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General Surgery Residency Overview

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A general surgeon is trained to manage a variety of disease and injury, and will be involved in care from diagnosis through to treatment and pre/intra/postoperative care. General surgeons typically manage trauma and critical care patients in addition. General surgery will usually be defined as including the abdomen, neck, peripheral vasculature, breasts and skin – other areas are the remit of specialised surgeons working in set fields. The salary for a general surgeon is relatively high, with $383,000 being the median for those working clinically rather than in academia.

Residency Core Requirements

General surgery is a four or five year residency. Typically, a resident must undertake five years of postgraduate training in an accredited general surgery residency program, but this can be brought down to four years in specific training programs if a resident is then to pursue a particular fellowship. There is a vast range of subspecialty training on offer, including the following: colorectal surgery, minimally invasive surgery, surgical oncology (also including hepatobiliary surgery, endocrine surgery, and/or breast oncology), transplant, vascular surgery, pediatric surgery, plastic surgery, burn surgery, acute care surgery, surgical critical care, trauma, and cardiac or thoracic surgery.

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Application Statistics & Competition

In the most recent available data, there were a total of 2,400 applicants for 1,622 spots, which makes a ratio of 1.48 applicants per spot. This makes the specialty one of the more competitive. There were 1206 US MD Seniors who applied, of whom 222 failed to match. Meanwhile 325 US DO Seniors applied, of whom 200 failed to match – a non-match rate of more than 61%. General surgery is therefore a very difficult field for DO applicants, and not generally recommended. Looking at international applicants, IMGs are relatively safe applying here with only 0.74 US MD applicants per spot. The mean USMLE Step 1 score for those who successfully matched was 237, and the mean USMLE Step 2 score was 250. A Step 1 score of 200 would mean a match probability of just 34%, whilst a score over 240 would mean a match probability of 91%.

Sample Interview questions

What subspecialty are you interested in?

I’m interested in taking a fellowship in colorectal surgery. Being able to undertake inpatient and outpatient care, and cover such a broad range of conditions, from cancer management through to benign disease, as well as being able to carry out surgery using new technology – chiefly through robotics – is very motivating for me. I’ve noted that many residencies offer blocks focusing on minimally-invasive robotic surgery, and being able to push Medicine forward with new technology is core to my career goals. The fact that one covers such common diseases, like UC or Crohn’s, cancers, and can focus on specific areas within these conditions over time and become increasingly specialised, also means that one can both remain something of a generalist, whilst being able to become an expert in one niche. During my general surgery rotation I was lucky enough to work as part of a colorectal surgery team, and it continued my interest in this system that had first begun during my GI Medicine rotation. 

Tell me about the two different types of gallstone.

The two types of gallstone are cholesterol and pigment. Cholesterol gallstones are more common, and make up around 90% (or more in developed countries) of all cases. This type of gallstone forms due to cholesterol supersaturation. Nucleating factors such as mucin lead to the precipitation of microscopic crystals in the gallstone, where a relative lack of motility allows time for the growth of a stone. A cholesterol gallstone consists of undissolved cholesterol plus calcium carbonate and other substances – it is typically yellow-green. A pigment gallstone may be brown or black, and are made of bilirubin. They form due to the bile having too much bilirubin in (be it conjugated or unconjugated).

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Important considerations

It’s vital to note the very low success rate for DO applicants here. Whilst matching as an MD or even as an IMG applicant is mid-tier in terms of competition, DO applicants are perhaps better off looking at other routes. Even for MD applicants, you will need strong USMLE scores to be competitive, with the match rate for those scoring over 240 still not as high as in many other residencies.

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