Friday, July 25, 2014

The best general surgery residency programs for clinical training?

I've received a couple of emails from Doximity [A closed medical "community" of > 280,000 doctors] reminding me to complete a survey which they are sponsoring jointly with U.S. News & World Report. They are asking members, possibly only surgeons, to name the best general surgery training programs in the country.

Not mentioned in the email but stated at the beginning of the survey is that they want respondents to name the 5 best programs for clinical training.

I have a feeling that not everyone will notice the part about clinical training, and we will get a list of the usual suspects just as we do every year with the U.S. News best hospitals survey.

For several reasons, the survey is fundamentally flawed.

There are 240 general surgery residency programs in the country. Unless one is personally involved with a program, it is impossible to judge the competency of its graduates. How would I or anyone else who does not work there know whether residents training at UCLA or Baylor or Lehigh Valley are clinically competent?

There are no accepted ways to judge the clinical skills of any surgeon. Video recording of procedures with judging by peers can assess technical ability, and as shown in the recent New England Journal paper from Michigan, there is some correlation with outcomes.

The American Board of Surgery publishes first attempt board passage rates for all programs, but passing the boards does not necessarily equate to clinical skill.

Most surgeons have probably encountered only one or two graduates of any of surgical residency. Even if the ones we have seen were great, they may not represent the majority of graduates.

I'll bet I can name most of the top 5 programs right now. These are not necessarily the programs that produce the best clinically trained residents.

Here are my guesses: Massachusetts General, Johns Hopkins, Mayo Clinic-Rochester MN, New York Presbyterian-Columbia, Cleveland Clinic.

In the past, some institutions on my list were rumored to be terrible places to learn to perform surgery because the residents did a lot of watching and retracting but not much operating. Whether that is true today or was so in the past, I could not tell you.

I guarantee you that no community hospital will rank in the top 20 [maybe top 50] despite the fact that such hospitals produce many fine clinical surgeons.

I have no idea which programs produce the best clinically trained surgeons. After the Doximity-U.S. News survey results are published, you won't know either.


Anonymous said...

So true.

Anonymous said...

Well said.

George Gasman said...

Patient: "But Doctor, I want to have my surgery at a teaching hospital."

Me: "It's not a teaching hospital, it's a *learning* hospital."

That said, having been in academia and private practice I find that the range of competence I see in the OR (see earlier post about how I (inaccurately) assess competence) is no different in academia than it is in the community.

Bozos exist everywhere - as do geniuses.

artiger said...

Just my observation only, but I've noticed that people coming out of "State University" type programs seemed to be quite competent. Especially when the program is located in a place with lots of indigent patients and crime.

Anonymous said...

As I have introduced myself, I'm a rookie surgical intern. What I have observed from doing audition rotations and electives as a student, the leadership of a surgical dept really can make or break a program. In one program I did an audition rotation at, they hired someone from what I think is in the top 10 and he flipped that univ program around in a yr into something really amazing. Faculty changes, new roles, new research. Its amazing how one person can change things around.

Skeptical Scalpel said...

George, I agree. There's a lot of variation within programs.

Artiger, that's possibly true in general.

Anon, interesting point. The only thing bad about that is the program may collapse after the driving force, the new chairman, leaves, which is inevitable.

Unknown said...

Thank you for share this informative post.

Julie Alvarez said...

So what advice do you have for a fourth year medical student with a desire to be the best surgeon clinically, looking into general surgery residency programs? Is it just a crap shoot? Or do you rank the highest ranked program you think you could get into and hope they live up to their name?

Skeptical Scalpel said...

Julie, it is a bit of a crap shoot. You need to do a lot of research. It's very important to speak to the current or recently graduated residents of a program to find out exactly how much surgery they get to do and how much responsibility for pre- and postop care they are given. The more famous programs are not necessarily the ones that produce the best clinical surgeons.

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