Disparities in hepatopancreatobiliary operative experience among general surgery residents: a 27-year analysis of ACGME case logs

IntroductionGeneral surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its temporal changes are unknown. The goal of our study was to assess the current trends in core general surgery and subspecialty procedure distributions during general surgery residency training.MethodsData were collected from the ACGME core general surgery national resident available report case logs from 2007 to 2019. Descriptive and time series analyses were used to compare proportions of average procedures performed per resident in the core general surgery category versus the subspecialty category. F-tests were conducted to show whether the slopes of the trend lines were significantly non-zero.ResultsThe mean of total procedures completed for major credit by the average general surgery resident increased from 910.1 (SD=30.31) in 2007 to 1070.5 (SD=37.59) in 2019. Over that same period, the number of general, cardiothoracic, plastic and urology surgery procedures increased by 24.9%, 9.8%, 76.6% and 19.3%, respectively. Conversely, vascular and paediatric surgery procedures decreased by 7.6% and 30.7%, respectively. The neurological surgery procedures remain stable at 1.1 procedures per resident per year. A significant positive correlation in the trend reflecting total (p<0.0001), general (p<0.0001) and plastic (p<0.0016) surgery procedures and the negative correlation in the trend lines for vascular (p<0.0006) and paediatric (p<0.0001) surgery procedures were also noted.ConclusionsTrends in overall surgical case volume performed by general surgery residents over the last 12 years have shown a steady increase in operative training opportunity despite the increasing number of subspecialty training programmes and fellowships. Further research to identify areas for improvement and to study the diversity of operative procedures, and their outcomes is warranted in the years to come.

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Vascular Trauma Operative Experience is Inadequate in General Surgery Programs

Annals of Vascular Surgery ◽

10.1016/j.avsg.2016.02.005 ◽

2016 ◽

Vol 33 ◽

pp. 94-97 ◽

Cited By ~ 8

Author(s):

Huan Yan ◽

Steven Maximus ◽

Matthew Koopmann ◽

Jessica Keeley ◽

Brian Smith ◽

...

Keyword(s):

General Surgery ◽

Vascular Trauma ◽

Operative Experience

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0 + 5 Vascular Surgery Residents’ Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs

Journal of Surgical Education ◽

10.1016/j.jsurg.2015.12.010 ◽

2016 ◽

Vol 73 (3) ◽

pp. 536-541 ◽

Cited By ~ 6

Author(s):

Brigitte K. Smith ◽

P. Chulhi Kang ◽

Chris McAninch ◽

Glen Leverson ◽

Sarah Sullivan ◽

...

Keyword(s):

Vascular Surgery ◽

General Surgery ◽

Integrated Programs ◽

Operative Experience

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Resident operative experience in pediatric neurosurgery across the United States

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.9.peds20518 ◽

2021 ◽

pp. 1-9

Author(s):

Rahul Kumar ◽

David S Hersh ◽

Luke G. F Smith ◽

William E Gordon ◽

Nickalus R Khan ◽

...

Keyword(s):

