IamNikolas OSRR Fellow Posts: 102 (12/17/01 10:06:20 pm) Reply Decisions...Decisions... I had a question for OrthoDoc or any other residents who can contribute: My question is regarding orthopaedic training in general...just looking for some perspective. I have interviewed at a program that seemed VERY "cush"...like home call all 5 years with as good as q6 or q7, and I've interviewed at programs with a tough schedule ...like Q3 call for first 2 years, with in-house call for most of your residency. I'm wondering if this really makes a difference in the type of orthopaedic surgeon you become...it seems that if a program is so cush, you don't learn as much. I have the "If it doesn't kill you, it only makes you stronger" attitude about most things...but 5 years of relatively low stress is also appealing...i'm just wondering if I'll be as competent a surgeon. But the problem is that residents and attendings at all of these programs claim that their training is "balanced" and that they would be "ready for anything" after residency...but on the surface (from 1 day of interviewing) there is a huge discrepancy between programs in terms of the demands on the residents and the types of cases they are exposed to. Should this be something to consider? Also, if a program is in a location that doesn't see a lot of inner city type injuries like gunshot wounds, should this be viewed as a weakness? I cannot imagine working in an inner city program as an attending if I have not seen many gunshot injuries as a resident. Not that I will want to...but just how important is it to be exposed to these types of injuries? Finally, I have a special interest in spine (I know it's early and I'm a stupid medical student but I've done a lot of research in the field and really dig it)...if a program isn't that strong in spine, will this hurt me when I apply for fellowships? Phrased another way, should I rank a program higher because it has a strong spine program or is this not an issue because you have to do a fellowship anyway? There is a program i interviewed at that I really liked, but their spine experience isn't as great as a couple of other places that I can rank higher. Just wanted your thoughts on this Thanks for ANY input! orthopaedicwannabe OSRR Newbie Posts: 4 (12/18/01 8:25:42 am) Reply decisions You never know for sure at this stage what you'll wind up doing or want to do in the future. I have never heard an attending say they wish their residency had not been so trauma heavy, or too much OR time, or too much call. I have heard the opposite. You're only a resident once, so go to the best program you can and get the best experience possible. You can have cush afterwards if you want; if you go to a cush residency, it may limit your choices later if you change your mind. bonedoc2be OSRR Senior Posts: 53 (12/18/01 3:13:24 pm) Reply But where did you like the most? You did not mention where you felt like you fit in the most. I think you would be making a mistake to try to go somewhere you did not fit in just b/c you think they are better in one category or another. People nit pick but what are you gonna be when your done with any of these programs? An orthopedic surgeon. Period. Earthdawg OSRR Intern Posts: 10 (12/19/01 8:13:14 am) Reply "cush" You need to be careful how you define the word "cush". A "cush" program does not necessarily mean that you will operate any less, in fact you may operate more. It's a matter of when you will be operating. Many private programs have nicer call schedules, but because residents operate at surgery centers and at private hospitals, the turn over time is much faster and the total number of cases is higher by the end of residency. It also depends on what you want to do when you are done. If you want to be a joint or sports guy, I can guarantee that no matter HOW much call you take, you won't be doing a total knee or an ACL at three AM. Most operating at night consists of trauma - I & D of open fractures, IM nails, etc. As with anything, there is a learning curve but at some point you become proficient and additional cases become little more than additional work without much gain in proficiency. For example, sewing up 20 forearm lacerations in medical school would be educational. Taking call every other night and sewing up 400 probably would result in a lot more pain with little increase in proficiency. The same holds true for IM nails, I&D, washouts, etc. While the experience on call is important to consider, the TOTAL number of operative cases during your residency, and the amount of cases as primary surgeon and first assist are at least equally important in determining the operative skill you will acquire. From my experience, the amount of call at any given program does not correlate with the number of cases their residents perform. All that said, from your previous posts you seem to be very interested in research and want to do spine. If you have not ruled out a career in Academic Orthopaedics, you probably should look toward a university program. A private "cush" program may train you very well for the OR, but is unlikely to provide you with the "high power" research opportunities you seem to want. OrthoDoc Orthopedic Surgeon Posts: 70 (12/20/01 5:33:50 pm) Reply Community Supporter Re: "cush" I agree that most call cases are trauma related and at most programs, you'll have more than enough experience washing out drunkerds bones in the middle of the night and slamming rods down long bones. However, most of the call issues relate to non-operative orthopedics and patient