Best operative experience from the "academic" programs

[intelinside]

I am searching for a program(s), to do aways, that combines the operative experience of a community program while also holding the facilities and resources of the academic powerhouses. What residencies would fall under this category...Mayo, Pitt, WashU, UCSF?

[orthuller]

Others with excellent operative/academic balance are Emory, Utah, Vanderbilt, UT-Southwestern, Miami, Carolinas, Wisconsin.

[orthoguy123]

Based on my experiences, here is a list of strong academic/strong operative experiences: Pitt, Case, Baylor, Utah, Vanderbilt, Iowa, and Carolinas. I'm sure there are more.

Obviously, Mayo, WashU, and UCSF are awesome programs and have unlimited resources, but I wouldn't put their operative experiences in the same category as the above programs.

[Orthononymous]

Of Orthuller's list, I think Emory, UTSW, and probably Miami and Carolinas are way more focused on operative experience than research. You can't beat their autonomy and operative experience, but I wouldn't consider them balanced.

When I think of programs that have extensive operative experience AND research opportunities, the following programs come to mind:

Pitt, Brown, Vanderbilt, Case Western, Utah, Iowa
(I didn't apply to Mayo, UCSF, or WashU, so I can't speak to their experiences)

[WestCoastOrtho123]

Something to consider is the type of operating experience that you want. Do you want just to be in the "OR" or do you want lots of trauma (and what type - blunt, penetrating, cold, hot, etc)...or do you want lots of specialty operations (joints, spine, sports, etc)..or a mix?

I think you'll see that a large portion (by their nature) of the residencies listed above are trauma heavy. While it's very important, just doing a 1000 distal radii may not be the highest yield for someone interested in spine or other field mostly. Also, a lot of the coined 'operative heavy' residencies get their reputation by the nature of the pgy2 year. Whereas at other places its more ED/Floor/NF/Call, these tend to have a lot of dedicated OR time...however, these same residencies often have lower volume in the specialty driven years of pgy 4&5.

Also, make sure to ask about fellow involvement.

Just keep this in mind bc when you're finishing your chief year, you want to make sure that you just didn't choose the residency because you nailed a lot of femurs on trauma during your 2nd yr (even if you're interested in being a traumatologist since you'd likely have wanted to be involved in complex pelvic fx and that sort by the time you're a chief)...anyway - good luck - just my 2 cents. All the residences listed above, fyi, are great choices.

[abcd1234]

good discussion. I think it is worth looking into what areas you have a preference to be heavy rather than just the classic "operative heavy" residencies. I can only comment on academic residencies, but for example, a limited discussion might go something like this (and these aren't intended to be the highest or best academic/operative...just a sample)

UCSF: Heavy and early operative trauma (mostly blunt, but some penetrating as well), joints, and spine experiences. On the downside, it's volume is sig. less in f&a, hand, and to some extent, peds. Very few fellows = resident expected to operate early.

Mayo: Absurdly busy on joints as well as hand. Trauma is lower volume and limited to mostly cold trauma (Shock avail for away rotation) as well as in sports. Apprenticeship model so fellows not much of an issue.

Vandy: Tons of trauma, early and often. 2 trauma fellows and a fair # of others, but sufficient volume. Decently balanced in other specialties.

Penn: Penetrating trauma galore. Hardly any spine volume.

Harvard: Pgy 1-2 is a limited independent operative experience. However, PGY3 is a 6mo dedicated block at Children's and they operate all day and night. From there on, it's apprenticeship rotations (separate from fellows) through all the specialties which are all very very busy.

HSS: Pgy3+ is 4 days a week in the OR w/ never having to miss a post-call day since no in house call so some could make the case that it would be one of the heaviest volumes at the end of year 5. However, how those hours are spent in the OR (operating vs. retracting) has been debated.

If you want to guarantee you operate a lot from the very beginning, choose a program that doesn't have any fellows or PAs. However, you may find that in a few yrs it would actually be great to have some support as well as programs w/ a fair # of these tend to be the bigger academic powerhouses since those figures help publish, contribute to academic environment, allow for greater volume etc. On interview day, you can always ask for # of procedures (and theyre often included in presentation) but it's hard to make much use of them unless you see that a program lacks something like tumor or hand, or sports cases, etc.

[orthuller]

I agree with much of what has been said here. However, I do think the original poster's question is important to keep in mind here: which academic programs operate like community ones?. I think for those that interviewed at primarily academic places, we all know there are programs that emphasize operative experience, those that are balanced, and then those that hang their hat on their academic environment.

To the OP- after interviewing at the places you posted, I would call those balanced, not really "academic programs that operate like community ones". All excellent programs.

