Early operative exposure

Hey micky,

I didnt mean that I want to close wounds - I agree that a junior resident can do that ... but the impression that I get from some US residents is that in top heavy programs the big name attending may not feel comfortable at letting a resident do the critical bit of the case, e.g. deciding on the version of the acetabular cup in a total hip arthroplasy ...

I'm not interested in stirring anyone or engaging in a debate of whether one country has better training than another but I'm still looking for some folk on here to give feeback on how much operating as "primary" they're getting ....?

to those who are concerned about early operative time, the amount of early operating depends on a number of things.
1. the attending staffs comfort level with allowing someone to "futz around"
2. complexity of the case
3. operators skill level (some residents have better hands that others0
4. is a minor error easily repairable with causing harm to the patient and changing ultimate outcomes.

i personally believe that young residents are far to eager to jump in and do something without an actual concept of what they are doing. oh yeah they can recite what they read in the book last night, but do they actually have the visual concept in their head? i had a hand attending tell me once that he visualized the case from beginning to end before he came into the room. how can you do that if you have never seen it or have little experience with it?

i believe, yes this is only my opinion, that the surgical training should be weighted. this doesn't mean no surgical exposure in the first few years, but it means there are cases that may be above your skill level. for instance, doing a Ganz osteotomy as a pgy2 or 3 is probably too early, without having basic pelvis exposure with simple posterior wall fractures or primary total hips. i think the ACGME should come out with a skill rating system for each procedure. like some RPG's, "in order to perform this skill set you must rise to pgy-x level."