The Fellowship Effect: Does Surgical Subspecialty Training Affect Pediatric Surgery Case Volume?

2021 ◽  
Author(s):  
Joseph R. Esparaz ◽  
Michelle S. Mathis ◽  
Robert T. Russell
Keyword(s):  
Pediatric Surgery ◽  
Subspecialty Training ◽  
Case Volume ◽  
Surgical Subspecialty

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

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.

Effect of hospital case volume on outcome in congenital diaphragmatic hernia: the experience of the Canadian Pediatric Surgery Network

2009 ◽  
Vol 44 (5) ◽  
pp. 873-876 ◽  
Author(s):  
Jeremy R. Grushka ◽  
Jean-Martin Laberge ◽  
Pramod Puligandla ◽  
Erik D. Skarsgard
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Pediatric Surgery ◽  
Case Volume ◽  
Hospital Case

scholarly journals Impact of surgical subspecialty training on outcomes with pancreatic resection

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S144
Author(s):  
K. Meredith ◽  
T. Maramara ◽  
C. Takahashi ◽  
J. Huston ◽  
R. Shridhar
Keyword(s):  
Pancreatic Resection ◽  
Subspecialty Training ◽  
Surgical Subspecialty

Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle–Income Country Academic Hospital

2021 ◽  
Author(s):  
Christina Oetzmann von Sochaczewski ◽  
Andrea Zanini ◽  
Sonia Basson ◽  
Giulia Brisighelli ◽  
Antonio Di Cesare ◽  
...  
Keyword(s):  
South Africa ◽  
Surgical Training ◽  
Pediatric Surgery ◽  
High Volume ◽  
Academic Hospital ◽  
Middle Income ◽  
Surgical Trainees ◽  
Surgical Subspecialty ◽  
International Fellowship ◽  
Index Cases

Abstract Objective A relative oversupply of pediatric surgeons led to increasing difficulties in surgical training in high-income countries (HIC), popularizing international fellowships in low-to-middle–income countries (LMIC). The aim of this study was to evaluate the benefit of an international fellowship in an LMIC for the training of pediatric surgery trainees from HICs. Methods We retrospectively reviewed and compared the prospectively maintained surgical logbooks of international pediatric surgical trainees who completed a fellowship at Chris Hani Baragwanath Academic Hospital in the last 10 years. We analyzed the number of surgeries, type of involvement, and level of supervision in the operations. Data are provided in mean differences between South Africa and the respective home country. Results Seven fellows were included. Operative experience was higher in South Africa in general (Δx̅ = 381; 95% confidence interval [CI]: 236–656; p < 0.0001) and index cases (Δx̅ = 178; 95% CI: 109–279; p < 0.0001). In South Africa, fellows performed more index cases unsupervised (Δx̅ = 71; 95% CI: 42–111; p < 0.0001), but a similar number under supervision (Δx̅ = –1; 95% CI: –25–24; p = 0.901). Fellows were exposed to more surgical procedures in each pediatric surgical subspecialty. Conclusion An international fellowship in a high-volume subspecialized unit in an LMIC can be highly beneficial for HIC trainees, allowing exposure to higher caseload, opportunity to operate independently, and to receive a wider exposure to the different fields of pediatric surgery. The associated benefit for the local trainees is some reduction in their clinical responsibilities due to the additional workforce, providing them with the opportunity for protected academic and research time.

Head and neck surgical subspecialty training in Africa: Sustainable models to improve cancer care in developing countries

Head & Neck ◽  
2016 ◽  
Vol 39 (3) ◽  
pp. 605-611 ◽  
Author(s):  
Johannes J. Fagan ◽  
Mark Zafereo ◽  
Joyce Aswani ◽  
James L. Netterville ◽  
Wayne Koch
Keyword(s):  
Developing Countries ◽  
Head And Neck ◽  
Cancer Care ◽  
Subspecialty Training ◽  
Surgical Subspecialty

Effect of surgical subspecialty training on patent ductus arteriosus ligation outcomes

2014 ◽  
Vol 30 (5) ◽  
pp. 503-509 ◽  
Author(s):  
Dor Markush ◽  
Kelleigh E. Briden ◽  
Michael Chung ◽  
Katherine W. Herbst ◽  
Trudy J. Lerer ◽  
...  
Keyword(s):  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Subspecialty Training ◽  
Surgical Subspecialty ◽  
Patent Ductus

scholarly journals The Impact of ACGME Work-Hour Reforms on the Operative Experience of Fellows in Surgical Subspecialty Programs