care. The only plus to having a little more call is that you get a little more experience with closed reductions and other unusual cases that come around rarely. There are lots of tricks when it comes to closed reductions, casting, splinting, etc... most of which aren't talked about in any books. Many of them are passed down from senior to junior resident and it takes time and experience to learn them. I would be skeptical of a program with "home" call for all five years, but not one with a light "in-house" call schedule. Most programs have "in-house" call b/c they are level I trauma centers which require an orthopod to be in the hospital at all times. You'll find a lot more time to read and time with your family if you choose a program with a lighter call schedule. Just talk to the senior residents and ask them how their experience has been and whether or not they are comfortable in all areas of orthopedics. Their overall training is more important than the call schedule, but if you feel two programs are equal, go with the one with a better lifestyle. IamNikolas OSRR Fellow Posts: 106 (12/20/01 5:49:45 pm) Reply re: Thank you for the replies. I'm having a hard time deciding on a few programs...Is it me, or does EVERY program tell you their residents get GREAT fellowships? I mean, how many great fellowships are there out there?!? Also, as for the call schedules, even the "cushest" of the cush have said that they are well-trained and feel ready for any area of practice. Maybe they feel ready for the area they serve as residents...i'm thinking if they worked in another setting, they may not make such claims? Who knows. I guess you just go by gut instinct and decide where you would be happiest. I think my problem is that I've gotten interviews from such a mix of programs -- some highly academic and university based, some very community with "cush" lifestyles and some in-between -- I'm having a hard time...I guess the rest of you are in the same boat...i would appreciate any more insights from anyone. orthohopeful OSRR Junior Posts: 47 (12/20/01 6:57:41 pm) Reply my take for Nikolas Here's my take on your situation (one similar to my own). You have to look at your career goals and inclinations, family situation, and personality. If you know for a fact that you want to be a sports guy doing six or seven knee scopes a day with no inpatients and no trauma, then you can afford to go to a less intense program with less trauma call. You'll have to do some trauma when you are the new attending in the group, but that doesn't mean you need to do several hundred IM nails during your residency to be comfortable. That sort of predeliction also affords you the luxury of not caring whether or not a given program is strong in spine, or hand, or whatever subspecialty that you aren't really interested in. If you have family and want some time to spend with them then you obviously would be better served in a more "cush" program. The thing that gets me in this choice is my personality. Obviously this is a big choice for all of us, and the enormity of it has different effects on each one of us. Personally, my mind works in such a way as to always want to have options. There is nothing more loathsome to me than regret at having made a poor choice that limits my future options. I think I know what I want to do (spine in private practice), but I'm not sure enough about that choice to rule out academics or trauma or hand, pedi, etc. If I'm right about wanting to do private spine in the long run then I could rank No. 1 a program with easy call, light trauma, and a great spine department that would get me into a good fellowship. However, I'm so worried about changing my mind and being locked into a program that limits my future career choices, that I probably won't be able to turn down a well rounded program with the big name that will afford me the choice to do anything after I'm done. I think that if you aren't sure what you want to do, then you have to choose the most well-regarded, well-rounded program that you interview at. My advice would be to ask yourself the above questions and decide what is best for you. I wish you the best of luck. Chaney3 OSRR Senior Posts: 54 (12/20/01 7:58:17 pm) Reply re: I agree with the above. All programs do seem to claim their residents get top fellowships. And it is hard to decide between a "cush" and an inner city level 1 trauma center. It seems you have to either sacrifice lifestyle or exposure to variety. Although it's still early, we have to start thinking about our rank lists. Personally, I am very clear about my first couple of choices. I anticipate having much difficulty past choices 4 or 5. You enter the gray area at that point and decisions are more difficult. I'm interested in general ortho (don't think I'll do a fellowship). The question of exposure to gunshot wounds was not addressed. Is this exposure beneficial? If trained to handle blunt trauma, is that adequate to handle the gunshot fractures as well? BoneWax OSRR Newbie Posts: 5 (12/23/01 12:38:08 pm) Reply Gunshots -- my 2 cents I don't think it's a big deal if you don't see that many gunshot injuries. The reason I say that is because so many programs in the country are not in locations that would be exposed to such injuries. And you really don't hear anyone complaining at these places. And I have NEVER heard of anyone saying: oh that program is weak -- they don't see any gunshot injuries! I mean, if I were to take this into account, I would have to eliminate more than half the places I have been invited to !