Friends,

i would like to know when several folks here discuss about the operative experience during their residency, what do they exactly mean with “tons of surgeries”? I am not a doctor, but I work as a tech in the OR and when I see the junior residents they first must learn to open and to close, do you guys mean the opening and the closure as “tons of operative experience” or what do you exactly mean? Junior residents open and the attending usually takes the case and removes the tumor or the disc and the residents assist, depending on the case, if a case is easy the resident is enabled to take the tumor or the disc out.
So I am confused when people here talk about “tons of surgeries” during residency.

It is funny....

You have to do anything a lot of times before you are good at it.  That experience opening and closing is crucial, and, as you mentioned, it’s a task for junior residents.  That way, when they are senior residents, they have already mastered that skill and can spend time actually taking out the tumor or whatever.  Do you think it would be appropriate to have the junior residents taking out complicated brain tumors on day 1?  The chief residents I have known do about 90-95% of most of their cases including removing tumors, clipping aneurysms, etc, and the attendings mostly watch or scrub in to assist in a minor way.  One chief I’m working with currently is on pace to do over 500 cases this year, and he will be the primary surgeon for most of those operations.  If you don’t think that qualifies as a “ton of surgeries during residency” then I don’t know what you’re after.

I am doing this job for more than 8 years and I have never seen chief residents removing AVMs or clipping aneurysms on their own, of course there were cases where some good chiefs did it but usually the attending was always present and doing the main part of surgery, it is not true that the residents do everything on their own.

dumb scrub - 12 October 2009 11:01 AM

I am doing this job for more than 8 years and I have never seen chief residents removing AVMs or clipping aneurysms on their own, of course there were cases where some good chiefs did it but usually the attending was always present and doing the main part of surgery, it is not true that the residents do everything on their own.

You would do all the potential applicants reading this board a favor, then, if you would say what program you’re at.  You’re probably a unionized employee, and definitely not at the mercy of the Neurosurgery program director or other faculty, so you have nothing to lose, unlike most of us who are residents or med students and potentially subject to retribution for speaking up.

I would love to know what program this is where chief residents don’t get to do good cases on their own, as I’m sure would many of the applicants here.  At my program, we get to do simple cases by ourselves as a PGY-2, and the chief has clipped several aneurysms already this year.

Honestly, though, if you were a patient, would you want the attending to leave and go take a coffee break while a resident clipped your aneurysm?  When we dictate, we dictate “Dr. So-and-so was present for all *critical portions of the case*.” It is completely appropriate for the attending to hang out in the room and guide the chief resident while he clips an aneurysm or takes out an AVM.  Those are moments when lack of experience could lead to a critical mistake and could change an outcome from good to devastating.  What is not appropriate (if the chief has decent skill) is for the attending to do the entire case, or to have a chief resident open and close only to have the attending steal the clipping.

I too am curious as to which program dumb scrub is at. At my school’s program, there is actually some grumbling from residents about how _little_ supervision there is.

The programs I have seen, as I indicated above, mirror the other posts here.  I have seen residents operate for hours at a time without an attending present, because the attending trusts them to page him if they encounter something they can’t handle or are about to do something critical.  Then he will scrub in and stand next to them while they keep working just to be available if needed.  But most of the time the attending will watch through the observing head on the scope and just offer occasional suggestions, and leave the hands-on operating to the resident.