Surgical Volume/appreciate your opinion

[KWTRCSI]

Hello every one,

The director of my residency program told me that the resident does an average of 200 cataract ( 50 as a primary surgeon while rest as an assistant) .

I highly appreciate your opinion on the adequacy of such number and what can be done to enhance it !!

Thank you

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[Arthelion]

The number, as you've described it is extremely misleading. Surgical numbers (as I've heard them and as most people I interviewed with described) should be counted only if they are primary surgeon (or at least class 1 which, i think, is doing >50% of the case as primary). If a program truly only offers 50 as primary surgeon, I'm not sure they even qualify for ACGME requirements to be accredited. Someone can correct me here if I'm misinformed, but I would be very unhappy with those numbers at my program.

 

[7ontheline]

That is seriously lame, to count assisted cataract numbers in your totals. 50 cataracts as primary surgeon is a really low number, especially with the new requirements.

 

[WhatNEyeTem]

Hello every one,

The director of my residency program told me that the resident does an average of 200 cataract ( 50 as a primary surgeon while rest as an assistant) .

I highly appreciate your opinion on the adequacy of such number and what can be done to enhance it !!

Thank you

Are you from the United States? Just curious...


50 is really low. The ACGME requirements are at least 86 cataract surgeries as primary surgeon.


-J

 

[Krony]

and what can be done to enhance it !!

Hmmm - tell whoever is at the scope for those other 150 cases to trade places with you!

 

[KWTRCSI]

The number, as you've described it is extremely misleading. Surgical numbers (as I've heard them and as most people I interviewed with described) should be counted only if they are primary surgeon (or at least class 1 which, i think, is doing >50% of the case as primary). If a program truly only offers 50 as primary surgeon, I'm not sure they even qualify for ACGME requirements to be accredited. Someone can correct me here if I'm misinformed, but I would be very unhappy with those numbers at my program.

Many thanks

That is seriously lame, to count assisted cataract numbers in your totals. 50 cataracts as primary surgeon is a really low number, especially with the new requirements.

Thanks

Are you from the United States? Just curious...


50 is really low. The ACGME requirements are at least 86 cataract surgeries as primary surgeon.


-J

Well im not from the states, however the gap between 50 and a minimum of 86 makes me really anxious !!!

Hmmm - tell whoever is at the scope for those other 150 cases to trade places with you!

Seems like a good idea after all

 

[JMK2005]

Sounds like it should be 150 primary and 50 as assistant.

 

[orbitsurgMD]

Sounds like it should be 150 primary and 50 as assistant.

50 as primary is insufficient, regardless of the ACGME requirements. You won't be competitive to hire and you won't have the body of experience with complications sufficient to be able to bail yourself out of difficult cases. That isn't something you want starting out. You will almost have to do a fellowship.

I really wouldn't want to do a residency today where the surgical cataract category 1 numbers were less than 120 cases for even the least motivated or fortunate residents.

 

[OphthoApp]

50 is low, my program that I matched at has 200+ primary cataracts

 

[KWTRCSI]

Sounds like it should be 150 primary and 50 as assistant.

50 as primary is insufficient, regardless of the ACGME requirements. You won't be competitive to hire and you won't have the body of experience with complications sufficient to be able to bail yourself out of difficult cases. That isn't something you want starting out. You will almost have to do a fellowship.

I really wouldn't want to do a residency today where the surgical cataract category 1 numbers were less than 120 cases for even the least motivated or fortunate residents.

50 is low, my program that I matched at has 200+ primary cataracts

You guys rock this will certainly change my plans, i will try to get into a better program, in case i fail to do so, i would rather move on to a different speciality despite the fact im passionate about ophthalmology.

 

[TMinusZero]

I think 50 is on the low side compared to other programs, but more may not be necessary to develop a well-prepared cataract surgeon.

 

[cme2c]

I think 50 is on the low side compared to other programs, but more may not be necessary to develop a well-prepared cataract surgeon.

50 is way below the "low side" it is out of compliance with RRC guidelines. 50 is definitely not enough to develop a well-prepared cataract surgeon.

 

[7ontheline]

I think 50 is on the low side compared to other programs, but more may not be necessary to develop a well-prepared cataract surgeon.

LOL medical student.

Anyway, OP, you and your classmates should speak with your program director and make it clear that 50 is not enough. If nothing else, it clearly is below the current guidelines. You are clearly present at enough cataract surgeries in this program to be doing more, and you should make it clear that you feel the low number of primary surgeon cases is unacceptable.

 

[Mirror Form]

You guys rock this will certainly change my plans, i will try to get into a better program, in case i fail to do so, i would rather move on to a different speciality despite the fact im passionate about ophthalmology.

