarcophageal

    Sarcophageal Intern

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    Well I guess that is what I really want to hear. It is scary to know that you have to "match" into a program that is supposed to fully train you. A program that you have never worked in. A program that you see for an interview. And my main goal is to be competent and skilled when I finally go out on my own. A majority of that will be my own choice, for example how much I study, how hard I work. But, I want great training.

    I realize early cases does not make you a good surgeon. I just know that "practice makes perfect." I plan doing an away rotation and applying to at least 15 programs. So, I will get some more perspective. I appreciate everybody and their input.
     
  8. SLUser11

    SLUser11 CRS

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    I don't mind you voicing your opinion, it's just your past posts parading your opinion as universal truths, which honestly you've been less prone to do recently.....

    Somebody else already mentioned this, but you will learn how to operate at most solid programs. However, the surgeon is much more than an OR technician. When making decisions about where to train, you need to focus more on the surgical curriculum/quality of teaching, rather than the number of lap choles the interns get to scrub.

    One thing that I did at each program was ask about ABSITE scores and Board pass rates. It's may not be the program's most important detail, but it can help raise a few red flags.

    Of course, there are other important things to consider as well: Geography, healthiness of the learning environment, research opportunities, fellowship opportunities, etc. It's a big bag of fun picking out residency programs. Good luck.
     
  9. DrDre311

    DrDre311 Makaveli

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    It's even more fun when you realize that, after you make your rank list, you might not get your first choice or even your first couple of choices. You spend your whole 4th year getting yourself ready for the Match, but I don't think it really hits you just how much chance is involved until you submit your rank list for the final time. It really is pretty scary. That being said, I've been really thrilled with the outcome of my match, so maybe the people who set it up actually knew what they were doing.
     
  10. SocialistMD

    SocialistMD Resident Objectivist

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    It's the most important thing, in my opinion.

    How is that any different than applying for med school? You still don't really know much about the school except what you learned on your interview, and in the end you still had to choose one school to attend. Maybe I just see it better because I went to school in Texas where you match for med school, too. I felt much more prepared for residency match than I did for the med school match.
     
  11. njbmd

    njbmd Guest
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    I came from a program where PGY-1s tended to spend most of their time on patient care as opposed to heavy OR experience. I have to say that I had no trouble scrubbing a fair number of cases and getting good operative teaching as an intern. What I found myself doing was being very proactive about getting into cases as often as possible. I literally scrubbed anything and everything that I could at every level. This led to my being able to get plenty of cases that were intern-appropriate (hernia, appys, breast biopsies, vascular access) in addition to plenty where I had the opportunity to spend time with chiefs who taught the skills that I needed to master before moving up the ladder.

    The good programs will have a healthy mix of level-appropriate cases and opportunities for patient management skill development. In addition, good programs will have attendings and chiefs who will teach and challenge medical students and junior residents to keep up with the literature, develop their operative skills and continue professional development.

    Early OR exposure is not wonderful if your patient management skills suffer. On the other hand, if mid levels are replacing you or you have become a "surgical assistant" as opposed to a resident who is attempting to develop skills, you are not going to do well in practice either. I would say that the best criteria to judge a program are the products that it produces.

    Are the graduates able to pass boards?
    Do the graduates have strong technical skills and strong patient management skills?
    Does the program offer a breadth of surgical experiences from a VA-type setting to a university-type setting?
    Does the program had a good record of resident autonomy? (Not that residents can totally take a patient to the OR independent of an attending but that residents are not used as "practice extenders").
    Does the program have a high level of didactics? How do ABSITE scores run? If there are problems, what is the remediation for residents who may be struggling?

    Whipples are great but the average general surgeon is not going to be performing them. The best general surgery programs turn out excellent general surgeons with strong patient management skills, excellent academics and excellent technical skills in an supportive environment.
     
  12. Castro Viejo

    Castro Viejo Papa Clot Buster

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    These are great questions to ask a program and ones which no one there should mind answering.