I agree with one of the previous posters that Emory, Miami, UTSW and Carolinas and probably a few others emphasize operative experience significantly more than research. To me, these are the academic programs that operate like community programs (not necessarily "balanced"). However, because they are academic centers, it wont just be 1000 simple femurs or primary joints. These places will handle as complex a case as anybody, as all of these programs are tertiary referral centers for large portions of the country. Indeed, these places are trauma heavy. But again, because these places are tertiary centers, they typically have plenty of volume and the expectation of autonomy is evident in other subspecialties besides trauma.

Bottom line: I think if you are looking to go to an academic place and operate with the volume and autonomy of a community program, you can do that. There are advantages to that experience, and there are plenty of advantages to going to an academic research powerhouse. And like westcoast said, you really can't go wrong with any of these places. However, some may be a better or worse fit for you and your goals.

[orthoguy123]

If you really wanted to, you could look at the posts this way:

Academic + Research>/=Operative Experience: Mayo, UCSF, WashU, HSS, Harvard, etc.

Academic + Operative Experience>/=Research: Pitt, Case, Baylor, Utah, Vanderbilt, Iowa, Carolinas, etc.

Whichever you choose, all of these programs are top-notch and will train you well. It really depends on your goals and how you think you will learn Ortho best.

[hapless hack]

When I was looking to apply to programs criteria were as follows....

1. location - you will live there for 5 years, you may not think it matters but it does. I condensed my program list to about 80 using this.

2. fellows - I did not want to go to a place with alot of fellows. They take away from your operative experience. Where I am at we have a few fellows, but they are there to assist and teach us. I work with them on less than 5% of my cases.

3. Everything else - if you want a name, go for a name. If you want to learn, look for a busy program with a robust trauma program. Contrary to what many here have posted, doing a ton of one surgery DOES prepare you to do others. The simple act of operating prepares you to do things you haven't done before. If you can tie an arthroscopic knot to do a rotator cuff tear you can tie one to do a SLAP. If you understand how to reduce one fracture, then reducing a different one makes sense once you have done enough. The farther you get along in training the easier it becomes to do things you haven't done before. Watching works to some extent, but nothing beats muscle memory developed from doing. Regardless of where you end up, you will develop skills that improve with every case you do. That's why its a 5+ year program. I can say there are few things I won't feel comfortable doing when I graduate.

[0RTH0]

Iowa vs Case

These seem very similar to me... top 5-10 reputation according to previous posts, strong operative/ academic/ research experiences, all subspecialties represented well, midwest locations. Is either more prestigious than the other? I realize anything posted on this website is purely opinion, but I'm curious what other people think.

[fabricantp]

Great discussion. Agree with alot of what was said, but wanted to mention something of great importance that was not mentioned. For full disclosure Im a senior resident at HSS so will only speak to what we have here.

I too was worried about how fellows affect resident education (and now that Im applying for fellowship, Im worried about how residents will affect fellow education!) Its very important to look at the number of fellows in the context of the institution. here at HSS we have alot of fellows. Alot. But we also have an insane amount of clinical volume. Each day we run 35+ ORs (ortho only) at HSS, plus another 6-8 at other locations (eg. Cornell trauma, VA, etc.). At HSS alone we have 205 beds for inpatient orthopedics (and growing) and did 13,000+ inpatient surgeries and 11,000+ outpatient cases last year (and growing).

In that context, fellows and residents do not affect each other. In fact, several rooms are first assisted by PAs because there are more cases than residents/fellows on site. Furthermore, on essentially every service, the chief resident makes the OR assignments each day, not the fellows. The senior surgeons typically run 2 rooms, and if there is a resident and a fellow on their service they each take a room. In the event that 2 trainees are scrubbed together (eg. fellow/resident or resident/resident), the senior is taking the junior through the case with very rare exception. Or, as is the case in a large spine case, the fellow does one side and the resident does the other.

As was previously said, the above listed programs are all excellent and its a matter of where you fit in, how you feel when you interview, etc. The best way to know how the fellow/resident dynamic really is would be to rotate there, or ask med students who have rotated there or who are students at that program/school. In the end, go interview and ask for yourself, but just looking at number of fellows, etc. without taking clinical volume into account is foolish.

Finally, asking which place is "more prestigious" when trying to decide between the top 10 or so programs is somewhat ridiculous. Go somewhere you fit in, not just because it carries alot of prestige. Youll be happier for it and learn more.

[Jeeper95]

These questions can't honestly be answered by anyone because we all have a true experience of no more than four programs and in all honesty really only one, the one where we end up going. Sure, we all hear things and regurgitate it as if we know, but we really don't. For instance, I'm at Mayo and very pleased with my experience in the OR. The mentor model lends itself to a great experience for those who gain the trust of the staff they work with. One of the above posts stated we had academics/research as being more important than operative skill. This may be so for a few of my colleagues, but it certainly isn't so for most. Yes, there is a wonderful opportunity to do it if you want to, but most of us wind up doing 2-4 projects, more on the lower end.

So I would be wary of any post in these types of forum that tries to be too knowledgable about more than one or two programs because you can't really know without spending more time somewhere. With that, I'm happy to answer any questions about our program.