Personally, I'd much rather train at a program with sub-par numbers than to not match into ophthalmology at all. If you work hard and excel during your residency then you'll hopefully be at least safe to operate, especially if you can join a practice where a more senior ophthalmologist can mentor you a bit. And if not then you'll likely be able to do a fellowship in order to get more experience. Obviously none of this is ideal, but it's better then matching into FP.

 

[speyeder]

Hello every one,

The director of my residency program told me that the resident does an average of 200 cataract ( 50 as a primary surgeon while rest as an assistant) .

I highly appreciate your opinion on the adequacy of such number and what can be done to enhance it !!

Thank you

In what country is your residency program? Are these low numbers typical of all ophthalmology programs in your country?

 

[toulouselautrec]

50 is way below the "low side" it is out of compliance with RRC guidelines. 50 is definitely not enough to develop a well-prepared cataract surgeon.

During the 2006-2007 residency year, the ACGME raised the minimum category 1 cataract requirement from the 40s to the 80s. So prior to 2006, 50 primary cases would have been sufficient.

Minimum-number requirements are arbitrary. I wonder how many more programs would struggle even more or get shut down if the requirement was raised again to >100. How many it takes to develop "proficiency" is totally up for debate. I've asked a lot of attendings and have gotten wildly different answers based on their particular personal experiences.

And who knows how much of the surgery one has done to count that case as category 1...all you need is a portion of the entire surgery. did you do the clear corneal incision? put in the IOL? take out the viscoelastic? or did the entire thing beginning to end?

 

[JMK2005]

I wonder how many more programs would struggle even more or get shut down if the requirement was raised again to >100.

Well... if a program has you watching/assisting on a 150 cases, that's unacceptable when the residents are only getting 50 primary. Tells me that the program is not making resident surgery a priority!

 

[cme2c]

During the 2006-2007 residency year, the ACGME raised the minimum category 1 cataract requirement from the 40s to the 80s. So prior to 2006, 50 primary cases would have been sufficient.

Minimum-number requirements are arbitrary. I wonder how many more programs would struggle even more or get shut down if the requirement was raised again to >100. How many it takes to develop "proficiency" is totally up for debate. I've asked a lot of attendings and have gotten wildly different answers based on their particular personal experiences.

And who knows how much of the surgery one has done to count that case as category 1...all you need is a portion of the entire surgery. did you do the clear corneal incision? put in the IOL? take out the viscoelastic? or did the entire thing beginning to end?

50 primary cases was not "sufficient" they changed it for a reason. I don't care how good the surgeon, 50 is not enough to see the complications that you need to see to be a proficient surgeon. Also , there is no such thing as class I or class III anymore, they have done away with those terms. To log a case as primary surgeon, he/she must be "present for all of the critical portions, and must perform the majority of the critical portions of the procedure under appropriate faculty supervision." You cannot just do the "clear corneal incision or "put in the IOL". My guess is that the attending that were okay with 40 cases were attendings that don't let their residents do anything. Can any of us say that we want to be that persons 41st case after graduation without someone helping?

 

[toulouselautrec]

To log a case as primary surgeon, he/she must be "present for all of the critical portions, and must perform the majority of the critical portions of the procedure under appropriate faculty supervision." You cannot just do the "clear corneal incision or "put in the IOL".

It may not seem right, but some programs do that to boost numbers. They will of course never tell you that, say, on an interview day.

 

[Arthelion]

I was under the impression the minimum numbers were not arbitrary. I'm not sure where I heard this, but apparently there was some research which showed new cataract surgeon complication rates went down significantly at 2 breakpoints at around 80 and 160 cases. Once again, I never independently verified this, but it seems reasonable.

 

[MAYOphtho]

I was under the impression the minimum numbers were not arbitrary. I'm not sure where I heard this, but apparently there was some research which showed new cataract surgeon complication rates went down significantly at 2 breakpoints at around 80 and 160 cases. Once again, I never independently verified this, but it seems reasonable.

I can't verify if this is fact either, but I would agree with these numbers. When I interviewed at UTSW, they had mentioned those exact numbers as well...so it makes sense.

 

[Mirror Form]

I was under the impression the minimum numbers were not arbitrary. I'm not sure where I heard this, but apparently there was some research which showed new cataract surgeon complication rates went down significantly at 2 breakpoints at around 80 and 160 cases. Once again, I never independently verified this, but it seems reasonable.

The prior number of 40 something was arbitrary. You are correct that the 86 number is based on data. However, I'm not sure how significant the drop in complications was after 86.