tag:blogger.com,1999:blog-4968787219619380438.post3012808473708482119..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: How to fix the problem of general surgery resident attritionSkeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger14125tag:blogger.com,1999:blog-4968787219619380438.post-55316958954490628802017-07-09T03:57:06.465-04:002017-07-09T03:57:06.465-04:00Anonymous Europe: Anonymous I strongly agree with ...Anonymous Europe: Anonymous I strongly agree with you! I started working at the local pediatric surgery unit when I was 19 and got stuck there for the next 9 years( except when living in the US). If you want to get good then you have to start as early as possible. Rigor is important but I guess teaching has to be done in good humor and with care. (Lot of people tend to shout in the OR, which only traumatizes the team). Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-45724263584161330762017-07-07T12:25:13.488-04:002017-07-07T12:25:13.488-04:00This problem - breadth of training and level of pr...This problem - breadth of training and level of pre-residency exposure to surgical residency reality is only exacerbated by the fourth year follies - "the only tie I will have to relax before started residency + where is a program with good skiing?", and the stranglehold specialties have on residency slots - really need two residents on transplant team, hand surgery...<br />- There needs to be a chance to focus on breadth for rural surgery and to live in the rural environment.<br />- There needs to be chance to practice in the community hospital scenario without all of the bells and whistles.<br />- The MS 3 and MS4 courses pre-match need rigor, progressive responsibility..<br />[I was always told the more call I took as a student, the less I was paying per hour of training...YMMV.]Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-72484926741204489142017-07-07T06:49:48.151-04:002017-07-07T06:49:48.151-04:00Yes, I know of a tertiary center where the student...Yes, I know of a tertiary center where the students and residents rarely see an appendectomy. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-14423967620246013342017-07-06T13:04:16.850-04:002017-07-06T13:04:16.850-04:00Anonymous Europe: When I hear from my peers that i...Anonymous Europe: When I hear from my peers that it is better to be in a university centre, because you "see everything there" I always think, that this thinking is false. Huge centrums get to operate the "big, complicated cases", mostly (not always), at least in Europe.... <br />On the other hand. As a trainee you need the "boot camp" operations to know for sure first, not Whipple's procedure. And the "boot camp" operations tend to pop up in the small, community hospitals mostly, not in the big university centres..... If I had to chose again, I would rather go to a nice small town hospital where I would operate 5 hernias one after the other on a normal day and learn 10 types of operations which I would be able to perform absolutely securely, than go to some university centre where I would assist 2-3 different operations which I would not get to do for the next half year..... Thank God where I am I get to my numbers and teaching is excellent!<br />Surgery is nice to look at, but way more exciting to actually do it. One other big plus for the small hospitals is (at least for me), that you don't have to do science and you get to spend all your time in the OR, not pipetting some meaningless "academic" experiment (big things that matter come from Elon Musk and co, not from academic research....).<br />Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-61059933603181586532017-07-01T12:38:37.427-04:002017-07-01T12:38:37.427-04:00I am not aware of such studies. I will research th...I am not aware of such studies. I will research the topic and get back to you if i find any.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-64062382334151957272017-06-30T09:14:17.620-04:002017-06-30T09:14:17.620-04:00Scalpel, is there any data on resident attrition p...Scalpel, is there any data on resident attrition prior to 1992? Just curious if this has been a problem for more than the past 25 years. Incidentally, 1992 was when I started residency, and I saw some of this attrition directly. A lot of the people who dropped out were the strongest candidates on paper, but they were often white males, oddly enough. Just my experience, others' mileage may vary.artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-76667840542853172002017-06-30T07:10:36.641-04:002017-06-30T07:10:36.641-04:00Jack, I appreciate your comments. They are thought...Jack, I appreciate your comments. They are thought-provoking. My response may turn into a separate blog post.<br /><br />As far as I know, no program director has resigned or been fired because of resident attrition. The selection of residents is far from an exact science. For one thing, if a program director identifies several excellent candidates, the NRMP matching algorithm may distribute those candidates to other programs since the way applicants rank programs is factored into the match.