2011 ◽  
Vol 3 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Christopher Simien ◽  
Kathleen D Holt ◽  
Thomas H Richter
Keyword(s):  
Vascular Surgery ◽  
Pediatric Surgery ◽  
Medical Residents ◽  
Clinical Exposure ◽  
Surgical Subspecialty ◽  
Work Hour ◽  
Medical Educators ◽  
Operative Experience ◽  
The Impact ◽  
Academic Year

Abstract Background In July 2003, the Accreditation Council for Graduate Medical Education (ACGME) introduced a set of regulations that mandated a reduction in the number of hours that medical residents can work. These requirements have generated controversy among medical educators, with some expressing concern that reducing resident hours may limit clinical exposure and competency, particularly in surgical specialties. Objective This study examines the impact of duty hour restrictions on resident operative experience in residents in 2 surgical subspecialties since the implementation of the ACGME duty hour limits. Method We examined operative log data for vascular surgery and pediatric surgery, using the academic year immediately preceding the duty hour restrictions, 2002 to 2003, as a baseline for comparison to subsequent academic years through 2006 to 2007 for vascular surgery and 2007 to 2008 for pediatric surgery. Results Graduating fellows in pediatric surgery showed no change in their total operative volume following duty hour restrictions. The pediatric-defined category of neonate procedures showed an increase following duty hour restrictions. Graduating fellows in vascular surgery showed an increase in total major procedures as surgeon. The vascular-defined categories of endovascular-diagnostic, endovascular-therapeutic, and endovascular-graft procedures also increased. Conclusions The reduction of duty hours has not resulted in a decrease in operative volume as some have predicted. Operative volume in pediatric surgery remained mainly unchanged, whereas operative volume in vascular surgery increased. We explore possible explanations for the observed findings.

scholarly journals Multidisciplinary Subspecialty Capacity Building for Global Pediatric Oncology

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 60-60
Author(s):  
Ruth Namazzi ◽  
Peter Wasswa ◽  
Ezekiel Mupere ◽  
Kristina Wilson-Lewis ◽  
Carl Allen ◽  
...  
Keyword(s):  
Critical Care ◽  
Pediatric Oncology ◽  
Cancer Care ◽  
Pediatric Surgery ◽  
Clinical Care ◽  
Evidence Based ◽  
Local Health ◽  
Subspecialty Training ◽  
Fellowship Programs ◽  
Pediatric Subspecialty

PURPOSE Specialized multidisciplinary care is central to childhood cancer control. Expertise and infrastructure in the pediatric disciplines of hematology, surgery, critical care, nursing, and pathology are as critical as pediatric oncology. Survival of the majority of children with cancer globally remains dismal because of the scarcity of multidisciplinary pediatric subspecialty services. We present the innovative approach and impact of Texas Children’s Global HOPE initiatives to cost-effectively develop capacity for specialized multidisciplinary cancer care for children in sub-Sahara Africa (SSA). METHODS Global HOPE designed and supports subspecialty training and contingent infrastructure building in SSA in the following disciplines that are critical to pediatric cancer care: pediatric hematology and oncology (PHO), pediatric surgery, pediatric critical care, anatomic and molecular pathology, and pediatric oncology nursing. Key principles underlying the design of each disciplinary program are that it enables the implementation of current best evidence-based practices, primarily uses a problem-based learning approach, and is integrated and accredited by the local health sciences university. Training primarily occurs at an African hub where Global HOPE also supports infrastructure for clinical care and research, in addition to onsite faculty and offsite telemedicine support from the headquarters in Houston, TX. RESULTS The PHO and pediatric surgery fellowship programs based at Makerere University, Kampala, are the most advanced thus far. Twenty pediatricians from 6 African countries have enrolled and 8 have graduated from the 2-year PHO program. One surgeon enrolled in the 3-year pediatric surgery fellowship annually and 6 have graduated since inception. The fellowship programs have directly affected patient outcomes because of evidence-based clinical rigor and enhanced clinical infrastructure. All graduates from the 2 fellowships are currently practicing in SSA. CONCLUSION Formal in situ pediatric subspecialty training is feasible in low- and middle-income countries and carries the critical advantages of infrastructure development, direct patient impact, and is less susceptible to brain drain.

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