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How many cases each year?
#11
(11-08-2021, 09:45 AM)Guest Wrote: PGY7 at a busy southern program. Intern year was ~100, PGY2/3 were 250ish, PGY4 was 300, PGY5 (research) around 150, Chief year was around 450-500, enfolded fellowship ~250. If you count the non-surgical and EVD stuff that's another 300-400, but I wouldn't include that in any calculation.

Someone has already mentioned that pure case numbers are incredibly deceiving. Nothing beats actual autonomy in the OR. My PGY7 was many fewer cases - but they were T10-pelvis deformity cases done with the attending not in the room. Can't do more than two of those in a day (don't care who you are). I would wager that one of those cases where you independently do the instrumentation is worth 10+ where the attending is guiding you through it. You cannot say "I can do X" until you've done it all the way through with the attending only minimally scrubbing.

Excellent post, lots of wisdom here.

Also be wary of programs that group surgical and endo cases, these should be reported separately to applicants
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#12
(11-08-2021, 09:47 AM)Guest Wrote:
(11-08-2021, 09:45 AM)Guest Wrote: PGY7 at a busy southern program. Intern year was ~100, PGY2/3 were 250ish, PGY4 was 300, PGY5 (research) around 150, Chief year was around 450-500, enfolded fellowship ~250. If you count the non-surgical and EVD stuff that's another 300-400, but I wouldn't include that in any calculation.

Someone has already mentioned that pure case numbers are incredibly deceiving. Nothing beats actual autonomy in the OR. My PGY7 was many fewer cases - but they were T10-pelvis deformity cases done with the attending not in the room. Can't do more than two of those in a day (don't care who you are). I would wager that one of those cases where you independently do the instrumentation is worth 10+ where the attending is guiding you through it. You cannot say "I can do X" until you've done it all the way through with the attending only minimally scrubbing.

Excellent post, lots of wisdom here.

Also be wary of programs that group surgical and endo cases, these should be reported separately to applicants
Some programs also lump in gamma knife/cyber knife, so watch out for that too
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#13
Gamma knife and EVDs are a prime way for places to inflate numbers. Also, look at endo cases - those are fluff for anyone not doing the fellowship since you won't get privileges (there is value in knowing how to interpret them).

There are a couple of papers out there that look at trends in case logs. The RCC also has data on where your program would be percentile-wise. The relevant numbers (from Licci et al 2020): 450 spine, ~170 tumors, 130 traumas (includes cranioplasty), 30 aneurysms, 100 functional. That's senior and lead only. 1000 seems low but they have the logs...

Everyone learns to operate at a different pace. It is dependent on knowledge of anatomy, commitment to taking notes and making progress in each case, and prep ahead of time. Yes, dexterity and some natural, innate ability play a role. I would recommend everyone read some of the Lawton books where he directly addresses this. He flat out says that his technical abilities stem from being willing to work at it harder and spend time in the skull base lab. He's left-handed for crying out loud. There's no reason he should be the technically most accomplished person in our field, but he is.

Personally, it didn't click with me until around ~1200 cases. I saw my co-resident catch on earlier and I've watched other people struggle for longer. I didn't start making massive progress until I internalized the reality that I would have to work/study at it to get it right. Every attending I've seen who struggles in the OR has a common set of traits: they fail to recognize when THEY made an error and they lack the discipline to work hard to improve.
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