Do Orthopaedic Resident and Fellow Case Logs Accurately Reflect Surgical Case Volume?

Surgical case volume during orthopaedic surgical residency is a concern among trainees and program directors alike. With an ongoing trend toward further subspecialization and the rapid development of new techniques and devices, the breadth of procedures that residents are exposed to continues to increase. Accreditation Council for Graduate Medical Education surgical case logs from 2009 to 2013 for graduating orthopaedic surgery residents were examined to assess the national averages of orthopaedic procedures logged by graduating orthopaedic surgery residents in the leg/ankle and foot/toes categories. This investigation revealed that there was an 8% increase in the total number of leg/ankle cases and 12% increase in foot/toes cases performed by graduating orthopaedic surgery residents, which has not significantly increased from 2009 to 2013. Across years examined in this study, significant variability existed between the 10th and 90th percentiles for total foot and ankle resident case exposure (P < .05), particularly within ankle arthroscopy, where there was a 15-fold difference in the number of arthroscopy cases performed by residents in the 90th percentile compared with the 10th percentile. The overall volume of foot and ankle cases performed by graduating orthopaedic surgery residents has increased despite not being statistically significantly from 2009 to 2013. Levels of Evidence: Level III: Cohort study

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MP35-17 DESCRIBING UROLOGY RESIDENCY SURGICAL CASE VOLUME OVER TIME: A REVIEW OF THE ACGME RESIDENT CASE LOGS

The Journal of Urology ◽

10.1097/01.ju.0000556007.40419.76 ◽

2019 ◽

Vol 201 (Supplement 4) ◽

Author(s):

Jonathan Wingate* ◽

Byron Joyner ◽

Judith Hagedorn ◽

Niels Johnsen

Keyword(s):

Case Volume ◽

Surgical Case ◽

Case Logs ◽

Over Time ◽

Urology Residency

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The effect of surgical case volume on outcome after the Norwood procedure

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2004.07.056 ◽

2005 ◽

Vol 129 (4) ◽

pp. 754-759 ◽

Cited By ~ 86

Author(s):

Paul A. Checchia ◽

Jamie McCollegan ◽

Noha Daher ◽

Nikoleta Kolovos ◽

Fiona Levy ◽

...

Keyword(s):

Norwood Procedure ◽

Case Volume ◽

Surgical Case

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Trends in Surgical Case Volume during Humanitarian Aid Missions aboard United States Naval Ship Mercy

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2016.08.321 ◽

2016 ◽

Vol 223 (4) ◽

pp. e128-e129

Author(s):

Jason B. Brill ◽

James D. Wallace ◽

Paul R. Lewis ◽

Jonathan H. Berger ◽

Marion Henry ◽

...

Keyword(s):

United States ◽

Humanitarian Aid ◽

Case Volume ◽

Surgical Case ◽

Naval Ship

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857-4 The effect of surgical case volume on outcome following the norwood procedure: An analysis of 29 hospitals

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)91672-5 ◽

2004 ◽

Vol 43 (5) ◽

pp. A395 ◽

Cited By ~ 1

Author(s):

Paul A Checchia ◽

Jamie McCollegen ◽

Nikoleta Kolovos ◽

Fiona Levy ◽

Barry Markovitz

Keyword(s):

Norwood Procedure ◽

Case Volume ◽

Surgical Case

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Trends of core versus subspecialty operative procedures completed in general surgery residency training programs

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2021-140503 ◽

2021 ◽

pp. postgradmedj-2021-140503

Author(s):

Faiz Tuma ◽

Rafael D Malgor ◽

Nikit Kapila ◽

Mohamed K Kamel

Keyword(s):

Residency Training ◽

General Surgery ◽

Operative Procedures ◽

Steady Increase ◽

Subspecialty Training ◽

Paediatric Surgery ◽

Case Volume ◽

General Surgery Residency ◽

The Core ◽

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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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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Abstract 67: Cardiac Arrest and Surgical Case Volume, Household Income and Availability of Trauma and Cardiac Surgery Are Associated with Higher Risk-Standardized Survival After Cardiac Arrest Among University Hospital Consortium Institutions in 2012

Circulation ◽

10.1161/circ.130.suppl_2.67 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Michael C Kurz ◽

John P Donnelly ◽

Henry E Wang

Keyword(s):

Cardiac Arrest ◽

Cardiac Surgery ◽

Household Income ◽

University Hospital ◽

Individual Risk ◽

P Value ◽

Case Volume ◽

Surgical Case ◽

Catchment Areas ◽

Cardiac Arrest Survival

Objective: Wide variation exists in cardiac arrest survival. Historically cardiac arrest research has focused upon clinical pre-arrest and intra-arrest factors to explain this variation in outcomes. In-hospital post-arrest care is increasingly recognized as an important aspect of survival. We sought to identify hospital characteristics associated with improved cardiac arrest survival. Methods: We examined all participating hospitals in the University Hospital Consortium (UHC) clinical database with more than 25 adult cardiac arrests in 2012. Cases were identified using International Classification of Diseases, 9th Edition, code 427.5 (cardiac arrest) or 99.60 (CPR), excluding prisoners, pregnant patients, transfers, and hospice patients. We estimated hospital-specific risk-standardized survival rates (RSSRs) using hierarchical logistic regression, adjusting for individual risk of mortality. Institutions in the highest RSSR quartile were compared with those in the lowest three quartiles using Pearson chi-square tests of association. Results: UHC institutions admitted 3,686,296 patients in 2012, of which 33,700 patients experienced cardiac arrest. Overall survival was 42.3% (95% CI 41.8-42.9) with median RSSR of 42.7% (IQR 35.5-50.8). Hospitals in the highest quartile of RSSR had higher cardiac arrest volume (median 193 vs. 150, p-value 0.019), higher annual surgical operation volume (21,177 vs. 14,122, 0.007), cared for patients from catchment areas with higher household income ($60,753 vs. $56,424, 0.027), and were more likely to be a trauma (79% vs 59%, 0.024) or cardiac surgery center (91% vs 70%, 0.007). In addition, hospital size (477 vs 415 beds, 0.060) and teaching status (77% vs. 62%, 0.067) demonstrated a trend toward association with higher RSSR. Conclusion: Among hospitals in the UHC, those with higher cardiac arrest and surgical case volume, patient household income, and availability of trauma and cardiac surgery were associated with improved RSSR.

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Correlation of Surgical Case Volume and Fellowship Training with Simulated Procedural Tasks

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2019.09.636 ◽

2019 ◽

Vol 26 (7) ◽

pp. S58-S59

Author(s):

V Palvia ◽

JA Doneza ◽

SS Mathews ◽

CJ Ascher-Walsh

Keyword(s):

Fellowship Training ◽

Case Volume ◽

Surgical Case ◽

Procedural Tasks

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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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