This is tale as old as time.
Different residents as first assist on truly different procedures is technically allowed, but it'd never happen at most quality programs since you just want efficiency in the OR. It's a hallmark of subpar programs if a Gastroc/Evans/FDL or TAL/Dwyer or whatever is so uncommon that they want to split it up between residents. In my eyes, it's basically the whole case and primary teaching for either resident A or B (hopefully just one of them for most fore/mid and easy RRA stuff!)... not switch midway through. I would never tolerate pgy2 does lapidus and weil 2nd, they they want it to be that pgy1 does hammertoes 2-4th, student does 5th digit. That's just plain dumb and needlessly prolongs the OR time. The time will come for the others... no scarcity mentality needed. It's the first assist's case (and dictation!), and if they struggle or seem unprepared or defer, I will just do it from there out.
There are
actually pubs about PRR proper logging, and 'common mistakes,' but they are to give the appearance of oversight and integrity. When most of the people on CPME are the same people opening new school$ and needing as many residency spot$ as we can have$, do you expect any residencies to reduce/close?
This stuff goes on every day at some programs (trying to squeeze more numbers and fragment procedures)... not a lot can really be done about it.
The biggest garbage bags are the breaking ulcerated Charcot triple or pantalar into three or four RRA fusions (one for each resident), maybe add TAL and other nonsense... and the pt gets their BKA the next month anyways. Joy.
Other favorites include Austin-Akin as bunion with met osteotomy (for one resident) and bunion with phalanx osteotomy (for the other). Doppelganger first ray procedure.
I&D and amp on the same case is as common as they day is long (no idea what program has trouble getting those numbers, but just embellishing overall graduation count I suppose?)
There is bi/trimalls into two fx repairs (one resident tib, one fib), de/re Achilles is a rupture repair for one and tarsal exostectomy for another... sky's the limit.
The biggest nonsense is the "first assist" and "getting numbers" for RRA with ortho where the resident is retractor city and (maybe) helps splint at the end. That is what allows many programs to get "RRA" for doing the job of a traveler scrub tech and with little or no teaching from the "attending," and that's sad.
In the end, though, follow the money. The
people in charge of this (deans, directors, professors, etc) are largely the people who profit from more schools/students/residents/DPMs. It's a conflict of interests through and through. There are some people who have an open mind and try to be objective, but they're likely overshadowed or politicked into "the right choice." I have known a few people who volunteer for site visits of programs; any concerns or recommendations for program improvement typically fall on deaf ears. Perhaps a few probations or corrections might be considered in times of a residency spots surplus, but in a shortage or potential one (new schools)? Fuggeddaboudit. Follow the money.
Maybe this upcoming pod school enrollment crisis will be a wake-up call to close/reduce/consolidate the many suspect "PMSR/RRA" programs, but I sure wouldn't hold your breath.
...If any pre-match students happen to read this thread, this is a very good thing to look for on clerkships... ask to see logs or ask residents to show you how they log. The BS logging after a case by a resident is a sizable red flag of a program you probably don't want. Residents reluctant/refusing to show logs is another potential problem. Resident with robust logs and actual surgery schedule anemic to the point of them being in different universes is one of those red flags that covers a whole bball court at a halftime show.
