A. R. Cortez1, G. D. Katsaros2, V. K. Dhar1, F. Drake3, T. A. Pritts1, J. J. Sussman1, M. J. Edwards1, R. Quillin4 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA 2University Of Cincinnati,College Of Medicine,Cincinnati, OH, USA 3Boston University,Department Of Surgery,Boston, MA, USA 4Columbia University College Of Physicians And Surgeons,Center For Liver Disease And Transplantation,New York, NY, USA
Introduction: Operative volume is traditionally used to assess graduating trainees’ readiness for independent practice. Although studies have shown that overall operative volume has remained stable despite implementation of duty hour restrictions, subcategory analyses have revealed shifts in the diversity of resident operative experience. Understanding these differences in operative trends may allow educators to better appreciate the impact of the current training environment on the competency of graduating surgical residents.
Methods: Accreditation Council for Graduate Medical Education (ACGME) national operative log reports from 1990 to 2016 were reviewed. Statistical analysis was performed using linear regression analysis. A p-value <0.05 was considered to be statistically significant.
Results: ACGME operative log data was analyzed for 27,851 graduating general surgery residents from 1990 to 2016. During this period, the number of residents increased (+4.87 residents/year) while the number of programs decreased (-1.33 programs/year, all p<0.05), such that each program had on average one more resident at the end of the study period. Linear regression analysis revealed no change in total major cases during the 27-year study period (p=0.54). Subcategory analysis, however, showed an increase in total major cases upon graduation in the following categories: skin and soft tissue (+1.60 cases/year), alimentary tract (+2.6 cases/year), abdomen (+4.01 cases/year) and endoscopy (+0.71 cases/year, all p<0.05). There was a concurrent decrease in breast (-0.54 cases/year), pediatrics (-0.87 cases/year) and trauma (-1.73 cases/year, all p<0.05). During this time, first assistant operative volume decreased markedly (-10.2 cases/year, p<0.05). Residents also completed fewer cases during their chief year (-1.77 cases/year), operated more during their non-chief years (+3.1 cases/year) and taught fewer operations over the course of their residency (-1.9 cases/year, all p<0.05). A decrease in overall operative volume variability (-6.77 cases/year, p<0.05) was seen as a result of a 3.3 cases/year decrease for the 90th percentile and 6.6 cases/year increase for the 10th percentile of total major cases converging toward the median (Figure).
Conclusion: While total major cases upon graduation have remained stable over the past 27 years, the operative experience of general surgery residents has narrowed significantly. Residents appear to be operating more in the early years of training, performing fewer first assist cases and operating less often as teaching assistants. Surgical educators must look beyond total case numbers and be aware of these subtle shifts to ensure all residents achieve technical competency upon graduation.
