Trauma & CC fellowship training!

[Trauma Surgeon]

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Hi,

I’m a third year surgical resident at one of Europe’s tier surgical programs and as my name suggest I’m interested in trauma and CC as a future career. I have done some research in the field with numerous publications and through my research and PhD degree I have had the chance to make some contacts with a couple influential and highly respected trauma surgeons in US who have encouraged me to seek a fellowship in US.

My concern is that some of my training is not sufficient for a US fellowship. More specific: the vascular part! At our institution 100% of the elective aortic repairs are done endovasculary, and the acute ones are done by attendings (sure you can assist but as third assistant it does not add so much to our training since the cases are few and far between). The carotid cases are done by attendings and fellows and so on. How well prepared are the residents in trained in US for their fellowship? Are they confident doing vascular anastomosis/repairs?

Thanks for your responses,

TS.

 

[Winged Scapula]

Confident is a subjective matter.

But I would venture that in the US, residents are doing the anastomoses in most routine vascular cases; if you have done none or very few by the end of your training, that might be a problem.

We had Vascular fellows in my residency and there were still enough cases to go around to allow the residents to do being the bulk of the work. Endovascular was still in its infancy at that time, so most of our AAAs were open.

 

[SLUser11]

Endovascular was still in its infancy at that time, so most of our AAAs were open.

I'm a little bit jealous of that. I only had a chance to do a few open AAA's, and they were always awesome. That being said, the staff usually let me do a substantial amount of the endoAAA's.

 

[thedrjojo]

I'm a little bit jealous of that. I only had a chance to do a few open AAA's, and they were always awesome. That being said, the staff usually let me do a substantial amount of the endoAAA's.

As a PGY 2 I did some vascular anastomosises (sp?) including avf's, carotid endarterectomy, distal anastomosises of fem-x bypass... And my chiefs clearly get much more experience. So yeah, lacking that experience is a negative...

certain fellowships though, you don't necessarily have ever done it or extensively done it. CT surgery, Transplant surgery, even colorectal surgery (they expect you to have done many if any J pouches, etc)? But the basic prinicples like vascular, bowel anastomosis, dissecting, etc, probably needed.

 

[Trauma Surgeon]

It is not that we don't so some small procedures with anastomosis and vasclurar cases( AV fistulas, port-a-cath, endarterectomies and so on), but the bigger cases and specially the acute ones are lacking for residenst. Specially since the endovascular procedures are grabbing more cases.

My question is really regarding the experience of your residents at a university setting where they have to compete with both vasc. fellows and endovascular lab for cases. Are there still so many cases to go around that they feel confident (I understand your point WS when you comment on confidence, but will use it for lack of better word) to do a vascular case first day out of residency?

To thedrjojo: I don't feel unprepared for other procedures such as bowel anastomosis, right hemis, lap apps and choles and so on. But my concerns is vascular, and I'm not sure about the extent of fellow training i US but here I would seriously qouestion the new generation of vascular surgeons ability to do acute open cases here in Euorope since their training is more focused on endovasc.