Surgical numbers

[smq123]

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In looking at APGO's residency directory, I'm finding myself getting more confused. I have two questions:

1) What are some traditionally gyn and gyn-onc heavy programs? I'm interested in gyn-onc, but I'm not comfortable with the programs that have minimal gyn-onc exposure before your chief year.

I like the OB part of OB/gyn too - really enjoyed delivering babies - I'm not just in it for gyn onc. But I'd like to be at a program that will give me more exposure and experience in the OR before I start thinking about doing a fellowship.

2) What are "good" surgical/delivery numbers? I don't know what kind of numbers I should be looking for.

Thanks very much!

 

[nykka3]

In looking at APGO's residency directory, I'm finding myself getting more confused. I have two questions:

1) What are some traditionally gyn and gyn-onc heavy programs? I'm interested in gyn-onc, but I'm not comfortable with the programs that have minimal gyn-onc exposure before your chief year.

I like the OB part of OB/gyn too - really enjoyed delivering babies - I'm not just in it for gyn onc. But I'd like to be at a program that will give me more exposure and experience in the OR before I start thinking about doing a fellowship.

2) What are "good" surgical/delivery numbers? I don't know what kind of numbers I should be looking for.

Thanks very much!

hi smq,
on the apgo db ( http://www.apgo.org/residencies/ ) look for programs that have gynonc rotations for most or all 4 years, but keep in mind gynonc rotations during PGY1 will mostly be primarily floor work/mgmt. on the interview trail, i noticed that wash u. was heavily geared to gynonc and jefferson in philly stated they were a surgical prgm. look for prgm's with good sim labs/gross anatomy courses that are a requirement. i have interviewed at a few with these requirements but i can't recall all of them right now. i can PM you later with more details. also, look for prgms that have good match rates for those pursuiing gynonc. you could also look at prgm's where the chairman or the PD is a gynonc or urogyn doc b/c they may favor a residency prgm that is more surgically oriented. this is just my opinion though, and i am sure actual residents probably know more about this.

 

[pruritis_ani]

Don't know about other programs, but at my program (pm me for details), we currently have 2 gyn-oncs, soon to be 4, no fellows, and begin rotating in our second year. Typically, gyn onc is 4 days OR, 1 day clinic during the week. Lots of call, lots of cases (that you primary, as there are no fellows, and one gyn resident on each month).

As for numbers, it is tough to really say. Don't have a good answer....you shouldn't have problems getting "enough" C sections and vaginal deliveries though.

Good luck!

hi smq,
on the apgo db ( http://www.apgo.org/residencies/ ) look for programs that have gynonc rotations for most or all 4 years, but keep in mind gynonc rotations during PGY1 will mostly be primarily floor work/mgmt. on the interview trail, i noticed that wash u. was heavily geared to gynonc and jefferson in philly stated they were a surgical prgm. look for prgm's with good sim labs/gross anatomy courses that are a requirement. i have interviewed at a few with these requirements but i can't recall all of them right now. i can PM you later with more details. also, look for prgms that have good match rates for those pursuiing gynonc. you could also look at prgm's where the chairman or the PD is a gynonc or urogyn doc b/c they may favor a residency prgm that is more surgically oriented. this is just my opinion though, and i am sure actual residents probably know more about this.

 

[smq123]

hi smq,
on the apgo db ( http://www.apgo.org/residencies/ ) look for programs that have gynonc rotations for most or all 4 years, but keep in mind gynonc rotations during PGY1 will mostly be primarily floor work/mgmt. on the interview trail, i noticed that wash u. was heavily geared to gynonc and jefferson in philly stated they were a surgical prgm. look for prgm's with good sim labs/gross anatomy courses that are a requirement. i have interviewed at a few with these requirements but i can't recall all of them right now. i can PM you later with more details. also, look for prgms that have good match rates for those pursuiing gynonc. you could also look at prgm's where the chairman or the PD is a gynonc or urogyn doc b/c they may favor a residency prgm that is more surgically oriented. this is just my opinion though, and i am sure actual residents probably know more about this.

Thanks very much! This was really helpful info. 🙂

 

[smq123]

Don't know about other programs, but at my program (pm me for details), we currently have 2 gyn-oncs, soon to be 4, no fellows, and begin rotating in our second year. Typically, gyn onc is 4 days OR, 1 day clinic during the week. Lots of call, lots of cases (that you primary, as there are no fellows, and one gyn resident on each month).

As for numbers, it is tough to really say. Don't have a good answer....you shouldn't have problems getting "enough" C sections and vaginal deliveries though.

Good luck!

Thanks for the helpful info! 🙂 So do you recommend going to a program with a lot of gyn-onc attendings, but no fellows?

 

[nykka3]

Thanks for the helpful info! 🙂 So do you recommend going to a program with a lot of gyn-onc attendings, but no fellows?

i would look at their surgical volume and the percentiles they post for RRC. i would also see what the numbers are for you being the surgeon vs. assistant. see if residents operate with fellows or attendings.

 

[Global Disrobal]

Ask the program director to give you the range and average numbers for the graduating chief class with respect to Vag-Hyst, Abd-Hyst, LAVH, TLH, myomectomies, etc.

As for the suggestion of going to a program without fellows, its not so much the presence or absence of fellows, but rather the interaction with them. At our institution, we do 2 months of GYN-ONC in second and third year, and serve as chief for 3 months in 4th year. There is a fellow on the service, but GYN-ONC is run by the chief. There are 2 attendings (one specializing in MIS including robots, and other more traditional practice). If there is a fellow in the case, you genetally do the hyst +/- BSO with them and then the fellow does the nodes, bowel resection, debulking with the attending. If there is no fellow (usually the case when the chief is in the case), you are one on one. In my 4 years, I can confidently say that the fellow's presence has helped immensely!

In general, going back to your original point, look at the percentage of cases entered as asst vs surgeon (as mentioned above), how the residents label their program, ask how many major GYN cases are posted on an average day, and howmany majors do interns finish the year with.

good luck

 

[pruritis_ani]

Thanks for the helpful info! 🙂 So do you recommend going to a program with a lot of gyn-onc attendings, but no fellows?

I don't think having fellows helps with anything, except perhaps getting a fellowship. That being said, I don't think it is bad to have fellows, if you still get to do cases. They can be great teachers, and there can be plenty of cases to go around. I wouldn't avoid a program simply because there are fellows there, but if I was interested I would look very, very carefully about how they interact and affect the case numbers.

In my case, I looked at many, many programs. The places with fellows tended toward academic, the numbers and autonomy were lower. But, they did better in terms of research and fellowship placement. The best places (IMHO) were the ones with lots of sub specialty faculty and no fellows, as that made each month on the service essentially a fellowship. Good stuff! There was also a big difference in the residents at those programs....the chiefs at no fellow programs almost universally were very confident with going out and entering practice, where the ones that were leaving programs with the fellows tended toward ambiguous answers, and tended to wish they had more cases....now, these are simply my experiences, and may simply reflect the difference in University vs Community programs.

Moral of the story...take a careful look, and figure out which is better for your needs. They both do a fine job of educating residents.