The Stitch

Finding the ideal surgical residency


In these virtual times, selecting a residency program can be as challenging as it is essential to the successful growth of a physician’s lifelong career. In my years of discussions with students and residents, and reflecting upon my own career path in the four decades since my training, I have unearthed valuable wisdom for students approaching this critical life juncture.

The somewhat uncomfortable truth is that training at a program that is both high in caliber and well-fitted to a trainee’s goals provides a critical foundation for future career development. The right program is an invaluable asset not readily replaced by subsequent learning opportunities.

Here are five thoughts that I hope will help guide students in selecting an ideal training program.

To be a well-prepared clinician, nothing is more important than clinical experience.
Dr. Todd Rosengart

The “10,000 hour” maxim of Gladwell and Ericsson is nowhere more relevant than in the field of surgery, where the practice of technical skills is as important to trainees as the cognitive skills gained through exposure to clinical decision-making. Programs that combine busy municipal and university hospital venues usually provide a good variety of this crucial experience. Opportunities for trainees to participate in or lead “first pass” clinical decision making – under appropriate supervision – is a subtle but important addition to this recommendation.

In short, being a spectator is a poor substitute for being on the front line, and trainees must carefully investigate the clinical opportunities that potential training programs will afford them.

The positive influence of strong mentors and expert faculty cannot be overstated.

Whether in the operating room or bedside, I have always been amazed to observe the influence of good teaching on the skills and performance of trainees  I have seen surgeons with apparently equal dexterity perform at entirely different levels as a result of the technical skill and teaching caliber of the individual who taught them.

It is hard to compensate by skill or effort alone for the advantages that can otherwise be gained by being well-taught by a particularly adept mentor, whether that be a superior surgical technique, cognitive discipline, or leadership trait. It’s important that candidates for surgical residency programs carefully screen faculty rosters for the presence of well-regarded teachers, role models, and experts in their fields, who are fully engaged in and committed to resident education.

The years spent in residency mandate that trainees feel comfortable with the professed and perceived culture of their selected training program.

Surgical residencies, as with most multi-year training programs, consume many hours of a trainee’s day and occur at a critical point in the individual’s personal and professional life. The culture of a chosen training program thus figures significantly in forming us as surgeons, and even as growing adults. I can distinctly recall the many times over my career when I deeply appreciated the discipline and professional traits that I had learned from the culture of my training program in New York. I can also remember the hard work it required for me to unlearn the less desirable cultural traits that I had absorbed during those same years.

A program’s culture includes the values and behaviors that it reinforces and those that it will not tolerate. This culture can be found in the writings and statements of a department or reports on the activities of a program and its members (found online or elsewhere).

It can also be found in the attitudes of faculty and residents. It’s important for candidates to get a good sense of a program’s culture, because it will inevitably influence a trainee’s later professional development.  It will also enrich or lessen the trainee’s daily enjoyment of the residency experience.

It is a myth that the geography of a program heavily influences a trainee’s subsequent career choices.

In our interconnected, virtual world, it is as easy to apply to a hospital or for a faculty position across the country as in one’s own city. In some ways, potential employers may value the highly regarded reputation of a distant institution than the familiarity of a training program or sponsor in one’s own neighborhood.

In the field of academic surgery, excellence is of utmost importance, so geography should not trump the quality of a training program. Candidates should therefore carefully weigh program assets without too much emphasis on where the program is located.

Dr. Rosengart greeting incoming medical students.
The opportunities that can be gained during training will inevitably magnify over time.

Being in the right place at the right time may seem like the result of lucky coincidence, but it can also be the result of careful, conscious choices. When I read the biography of Dr. Michael E. DeBakey, I was struck by just how influential his early role in the U.S. Army Surgical Consultants Division during World War II was to the remainder of his meteoric career.

It was in the Army that Dr. DeBakey met and worked with luminaries in the surgery community and with future government leaders. Had they not witnessed his prodigal gifts and talents, Dr. DeBakey’s career may have followed a different path.

By example, here at Baylor College of Medicine, we can leverage the talents of the many world-renowned experts in the Texas Medical Center. I fully anticipate that the exposure of our residents and young faculty to these invaluable force multipliers will advantage them for years to come.

Advanced doctoral training, research initiatives, or other granting programs represent several of many such available opportunities. Identifying early career levers is important for students and other trainees as they seek the training program best suited to their career development goals.

-By Dr. Todd Rosengart, chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine

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