programs which let you opperate without staff

[slingblade]

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I am looking for programs that let you opperate the most as a resident without staff. I've heard of some programs where you watch alot of surgeries, but always have to have staff in the room, or even as a 5th year, where staff does alot of the case. There are also other programs where the residents run alot of the service and they get to do whole cases by themselves, or with only other residents helping?

 

[ExtraCrispy]

The ward service at MGH allows this.

 

[Pilot Doc]

As of several years ago, Wake Forest had a chief's service as well.

Most VA's allow high resident autonomy.

And as a general rule, seek out uninsured, low socioeconomic status patients who are receiving basic surgical care (e.g. trauma, lap chole; not whipples) and the autonomy will follow along.

That having been said, those opportunities are fast disappearing b/c not having staff in the room generally = not billing for the case. The places that can afford to give up that billing are few and far between.

 

[Jocomama]

You don't want extremes.
Any program with a County and/or VA is a good bet. However, you also want to make sure you have a 3 month stint at least JR and Sr level with some private guys - otherwise you won't really know what you are doing.

I was at MCO years ago - said it was a mediocre program (graduated 1993) - but I was trained by private practice AND university - we did NOT have a VA nor county. We rotated at Denver Childrens with the Colorago group - the residents at Denver were supposed to be the best- I managed cases as well if not better than they did. Oh, sure they had independent operating - but didn't mean they did it right.

Look for a good mix. Because it only takes a few cases on the other side to realize the golden rule -
IT IS NOT HOW YOU OPERATE; YOU CAN TEACH A MONKEY HOW TO DO SURGERY. IT IS ABOUT WHEN AND WHEN NOT TO OPERATE.

Good luck

I am looking for programs that let you opperate the most as a resident without staff. I've heard of some programs where you watch alot of surgeries, but always have to have staff in the room, or even as a 5th year, where staff does alot of the case. There are also other programs where the residents run alot of the service and they get to do whole cases by themselves, or with only other residents helping?

 

[Surgeon24]

YOU CAN TEACH A MONKEY HOW TO DO SURGERY.

BS! I've never seen a monkey stand in the same spot for more than 2 minutes.

 

[Playmakur42]

x

 

[Tenesma]

fyi: the ward service at MGH requires an attending surgeon be present... albeit they call the attending a super-chief, but that person is nonetheless finished with their training...

 

[Winged Scapula]

fyi: the ward service at MGH requires an attending surgeon be present... albeit they call the attending a super-chief, but that person is nonetheless finished with their training...

JCAHO requires an attending be present. Of course, the ORs will define "present" in different ways - from being in the room, to being "available" - whatever that means.

Its much more uncommon these days to have residents operating without the attending, even at the Chief level. The supervision has increased, probably not suprisingly, as the malpractice and public overview of the situation has increased.

 

[boston]

JCAHO requires an attending be present. Of course, the ORs will define "present" in different ways - from being in the room, to being "available" - whatever that means.

Its much more uncommon these days to have residents operating without the attending, even at the Chief level. The supervision has increased, probably not suprisingly, as the malpractice and public overview of the situation has increased.

You know, I wonder if the operative training for our generation of residents is as good as those of the olden days. I finished my PGY-3 year at a top-heavy academic hospital and I question if my operative experience is adequate. I've found that the few times that the attending wasn't in the room to watch over my shoulder and I was allowed to do the majority of the case independently was enormously educational. But I can count these experiences on one hand. It sure is different when the attending is there to assist, expose, or set up the next step to keep it moving along. I often find myself making such slow progress or being hesitant and unsure about the next move when the attending steps out. I wonder if I will be truly ready to operate independently at the end of my residency.

What do you all think? Any attendings care to comment on the operative preparation of recent grads compared to older grads?

 

[Winged Scapula]

You know, I wonder if the operative training for our generation of residents is as good as those of the olden days. I finished my PGY-3 year at a top-heavy academic hospital and I question if my operative experience is adequate. I've found that the few times that the attending wasn't in the room to watch over my shoulder and I was allowed to do the majority of the case independently was enormously educational. But I can count these experiences on one hand. It sure is different when the attending is there to assist, expose, or set up the next step to keep it moving along. I often find myself making such slow progress or being hesitant and unsure about the next move when the attending steps out. I wonder if I will be truly ready to operate independently at the end of my residency.

What do you all think? Any attendings care to comment on the operative preparation of recent grads compared to older grads?

I'm sure most will agree that it has suffered since the 80 hr workweek was enforced.

 

[dawg44]

I will never mention where I went on the internet but I wouldn't give anything for the operative experience I recieved. We did a ton of volume at my hospital and typically every time an attending had cases he had two rooms. You would pick and choose the cases you wanted and most of the time they never washed their hands. They were available if you got into any trouble but most of the time you worked on getting better and better and more efficienct until the last 6 months you rarely took any cases from a junior. To do that though the gave guys alot of experience early on in your PGY 2 and 3 so they could trust you as a chief.

 

[Fah-Q]

I'm sure most will agree that it has suffered since the 80 hr workweek was enforced.

The 80 hour work week has nothing to do with autonomy.

Increasing attending presence has nothing to do with education or improving patient care and everything to do with reimbursement. We, as the next generation of surgeons, will suffer and ultimately the patients will suffer. We will not be as prepared as those before us.

Resident training has definitely changed. However, in the world of surgery I think the decrease in resident autonomy has just as much effect as the 80 hour work week.

 

[Winged Scapula]

The 80 hour work week has nothing to do with autonomy.

No one said that it did. My post stating that most would agree that it has changed since the 80 hr workweek, was in reponse to the query above which asked, "You know, I wonder if the operative training for our generation of residents is as good as those of the olden days." I stand by my statement in response to that question. Most attendings will agree and the research substantiates, that residents now have fewer cases by their Chief year and less OR time, and they believe that it means we are less skilled. Many will go on to say, however, that the first years out in the working world are difficult anyway, and they have no doubt that residents graduating these days will pick up the skills they need once in practice.

I agree; I think we are nowhere as prepared as our predecessors and wonder whether or not the interest in fellowship will increase as those amongst us feel less prepared?

 

[Winged Scapula]

I will never mention where I went on the internet but I wouldn't give anything for the operative experience I recieved. We did a ton of volume at my hospital and typically every time an attending had cases he had two rooms. You would pick and choose the cases you wanted and most of the time they never washed their hands. They were available if you got into any trouble but most of the time you worked on getting better and better and more efficienct until the last 6 months you rarely took any cases from a junior. To do that though the gave guys alot of experience early on in your PGY 2 and 3 so they could trust you as a chief.

That was the experience that the surgical subspecialty residents had at my program. It was not unusual to see one of the ENT attendings "running" 3 rooms at a time and to go into one of the rooms and see only a senior resident and one of the juniors operating. Other subspecialty residents would be sent to the general rooms for intraoperative consults, to put in ureteral stents, etc. by themselves. I'm not sure how JCAHO would view this - can you effectively "run" 3 rooms at a time as an attending? I'm not sure you can.