tag:blogger.com,1999:blog-4968787219619380438.post8858303527383359641..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Some general surgery residency graduates may not be competent to operate Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-4968787219619380438.post-35530664137013975522017-07-09T10:56:25.240-04:002017-07-09T10:56:25.240-04:00Anonymous Europe: I learnt my work ethics in the U...Anonymous Europe: I learnt my work ethics in the US which gives me more than an edge in Europe.:)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86472065719838716822017-07-09T04:02:52.920-04:002017-07-09T04:02:52.920-04:00Anonymous Europe: Yeah:):) We even have the burger...Anonymous Europe: Yeah:):) We even have the burgers when I am on call( I order them). Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-2493858973178344842017-07-07T14:10:47.560-04:002017-07-07T14:10:47.560-04:00Ah, yes. The ideal world. Your residency sounds a ...Ah, yes. The ideal world. Your residency sounds a lot like a residency in the US.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-14554244833303013182017-07-07T12:11:07.905-04:002017-07-07T12:11:07.905-04:00Anonymous Europe: I was talking about an ideal wor...Anonymous Europe: I was talking about an ideal world..:). Unfortunately no such hospital exists...As from a trainee's point of view: I am hustling at the ward, my phone keeps ringing every minute, and the nurses keep harassing me with every possible nuisance. Then the call comes in that I need to go to the OR. By the time that call comes in I am already wasted psychically from the constant stress. And then I should calm down and should only concentrate on the intervention at hand, while my phone (it is the telefone system we use in the hospitals) keeps on ringing, even though I told the nurses at the ward, that I am in the OR.... By the time I get off of my shift I am too wasted to do anything... Not to mention the days when I need to cancel my operations because I have to play ward manager or run the outpatient unit....I do not mean to complain, I love what I do, just wanted to provide a picture from the trainee's point of view.What we would need is a ward secretary who would do the scuttle work so that the trainees could go into the OR more. We are used as coding nurses, administrators and it technicians and the least as doctors....Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-16062795278443976302017-07-07T06:52:00.761-04:002017-07-07T06:52:00.761-04:00Regarding the last part of your #2 comment, what y...Regarding the last part of your #2 comment, what you say would be ideal, but in what hospital could every resident be operating 8 hours a day? None that I know of.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-10317852951598237982017-07-06T13:21:42.567-04:002017-07-06T13:21:42.567-04:00Anonymous Europe: I am trainee in Europe, and what...Anonymous Europe: I am trainee in Europe, and what I can tell is, the problem lies at two points:<br />1. We are used for scut work. Filling out papers, running the outpatient unit, and organizing CT scans, US scans, whatever, which should be a secretary's job or a ward administrator's whatever. We do not get to relax between the operations,and this impedes our performance to... <br />2. The legal situation is so hostile, that if we are left alone in the OR, and something happens we get sued and all hell breaks lose. <br />I guess if a trainee were allowed to do nothing else through the day but to perform operations one after the other for 8 hours a day (not organising CT scans, and doing stupid paperwork) He/she would be one hell of a surgeon in two years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-14245905570343432412017-07-01T12:40:32.288-04:002017-07-01T12:40:32.288-04:00I would never criticize a surgeon who asks for hel...I would never criticize a surgeon who asks for help when needed. It's the ones who don't ask for help who are the problem.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60580792423896005142017-07-01T11:42:22.081-04:002017-07-01T11:42:22.081-04:00Rotator, that is not a bad practice for a newly mi...Rotator, that is not a bad practice for a newly minted surgeon. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-52010956488830296172017-06-30T18:37:25.513-04:002017-06-30T18:37:25.513-04:00This reminds me of the change in cardiology and ra...This reminds me of the change in cardiology and radiology<br />a dozed yrs of so back where interventional qualifications needed another year or two of study. With such a variety of approaches (open/lap/robotic etc) it would seem another year or two of residency might be in order.<br /><br />I am also reminded of an experience ~10 yrs ago when a newly minted comm hospital GS came on staff and for the first yr or so when on call he was calling in his partners for assistance on some cases. The senior partner was the only one in the group to do aortic vascular, the others did only peripheral vascular.rotatorhttps://www.blogger.com/profile/01489496135116846713noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-34384579515318283362017-06-29T11:39:05.671-04:002017-06-29T11:39:05.671-04:00Jamal, except for some minor surgery cases, a thir...Jamal, except for some minor surgery cases, a third-year resident would probably not operate independently in the US. We do have the option for a chief resident to act as a teaching assistant taking a junior resident through a case in the OR. <br /><br />Amos, so are some attendings.