Diversity Index ◽

Pediatric Neurosurgery ◽

The United States ◽

Case Volume ◽

Pediatric Case ◽

Accreditation Council ◽

Site Characteristics ◽

Recent Graduates ◽

Operative Experience ◽

Case Logs

OBJECTIVE Neurosurgical residents receive exposure to the subspecialty of pediatric neurosurgery during training. The authors sought to determine resident operative experience in pediatric neurosurgery across Accreditation Council for Graduate Medical Education (ACGME)–accredited neurosurgical programs. METHODS During 2018–2019, pediatric neurosurgical case logs for recent graduates or current residents who completed their primary pediatric exposure were collected from US continental ACGME training programs. Using individual resident reports and procedure designations, operative volumes and case diversity were analyzed collectively, according to training site characteristics, and also correlated with the recently described Resident Experience Score (RES). RESULTS Of the 114 programs, a total of 316 resident case logs (range 1–19 residents per program) were received from 86 (75%) programs. The median cumulative pediatric case volume per resident was 109 (IQR 75–161). Residents at programs with a pediatric fellowship reported a higher median case volume (143, IQR 96–187) than residents at programs without (91, IQR 66–129; p < 0.0001). Residents at programs that outsource their pediatric rotation had a lower median case volume (84, IQR 52–114) compared with those at programs with an in-house experience (117, IQR 79–170; p < 0.0001). The case diversity index among all programs ranged from 0.61 to 0.80, with no statistically significant differences according to the Accreditation Council for Pediatric Neurosurgery Fellowships designation or pediatric experience site (p > 0.05). The RES correlated moderately (r = 0.44) with median operative volumes per program. A program’s annual pediatric operative volume and duration of pediatric experience were identified as significant predictive factors for median resident operative volume. CONCLUSIONS Resident experience in pediatric neurosurgery is variable within and between programs. Case volumes are generally higher for residents at programs with in-house exposure and an accredited fellowship, but case diversity is relatively uniform across all programs. RES provides some insight on anticipated case volume, but other unexplained factors remain.

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The Effects of the Addition of a Pediatric Surgery Fellow on the Operative Experience of the General Surgery Resident

The American Surgeon ◽

10.1177/000313481508100626 ◽

2015 ◽

Vol 81 (6) ◽

pp. 610-613

Author(s):

Alexander Raines ◽

Tabitha Garwe ◽

Ademola Adeseye ◽

Alejandro Ruiz-Elizalde ◽

Warren Churchill ◽

...

Keyword(s):

General Surgery ◽

Pediatric Surgery ◽

Resident Education ◽

Single Institution ◽

Residency Programs ◽

Relative Value ◽

General Surgery Resident ◽

Operative Experience ◽

Surgery Resident

Adding fellows to surgical departments with residency programs can affect resident education. Our specific aim was to evaluate the effect of adding a pediatric surgery (PS) fellow on the number of index PS cases logged by the general surgery (GS) residents. At a single institution with both PS and GS programs, we examined the number of logged cases for the fellows and residents over 10 years [5 years before (Time 1) and 5 years after (Time 2) the addition of a PS fellow]. Additionally, the procedure related relative value units (RVUs) recorded by the faculty were evaluated. The fellows averaged 752 and 703 cases during Times 1 and 2, respectively, decreasing by 49 ( P = 0.2303). The residents averaged 172 and 161 cases annually during Time 1 and Time 2, respectively, decreasing by 11 ( P = 0.7340). The total number of procedure related RVUs was 4627 and 6000 during Times 1 and 2, respectively. The number of cases logged by the PS fellows and GS residents decreased after the addition of a PS fellow; however, the decrease was not significant. Programs can reasonably add an additional PS fellow, but care should be taken especially in programs that are otherwise static in size.

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Operative Experience in the Era of Duty Hour Restrictions: Is Broad-Based General Surgery Training Coming to an End?

The American Surgeon ◽

10.1177/000313481007600619 ◽

2010 ◽

Vol 76 (6) ◽

pp. 578-582 ◽

Cited By ~ 14

Author(s):

Lindsay M. Fairfax ◽

A. Britton Christmas ◽

John M. Green ◽

William S. Miles ◽

Ronald F. Sing

Keyword(s):

