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

2018 ◽  
Vol 84 (9) ◽  
pp. 1476-1479 ◽  
Author(s):  
Christopher DuCoin ◽  
Alexandra Hahn ◽  
Maria Baimas-George ◽  
Douglas P. Slakey ◽  
James R. Korndorffer

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.

2019 ◽  
Vol 85 (12) ◽  
pp. 1314-1317
Author(s):  
Laura S. Johnson ◽  
Taryn E. Travis ◽  
Jeffrey W. Shupp

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.


Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Shahjehan Ahmad ◽  
Bledi C Brahimaj

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.


1996 ◽  
Vol 2 (1) ◽  
Author(s):  
David S. Mulder

Societal (1), technological, organizational (2), and educational developments during the past ten years havebrought about increasing pressures for change in the graduate medical education of cardiac and thoracicsurgeons (3). These changes effectively lengthened their training to eight years and created a double standardfor the education of a thoracic surgeon. A task force mandated by the Royal College of Physicians andSurgeons of Canada nucleus committees in both cardiac and thoracic surgery, with the support of theCanadian Society of Cardiovascular and Thoracic Surgeons, addressed these issues and made the followingrecommendations: cardiac surgery and thoracic surgery should each become a primary specialty with its ownnucleus committee. Each specialty would require six years of training, with the possibility of obtainingcertification in both specialties after an additional eighteen months of training. Each specialty could also beentered after the completion of full training in general surgery. In addition, the task force urged thedevelopment of a curriculum to guide educational objectives in each specialty. These changes promise tocreate a flexible, shorter, and more focused program for cardiac and thoracic surgeons in both university andcommunity settings.


2020 ◽  
pp. postgradmedj-2020-139223
Author(s):  
Shearwood McClelland III ◽  
Blair Murphy ◽  
Jerry J Jaboin ◽  
Richard C Zellars

Pre-residency peer-reviewed publications (PRP) have been associated with subsequent resident choice of academic versus private practice career. The evolution of PRP prevalence among radiation oncology resident classes has yet to be examined. A list of radiation oncology residents from the graduating classes of 2016 and 2022 were obtained, and PRP was compiled as the number of publications a resident had listed in PubMed as of the end of the calendar year of residency application. Statistical analysis was conducted using Fisher’s exact test. Analysis of 163 residents from the 2016 class compared with 195 from the 2022 class revealed that the proportion of residents with zero PRP decreased from 46.6% to 23.6% between the 2016 to 2022 classes (p<0.0001), while that of residents with one PRP increased from 17.8% to 19.0% (p>0.05) and with at least two PRP increased from 35.6% to 57.4% (p<0.0001). Residents with a PhD were more likely to have at least two PRP in each class (p<0.0001). As with the class of 2016, there remained no significant difference in PRP by gender for the class of 2022. Over the past six years, PRP has become more prevalent among incoming radiation oncology residents. Residents in the class of 2016 were 180% less likely than the class of 2022 to have at least one PRP, and 60% less likely to have at least two PRP. These findings are indicative of the increasing pressure on medical students to enter residency with a publication background.


2015 ◽  
Vol 7 (3) ◽  
pp. 401-406 ◽  
Author(s):  
Natasha Gupta ◽  
Kristina Dragovic ◽  
Richard Trester ◽  
Josef Blankstein

ABSTRACT Background Significant changes have been noted in aspects of obstetrics-gynecology (ob-gyn) training over the last decade, which is reflected in Accreditation Council for Graduate Medical Education (ACGME) operative case logs for graduating ob-gyn residents. Objective We sought to understand the changing trends of ob-gyn residents' experience in obstetric procedures over the past 11 years. Methods We analyzed national ACGME procedure logs for all obstetric procedures recorded by 12 728 ob-gyn residents who graduated between academic years 2002–2003 and 2012–2013. Results The average number of cesarean sections per resident increased from 191.8 in 2002–2003 to 233.4 in 2012–2013 (17%; P &lt; .001; 95% CI −47.769 to −35.431), the number of vaginal deliveries declined from 320.8 to 261 (18.6%; P &lt; .001; 95% CI 38.842–56.35), the number of forceps deliveries declined from 23.8 to 8.4 (64.7%; P &lt; .001; 95% CI 14.061–16.739), and the number of vacuum deliveries declined from 23.8 to 17.6 (26%; P &lt; .001; 95% CI 5.043–7.357). Between 2002–2003 and 2007–2008, amniocentesis decreased from 18.5 to 11 (P &lt; .001, 95% CI 6.298–8.702), and multifetal vaginal deliveries increased from 10.8 to 14 (P &lt; .001, 95% CI −3.895 to −2.505). Both were not included in ACGME reporting after 2008. Conclusions Ob-gyn residents' training experience changed substantially over the past decade. ACGME obstetric logs demonstrated decreases in volume of vaginal, forceps, and vacuum deliveries, and increases in cesarean and multifetal deliveries. Change in experience may require use of innovative strategies to help improve residents' basic obstetric skills.


