Trends in Thoracic Case Experience among General Surgery Residents: Review of 20 Years of Resident 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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Disparities in hepatopancreatobiliary operative experience among general surgery residents: a 27-year analysis of ACGME case logs

HPB ◽

10.1016/j.hpb.2018.02.072 ◽

2018 ◽

Vol 20 ◽

pp. S35

Author(s):

R.C. Quillin ◽

A.R. Cortez ◽

D.N. Debow ◽

G.D. Katsaros ◽

F.T. Drake ◽

...

Keyword(s):

General Surgery ◽

Operative Experience ◽

Case Logs

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Resident Exposure to Peripheral Nerve Surgical Procedures During Residency Training

Journal of Graduate Medical Education ◽

10.4300/jgme-d-15-00318.1 ◽

2016 ◽

Vol 8 (2) ◽

pp. 173-179 ◽

Cited By ~ 7

Author(s):

Joseph A Gil ◽

Alan H Daniels ◽

Edward Akelman

Keyword(s):

Peripheral Nerve ◽

Plastic Surgery ◽

Surgical Procedures ◽

General Surgery ◽

Orthopaedic Surgery ◽

Case Volume ◽

Peripheral Nerve Surgery ◽

Case Logs ◽

Nerve Surgery ◽

Neurological Surgery

ABSTRACT Variability in case exposures has been identified for orthopaedic surgery residents. It is not known if this variability exists for peripheral nerve procedures.Background The objective of this study was to assess ACGME case log data for graduating orthopaedic surgery, plastic surgery, general surgery, and neurological surgery residents for peripheral nerve surgical procedures and to evaluate intraspecialty and interspecialty variability in case volume.Objective Surgical case logs from 2009 to 2014 for the 4 specialties were compared for peripheral nerve surgery experience. Peripheral nerve case volume between specialties was performed utilizing a paired t test, 95% confidence intervals were calculated, and linear regression was calculated to assess the trends.Methods The average number of peripheral nerve procedures performed per graduating resident was 54.2 for orthopaedic surgery residents, 62.8 for independent plastic surgery residents, 84.6 for integrated plastic surgery residents, 22.4 for neurological surgery residents, and 0.4 for surgery residents. Intraspecialty comparison of the 10th and 90th percentile peripheral nerve case volume in 2012 revealed remarkable variability in training. There was a 3.9-fold difference within orthopaedic surgery, a 5.0-fold difference within independent plastic surgery residents, an 8.8-fold difference for residents from integrated plastic surgery programs, and a 7.0-fold difference within the neurological surgery group.Results There is interspecialty and intraspecialty variability in peripheral nerve surgery volume for orthopaedic, plastic, neurological, and general surgery residents. Caseload is not the sole determinant of training quality as mentorship, didactics, case breadth, and complexity play an important role in training.Conclusions

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Changes in Thoracic Surgery Experience During General Surgery Residency: A Review of the Case Logs From the Accreditation Council for Graduate Medical Education

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.06.058 ◽

2016 ◽

Vol 102 (6) ◽

pp. 2095-2098 ◽

Cited By ~ 3

Author(s):

William S. Ragalie ◽

Paula M. Termuhlen ◽

Alex G. Little

Keyword(s):

Medical Education ◽

Thoracic Surgery ◽

Graduate Medical Education ◽

General Surgery ◽

Accreditation Council ◽

General Surgery Residency ◽

Graduate Medical ◽

Case Logs

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The Change in Surgical Case Diversity over the past 15 Years and the Influence on the Pursuit of Surgical Fellowship

The American Surgeon ◽

10.1177/000313481808400953 ◽

2018 ◽

Vol 84 (9) ◽

pp. 1476-1479 ◽

Cited By ~ 2

Author(s):

Christopher DuCoin ◽

Alexandra Hahn ◽

Maria Baimas-George ◽

Douglas P. Slakey ◽

James R. Korndorffer

Keyword(s):

Medical Education ◽

Statistical Analysis ◽

General Surgery ◽

Close Monitoring ◽

National Data ◽

Surgical Case ◽

The Past ◽

Significant Difference ◽

Time Periods ◽

Case Logs

The surgical community has expressed concern that residents do not receive the same caliber training as their predecessors and the increase in fellowships have been described as secondary to perceived lack of preparation. Yet, data show no change in total cases even after implementation of the 80-hour workweek. It is hypothesized that the increasing subspecialization of general surgery may decrease in certain resident case numbers. Data were collected from the Accreditation Council for Graduate Medical Education (ACGME) General Surgery Case Logs National Data Report (1999–2014) of mean number of procedures per resident for 19 surgical categories. Statistical analysis was performed with analysis of variance over three time periods between 1999 and 2014. The number of total cases performed by residents has not changed significantly. There was a statistically significant difference observed in the variety of cases: vascular, esophageal, breast, and trauma cases decreased (P < 0.01), whereas major intestinal, hernia, liver, pancreatic, and biliary cases increased (P < 0.01). There are many reasons to pursue additional training after residency. The demonstrated change in case variability, presumably secondary to increasing fellowships, may play a significant role on training and preparation. Close monitoring of curriculums is essential to ensure a comprehensive general surgical education.

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What is the Value of a Burn Surgery Rotation in Surgical Residency?

The American Surgeon ◽

10.1177/000313481908501222 ◽

2019 ◽

Vol 85 (12) ◽

pp. 1314-1317

Author(s):

Laura S. Johnson ◽

Taryn E. Travis ◽

Jeffrey W. Shupp

Keyword(s):

Medical Education ◽

Critical Care ◽

Graduate Medical Education ◽

General Surgery ◽

High Volume ◽

Graduate Medical ◽

Surgical Case ◽

Time Period ◽

Case Logs ◽

Critical Care Patients

Declining case volumes on trauma rotations and early specialization of traditional surgical rotations have limited the service lines on which general surgery residents can obtain critical operative and management experience. Meanwhile, a significant portion of residents have no exposure to a burn rotation during their training. A burn rotation may address both of these issues in a meaningful way. Surgical case volumes and burn ICU patient volume were queried for an urban regional verified burn referral center. General surgery program resident case logs were queried for procedures performed during a burn rotation during that same time period. Over a four-year time period, three burn surgeons performed a total of 2374 procedures on burn and wound service patients. In the burn ICU over that same time period, 419 individual critical care patients were managed. Twenty-seven general surgery program residents logged 632 major operations and 67 critical care patients; more than 50 per cent of cases performed were not captured by the Accreditation Council for Graduate Medical Education case log system. A high volume burn service can adequately provide surgical and critical care exposure to junior surgical residents. Accreditation Council for Graduate Medical Education surgical case logs may not fully represent the full scope of exposure sustained on a high-volume burn service.

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Variability in Resident Operative Hand Experience by Specialty

Hand ◽

10.1177/1558944716677537 ◽

2016 ◽

Vol 13 (1) ◽

pp. 103-107 ◽

Cited By ~ 1

Author(s):

Jason Silvestre ◽

Ines C. Lin ◽

L. Scott Levin ◽

Benjamin Chang

Keyword(s):

General Surgery ◽

Orthopedic Surgery ◽

Hand Surgery ◽

The United States ◽

Future Research ◽

General Surgery Residency ◽

Surgery Training ◽

General Surgeons ◽

Case Logs ◽

Recent Attention

Background: Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Methods: Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Results: Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). Conclusions: As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

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