Resident operative experience in pediatric neurosurgery across the United States

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.

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

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_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.

Trends in Spine Surgery Training During Neurological and Orthopedic Surgery Residency: A Ten-Year Analysis of ACGME Case Log Data

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Martin H Pham ◽  
Andre M Jakoi ◽  
Arvin Raj Wali ◽  
Lawrence Lenke
Keyword(s):  
Spine Surgery ◽  
Orthopedic Surgery ◽  
The United States ◽  
Surgical Patient ◽  
Case Volume ◽  
Average Percentage ◽  
Surgery Training ◽  
Case Logs ◽  
Neurological Surgery

Abstract INTRODUCTION Spine surgery training in the United States currently involves residency training in neurological or orthopedic surgery. Due to different core residency surgical requirements, volume of spine surgery procedures may vary between the two residencies. METHODS The Accreditation Council of Graduate Medical Education resident case logs for both orthopedic surgery and neurological surgery were reviewed for exposure to spine surgery procedures for the graduating years of 2009 to 2018. RESULTS The average number of spine surgery procedures performed during that 10-yr period was 433.8 for neurosurgery residents and 119.5 for orthopedic surgery residents (P < .01). From 2009 to 2018, neurosurgery residents saw an increase of 26.5% in spine surgery procedures from 389.6 to 492.9 procedures whereas orthopedic surgery residents saw a decrease of 41.3% from 141.1 to 82.8 procedures. The 10-yr average percentage of total spine procedures of all total surgical cases was 33.5% for neurosurgery residents compared to 6.2% for orthopedic surgery residents (P < .01). This percentage decreased both for neurosurgery residents (35.8% in 2009 to 31.3% in 2018) and orthopedic surgery residents (7.2% in 2009 to 4.9% in 2018). Neurosurgical residents performed on average 3.6 times more total spine procedures than orthopedic surgery residents, a number that increased from 2.8-fold in 2009 to 6.0-fold in 2018. CONCLUSION Case volume of spine surgery procedures vary greatly with higher rates for neurological and lower for orthopedic surgery residencies, with an enlarging increasing discrepancy over time. Although case volume alone cannot solely determine quality of training, it is one measure to assess opportunities to develop optimal spine education around a certain accepted volume of surgical patient care. The results found here may help to explore various needs and differences between residents seeking to pursue careers in spine, and the role of spine surgery fellowships currently and in the future.

A National Survey of Robotic Surgery Training Among Otolaryngology—Head and Neck Surgery Residents

2021 ◽  
pp. 000348942199696
Author(s):  
Hilary C. McCrary ◽  
Sierra R. McLean ◽  
Abigail Luman ◽  
Patricia O’Sullivan ◽  
Brigitte Smith ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Head And Neck ◽  
National Survey ◽  
Neck Surgery ◽  
The United States ◽  
Head And Neck Surgery ◽  
Residency Programs ◽  
Surgery Training ◽  
Robotic Surgery Training ◽  
Operative Experience

Objective: The aim of this study is to describe the current state of robotic surgery training among Otolaryngology—Head and Neck Surgery (OHNS) residency programs in the United States. Methods: This is a national survey study among OHNS residents. All OHNS residency programs were identified via the Accreditation Council for Graduate Medical Education website. A total of 64/127 (50.3%) of OHNS programs were selected based on a random number generator. The main outcome measure was the number of OHNS residents with access to robotic surgery training and assessment of operative experience in robotic surgery among those residents. Results: A total of 140 OHNS residents participated in the survey, of which 59.3% (n = 83) were male. Response rate was 40.2%. Respondents came from middle 50.0% (n = 70), southern 17.8% (n = 25), western 17.8% (n = 25), and eastern sections 14.3% (n = 20). Most respondents (94.3%, n = 132) reported that their institution utilized a robot for head and neck surgery. Resident experience at the bedside increased in the junior years of training and console experience increased across the years particularly for more senior residents. However, 63.4% of residents reported no operative experience at the console. Only 11.4% of programs have a structured robotics training program. Conclusion: This survey indicated that nearly all OHNS residencies utilize robotic surgery in their clinical practice with residents receiving little formal education in robotics or experience at the console. OHNS residencies should aim to increase access to training opportunities in order to increase resident competency. Level of Evidence: IV

Narrowing of the surgical resident operative experience: A 27-year analysis of national ACGME case logs

Surgery ◽  
2018 ◽  
Vol 164 (3) ◽  
pp. 577-582 ◽  
Author(s):  
Alexander R. Cortez ◽  
Gianna D. Katsaros ◽  
Vikrom K. Dhar ◽  
F. Thurston Drake ◽  
Timothy A. Pritts ◽  
...  
Keyword(s):  
Surgical Resident ◽  
Operative Experience ◽  
Case Logs

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.