    If a program struggles to give you a straight answer or, somewhat more rarely, flip out on you because you ask the "toughy" questions, turn away and walk out the door (No, don't do that literally... As I learned, that would be a mistake...). :)
     
  13. sponch

    sponch Senior Member

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    best way to judge a program is to do a subi and check out what the residents are doing and how proficient they are clinically and technically. i'd pay close attention to the CHIEFS. they're a good litmus test of the type of resident a program trains. junior residents vary widely, especially interns and second years. i've seen r2's who were who pretty badass on the OR while others struggle with knot tying and handling of instruments, believe it or not. i've even seen some r3's that struggle with pretty routine lap choles. by the time they became chiefs, they were all pretty good...some better than others of course. there's a reason why surgery takes 5 years. it takes that long to ensure that even the least skilled resident graduating from a program is competent. who cares if interns get to do hernias and lap appes or what not.

    the question you want to answer is: if i go here, by the time i graduate, can take care of a patient circling the drain in the icu, can i make the correct decisions quickly enough in the trauma bay to save a life, can i do a big case like a whipple without inflicting horrible complications on my patient?
     
  14. kaos

    kaos Web Crawler

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    Did you really do that?? Awesome! :thumbup:
     
  15. Kubed

    Kubed Mostly Harmless

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    From the other thread: Why doesn't Castro sit down and operate? Because he doesn't want to sit on and crush his giant balls.
     
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  17. Castro Viejo

    Castro Viejo Papa Clot Buster

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    Well as I said I wouldn't recommend it, but yes, I did do that at a certain New York academic program when the PD jumped down my throat when I inquired about the program's board pass rate, ABSITE performance, and as njbmd described, what did the program do for those who performed poorly on the in service.

    He started waving his hands and saying, repeatedly and sort of mocking me, "I don't see how your question is relevant."

    So I rephrased it. Still didn't seem to work.

    "do you know how this thing works?" he asked me, referring to the timing of the boards and the in service, trying to convince me that because the boards came after graduation from residency, he couldn't answer the question of whether or not their remediation worked. That's obviously bullcrap.

    So he got annoyed with me since I had obviously struck a nerve. Said a few things about my ethnic background, hurled some racial epithet my way, and continued to verbally abuse me.

    I was post call from a rotation... I forget which and drove out there half dead from being up all night for this nonsense. He obviously wasn't going to rank me, so to give him the big F.U. Without saying it, I got up, turned around, walked out his office, and went home.

    Then I got a call from my Chairman asking me what had happened and proceeded to listen to a 30 minute over the phone butt whopping of how I was wrong.

    To this day I swap these stories with other people who interviewed there and am happy to report that he wasn't singling me out. He's just an a$$hole.
     
  18. Plastikos

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    wow, you had to be blown away with that. its amazing and unfortunate that these kind of people are still in places of power and in charge of our learning and "best interest".
     
  19. DrDre311

    DrDre311 Makaveli

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    Hilarious. That is the best thing I've ever read on this forum. I think I may have interviewed with this same guy.

    I remember being interviewed by a general surgery PD at a certain academic combined plastics program at the northern end of Manhattan and he jumped all over me because I couldn't give him an adequate answer for the existence of integrated plastics programs (apparently the answer is "no, you're wrong, it's about MONEY--what the hell is wrong with you?", not "more focused education of plastic surgeons by plastic surgeons"). This interview was seriously the single most awkward, worst interview I had out of all 22 programs at which I interviewed. The guy went on to call me a greedy bastard (not in so many words) for going into plastics and I thought about just going back to my hotel, but I guess I didn't have the ten-pound sack Castro does...I just ranked that program dead last.
     
  20. Castro Viejo

    Castro Viejo Papa Clot Buster

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    I've met about four or five other people who've interviewed with this guy and the experience has always been about the same. Sort of surreal. You just can't believe that you're at an interview for a residency position in General Surgery and that you're being called just about every bad name in the book... And then he started in on my mom. You don't talk about my mom unless you want that to be the last thing you say. :mad:

    How childish too... I mean, WTF? Maybe it was a test. I was supposed to sit there, take it, and smile. Please.

    It really isn't the right thing to do, though.
     