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-10968637760789873522017-06-29T09:34:36.955-04:002017-06-29T09:34:36.955-04:00There is some truth..... Some residents are abit c...There is some truth..... Some residents are abit careless in the ORAmoshttp://swa.uonbi.ac.kenoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-81067513079522932632017-06-24T11:02:09.422-04:002017-06-24T11:02:09.422-04:00I think the situation is better in Canada. I'v...I think the situation is better in Canada. I've seen lots of 3rd year residents independently operating (smaller cases though). <br /><br />I also think residents are used for scut work and as bus boys. They should get more OR time under supervision.Jamalnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-90561148789060353502017-06-22T04:06:46.211-04:002017-06-22T04:06:46.211-04:00Antonio, thank you for reading my blog and followi...Antonio, thank you for reading my blog and following me on Twitter. <br /><br />I agree that as a resident the information may be difficult to accept. I hope you understand that it was the study that said some residents are not competent to operate. I merely reported and discussed its results. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-14370543010906844002017-06-21T20:28:46.589-04:002017-06-21T20:28:46.589-04:00hello Dr. im from venezuela, im in the second year...hello Dr. im from venezuela, im in the second year of residency in general surgery, i find really interesting your article. as a resident, i feel uncomfortable at the OR sometimes. even more if im going to make a procedure i have never done before, but sometimes it depends on who you have in front of you, the attending attitude towards the student is really important. i believe that the confidence comes with the time, and its probably normal that some percentage of residents might feel odd when doing a procedure themselves, tho i believe that "not competent to operate" its kind of hard... im a big fan of your TL in twitter! cheers!!! Anonymoushttps://www.blogger.com/profile/03817616139461143194noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-29681571429244521162017-06-21T08:39:39.153-04:002017-06-21T08:39:39.153-04:00Anon, I am partial to community hospital programs....Anon, I am partial to community hospital programs. <br /><br />The problem may be due to all three things anon listed but I think the first one is probably the most important. Others include medicolegal and regulatory concerns and patients not wanting to be operated on by trainees.<br /><br />Artiger, I understand. I'm glad I'm not trying to run a residency program right now.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-37871183337478525842017-06-20T22:53:38.502-04:002017-06-20T22:53:38.502-04:00If I was a medical student today, there's no w...If I was a medical student today, there's no way I'd choose surgery for my residency. Then again, I'm not sure I'd even be in medical school today. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-23743083250254531132017-06-20T20:57:10.406-04:002017-06-20T20:57:10.406-04:00Just finished residency last year from a "com...Just finished residency last year from a "community" program where my attendings rarely scrubbed and frequently didn't sit in OR unless asked to do so for chief cases (obviously some exceptions existed). I felt nervous but very ready to be done with training. My questions to those who have been on both sides of the training OR table.<br /><br />Is the lack of competency due to:<br />-Larger institutions with more attendings not knowing their residents as well and therefore not trusting them to do cases?<br />-The larger number of ways procedures are done now vs. 15-25 years ago (i.e. open vs. lap vs. robot vs. endoscopic...). I.e. you've seen a hundred colectomies, but you've seen it done 50 different ways.<br />-A generational gap in confidence<br /><br />Or a little bit of all 3?<br /><br />Do you think the "apprenticeship" model some programs are adopting will help?<br /><br />Thanks,Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-49465310650877936892017-06-20T20:28:53.457-04:002017-06-20T20:28:53.457-04:00Ip, good idea. It would solve the problem for some...Ip, good idea. It would solve the problem for some residency programs. It will never happen. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60585044549298949962017-06-20T20:26:27.492-04:002017-06-20T20:26:27.492-04:00The solution is easy but there is no political wil...The solution is easy but there is no political will to do so. Bring back county and charity hospitals for the uninsured. Several problems solved at once!!lphttps://www.blogger.com/profile/16540286312199014665noreply@blogger.com