Are There Any Surgeries Every Resident Performs Initially?

Do residents begin their surgical careers with a specific procedure, or is it more of a random experience? This article explores the structure of surgical residency programs in the United States and how residents initially engage with their training and certification.

The Structure of Surgical Residency Programs

Residency programs in surgery are structured to provide a comprehensive education. Unlike a fixed curriculum, the nature of the first surgery a resident experiences can be quite varied. Depending on the program and the resident's specific branch of surgery, they might start with Emergency General Surgery, Vascular Trauma, Surgical Oncology, Bariatric Surgery, Foregut Surgery, Colorectal Surgery, Hepatobiliary Surgery, or even Transplant Surgery.

Typically, a resident's first year is composed of several rotations. Each rotation lasts one month and rotates through different departments. Due to the small number of residents per rotation (usually a handful), participants rotate every month. This variability means that the first surgery might be something simple like a superficial lipoma excision, or a more complex procedure like a total colectomy.

Surgical Education and Graduated Responsibility

Surgical education is fundamentally based on the principle of graduated responsibility. Residents begin with more straightforward and less risky procedures, gradually working their way up to more complex and challenging surgeries. This progressive learning ensures that they can handle increasingly difficult cases as their training progresses.

ACGME Accreditation and Certification Standards

Medical residency training programs in the US are accredited by the American Council on Education for Graduate Medical Education (ACGME). Each specialty and sub-specialty has outlined a minimum number of patient encounters and specific procedures that residents must complete during their training.

The primary goal is to ensure that the graduating resident is eligible to take certification examinations offered by their specific specialty or sub-specialty board. A key part of this evaluation is the review of the resident's log book, which documents all patient encounters and procedures completed.

Residents who successfully meet the required benchmarks can apply to sit for these certification exams. However, elective procedures, which are not strictly required for board eligibility, are only permitted once the basic training program is completed. This is to ensure that residents have a solid foundation of training before undertaking any elective procedures.

Proctoring Requirements Before Solo Practice

Even after completing their basic training, there may be a period before a surgeon is allowed to perform certain procedures independently. Hospitals often require a monitored period, or proctoring, before granting solo practice. This is in place to ensure the safety and competency of the surgeon, as even experienced residents may perform their first complex surgeries post-residency.

While it is theoretically possible for a surgeon to perform a specific procedure for the first time after residency, it is uncommon. This step is generally reserved for more straightforward procedures, with more complex surgeries requiring further training and proctoring before the surgeon is ready to work unsupervised.