2016 ◽  
Vol 1 (9) ◽  
pp. 171-188
Author(s):  
Katayoon Katoozian

Étant donné la difficulté de l’homophonie des formes verbales en /E/ qui peuvent s’écrire par au moins dix formes différentes dont l’infinitif (-ER), le participe passé (-É) et l’imparfait (-AI), le choix entre ces formes reste une question délicate dans l’orthographe grammaticale du français. Cette recherche vise à étudier les problèmes des apprenants iraniens du FLE (Français Langue Étrangère) dans la gestion de ce secteur. Basée sur les recherches antérieures menées auprès d’élèves français et québécois, la présente étude cherche précisément à répondre aux questions suivantes : 1- Comment se fait l’évolution de la compétence de gestion des finales verbales en /E/? 2- Parmi les formes en -ER, -É, et -AI laquelle est mieux réussie ? 3- a) Dans les formes en -É, est-ce que les apprenants font l’accord avec le genre et le nombre sujet ? b) Est-ce qu’ils ont des problèmes d’accord en personne dans les formes en -AI ? Afin de répondre à ces questions, nous avons fait passer un test aux 113 apprenants iraniens du français des niveaux A1, A2 et B1 acquis inscrits à quelques instituts de langue de Téhéran. Les résultats de notre étude à l’aide de l’analyse statistique de variance (ANOVA) montrent que : 1- La gestion des finales verbales en /E/ n’est pas maitrisée à travers ces niveaux. Il n’existe pas de différence significative entre les notes globales de ces trois niveaux successifs. 2- La forme en -ER est mieux maitrisée suivie de la forme en -É et celle en -AI ce qui montre la tendance des apprenants pour l’invariabilité. En plus de ces trois formes, nous avons trouvé d’autres types d’erreurs (ex. erreurs phonétiques et erreurs de segmentation) fréquents dans notre corpus qui n’ont pas été rapportés par les recherches antérieures en FLM (Français Langue Maternelle). 3- a) En ce qui concerne les formes en -É, il n’existe pas d’accord avec le sujet et la tendance réside dans l’invariabilité. b) Quant aux formes en -AI, le problème d’accord en personne ne se pose pas. Ces résultats diffèrent de ceux obtenus dans le contexte d’autres recherches en FLM. Comme perspective didactique, nous avons proposé la redéfinition de la place de l’orthographe dans les méthodes actuelles du français tout en soulignant l’efficacité de la démarche réflexive dans l’enseignement-apprentissage de l’orthographe. Abstract Given the difficulty of homophony in verbal endings in /E/ which can be written by at least ten different forms including the infinitive (-ER), the past participle (-É) and the imperfect (-AI), the choice between these forms remains a delicate question in learning French grammatical orthography. The purpose of this research is to study the problems of Iranian learners of French dealing with this issue. Based on previous investigations focusing on French and Quebecois students, the present study aims specifically to answer the following questions: 1- How does the ability to deal verbal endings in /E/ evolve? 2- Among the -ER, -É and -AI forms which is the most successful? 3- a) Among the -É forms, do the learners make agreement between the gender and the number of the subject? b) Do they have any problems with agreement in person among the -AI forms? In order to answer these questions, we have distributed a test to 113 Iranian learners of A1, A2 and B1 levels in French registered in some language institutes in Tehran. Our results based on statistical analysis of variance (ANOVA) show that: 1- The management of verbal endings in /E/ is not mastered at these levels. There is not a significant difference between global scores of these three successive levels. 2- The -ER form is the most successful before the -É and -AI forms respectively, which shows the tendency of learners for invariance. In addition to these three forms, other types of errors (e.g. orthographical errors phonetically-based and errors of segmentation) were frequent in our data yet not reported by previous investigations in French as a First Language (FFL). 3- a) Concerning -É forms, the agreement does not exist and the tendency lies in invariance. b) As for -AI forms, the issue with agreement does not arise. These findings differ from those obtained by other studies in FFL. As a didactic solution, it is suggested to redefine the place of orthography in the actual methods of French language teaching and to emphasize the effectiveness of reflexive way in teaching-learning of French orthography.


2017 ◽  
Vol 156 (6) ◽  
pp. 1072-1077 ◽  
Author(s):  
Sarah M. Dermody ◽  
William Gao ◽  
Johnathan D. McGinn ◽  
Sonya Malekzadeh

Objective (1) Evaluate the consistency and manner in which otolaryngology residents log surgical cases. (2) Assess the extent of instruction and guidance provided by program directors on case-logging practices. Study Design Cross-sectional national survey. Setting Accreditation Council for Graduate Medical Education otolaryngology residency programs in the United States. Subjects and Methods US otolaryngology residents, postgraduate year 2 through graduating chiefs as of July 2016, were recruited to respond to an anonymous questionnaire designed to characterize surgical case-logging practices. Program directors of US otolaryngology residency programs were recruited to respond to an anonymous questionnaire to elucidate how residents are instructed to log cases. Results A total of 272 residents and 53 program directors completed the survey, yielding response rates of 40.6% and 49.5%, respectively. Perceived accuracy of case logs is low among residents and program directors. Nearly 40% of residents purposely choose not to log certain cases, and 65.1% of residents underreport cases performed. More than 80% of program directors advise residents to log procedures performed outside the operating room, yet only 16% of residents consistently log such cases. Conclusion Variability in surgical case-logging behaviors and differences in provided instruction highlight the need for methods to improve consistency of logging practices. It is imperative to standardize practices across otolaryngology residency programs for case logs to serve as an accurate measure of surgical competency. This study provides a foundation for reform efforts within residency programs and for the Resident Case Log System.


2016 ◽  
Vol 73 (6) ◽  
pp. e59-e63 ◽  
Author(s):  
Fadi Balla ◽  
Tabitha Garwe ◽  
Prasenjeet Motghare ◽  
Tessa Stamile ◽  
Jennifer Kim ◽  
...  

2013 ◽  
Vol 70 (6) ◽  
pp. 683-689 ◽  
Author(s):  
Andrew C. McCoy ◽  
Enej Gasevic ◽  
Randolph E. Szlabick ◽  
Abe E. Sahmoun ◽  
Robert P. Sticca
Keyword(s):  
The Past ◽  

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