Category Archives: Residents

Residents and Fellowships the Saga Continues

Residents and Fellowships

General Surgery News¬†had an article in the January edition about how residents are pursuing fellowships despite the job market not requiring fellowship training. The article can be found here.¬†Clearly there appears to be a multitude of problems when 70% of surgery residents are entering fellowship and only 1/3rd of the job postings require a fellowship. While a lot has changed in general surgery, general surgery training, and the culture of the medical field resulting in residents wanting to specialize, I don’t think that analysis of job postings is the right way to look at it. Here are my thoughts:

  1. Fellowship trained physicians enter a much smaller community where job postings may not need to be as frequently utilized. Job postings are likely to be for more difficult to fill positions.
  2. Likely the organizations care less about your fellowship and more about how you fit into the call pool, and they want you in the general surgery call pool.
  3. Surgery has been in a specialization phase to keep up with the rapid advancement of minimally invasive techniques. This created a over-inflated demand for the young specialist who could do these procedures. Supply will overturn demand eventually.
  4. The real study should be surveying graduated fellows how completion of the training program affected their job, with a follow up survey at 3 years about the utility of their fellowship in their daily practice.
  5. The societies of the specialties should be the ones monitoring the utility of their fellowship and figuring out how to create maximum benefit to the graduates even if this means winding down lower tier fellowships ultimately reducing the number of members of their society. They have a duty to maintain the integrity of the specialty.

Ultimately with the proper training, good bedside manner, and excellent interactions with referring physicians you can find your niche and practice your specialty but it may become increasingly difficult to keep yourself in a specialist only practice and call pool and to fend off the wave of incoming newly minted specialists.

SICKO surgical training

SICKO is a surgery related educational game designed to aid learners in applying didactic learning to clinical situations. I found the game to be both entertaining and educational. It broke free from the boredom of standard case presentation interactive software by having you manage multiple patients under time constraints, and giving you feedback as you correctly manage the patient rather than waiting till the simulation is over. The patients are represented by cards, and give you an idea of how they are doing by dropping to the bottom of the screen.

Screen shot from SICKO surgical simulator

I did notice that I kept getting docked points for putting NG tubes in patients, I guess I was trained to aggressively put NG tubes in early on patients with vomitting or obstructive patterns on imaging.

While playing around with the software I was chatting online and let a patient sit too long who I ultimately diagnosed with appendicitis. Apparently as a result of my delay the patient perforated and developed an abscess there in the ER. I lost points for that.

After you make a decision to operate, you have to know enough of the diagnosis to pick out an operation to perform. You then answer multiple choice questions about different problems that you could encounter with intra-operatively and post-operatively.

Screen Shot from Sicko Surgical Simulator

Overall I thought the simulator was one of the better ones I have tried. I think that it would be a great tool for medical students and lower level residents and maybe even higher level residents working with more diagnosis.

Try it out for yourself