I. A. Woelfel1, D. Strosberg1, S. Abdel-Misih1,2, A. Harzman1,3 1Ohio State University,Department Of Surgery,Columbus, OH, USA 2Ohio State University,Surgical Oncology,Columbus, OH, USA 3Ohio State University,Colon And Rectal Surgery,Columbus, OH, USA
Introduction: The combination of work hour restrictions and a continual increase in the documentation tasks required of all physicians makes clinical efficiency of utmost importance in gaining operative time during the first year of post-graduate training. However, the majority of patient-care responsibilities during the first year of post-graduate training focus on perioperative patient care. While other studies have documented clinical efficiency through discrete observation and recording of all daily activities, we wanted to analyze efficiency by one of its anticipated outcomes: time in the operating room. The aim of this study is to determine if hypothesized increased clinical efficiency throughout the first year of post-graduate training translates into increased time in the operating room.
Methods: We completed a retrospective review of all the logged surgical cases from current general surgery residents during their PGY 1 (intern) year at a single large academic training program from 2011-2017. All logged cases are recorded on the General Surgery Operative Log (GSOL) of the Accreditation Council for Graduate Medical Education website by surgical residents using current procedural terminology code (CPT). The cases were categorized according to the month and rotation in which they occurred. A correlation coefficient was calculated to determine the strength of the relationship between month and the operative volume.
Results: The ACGME case logs for 25 interns spanning the years 2011 to 2017 were examined, yielding a total 3,751 cases for analysis. We included central line placements, endoscopy, as well as ultrasounds, while excluding intensive care unit and non-operative trauma cases. The number of cases per resident peaked in June of intern year with a median of 18 (range: 3-52) cases; a total of seven more cases than the 11 (range: 1-38) per resident in July. The average numbers of cases per resident according to month are plotted in Figure 1. (Correlation coefficient = 0.26) Additionally it was found that Surgical Oncology had the highest case volume (Median = 23; range 3-88) while the Surgical Intensive Care Unit rotation had the lowest case volumes (Median = 4; Range 1-22).
Conclusion: Our results show that operative experience increases slightly throughout intern year with the highest average case experience in the final month. We hypothesize that this correlates positively with increasing efficiency in non-operative tasks such as documentation and care coordination. Therefore, increased early training in those areas may allow even greater early operative exposure for surgical residents.
