Thanks for the replies! Their students go all over the place in that specialty. The only worrisome thing I’ve heard on Reddit is that the program is sort of overrun by NPs and PAs who are on the “same level” as residents. Which is really bizarre because this is supposedly at a T30 med school. Not sure if that’s the reason.
My experience has been that midlevels are a huge bonus to residents. We had quite a few and added them during the course of my training. They are on the same “level” in some way - I think of them as lifelong residents, but with better hours and better pay. They take away the cyclical ignorance that’s inherent in trainees, so you don’t have the newly on service intern not knowing who to call for certain DME. The inpatient NP just texts their friend who does that and bam, patient ready to go. They’re also great for supervising junior trainees for simple bedside procedures, and they don’t really care about doing things since they get paid either way and they generally appreciate the teaching mission.
So all in all, frees up everyone from scut and keeps the service flowing smoothly. By the time you’re a later pgy2 or above you’re likely well beyond them in procedural skills anyhow.
I’m sure that medical students likely perceive their levels as equal because they don’t understand the arc of training yet. They see a PA scrubbing and assisting on a case while the intern or med student is less involved and see that as a midlevel taking away from a resident. In reality it may be a more advanced case than the resident is ready for because the chief tossed a junior in the room because he wanted to do something else even cooler. So the attending is miffed they have a junior for an advanced case and instead just work with the PA to get it done. Now if you see a chief holding hook while the attending and PA go at it, run.
(Side note- a friend of mine used to call this the PG-WHY rule of academic attendings: Why is the intern in my case? What’s the pgy2 doing? Why is the pgy2 in this case? What’s the 3 doing? And so on until you finally get to the senior fellow at which point they’re finally happy.)
But the level appropriateness of cases is hard to see as a student. If I had a PGY1/2 with me in a big complex case, I’d probably utilize my PA or usual FA more heavily because they know all my next moves and make things go better. I’d probably let the trainee do a little at the start, but they will very quickly exceed their skill level and I still have 8-12 hours of case left. I make a point to teach and demonstrate the entire time, but I can’t walk a junior trainee through something way beyond them in anything resembling a timely manner.
There are simply skills and anatomy you need to solidify in simpler cases before you’re ready for something more advanced.
In the program in question, you’ll want to see what their grads are doing. If they’re turning out well trained confident and safe surgeons, then their system works. You need to find out what their chiefs are comfortable doing when they graduate. If they’re not comfortable at all, and doing fellowships to make up for poor training rather than true specialty interest, then that’s a red flag.