General Surgery ◽

Alimentary Tract ◽

Gynecologic Surgery ◽

Case Volume ◽

Surgery Training ◽

Resident Work ◽

The Mean ◽

Operative Experience ◽

The Impact ◽

General Surgery Training

Since the institution of Accreditation Council for Graduate Medical Education (ACGME) resident work hour restrictions, conflicting evidence exists regarding the impact on resident case volume with most data from single-institution studies. We examined the effect of restrictions on national resident operative experience. After permission from the ACGME, we reviewed the publicly available national resident case log data (1999 through 2008) maintained on the ACGME web site ( www.acgme.org ), including total major cases with subanalysis of the ACGME-specified categories. The mean cases per resident were compared before (1999 to 2003) and after (2003 to 2008) restrictions. After the implementation of duty hour restrictions, the mean number of total cases per resident significantly decreased (949 ± 18 vs 911 ± 14, P = 0.004). Subanalysis showed a significant increase in alimentary tract (217 ± 7 vs 229 ± 3, P = 0.004), skin/soft tissue (31 ± 3 vs 36 ± 1, P = 0.01), and endocrine (26 ± 2 vs 31 ± 2, P = 0.006) cases. However, we observed a significant decrease in head and neck (21 ± 0.3 vs 20 ± 0.3, P = 0.01), vascular (164 ± 29 vs 126 ± 5, P = 0.01), pediatric (41 ± 1 vs 37 ± 2, P = 0.006), genitourinary (10 ± 2 vs 7 ± 1, P = 0.004), gynecologic surgery (5 ± 1 vs 3 ± 0.6, P = 0.002), plastics (16 ± 0.3 vs 15 ± 0.7, P = 0.03), and endoscopy (91 ± 3 vs 82 ± 2, P < 0.001) procedures. Analysis of the ACGME-compiled national data confirms that duty hour restrictions have significantly impacted resident operative experience. Importantly, experience in specialty areas, including vascular and endoscopy, appears to have been sacrificed for consolidation of resources into general surgery services as indicated by the increase in alimentary tract and endocrine cases. These findings raise the following question: Is the era of truly broad-based general surgery training coming to an end?

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The General Surgery Residency at Maine Medical Center

The American Surgeon ◽

10.1177/000313481007601115 ◽

2010 ◽

Vol 76 (11) ◽

pp. 1185-1188

Author(s):

Ajita S. Prabhu ◽

Jonathan F. Dreifus ◽

James F. Whiting

Keyword(s):

General Surgery ◽

Medical Center ◽

Surgical Residency ◽

Community Program ◽

General Surgery Residency ◽

Maine Medical ◽

Operative Experience ◽

University Affiliation

The surgical residency at Maine Medical Center is the only surgical residency in Maine. Established in 1947, it presently graduates four categorical residents/year. The residency is a classic example of a “hybrid” residency, retaining the benefits of a community program in terms of large operative experience in a wide variety of procedures, while at the same time allowing for academic exposure through a university affiliation.

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Analysis of Neurosurgery Resident Operative Experience: Training Tomorrow's Neurosurgeon

Neurosurgery ◽

10.1093/neuros/nyz310_714 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Shahjehan Ahmad ◽

Bledi C Brahimaj

Keyword(s):

United States ◽

Medical Education ◽

Statistical Significance ◽

The United States ◽

Case Volume ◽

The Past ◽

Operative Experience ◽

Case Logs ◽

Adult Spine ◽

Neurological Surgery

Abstract INTRODUCTION The Accreditation Council for Graduate Medical Education (ACGME) maintains self-reported logs of cases completed by US residents. This study analyzes trends in the operative experience of neurosurgical residents within the context of national case trends in neurosurgery over the past decade. METHODS ACGME case logs from 2013 to 2018 were reviewed. Operative domains were categorized as adult cranial, adult spinal, pediatrics, and epilepsy. Mean operative volume was recorded, as well as cases performed as senior or lead surgeon. As a measure of US national operative trends, the PearlDiver database was queried for operative volume between 2007 and 2016. Statistical analysis was performed using linear regression, and statistical significance was set at P < .05. RESULTS During the study period, the total case volume for neurological surgery residents increased by 61 cases every residency year (P < .001). Cases logged as lead surgeon increased by 173 cases every year, while cases logged as senior surgeon decreased by 112 cases every year (P < .05). The operative volume for adult spine and cranial increased (P < .05), while that for extracranial vascular and pediatric decreased (P < .05). Brain tumor, transsphenoidal, radiosurgery, shunting, and epilepsy volume remained stable over the study period (P > .05). These resident operative trends paralleled trends nationwide where there were increases in adult cranial, adult spine, and epilepsy (P < .001) but decreases in pediatric cases (P < .05). CONCLUSION Over the past decade, neurosurgical residents have been completing an increasing number of cases every year in the majority of operative domains. While an increased experience is beneficial, what is more important is that the resident operative experience appears to closely mirror trends for commonly performed operations in the United States. This is reassuring for surgical educators that tomorrow's neurosurgeons will have the competency to meet our nation's neurosurgical needs.

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