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Case volume vs research - defining high tier programs
#1
This is just for brain storming, it is not intended to hurt anyones ego!

It has been the trend in medicine that research output and grants funding determines the reputation and ranking of residency programs. This was automatically reflected on surgical specialties as well, including neurosurgery. In the way that you see many programs that benefit from their undergrad or research reputation to hold the label "high tier" or competitive, despite low case volume. Examples are plenty, including Yale, Stanford, Columbia, and many others. 
That is the same reason why for a long time the minimum requirement for graduation was 400 cases and only recently was changed to 800! 
Kinda ridiculously low number! It is intuitive that you need much more than this to be a competent surgeon, and certainly taking 2 years off your senior years of residency for "protected research" is not helping, nor does having attendings who are great but very hands on! Otherwise more of the likes of Dr. Death will be out there. 

Associated with all of this is the arbitrary definition of "high tier" programs. What really is a high tier program ? How could one program define itself as high tier while their residents graduate with 1200-1500 cases, regardless on how many residents they take per year ?! This has lead to many stories of new graduates from some of those programs suffering at their new place of hire, and some of them were let go. They are great researchers, but not competent surgeons!

A better definition of surgical tiers should be the number of cases done (as senior or lead surgeon) at time of graduation and the associated level of autonomy, in a way that:

- High tier - >2000 cases with reputation of supervised autonomy
- Middle tier - 1500-2000 cases 
- Low tier - < 1500 cases 
Of course per the ACGME definition a senior or lead surgeon has to do more than just opening and closing the wound to be able to log the case.

Certainly if the residents' interest is more directed towards basic science research, then their choice of such institutions is ideal. However, the programs still should not enjoy the definition of high tier only because they are good at handling lab animals for 2 years. It's incredibly counterintuitive to being a "surgeon"!

God bless!
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#2
(08-22-2020, 07:09 PM)Guest Wrote: This is just for brain storming, it is not intended to hurt anyones ego!

It has been the trend in medicine that research output and grants funding determines the reputation and ranking of residency programs. This was automatically reflected on surgical specialties as well, including neurosurgery. In the way that you see many programs that benefit from their undergrad or research reputation to hold the label "high tier" or competitive, despite low case volume. Examples are plenty, including Yale, Stanford, Columbia, and many others. 
That is the same reason why for a long time the minimum requirement for graduation was 400 cases and only recently was changed to 800! 
Kinda ridiculously low number! It is intuitive that you need much more than this to be a competent surgeon, and certainly taking 2 years off your senior years of residency for "protected research" is not helping, nor does having attendings who are great but very hands on! Otherwise more of the likes of Dr. Death will be out there. 

Associated with all of this is the arbitrary definition of "high tier" programs. What really is a high tier program ? How could one program define itself as high tier while their residents graduate with 1200-1500 cases, regardless on how many residents they take per year ?! This has lead to many stories of new graduates from some of those programs suffering at their new place of hire, and some of them were let go. They are great researchers, but not competent surgeons!

A better definition of surgical tiers should be the number of cases done (as senior or lead surgeon) at time of graduation and the associated level of autonomy, in a way that:

- High tier - >2000 cases with reputation of supervised autonomy
- Middle tier - 1500-2000 cases 
- Low tier - < 1500 cases 
Of course per the ACGME definition a senior or lead surgeon has to do more than just opening and closing the wound to be able to log the case.

Certainly if the residents' interest is more directed towards basic science research, then their choice of such institutions is ideal. However, the programs still should not enjoy the definition of high tier only because they are good at handling lab animals for 2 years. It's incredibly counterintuitive to being a "surgeon"!

God bless!
Dumb
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#3
(08-22-2020, 07:09 PM)Guest Wrote: This is just for brain storming, it is not intended to hurt anyones ego!

It has been the trend in medicine that research output and grants funding determines the reputation and ranking of residency programs. This was automatically reflected on surgical specialties as well, including neurosurgery. In the way that you see many programs that benefit from their undergrad or research reputation to hold the label "high tier" or competitive, despite low case volume. Examples are plenty, including Yale, Stanford, Columbia, and many others. 
That is the same reason why for a long time the minimum requirement for graduation was 400 cases and only recently was changed to 800! 
Kinda ridiculously low number! It is intuitive that you need much more than this to be a competent surgeon, and certainly taking 2 years off your senior years of residency for "protected research" is not helping, nor does having attendings who are great but very hands on! Otherwise more of the likes of Dr. Death will be out there. 

