Question about surgery residencies

[MadScientist95]

Hey guys, serious and yet simple question here. I am considering going into general surgery and have always heard that some residencies are better than others (obviously making them more competitive). My question is what makes surgical residencies different from others? If they are all ACGME accredited now, doesn't that theoretically mean no matter where I would go, I would receive the same standard of training as any other ACGME accredited residency?

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[mikeGR]

ACGME works to establish minimum standards and IMHO they do a relatively solid job at that. This is one of the major reasons that I moved to the US for training - in Europe, there is great variation in training, from excellent to inadequate (even among different programs in the same hospital).

Once programs adhere to the minimum ACGME/ABS standards, they can customize the residency training as they see fit. Thus there can be significant differences in the training. Some programs focus on academics (i.e. research), other programs focus on clinical excellence, and others just have residencies for administrative reasons. Even in the clinical aspect, the residency is 5 years for everyone and there is a lot of ground to cover, so if a program is super strong in i.e. HPB surgery because the residents spend 6 months on the service, they are getting less experience in another field of general surgery. There is no program that is perfect in everything, and usually, if a program is a leader in one aspect, it trails behind in other aspects. You have to decide what's most important to you and then figure out what (type of) program would be the best fit.

Good luck!

 

[Dr.LeoSpaceman]

Hey guys, serious and yet simple question here. I am considering going into general surgery and have always heard that some residencies are better than others (obviously making them more competitive). My question is what makes surgical residencies different from others? If they are all ACGME accredited now, doesn't that theoretically mean no matter where I would go, I would receive the same standard of training as any other ACGME accredited residency?

This is a loaded question.

The short answer is: "No, they aren't all the same." The ACGME mandates specific requirements for a program structure, and the ABS has specific case requirements. But there is still significant variability within those requirements.

But there's also quite a bit of nuance involved. It's much easier to work backward to explain the difference if you define the goal more specifically. For example, not all programs would prepare you the same to directly enter a solo community/rural surgery position, just like others won't prepare you to compete for highly competetive fellowships followed by an academic surgical practice. And unfortunately, there relatively few places able to accomodate both of those goals.

But I do think that, in general, if you complete residency and pass the boards you can be a "safe" surgeon.

 

[dienekes88]

Hey guys, serious and yet simple question here. I am considering going into general surgery and have always heard that some residencies are better than others (obviously making them more competitive). My question is what makes surgical residencies different from others? If they are all ACGME accredited now, doesn't that theoretically mean no matter where I would go, I would receive the same standard of training as any other ACGME accredited residency?

Different residencies have different quality teachers, different case mixes, different strengths, etc.

At some places, you get really great mentorship and are on the right side of the table operating. At other places, you scrape by with just the bare minimum for cases.

 

[ACSurgeon]

Also, you get out of residency what you put into it.

 

[AnatomyGrey12]

So these are my observations from going through the interview process right now and having interviewed at a variety of program types. Definitely listen to people ahead of me more, but this is what I've seen so far.

Traditionally people put programs in 3 bins: University Academic, Communiversity Hybrid, and pure community. Reality is that it's not bins so much as it is a continuous spectrum. There are some university programs that heavily emphasize research and putting people into academic careers, while others might actually be clinical powerhouses who operate more than the local community program and don't care about how much research you do.

What makes programs different or "better" is more in the eyes of the applicant than anything else, because the ACGME requirements are simply a bare minimum and there is a LOT of variation after you hit those requirements that allow people to customize according to their career goals. As you look at programs think about where you personally are trying to get to and whether or not that program fits what will best get you there. Like don't do a 7 year academic program with built in research years if you want to work as a community general surgeon just because it's a big name. In my experience the prestige of the program isn't really tied to the actual training quality, but more the specific career tracks of its graduates. Also there is no perfect program, all of them have some form of pros/cons to weigh and mull over.

tldr. Find out what your goals are, and then look at programs from that angle, and ask people ahead of you what programs they have a high opinion of. The more people you ask the better picture you'll get about which programs are known for what.