Procedural training?

[DDuncan]

I am a 3rd year student, currently in the investigating phase of residencies.

I would love to hear of anyone's experience with, or knowledge of FP residency programs with a heavy empasis on procedural training. I am primarily interested in finding programs which offer training in:

colonoscopy,
egd,
colposcopy,
treadmill testing.

Having FP faculty (other than or in addition to specialists) that teach these would be a plus.

It seams many (most?) programs say that these are "available" or possible - I would like to find programs where this is the norm, and not out of the ordinary.

I am primarily interested a program in the midwest, but would like to hear of any information on other programs.

--Derek

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[UHS2002]

If you are interested in a "procedures heavy" FP residency, you should do a sub-I at Via Christi Family Practice Program in Wichita, Kansas. It is affiliated with the Unversity of Kansas School of Medicine - Wichita.

This is an unopposed program, with clinics and rotations at two Wichita hospitals: St. Joseph and St. Francis, with a combined # of beds at about 1,400, with a Regional Trauma Center and Level III NICU.

Strong didactics, high volume services. Lots of procedures. High volume obstetrics with all residents qualified to do c-sections at the end of the program (numbers at graduation are aprox 50 c-sections as surgeon and 250 vaginal deliveries). You will be well trained and experienced in colpos, endometrial biopsies and D&C's. Also trained in colonoscopies and EGDs, although it is not always easy to get to the magic 100, which is the number you need for hospital privileges to do colonoscopies at most places. I estimate that you can easily get about 50 done without going out of your way, the rest you can get done with a little extra effort. Plus TONS of the small bread and butter FP procedures: circs, lesion removal, lac repairs, casting, etc.

Good benefits and a liveable call schedule, with 5-6 calls per month, since this is a large program, with 18 residents/year. When you are on call, you work hard, but you also have 2 weekends off/month guaranteed. You are on your pager 24/7 but you can always find a kind soul who is on call at the hospital anyways to take your pager when you need a brake.

Excellent full time faculty. Excellent benefits. Good camarederie among residents. Competitive program.

Fell free to e-mail me if you have questions.

 

[doccsg]

Go to John Peter Smith Hospital in Fort Worth, TX. You'll get all the procedures you want . No one else comes close. 817-927-1200 Talk to Dr. Baumer the Dept. Chair and Residency Director

 

[secretwave101]

I'm curious about the Ft. Worth program. Can you, or anyone else who had been in the program, talk about the hours, atmosphere, teaching etc? I'm looking mostly for a typical Scutwork review, if possible.

I read that it is the largest FP residency in the country with 27 doctors/yr. Does this present a problem, with everyone elbowing in for procedures etc? Are you able to interact well with attendings, or is it easy to be forgotten because of all the people?

Also, in terms of procedures, what about basic surgery stuff like appy's and gall bladders. Most FP programs claim to prepare you for rural medicine, and then give training in procedures that require some pretty sophisticated technical equipment (stuff you won't have in very rural places). I'm looking for somewhere that gives a good amount of basic surgical experience.

I know that's alot! Anything you want to answer would be helpful.

Geoff

 

[droliver]

Originally posted by secretwave101
Also, in terms of procedures, what about basic surgery stuff like appy's and gall bladders. Most FP programs claim to prepare you for rural medicine, and then give training in procedures that require some pretty sophisticated technical equipment (stuff you won't have in very rural places). I'm looking for somewhere that gives a good amount of basic surgical experien

Geoff,

I certainly would not characterize a cholecystectomy as a basic surgical procedure that you would tackle with limited surgical training, you can kill somebody pretty quick (by lacerating or avulsion of the cystic/hepatic arteries or the hepatic veins/vena cava) or cause a lifetime of future complications (by injuring the CBD). You might have the wrong impression of the procedure if all you've seen are 15 min. laparoscopic ones on acalculous dz.patients. This subject re. operative procedures was addressed before on another thread here & I made the point that there is nowhere in the United States today that you can't get to a general surgeon in a timely fashion to operate on appendicitis or cholecystitis. If you were in one of these implausible scenarios where transport out was not possible, your best option for those two processes would be antibiotics & maybe a cholecystostomy tube placement for drainage rather than an emergent cholecystectomy. Neither of these two operations tend to be truly emergent (they tend to evolve over hours or even days sometimes). The skills needed for true emergencies that could be learned by FP docs I think are are emergent c-sections , temporary decompression of a intracranial bleed by drilling a hole in the temporal bone, cricothyroidotomy, IABP placement for transport, and chest tube placement. I think trauma laparotomies & thoracotomies are prob. not feasible to get trained in.

 

[womansurg]

Originally posted by secretwave101
Also, in terms of procedures, what about basic surgery stuff like appy's and gall bladders. Most FP programs claim to prepare you for rural medicine, and then give training in procedures that require some pretty sophisticated technical equipment (stuff you won't have in very rural places). I'm looking for somewhere that gives a good amount of basic surgical experience.

Man, stuff like this just scares the bejeezus out of me. droliver is exactly right - there's no legitimate indication for an untrained person to conduct these procedures in this country.

Geoff, basically, you want to be in an FP program which has no competing residencies, especially IM.

Grant Medical Center in Columbus, Ohio has an excellent program. Since the FPs are the only residents, they do all procedures - chest tubes, intubations, central lines, arterial lines, pulmonary artery catheters, lumbar puncture, thoracentesis, pericardiocentisis, run all the codes, and so forth. They also do all the ob/gyn, which is a busy service. It's a Level I trauma center and has surgery residents rotating there, as well as it's own Fellows in Trauma and Colorectal, but the general patient population belongs entirely to the FPs.

Gool luck!

-ws

 

[doccsg]

JPS in Fort Worth has few other competing residents. You will do lots of OB including C/S (at least 100 deliveries your 1st year), chest tubes, intubations, central lines, LPs, endoscopy (EGD and colons), lots of minor surgical procedures. You will get great training in ICU, IM, ER. You will be well prepared for rural practice.


For GBs and appys do the fellowship in Lousiana after residency.


Call and check it out.

 

[doccsg]

Just reread your question.

You will work your butt off. Lots of hours - lots of call. Lots of responsiblity. The teaching is good. If you are looking for great training AND a great lifestyle then wake up - you are dreaming. The training comes at a price. You gotta work. Can't learn it all and be home by 5.

 

[secretwave101]

Thanks for the info doccsg. Many of the replies to my question have been more opinions than anything else, which were not very helpful.

No too worried about the hours. Willing to frequently work 80, unwilling to go over 100 regularly. Got a family, this is the line for me.

Can you give me any other info on the fellowship? The name of it, or the school/hosp?