Associated with all of this is the arbitrary definition of "high tier" programs. What really is a high tier program ? How could one program define itself as high tier while their residents graduate with 1200-1500 cases, regardless on how many residents they take per year ?! This has lead to many stories of new graduates from some of those programs suffering at their new place of hire, and some of them were let go. They are great researchers, but not competent surgeons!

A better definition of surgical tiers should be the number of cases done (as senior or lead surgeon) at time of graduation and the associated level of autonomy, in a way that:

- High tier - >2000 cases with reputation of supervised autonomy
- Middle tier - 1500-2000 cases 
- Low tier - < 1500 cases 
Of course per the ACGME definition a senior or lead surgeon has to do more than just opening and closing the wound to be able to log the case.

Certainly if the residents' interest is more directed towards basic science research, then their choice of such institutions is ideal. However, the programs still should not enjoy the definition of high tier only because they are good at handling lab animals for 2 years. It's incredibly counterintuitive to being a "surgeon"!

God bless!


Completely agree. However, too many academic neurosurgeons with mediocre technical competence need a system like the current one in order to survive and stay relevant. People who prefer to “talk about neurosurgery” are often the same who are the least technically capable and trained for surgical mastery. They must cling to academic/lab-based reputation, despite what the average person walking down the street cares about: Surgical technical competence.


Sent from my iPhone using Tapatalk
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#4
Absolutely! I go to a program in the MW and our residents graduate with 2000+. Yet places like JH still enjoy a better reputation in neurosurgery training while their residents graduate with 1400 cases and their attending are pretty hands on. Makes no sense.
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#5
It’d be nice if the ACGME published this data
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#6
This is obviously stupid. If no one tried to innovate, the field wouldn't exist. If no one cared about surgical skills, we'd kill most of our patients. The best program in the country is different depending on your goals.

If you want to work in the community or do something very complex like deformities or skull base, surgical skills might be more important. If you want to do research and build a practice on one specific disease, research training and mentoring will be way more important (NIH $ doesn't grow on trees). No one program is perfect for everyone's goals.

Ultimately, I think the best program in the country is the one you match at. The rest is on you. No math can account for that.
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#7
(08-22-2020, 09:52 PM)Guest Wrote: Absolutely! I go to a program in the MW and our residents graduate with 2000+. Yet places like JH still enjoy a better reputation in neurosurgery training while their residents graduate with 1400 cases and their attending are pretty hands on. Makes no sense.

Because, on average, the JHU resident is a superior person in terms of accomplishments, intellect, social aptitude. Doing 300 fewer cases won’t change that.
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#8
(08-23-2020, 05:46 PM)Guest Wrote:
(08-22-2020, 09:52 PM)Guest Wrote: Absolutely! I go to a program in the MW and our residents graduate with 2000+. Yet places like JH still enjoy a better reputation in neurosurgery training while their residents graduate with 1400 cases and their attending are pretty hands on. Makes no sense.

Because, on average, the JHU resident is a superior person in terms of accomplishments, intellect, social aptitude. Doing 300 fewer cases won’t change that.

"the JHU resident is a superior person"

dude you really need to take a long look in the mirror writing something like that
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#9
(08-23-2020, 05:46 PM)Guest Wrote:
(08-22-2020, 09:52 PM)Guest Wrote: Absolutely! I go to a program in the MW and our residents graduate with 2000+. Yet places like JH still enjoy a better reputation in neurosurgery training while their residents graduate with 1400 cases and their attending are pretty hands on. Makes no sense.

Because, on average, the JHU resident is a superior person in terms of accomplishments, intellect, social aptitude. Doing 300 fewer cases won’t change that.

This is the dumbest thing I’ve heard!

Sure thing their residents are mostly very nice people. But you think spending 5 years in a lab makes you “superior”?! Lol!! You have issues dude
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#10
(08-23-2020, 06:19 PM)Guest Wrote:
(08-23-2020, 05:46 PM)Guest Wrote:
(08-22-2020, 09:52 PM)Guest Wrote: Absolutely! I go to a program in the MW and our residents graduate with 2000+. Yet places like JH still enjoy a better reputation in neurosurgery training while their residents graduate with 1400 cases and their attending are pretty hands on. Makes no sense.

Because, on average, the JHU resident is a superior person in terms of accomplishments, intellect, social aptitude. Doing 300 fewer cases won’t change that.

This is the dumbest thing I’ve heard!

Sure thing their residents are mostly very nice people. But you think spending 5 years in a lab makes you “superior”?! Lol!! You have issues dude

Haters gonna hate. I’m sure you “lucked out” by not matching there dude
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