C. DuCoin1, A. Hahn1, D. Slakey1, J. Korndorffer1 1Tulane University School Of Medicine,Department Of Surgery,New Orleans, LA, USA
Introduction: There is a pervasive belief residents are less prepared for a career in general surgery upon completing residency than residents were 15 years ago. The increase in fellowship training over this time frame has been described as consequence of this perceived lack of preparation. However, data shows that there is an insignificant change in the total number of cases performed by surgical residents over this time period; even with the implementation of the 80-hr workweek. As case numbers alone cannot be implicated, additional factors should be examined. We hypothesize the continued subspecialization of general surgery may manifest as a decrease in certain resident case numbers. This lack of case volume experience in areas once deemed general surgery may be a factor in the resident preparation concerns.
Methods: The ACGME produced General Surgery Case Logs National Data Report from the 15-year period (1999-2014) was used to gather the mean number of procedures per resident for 19 different surgical categories, thus reflecting the current fellowships. Statistical analysis with ANOVA was used to compare categorical averages over three periods (1999-2004, 2004-2009 and 2009-2014) for all surgical residents as well as for all chief residents. We then specifically examined each surgical category for data trends over time.
Results:There has been an insignificant change in number of total cases performed by residents, as well as chief residents, in their final year over the last 15 years. However, there is a statistically significant difference in the variety of surgical cases based on category or subspecialty. Over the time interval, it was found that vascular, breast, and trauma cases decreased (p = 0.001, p <0.0001, p < 0.0001), while major intestinal, biliary, and hernia cases increased (p < 0.0001, p <0.0001, p< 0.0001).
Conclusion: This data suggests that in areas where subspecialized fellowships have been developed, resident cases have declined. This decline may be a potential factor in the perceived lack of preparation as a well-rounded general surgeon. Additionally, residents may be seeking fellowships in part to offset this decline. Monitoring of the variety of cases performed by residents should be analyzed to ensure residents do not lose access to cases needed for a well-rounded general surgical education.
