You did a whipple or a big liver whack or a low anterior resection and your attending at the time never scrubbed in?
You obviously didn't read what I wrote because at no time did I state that I was doing LARs or liver resections without an attending.
If you were doing complex cases alone as a pgy-3 with no attending supervision, then the patients were getting poor care. Where I trained, the pgy-3 generally did hernias, breast, amputations, appies, choles, hemorrhoids, ostomy takedowns, and lines without an attending scrubbed/in the room. However, complex cases like pancreas, liver, colon cases other than a right hemi, transplant cases, thoracic cases, and vascular cases all had the pgy-3 with an attending, or a chief resident. There is simply no way that one can become skilled enough to approach best-care status by the pgy-3 year to be performing complex cases independently, and safely. You may want to clarify your statements lest someone think that your academic training program is providing unsafe, sub-standard surgical care.
At no point in my previous post, did I state that I was doing complex cases alone with no attending. Hepatobiliary and Colorectal were not services that utilized PGY-3 residents as chiefs.
As a PGY-3, most of the cases that I performed were hernias, appys, choles, simple amputations and other more simplier cases. The attending was in the room, often not scrubbed but could scrub if necessary.
The other thing that you have to consider is that at my program, research years were done between PGY-2 and PGY-3 which meant that at the PGY-3 level, most of us were in our 4th year of residency (two clinical years and two research years) and had been able to scam plenty of the more junior resident cases while we were doing research so that we were pretty skilled.
As JAD stated above, no resident was allowed to enter a case without having pre-read the case. No attending would allow a resident to operate without the attending scrubbing if they were not totally comfortable that the resident was able to do the case.
Cases like LARs, APRs, hepatobiliary procedures were done by PGY-5s. A PGY-3 could scrub a more complex case but they were more "learners" than "doers" on these cases. However, lots of good experience can be gained by holding a retractor. I scrubbed plenty of APRs, LARs and other complex cases as a junior resident to get experience and to see anatomy. If something good was going, I was there to get a hand in it. While I couldn't claim the case, I could get the benefit of the operative experience and the wisdom of handling complications from the attending as they taught during the case. All in all, not bad experience for a junior resident.
Also, as a junior resident, you were not allowed to scrub a complex case with a fellow/attending unless you had pre-read, explained the case to the attending and knew the important surgical anatomy. That was just part of the heavy emphasis on teaching that my program expected of the attending staff. Again, residents were not assistants and were expected to get something out of every case that they scrubbed and I made sure that I did. That "deliberative observation" was some of the best learning that I experienced.
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