Surgery

[TheDBird90]

I tried searching but couldn't find an answer, so I'm curious. Does every surgeon have to go through a residency in General Surgery before they specialize in a fellowship? Like otolaryngology, for example, I've heard there's a residency for that in itself. I guess I'm confused - some surgical specialties make you go through General Surgey residency and others don't, right?

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[slippydubloons]

some surgical specialties make you go through General Surgey residency and others don't, right?

this. otolaryngology has its own residency, plastics has its own residency, vascular, urological surgery isn't through the gen. surg. track etc.
i do think some of the specialized residencies do, however, require you to do one year of a general surgery internship (neurosurgery comes to mind but i may be wrong)

 

[Go_Pokes_11]

To answer your proposed example, ENT would be one year in general surgery residency and four years in ENT residency.

Source: http://www.entnet.org/content/what-otolaryngologist

 

[stickgirl390]

Anyone know how residency works for pediatric surgery?

 

[gyngyn]

You can find the recognized Boards here: http://www.abms.org/member-boards/
If you go to the main board site, you will see the sub-specialty boards associated with each general specialty.

 

[LilKangaroo]

Anyone know how residency works for pediatric surgery?

You do a pediatric surgery fellowship after a general surgery residency.

For now.

 

[LilKangaroo]

To answer your proposed example, ENT would be one year in general surgery residency and four years in ENT residency.

Source: http://www.entnet.org/content/what-otolaryngologist

Not entirely true. You are always in an ENT residency, but your first year curriculum has a general surgery focus (working on general surgery services) while the rest of your curriculum is more or entirely ENT focused.

An ENT department will always be responsible for paying, scheduling, and evaluating their own residents, who will work for other surgery services as part of their curriculum.

 

[stickgirl390]

You do a pediatric surgery fellowship after a general surgery residency.

For now.

For now?

 

[NeuResurgens]

Isn't it somewhat program dependent? Like some surgical subspecialty programs have you do 1 year gen surg and then the rest of the time is the subspecialty, whereas others just have you jump straight in? That's how I thought it was..

 

[WedgeDawg]

The surgical residencies are as follows:

General Surgery - 5 years
Otolaryngology (ENT) - 5 years
Urology - 5 years
Orthopedic Surgery - 5 years
Ophthalmology - 5 years
Plastic Surgery - 5-6 years
Neurosurgery - 7 years

The following are fellowships after completing a general surgery residency: (cardio)thoracic surgery, breast surgery, vascular surgery, pediatric surgery, colorectal surgery, transplant, hepatobiliary surgery, surgical oncology, and a few others.

Now, a few of these, notably cardiothoracic and vascular surgery, have integrated programs where instead of doing the 5 (residency) + 2 or 3 (fellowship), you do a 5 year vascular surgery residency or 6 year cardiothoracic surgery residency, but you don't get certification in general surgery as well, which has pluses and minuses. However, these spots are generally limited and highly competitive.

 

[LilKangaroo]

For now?

Most surgical subspecialties were originally fellowships after a general surgery residency. More and more of these specialities are becoming "integrated" or a direct path. I don't think it's unreasonable to think that someday pediatric surgery will be its own residency.

 

[LilKangaroo]

Isn't it somewhat program dependent? Like some surgical subspecialty programs have you do 1 year gen surg and then the rest of the time is the subspecialty, whereas others just have you jump straight in? That's how I thought it was..

The curriculum is somewhat program dependent (ACGME rules require certain experiences) but you don't have one year as a general surgery resident and then match again into ENT. You will always be an ENT resident in an ENT residency that may or may not have a general surgery rotations in the curriculum.

Some specialities, such as radiology and anesthesia, you might have to match into a 1 year residency [called preliminary (prelim) years or transitional years] as well as your actual residency (the other option is a categorical year through your main residency). Prelim surgery years are generally not for people actually going into surgery (unless they didn't match into their desired field).

That being said, you can match into general surgery and try to get a PGY-2 slot at an ENT program. This is a much harder path, but not uncommon (but still not the norm, nor is it required).