Recent trends in bariatric surgery case volume in the United States

Surgery ◽  
2009 ◽  
Vol 146 (2) ◽  
pp. 375-380 ◽  
Author(s):  
Geoffrey P. Kohn ◽  
Joseph A. Galanko ◽  
D. Wayne Overby ◽  
Timothy M. Farrell
Keyword(s):  
United States ◽  
Bariatric Surgery ◽  
The United States ◽  
Case Volume ◽  
Recent Trends

Variation in pediatric stereoelectroencephalography practice among pediatric neurosurgeons in the United States: survey results

2021 ◽  
pp. 1-9
Author(s):  
Benjamin C. Kennedy ◽  
Joshua Katz ◽  
Jacob Lepard ◽  
Jeffrey P. Blount
Keyword(s):  
United States ◽  
The United States ◽  
Median Number ◽  
Pediatric Epilepsy ◽  
Case Volume ◽  
Median Response ◽  
Younger Patients ◽  
Electronic Survey ◽  
Survey Results ◽  
Survey Responses

OBJECTIVE Stereoelectroencephalography (SEEG) has become widespread in the United States during the past decade. Many pediatric neurosurgeons practicing SEEG may not have had experience with this technique during their formal training, and the literature is mostly limited to single-center series. As a result, implementation of this relatively new technique may vary at different institutions. The authors hypothesized that aspects of SEEG experience, techniques, and outcomes would vary widely among programs across the country. METHODS An electronic survey with 35 questions addressing the categories of training and experience, technique, electrode locations, and outcomes was sent to 128 pediatric epilepsy surgeons who were potential SEEG users. RESULTS Sixty-one pediatric fellowship-trained epilepsy surgeons in the United States responded to the survey. Eighty-nine percent were actively using SEEG in their practice. Seventy-two percent of SEEG programs were in existence for less than 5 years, and 68% were using SEEG for > 70% of their invasive monitoring. Surgeons at higher-volume centers operated on younger patients (p < 0.001). Most surgeons (70%) spent 1–3 hours per case planning electrode trajectories. Two-thirds of respondents reported a median implant duration of 5–7 days, but 16% reported never having an implant duration > 5 days, and 16% reported having had implants stay in place for > 4 weeks. The median response for the median number of electrodes initially implanted was 12 electrodes, although 19% of respondents reported median implants of 5–8 electrodes and 17% reported median implants of 15–18 electrodes. Having a higher volume of SEEG cases per year was associated with a higher median number of electrodes implanted (p < 0.001). Most surgeons found SEEG helpful in defining an epileptic network and reported that most of their SEEG patients undergo focal surgical treatment. CONCLUSIONS SEEG has been embraced by the pediatric epilepsy surgery community. Higher case volume is correlated with a tendency to place more electrodes and operate on younger patients. For most parameters addressed in the survey, responses from surgeons clustered around a norm, though additional findings of substantial variations highlight differences in implementation and philosophy among pediatric epilepsy programs.

scholarly journals Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories

2016 ◽  
Vol 18 (6) ◽  
pp. 753-757 ◽  
Author(s):  
Hector E. James
Keyword(s):  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Clinical History ◽  
The United States ◽  
Nursing Personnel ◽  
Cultural Barriers ◽  
University Of Florida ◽  
Clinic Patient ◽  
The University ◽  
Physical Findings

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

Effects of the decline in social capital on college graduates’ soft skills

2018 ◽  
Vol 32 (1) ◽  
pp. 47-56 ◽  
Author(s):  
Sarah Andreas
Keyword(s):  
Social Capital ◽  
Social Learning Theory ◽  
College Graduates ◽  
Soft Skills ◽  
Alternative Hypothesis ◽  
The United States ◽  
Business Environment ◽  
Face To Face ◽  
Recent Graduates ◽  
Recent College Graduates

Both businesses and recent college graduates in the United States attribute the lack of soft skills in recent college graduates to the colleges’ inability to prepare students for the workforce. This article explores the literature on social capital, human capital and social learning theory, offering an alternative hypothesis for why recent graduates are missing soft skills: namely, that it is the decline in social capital that is influencing the graduates’ ability to master those skills. Through the process of building social capital, college students gain the cultural and behavioural information and sensitivity they need to learn soft skills. College graduates are no longer accessing this experience; as a result, businesses and graduates are suffering the consequences of a decline in social capital. Therefore, the results of this study give rise to the hypothesis that the decline in social capital at the macrosocial level is negatively influencing recent college graduates’ formation of soft skills. This may be due to the decrease in building social capital through face-to-face interaction, rather than due to colleges not preparing graduates for success in the business environment.

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