<br /><br />Only about 15% of applicants in general surgery went unmatched in the 2017 match with 1.3% of those being current seniors in US medical schools. There are not hordes of people going unmatched in surgery.<br /><br />For years we have argued about the best way to identify applicants who would make excellent residents. The fact is no one knows what the best selection criteria are. I have blogged about this in the past. Furthermore, the definition of an excellent resident is also debatable. Is it someone who can pass the boards? Someone everyone likes? Should success be determined by performance as a resident or after an individual has been practicing as an attending surgeon for a few years?<br /><br />As far as the odds of success in the match being no better than choosing residents by lottery, I disagree. I don't know too many lotteries were you when 80% of the time.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-84822861168542337172017-06-30T05:55:22.517-04:002017-06-30T05:55:22.517-04:00Very EducativeVery Educativesirakohttp://estates.uonbi.ac.kenoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-54800875946477011932017-06-29T23:40:54.243-04:002017-06-29T23:40:54.243-04:00My questions are more serious than they may sound....My questions are more serious than they may sound. What happened to the program directors who selected the residents who failed to complete the residency? Did any of them resigned or was fired over that? If not why not? After all they, the directors, claim that they do the right thing by selecting good candidates based on predictability of success. How many candidates they eleminated before selecting those dropped residents? By choosing those dropped residents how much money did those directors waste from the taxpayers? Is there any accountability on the directors' part? I believe that these results render the directors irrelevant and their predictions of success are no better than choosing residents by lottery if not worse.Jack Williamshttps://www.blogger.com/profile/16058408234852989136noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-74536946332636272962017-06-29T08:14:46.436-04:002017-06-29T08:14:46.436-04:00Esther and Vamsi, thanks for the comments. Vamsi, ...Esther and Vamsi, thanks for the comments. Vamsi, I like your approach. I don't think you will drop out.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-32320667252767452022017-06-29T07:44:23.785-04:002017-06-29T07:44:23.785-04:00In medical school, I ended up voluntarily doing ab...In medical school, I ended up voluntarily doing about 4-5 months worth of Q3-Q4 call. When I got to residency, the grind was about what I expected it to be. It was physically worse, as the alternating weeks of nights were far worse than call, but mentally it hasnt been worse than what I knew I was getting into.Vamsi Aribindihttps://www.blogger.com/profile/05182545135805006712noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-71945606301532688992017-06-29T03:49:16.659-04:002017-06-29T03:49:16.659-04:00I thought Grey's Anatomy is just a program so ...I thought Grey's Anatomy is just a program so there is some truth in it. The numbers are quite low when you compare how many residents start the program and how many get to the finish line. something must be done. great researchEstherhttp://dvcaf.uonbi.ac.kenoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-64838816974867277942017-06-28T07:34:06.229-04:002017-06-28T07:34:06.229-04:00Anon, thanks for the comments. I agree that reprim...Anon, thanks for the comments. I agree that reprimanding a student will get you nothing but grief. Your advice about following a mid-level resident around is excellent.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-26944002825822773092017-06-27T20:42:38.975-04:002017-06-27T20:42:38.975-04:00I'd have to agree with the comments above. As...I'd have to agree with the comments above. As a recent residency grad (smaller "hybrid" program), many students wanted to see the "cool" cases but never bothered to read and prep for the daily routine/grind. As a senior resident, I literally had a student walk out of a 2a.m. case because she said she was tired. Unfortunately, in many cases we can't repremand that behavior or a bad evaluation is filed and we apparently want happy medical students more than we want informed residents.<br /> For those students who say they want to be a surgeon to me, I tell them to do what a fellow made me do when I was a 4th year student. Follow around the mid-level resident for a whole month for call, cases, and clinic. There should be a minute during that month that the resident is there when the student isn't. If the student is still interested at the end of the month, they have a chance. It was the best advice I got in med school.Anonymousnoreply@blogger.com