07-31-2022, 06:53 PM
Senior resident here, wanted to share some thoughts for applicants. Programs have all sorts of qualities you might be seeking, including prestige, academic support, location, culture etc. Rankings are usually heavily influenced by research dollars and inter-professional assessment of prestige. A common argument on this forum is where you get good operative experience. It’s difficult to measure but as you are on your subIs look out for the following. Most programs will make you a competent surgeon but remember residency is where you become the surgeon you’ll be for your career. You can do a fellowship and hone your skills all your career for sure, but residency is where you should learn when to operate, when to not operate, and of course the technical skills of 95% of neurosurgery cases.
-How many residents are in the room? The ACGME allows one resident to log as lead and one as senior, the rest are not counted, so programs where 4 residents are logging an aneurysm should raise an eyebrow. Look for programs with 1-2 residents per case.
-Who is doing the majority of the case? Is the attending doing it all and the chief is holding suction? Or is the chief leading, working with a junior, and the attending is supervising. For an aneurysm this means the chief should be splitting the fissure and having a chance to place the clip. For a spine the chief should be placing their side of hardware. For a tumor the chief should be resecting including the capsule.
-What are the middle year residents doing, PGY3-PGY5? These residents should ideally be in their own ORs with an attending, without a PGY6 or PGY7 there. Or, maybe they’re on off campus rotations getting 1:1 training with attendings. They shouldn’t be the 3rd or 4th resident in a case hoping to throw a suture. That’s sad. They should be leading or heavily assisting more bread and butter cases at least.
-Are there fellows and what is there role? Some programs have many fellows and they get to do a lot of the case. You don’t want to wait until PGY7 to get a real part of the case because fellows are around a lot.
-Is there a strong trauma service and/or a VA service? Trauma and VA are both excellent experiences to mature as a resident, you naturally are given more autonomy. Programs with both often provide a good operative experience overall.
-How old are the attendings? Attendings too young may not let you lead as much as they are nervous or inexperienced in their first years.
-Where did the attendings train? This could be good or bad, but you want to look for a program where attendings come from many different training programs. This leads to less groupthink and politics, and a range of teaching styles. Be wary of a program that keeps hiring only their own graduates.
-How many actual first start ORs are available to residents, the more the better for you.
-When programs report operative volumes try to suss out if they’re counting procedures, IR, or GK cases.
-How many residents are there per year? A 4/yr program should have twice the cases of a 2/yr program.
-How many residents are in the room? The ACGME allows one resident to log as lead and one as senior, the rest are not counted, so programs where 4 residents are logging an aneurysm should raise an eyebrow. Look for programs with 1-2 residents per case.
-Who is doing the majority of the case? Is the attending doing it all and the chief is holding suction? Or is the chief leading, working with a junior, and the attending is supervising. For an aneurysm this means the chief should be splitting the fissure and having a chance to place the clip. For a spine the chief should be placing their side of hardware. For a tumor the chief should be resecting including the capsule.
-What are the middle year residents doing, PGY3-PGY5? These residents should ideally be in their own ORs with an attending, without a PGY6 or PGY7 there. Or, maybe they’re on off campus rotations getting 1:1 training with attendings. They shouldn’t be the 3rd or 4th resident in a case hoping to throw a suture. That’s sad. They should be leading or heavily assisting more bread and butter cases at least.
-Are there fellows and what is there role? Some programs have many fellows and they get to do a lot of the case. You don’t want to wait until PGY7 to get a real part of the case because fellows are around a lot.
-Is there a strong trauma service and/or a VA service? Trauma and VA are both excellent experiences to mature as a resident, you naturally are given more autonomy. Programs with both often provide a good operative experience overall.
-How old are the attendings? Attendings too young may not let you lead as much as they are nervous or inexperienced in their first years.
-Where did the attendings train? This could be good or bad, but you want to look for a program where attendings come from many different training programs. This leads to less groupthink and politics, and a range of teaching styles. Be wary of a program that keeps hiring only their own graduates.
-How many actual first start ORs are available to residents, the more the better for you.
-When programs report operative volumes try to suss out if they’re counting procedures, IR, or GK cases.
-How many residents are there per year? A 4/yr program should have twice the cases of a 2/yr program.
