Will there ever be an integrated trauma survey residency?

[epsilonprodigy]

It's happened for plastics, vascular and CT...any hope for trauma? It's too late for me anyway, but am curious about what others think regarding potential barriers and overall likelihood.

Edit: stupid auto correct. Clearly I meant SURGERY, not survey. Oy vey.

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[Handinhand]

I'm not going into gen surg, but with what little I know I would say I doubt it. Those others broke away because there's really no reason for them to spend the large part of 5 years learning to operate in the abdominal cavity, when they're going to go off and sub-specialize in a field that doesn't deal with that -- while at the same time they spend more time now in their 5-6 years of residency focusing on their specific field. For trauma I would argue that you need a broad knowledge of all of those fields still, so I can't imagine where you would streamline the process.

 

[vhawk]

If you were to start from scratch designing a 5 year program aimed at creating a trauma surgeon to operate in the current market for trauma surgeons....it would look a lot like a general surgery residency. Whats the motivation for the earlier track?

 

[themockjock]

Not sure what the point of this would be... Other than very few systems specifically set up to be massive referral centers for trauma (and only trauma), the vast majority of trauma services are mostly going to be a combination of trauma and emergency general surgery (and many "trauma" surgeons have an elective general surgery practice as well). In both residency and med school I've rotated at large urban trauma centers with relatively high volume penetrating trauma and even there the trauma service also took care of emergent GS things (incarcerated hernias, appys, acute abdomens of whatever flavor).

Plus what would the goal of this be? If it's to learn to surgically manage all parts of trauma including neuro and ortho injuries, forget it. There's no way to be comfortable doing cranis, ex laps, and complex extremity reconstruction all together. If it's to learn how to be a competent trauma surgeon, you're better off going to a trauma-heavy residency and doing an extra year if you feel the need (although this isn't, strictly speaking, necessary).

 

[bannie22]

It would be too restrictive. Trauma surgeons require a broad based knowledge in the entire human body in order to manage their patient population well.
They, of all general surgeons, benefit most from subspecialty rotations and critical care rotations. Research much less, but in this day and age, a lack of research opportunity would make you a lesser candidate.

There's just no where to streamline the residency process.

 

[doc05]

yes, it's called a general surgery residency.

 

[thedrjojo]

Trauma surgery isn't a specialty. Every board certified general surgeon is trauma trained and qualified to perform trauma (especially if they get ATLS). There are no certification for trauma fellowships, which is why most trauma fellowships are actually critical care fellowships with trauma experience built into them.

 

[thedrjojo]

These integrated programs really only make sense for fields where the content overlap is minimal with the rest of general surgery. Of the remaining general surgery subspecialties, the only other ones I could really see making a case for are breast oncology and maybe endocrine.

However, for endocrine I think (a) at that point what's the difference between them and ENT (which already overlaps a lot) and (b) they'd suffer in their preparation for/ability to do big adrenal and pancreatic neuroendocrine cases (although those are increasingly limited to big regional centers anyways). I'm also not sure how many programs could really justify/support an integrated endocrine residency...

For trauma/acute care, the necessary skills are good open and lap operative techniques and broad knowledge base. I.e. general surgery.

I think more likely is that the ABS moves forward with tracking programs and increased flexibility in training requirements (i.e. you spend the first 3-4 years in a general program, then track into a sort of "pre" fellowship that is more specialized to your field of choice); or that we move to a 4 yr residency with mandatory 1-3 year fellowships (length dependent on field)

In most things I like the 4+ plan, but if you are going to be a gs, doing that 5th year at the same place as your residency vs a new place (attending comfort and familiarity with a resident goes so far) is so important that I think that it's silly to have to make them interview and rank/match. But I'd be thrilled to be starting fellowship in 3 months instead of a year later, but I don't know if I'd be ready to sew in a liver in 3 months (despite doing 2.5 of the 3 open aaa anastomoses two days ago)

 

[thedrjojo]

Agreed. I think while they were horribly mismarketed, the "transition to practice" fellowships (oh sorry, they dropped the "fellowship" title and call them junior partners now...) are what should actually happen for people doing general surgery in a 4+ plan.

Really, ideally, the TTP model is what a chief residency should be I think - increased autonomy, ability to staff your own clinic and book level-appropriate cases independently with senior backup available.

Those times are long gone... Although a case got booked under my name somehow last month... An Ivc filter, so I probably could have staffed it alone

 

[Trauma Surgeon]

I think one should ask the question in a different way, should most of the other subspecialties be integrated ones? Where I'm we are looking over the whole surgical residency. Cardiothoracic and plastic surgery had been on their own for decades. Now (since 2015-16), they are joined by vascular, peds, and urology. There are plans to do early sub-specialization, 2-3 yrs common trunk and then of to the subspecialty of ones choice. Why should future endo and breast surgeons do years of laparoskopik surgeries? extremely few will go into endocrine surgery involving abdominal cavity, and that will soon be centralized so future adrenal/pancreatic surgeon will have their second part of residency tailored to their future career.
Then we have the so called trauma surgeons, even in US they are not calling them selves that anymore, they are acute care surgeons! So their residency will be tailored as it is today and no way to do it differently! We are expected to get in all cavities, fix the problem (at least damage control), not do more damage, and get out… Unfortunately, most residencies are not good enough to produce trauma/acute care surgeons (both in US and Europe), but all general surgeons call them selves trauma surgeons!
We have already started this process at my hospital, waiting for national directives. I do take all acute cases and consults coming in and cover all the services during the night, except esophagus and pancreas service (their complications are out of my scope, and probably all future acute care surgeons too due the centralization of theses surgeries).
So, the general surgery residency as it is today will produce future junior acute surgeons, and all the other sub-specialities will be integrated ones (in my country).

 

[ItinerantSurgeon]

Gents, back in the day you were a trauma surgeon when you finished your gen surgery residency. But then again that was when PGY3's were taking interns through legit cases while the chief was asleep somewhere in an affiliated hospital across town and the attending was in rehab. In other words you were on your own and that's how you really learn when you have no back up to bail you out. Now they get coddled and in this everybody-gets-a-trophy society every PGY5 is a "Chief" instead of only the one best resident being appointed Chief by the Heavies.