Friday, January 20, 2012

Which type of surgery residency should I choose?

A reader asks if I have “any advice on choosing a surgery residency, e.g. academic, community, hybrid?” I’m not sure what a “hybrid” residency is, but I think he meant a university program with extensive exposure to community hospital rotations.

This is a companion piece to my recent blog “Is surgery the right career for me?

Having been a community hospital residency program director for many years I was always partial to that type of program. I felt that we trained people who got more operative experience and were more confident in their skills.

A recent paper in the Journal of the American College of Surgeons co-authored by [believe it or not] surgeons from Yale, Memorial Sloan Kettering Cancer Center and the American Board of Surgery validated my impression.

The paper was a survey of 4282 residents, who comprised 80% of all categorical surgical residents in 2007-2008.

Table 2 of that paper shows that residents at community hospitals are statistically significantly more satisfied with their operative experience and less likely to worry that they will not be confident operating by themselves after they finish training than university trainees. [I have blogged before about resident lack of confidence.] Surprisingly, they were also happier with the level of didactic teaching than university-based residents.

Of course, the choice of where to train depends on what the prospective trainee wants to do with her career in the long term. If one wants to be an “academic surgeon,” one might overlook the above deficiencies of university residencies. However, I always told my residents that they could get their academic ticket punched by taking a fellowship in a university program.

Remember, the definition of the word “academic” is varied. One online dictionary contains the following:

-of or pertaining to a college, academy, school, or other educational institution, especially one for higher education: academic requirements.
-pertaining to areas of study that are not primarily vocational or applied, as the humanities or pure mathematics.
-theoretical or hypothetical; not practical, realistic, or directly useful: an academic question; an academic discussion of a matter already decided.
-learned or scholarly but lacking in worldliness, common sense, or practicality.

So, choose wisely, my friends.


Anonymous said...

thanks for the post! all i wanted was to become a general surgeon and perform "bread & butter" general surgery cases. however, i fell into the "academic" trap you alluded to in your post and ended up at a place that was very top-heavy and not only provided the political BS that an academic residency provides but also a sparse operative experience. i actually resigned in 2011 after my PGY3 year (more due to the political BS than anything else--i miss operating and taking care of patients) and hope to get back into a community program when (and if) the time is right. thanks again for your insights! maybe i'll get lucky enough to meet you in person one day!

Zak said...

Sorry to resurrect an old posting, but I'm curious if you think this advice is applicable to a US grad considering a prelim surgery year before going into Radiology, Anesthesia, etc. And if not, what advice would you give to choosing a place to go for a year? There are fears on the internet that being only a prelim means a bad experience - attitudes of other, categorical residents/attendings, taking the vast majority of scutwork, being relegated to more call or the less desirable rotations, etc.

Skeptical Scalpel said...

Zak, no problem that it's an old post. I'm here to help if I can. I think it is very wise to do a prelim surgery year if you are going into anesthesia or radiology. I think the above post is probably valid for that path, but the problem us that you may find that prelim residents can be poorly treated in both community and university programs. I too have heard horror stories about prelims getting all the undersirable rotations and more call. You will just have to do your due diligence. You should talk to current or former prelim residents at the programs you are considering. They will likely be candid since they are not spending 5 years there. Good luck.

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