 

[NeuResurgens]

The curriculum is somewhat program dependent (ACGME rules require certain experiences) but you don't have one year as a general surgery resident and then match again into ENT. You will always be an ENT resident in an ENT residency that may or may not have a general surgery rotations in the curriculum.

Some specialities, such as radiology and anesthesia, you might have to match into a 1 year residency [called preliminary (prelim) years or transitional years] as well as your actual residency (the other option is a categorical year through your main residency). Prelim surgery years are generally not for people actually going into surgery (unless they didn't match into their desired field).

That being said, you can match into general surgery and try to get a PGY-2 slot at an ENT program. This is a much harder path, but not uncommon (but still not the norm, nor is it required).

Gotcha. The situation I bolded here is the arrangement I had heard of, I believe.

 

[LilKangaroo]

Gotcha. The situation I bolded here is the arrangement I had heard of, I believe.

It comes down to the philosophy of the program. Some programs still believe that their residents should learn general surgery skills before practicing in their own specialty (like many academic faculty had to do back in the day - "we don't want to have to teach them how to be surgeons") while others know a lot of those skills will be lost when they specialize so why even learn them anyway ("I basically had to forget everything I learned from my general surgery residency when I started my fellowship").

 

[NeuResurgens]

It comes down to the philosophy of the program. Some programs still believe that their residents should learn general surgery skills before practicing in their own specialty (like many academic faculty had to do back in the day - "we don't want to have to teach them how to be surgeons") while others know a lot of those skills will be lost when they specialize so why even learn them anyway ("I basically had to forget everything I learned from my general surgery residency when I started my fellowship").

Interesting. I think another situation I had heard of was neurosurgeons receiving some gen surg training in their first year. Some of them use those skills for international opportunities like MSF, where neurosurgical skills might not have been as in demand to treat some ailments in third world countries whereas gen surg skills were more helpful IIRC.

 

[LilKangaroo]

Interesting. I think another situation I had heard of was neurosurgeons receiving some gen surg training in their first year. Some of them use those skills for international opportunities like MSF, where neurosurgical skills might not have been as in demand to treat some ailments in third world countries whereas gen surg skills were more helpful IIRC.

Yeah, I think it's pretty rare to find a program without some general surgery exposure. Granted, I only really know from a plastics perspective, but I would have to assume other surgical subspecialties are the same.

 

[WedgeDawg]

Interesting. I think another situation I had heard of was neurosurgeons receiving some gen surg training in their first year. Some of them use those skills for international opportunities like MSF, where neurosurgical skills might not have been as in demand to treat some ailments in third world countries whereas gen surg skills were more helpful IIRC.

Yes, neurosurgery interns get 3-6 months (I think usually 6) on a general surgery service during their first year, but it's generally perioperative management experience. Neurosurgeons generally do not do things like MSF because they don't have highly in demand skills in locations without sufficient technology and infrastructure to support neurosurgery. Most neurosurgical diseases are not diseases that are widespread in populations that lack this type of infrastructure. The most helpful surgical skill in areas where MSF operates is the ability to perform a C-section.

 

[NeuResurgens]

Yes, neurosurgery interns get 3-6 months (I think usually 6) on a general surgery service during their first year, but it's generally perioperative management experience. Neurosurgeons generally do not do things like MSF because they don't have highly in demand skills in locations without sufficient technology and infrastructure to support neurosurgery. Most neurosurgical diseases are not diseases that are widespread in populations that lack this type of infrastructure. The most helpful surgical skill in areas where MSF operates is the ability to perform a C-section.

Great insight, thanks for clarifying that!

 

[gamieg]

just to add another data point, endocrine surgery = 5 years general + 1 year fellowship.

 

[WedgeDawg]

just to add another data point, endocrine surgery = 4 years general + 1 year fellowship.

Shouldn't you still need the 5 years of general surgery residency (including intern year which is generally not going to be separate)?

 

[mimelim]

Shouldn't you still need the 5 years of general surgery residency (including intern year which is generally not going to be separate)?

Yes. Endocrine is 5+1.

 

[gamieg]

Shouldn't you still need the 5 years of general surgery residency (including intern year which is generally not going to be separate)?

sorry, typo! fixed