Photo credit: Russell Stitzlein
For orthopaedic surgery residency applicants, this is a favorite question. There seemed to be two “company lines” based on whether a program was fellow-heavy or fellow-light. All the programs that have several fellows say that fellows enhance the resident education, and programs which have few or no fellows say it’s on purpose to ensure that the residents are the main focus. I remember discussing this topic with my fellow applicants last year. Everyone had his own opinion and was glad to share it. Some shared anecdotes of programs where fellows got to operate, and the residents held retractors and watched. Others noted programs where fellows and residents had little to no interaction, while at some programs the fellows helped teach the residents and allowed the residents to do most of the case.
While I think this is certainly an important issue, I think it’s overemphasized by many applicants and really shouldn’t be in the top five to ten items that help shape your impression of whether a program would be the right fit for you.
First of all, the number of trainees (residents/fellows) at an institution is based on the surgical volume. Most academic programs have about five or six residents. If a program wants to add a resident, it has to apply for and get approval. Basically, it has to prove that it can support an extra resident each year (or five total residents). While it’s not quite the case for fellowship training positions, programs generally only train fellows if they can. The overwhelming majority of programs are focused on training residents. Having fellows is a luxury.
Still, fellows can clearly have an impact on your training. A good fellow can absolutely enhance your experience. A fellow is only a year removed from being a resident, and can show you the basics and teach you the crucial tips and tricks that will help you succeed with bread and butter orthopaedic cases. Where the attending might be bouncing back and forth between two rooms or only in the room for the critical components of the case, the fellow will be there the whole time. Just as surely as this can be a good thing, it could also be bad. If the fellow is in there the whole time, it might mean your second assisting and not getting to do anything but watch. Another potential detriment in the OR is that fellows will do the “cool” or difficult cases. But then again, that’s why they’re the fellow. Now, if you want to go into spine, and you’re on a joints rotation, you might not care that the fellow is doing all the revision cases and you’re relegated to the primary joint arthroplasties. If you want to do joints, however, you’ll be left a bit sour that you don’t get the opportunity to do the revision cases with your attendings. The presence of fellows is certainly harder felt in smaller programs where there might be only one or two attendings and a fellow.
Outside the OR, I think fellows really have a chance to augment the resident experience, particularly at conferences. Fellows can help bridge the knowledge gap between the attendings and the residents, and ensure that residents understand the key concepts of a particular subspecialty. At our program, we have a handful of fellows, and this is where I’ve noticed that fellows play a big role in our education. One of the fellows frequently sends out “dogmatic” articles that have helped shape the field.
If you’re going into orthopaedics, you’ll almost certainly interact with fellows at some point (or you’ll be a fellow yourself one day). If surgical experience is a top priority, ask how many cases the residents are able to log. The role of fellows should be a secondary concern at best.
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All of the opinions expressed here are the author’s and his alone, and do not represent necessarily those of Kaplan or its employees.
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