  21. Musashi450

    Musashi450 Member

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    Wow, this story floors me! I've been reading this thread and trying to figure out what I would do if (hopefully not when) I was in this position. Honestly I'm the type of person to sit back and grit my teeth when it comes to that type of thing but when a person is sitting their being that disrespectful to your face and chooses to be racial about it, how is politely getting up and walking away not the right answer (haha although Castro I guess you did mention giving him the big FU). Out of curiosity did you have a chance to explain the situation to your PD and what was his response?

    BTW I'm currently an upcoming MSIII and have been reading everyones informative posts for a while. Its a pleasure to finally meet everyone. I hope everyone realizes that the advice on this board is greatly appreciated by those of us that don't speak up that often.
     
  22. MediCane2006

    MediCane2006 Living the dream
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    Haha, I totally interviewed with this guy too. I was so startled and taken aback that I didn't know what to say....then I got annoyed. The entire interview was pretty tense. I didn't rank that program, and I'd be surprised if they ranked me.

    Whatever, their loss....
     
  23. DrDre311

    DrDre311 Makaveli

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    Cane, weird, we have the same birthday.
     
  24. balaguru

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    Why the general reluctance to share the name of the program or interviewer? Hell, I would. Maybe partly as an f.u. but more so, so applicants don't waste their time. Especially, if there are issues with board pass rates that they don't seem to want to address. I remember asking the chairman at Minnesota about their low pass rates and while it was a bit uncomfortable I was satisfied that they acknowledged it and were doing something tangible about it.

     
  25. DrDre311

    DrDre311 Makaveli

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    I hate to badmouth an entire program just based on my n = 1 personal experience. It could have been because they were #22/22 on the trail for me.

    Seriously though this PD was a total a-hole and I hated that program.
     
  26. balaguru

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    True, but it seems that there were n >> 1 re: the guy that Castro was talking about. Maybe I'm being naive but I think the average reader on this forum understands a single negative comment about a program shouldn't keep them from applying but when there are as many "me toos" as suggested above they might want to consider cancelling that 22nd of 22 interviews and putting that plane/hotel fare to better use.

    We probably don't think twice about sharing our n=1 negative comments with colleagues in person but seem to shy away from putting it in print here, a practice which is probably more subject to bias as there's a greater chance of finding information to support or refute the comment on a public forum.

    Maybe I just don't have the sense to see how this might come back to bite me in the arse but if I was witness to something as crazy as what has been described here I would share it ... with names and places.

    I mean, come on .... racial slurs?

     
  27. Castro Viejo

    Castro Viejo Papa Clot Buster

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    Been there, done that, my friend. And I've been burned... Which sort of partly explains a lot when I reflect on things.

    Despite my use of "Castro Viejo" on SDN, a good handful of people still know my true identity. Secondly there's enough PDs who roam around SDN, as does the American Board of Surgery and its agents (yeah, really, trust me on this one...) that every comment is being watched.

    They can't truly fault you for saying stupid things about other stupid things, but to mention a program or interviewer by name based on my personal experience, wouldn't actually be fair. It could also be libel/slander and all that other good stuff.

    And I don't need to burn any bridges, quite honestly. General Surgery is a small enough community in the New York area that pretty much everyone knows everyone else's business, so most people who hear this story know exactly who and what program I'm talking about.

    And, as for others who might shy away from that program's interview invitation just because of what I write here, well, I doubt that would seriously happen.
     
  28. Castro Viejo

    Castro Viejo Papa Clot Buster

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    I was once like this. One day you'll see it too.

    Yes, they (racists) still exist in the United States.
     
  29. njbmd

    njbmd Guest
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    Absolutely agree and when you encounter this in something like residency, you think that you have landed in a time warp. Even though I did residency in the "old south", I rarely, if ever, encountered overt racism there. When I moved to the midwest, where I am currently, I was totally shocked at the overt racism and sexism.

    It's out there folks and all you can do is try not to get caught up in the "buzz saw" because training is stressful enough without feeling that you have to "battle" on a daily basis. I have learned much over the past year and I seen many good examples of how I DO NOT want to be as a physician.
     
  30. sponch

    sponch Senior Member

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    castro, did u get black listed in the match?
     
  31. Castro Viejo

    Castro Viejo Papa Clot Buster

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    I did match. Not quite my first choice of programs, but it all worked out in the end.
     

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