Surgery in Family Medicine

[drwatson]

Hello - I'm sure this gets touched on every few months but a quick search didn't show much.

My question is, what is the purpose/goal of having family medicine residents spend 2-5 months of a 36 month residency working on a general surgery floor. I can see how that might have been beneficial in the past but I can't imagine any family doctor getting operating privledges at a local hospital. Is it to learn how to do a proper I&D and suturing? Presurgical evaluation and management?

It seems with so much knowledge to "master" that any more than 2 months of surgical training would take up time that could be better spent on another service (ie. GYN, Peds, IM, Psych).

Any thoughts on this from residents and those in practice would be appreciated.

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[medmom]

Although I have not even started med school yet I beleive I can answer this. I think it is because you never know which of the residence will go into rural practice, sometimes very rural. Where I grew up and my mother in law was a FP doc, we were 45 minutes to an ER and 90 minutes to a major hospital. Therefore, there were times when the FP had to do minor "surgeries" that they wouldn't ordinarily do. Sometimes just enough to get to the hospital. Therefore it is the responsibility of the residencies to train docs that are competent if they are without a surgeon. As well, with only one general surgeon in the county it wasn't uncommon for the FP to do things like hernias.

 

[sophiejane]

Some programs are now including surgical specialties, particularly colorectal and endoscopy, in the required 2 months. That way you can get experience with scopes, etc. if you want them.

 

[elizabeth5863]

Hello - I'm sure this gets touched on every few months but a quick search didn't show much.

My question is, what is the purpose/goal of having family medicine residents spend 2-5 months of a 36 month residency working on a general surgery floor. I can see how that might have been beneficial in the past but I can't imagine any family doctor getting operating privledges at a local hospital. Is it to learn how to do a proper I&D and suturing? Presurgical evaluation and management?

It seems with so much knowledge to "master" that any more than 2 months of surgical training would take up time that could be better spent on another service (ie. GYN, Peds, IM, Psych).

Any thoughts on this from residents and those in practice would be appreciated.

The reason why it's required is because, as family physicians, we would be consulted by surgeons to do pre-op evaluations on pts. By going through surgery rotations, we'll know what our surgery colleagues view are important in their field. Also, many of our pts will come to us for their post-op care. In surgery, we'll learn about the surgical emergencies and know when to refer pts (i.e. acute abdomen). Surgery rotations are also a good place to refine physical exam skills -- evaluating hernias, breast lumps, testicular masses, prostatic enlargement, etc. In rural communities, the family physician may be needed by the general surgeon to assist in surgeries.

I do agree that spending too much time in surgery is a waste. 2-3 months is fine but beyond that, it's not as helpful to me. I have had enough of surgery in medical school and hate being in the OR. I'd rather be in surgery clinic; I think that would be more helpful in providing good care for pts.

Hope that is helpful. Good luck!

 

[raptor5]

I have never seen a residncy with 5 months of General Surgery. What I have seen is 1 month on General Surgery, 1 month of ambulatory/outpatient/office surgery, 1 month of Ortho, and an additional 2 weeks each of Urology, Ophthalmology, and ENT.

 

[lateness]

I have never seen a residncy with 5 months of General Surgery. What I have seen is 1 month on General Surgery, 1 month of ambulatory/outpatient/office surgery, 1 month of Ortho, and an additional 2 weeks each of Urology, Ophthalmology, and ENT.

i think there are places, ventura in cali for one

plus u can do ur electives too in surgery i suppose..

 

[deleted87716]

The utility of your general surgery rotations in residency is hugely dependent on who you work with.

I did mine with a laid-back guy who let me do the things that I wanted to do (suture, lumps & bumps, a few 'scopes, etc.) and didn't scut me or make me go to the OR and hold retractors on one repetitious case after another. I also helped him a lot in clinic with post-ops, doing wound care and that sort of thing. Overall, I thought it was pretty helpful.

 

[Faebinder]

Internal medicine do preops and you dont see them rotating 1 month in surgery.

I think 1 month of surgery is a waste of time.... Everyone learns to take care of abscesses in the ER rotations and previous experience in med school... if not then they will see it done in regular family medicine clinic. Suturing... can be learned in the ER/ortho/GYN.

On the other hand, 1 month of colorectal or gastroenterology is for scopes is very necessary...

 

[deleted87716]

Internal medicine do preops and you dont see them rotating 1 month in surgery.

IM residents usually don't do much in the way of procedures, other than lines...and it's becoming more commonplace to consult surgery for those, too. This is program-dependent, of course.

I think 1 month of surgery is a waste of time

It's two months, actually, and it's required by the ACGME.

Everyone learns to take care of abscesses in the ER rotations and previous experience in med school

Most med students don't have a great wound care or procedural experience, although there are always exceptions. In the ER, you're typically sticking a knife in it and slapping a band-aid on it (literally, in many cases) and telling the patient to follow up with their PCP. You don't get to see how these things resolve over time (or not), and you don't get to do any excisions or biopsies, which are bread-and-butter FM.

if not then they will see it done in regular family medicine clinic.

Not necessarily in volume, and usually not lots of cases back-to-back. That's the best way to hone your skills.

Suturing... can be learned in the ER/ortho/GYN.

No disrespect intended, but lots of the suturing that I've seen done in the ED and by OB-gyns is gawdawful. If you want to learn to suture the right way, learn from a surgeon.

1 month of colorectal or gastroenterology is for scopes is very necessary.

It helps, but you'll probably get to do more 'scopes on GI.

 

[sophiejane]

It helps, but you'll probably get to do more 'scopes on GI.

Depends on the program. The one I'm rotating at right now offers a month of colorectal surgery as part of the 2 month surgery requirement and residents are averaging 60 scopes for the month.

Not bad.

 

[deleted87716]

Depends on the program. The one I'm rotating at right now offers a month of colorectal surgery as part of the 2 month surgery requirement and residents are averaging 60 scopes for the month.

Not bad.

Pretty awesome, actually.

 

[elizabeth5863]

No disrespect intended, but lots of the suturing that I've seen done in the ED and by OB-gyns is gawdawful. If you want to learn to suture the right way, learn from a surgeon.

That is so funny!
(Not funny for the patient, of course).

 

[sophiejane]

Pretty awesome, actually.

I know...and that's not all...

Spoke to a 3rd year here recently who has logged ~ 500 deliveries, half of them sections, and half of those he was primary.

Now, granted, he did an extra OB month as an elective and a month of surgical obstetrics, and also lives a block from the hospital and has the OBGyns page him for sections, and he'll run over and scrub in. Obviously, a guy who knows what he wants out of residency!

This is throwing a huge wrench into what I thought was a done deal as far as my #1 is concerned, by the way. Seems I might be able to actually have everything I'm looking for...at the cost of living in a less-than-fabulous location (but still close enough so family issues don't arise), which I'm pretty sure I can deal with for 3 years.

Stay tuned....!

 

[raptor5]

Gotta be Waco? I think it is a great location but I am obviously in the minority.