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Thoughts on article about surgery residents' confidence

Discussion in 'Surgery and Surgical Subspecialties' started by Rollo, Aug 16, 2011.

  1. Rollo

    Rollo Renowned Wolf
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    http://archsurg.ama-assn.org/cgi/content/full/146/8/907?ct

    You have to login to see the article but I'll give a quick overview.

    The authors surveyed categorical surgery residents and asked them about how confident they felt as surgeons and in the operating room.

    The results:

    I'm planning a career in surgery, and I thought this was an interesting article. For the record, I'm a single male in the Northeast.

    The authors stipulate that the reasons residents at academic programs feel less confident is because they don't get much independent surgical cases and those who felt they could ask for help from an attending were more likely to be confident about their surgical skills.

    But anyway, do you guys think this study is accurate? Or it should be taken with a grain of salt because generalizations are just that, generalizations, and if you're talented and motivated enough, you will succeed in any type of program wherever you go?
     
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  3. SocialistMD

    SocialistMD Resident Objectivist
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    I agree with the above bolded statement.

    I read this article this morning as I was dozing off, but none of it really surprised me and I think a lot of it has to do with perceptions of the grass on the other side of the fence and maturity.

    1. Men tend to be bolder than women in most everything. Surgery is no differrent. It should come as no surprise that men feel more confident than women. This has been shown in previous studies using the FLS test (out of Stanford), where women scored just as well as men did on the actual exam, but didn't feel as confident about their skills.

    2. Academic programs tend to be more top heavy, so you will see less confidence in the junior resident as compared to the senior resident. As a resident at an academic hospital in the midwest, I had those same fears my first two years and into my third year, but by the end of my third year, a fellow let me take him through a Whipple (meaning I dissected things out and told him where to bovie, I did all anastomoses, etc...) and it went fine, albeit not record-setting in terms of time. Now, as an R-4 early in the year, I am confident that I can get through any neck, abdominal or extremity case and am now taking junior residents through those cases with the attendings watching from the stands. Yes, I'm a white male who is married with a child, but I'm also a PGY-7 and I have age and perspective on my side.

    3. Residents at academic programs hear about the residents at community programs operating independently and think they are being disserviced. This is made worse on the east coast, where you have a lot of training programs in close proximity, so you hear about it more, which I think is why it is worse on the east coast. There is also a little bit of expectation that goes into it as well, and I think those who match on the east coast tend to be a little more unrealistic than the rest of the country in terms of operative expectations (this is based on having met many applicants over the years and now being able to predict who wants to match on the east coast and who doesn't by the end of the interview day), particularly early in training. I'm not sure how much of it is really true, and I don't know that the complexity of the cases being done is the same, either.

    In the end, residency is what you make of it, and you can learn from every operation, even if you are just retracting, if you watch closely. While I fully believe it is a necessary experience to take another resident through both open and laparoscopic cases, I don't think you have to take another resident through every single case to become confident. It is all about stepping back and actually watching what you are doing instead of being focused on the actual doing. Technically, we make very few moves in any given operation; we just make them over and over again. Recognizing the parts of the whole and how you can apply them to other procedures is a cerebral thing, not a motor thing. Going through the motions with your hands isn't as necessary as going through them in your mind, something that really doesn't even require your being scrubbed for a case.
     
    #2 SocialistMD, Aug 16, 2011
    Last edited: Aug 16, 2011
  4. dynx

    dynx Yankee Imperialist
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    Thats pretty amazing. I'm not sure how many programs have high enough volume of whipples that a 3rd year would be 1st assisting let alone taking someone else through the case. I can tell you at my program a chief wouldnt let that happen and we get well above the national average #s. You guys must do 4 or 5 whipples a week.
     
  5. SocialistMD

    SocialistMD Resident Objectivist
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    We do. We also have an eat-what-you-kill policy in our program when it comes to consults and ensuring junior residents don't have cases poached from them by chiefs/fellows. This particular patient came from my consult service.

    It also gets to my point of case complexity being different at academic hospitals compared to community programs and why there is more attending involvement in some cases.
     
    #4 SocialistMD, Aug 18, 2011
    Last edited: Aug 19, 2011

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