[firstkill]

Originally Posted by El_Duderino

I would be happy for the cardiothoracic fellow, in concert with the attending surgeon, perform the bypass surgery. How in the world do you think the attending him/herself learned to do the surgery in the first place? I cannot envisage a scenario where the fellow would be left to do the surgery on their own. In my area of head and neck surgery, the fellow will often--with the attending--perform microvascular anastamoses for free tissue transplants -- one could argue this is technically far more challenging than a bypass given the caliber of vessels involved and the complex anatomy.

As far as senior residents harversting vein grafts -- yes, I'm totally ok with this. Harvesting the vein is straightforward and not technically demanding.

Having once been an intern who placed several central lines without incident -- again, I would be ok with this so long as it is a supervised procedure which, in my experience, it always is.

I understand your concern for the OP's mother -- however, please realize that the optimal outcomes in teaching facilities is not only due to resident participation in post-op care. Indeed, residents and fellows are involved in some of the most complex OR cases in virtually every large teaching hospital. I cannot think of a single incident where the fellow or resident is to blame for a poor outcome secondary to "technical" deficiencies.

Again, I ask, how do you think the attending staff learned all the "technical" aspects of the bypass surgery? By standing around and observing?

The key question to ask is, "As the attending surgeon, will you be present and participating in all the KEY portions of the surgery," to which any answer other than "yes" should have you looking for someone else to operate.
El Duderino

i agree, el duderino makes an excellent question to ask the doctor at the hospital u plan to have surgery at.

last time i supervised a IJ central line, by the time i got my gown on the syringe was flashing pleural fluid. Ive had good and bad residents and experience.

Its a crap shoot, you may get a good resident team, or a bad one.

As for teaching ANY type of medicine im all for it. I still round with residents, but call me selfish, for my family I wouldnt want a resident do any invasive procedure.
fk

[El_Duderino]

Originally Posted by firstkill

i agree, el duderino makes an excellent question to ask the doctor at the hospital u plan to have surgery at.

last time i supervised a IJ central line, by the time i got my gown on the syringe was flashing pleural fluid. Ive had good and bad residents and experience.

No offense but, quite frankly, if you have residents under your supervision drawing pleural fluid on an internal jugular central line then, perhaps, the issue is not with the resident. I can see how this might happen in an unsupervised IJ line placement by an intern. Even a basic knowledge of neck anatomy and technique should prevent this complication.

Its a crap shoot, you may get a good resident team, or a bad one.

I do not think it is a crap shoot with regards to quality of the resident team. Not all teaching hospitals are created equal. There is a huge difference between a random community "teaching" hospital that is "affiliated" with a large university and a tertiary-care university academic center. Similarly, there is a large difference in the quality of residents at these types of institutions as the latter are significantly more competitive to get into. Hence, my opinion that care in a large university center is the way to go -- with objective data to back it up.

As for teaching ANY type of medicine im all for it. I still round with residents, but call me selfish, for my family I wouldnt want a resident do any invasive procedure.
fk

I can understand your point of view, although it sounds like you may be an internist/intensivist and not a surgeon. I apologize if I am mistaken. If you are, on the other hand, not a surgeon then--frankly--you have no idea how things work in the OR.

I also appreciate that you would not want a resident performing any invasive procedures on a family member. If so, your family should not receive care at a large university teaching hospital -- the best of which include wording in their consent documents to the effect that residents/fellows WILL be involved in your care. Individuals are free to refuse this care, in which case they can go to any one of the thousands of community hospitals out there--where, ironically, outcomes are objectively poorer.

During training, the attendings I respected the most were those that told patients insisting on "elitist" attending-only care to "go find another provider, this is a teaching hospital."