A. R. Cortez1, V. K. Dhar1, J. J. Sussman1, T. A. Pritts1, M. J. Edwards1, R. Quillin2 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA 2Columbia University College Of Physicians And Surgeons,Center For Liver Disease And Transplantation,New York, NY, USA
Introduction: As surgical education continues to evolve, so too does the need for surgical educators to better understand how residents learn. Previous analyses of national Accreditation Council for Graduate Medical Education (ACGME) operative log reports have shown that total operative volumes for graduating general surgery residents have remained stable over time, despite changes in duty hour restrictions. However, variability in subspecialty operative volume and its impact on resident training experience has not been well studied.
Methods: ACGME operative log data from 1999 to 2016 for a single academic general surgery residency program were examined. All residents completed the Kolb Learning Style Inventory during their training and were subsequently classified as action-based or observation-based learners. Statistical analyses were performed using Wilcoxon rank-sum test, Chi-square test and linear regression analysis. A p-value <0.05 was considered to be statistically significant.
Results: Over the 18-year study period, 106 general surgery residents graduated from our training program. There were 92 action-based learners (87%) and 14 observation-based learners (13%). These two groups were similar in terms of race, sex and having a dedicated research experience (all p=NS). Linear regression analysis showed no change in total major cases during the 18-year study period (p=0.38). Subcategory analysis, however, revealed a significant increase in operative volume upon graduation in the following defined categories: skin, soft tissue and breast (+2.8 cases/year); alimentary tract (+10.1 cases/year); abdomen (+15.4 cases/year); endoscopy (+3.0 cases/year) and laparoscopy (+10.9 cases/year, all p<0.05). Conversely, a decrease was seen in the following defined categories: liver (-0.44 cases/year), vascular (-1.1 cases/year) and endocrine (-0.5 cases/year, all p<0.05). Learning style analysis revealed that action-based learners completed significantly more cases than observation-based learners in each of the domains in which operative volume increased (Figure).
Conclusions: While the total operative volume of graduates at our center has remained stable over the past 18 years, the operative experience of general surgery residents has become more narrowed toward a less subspecialized general surgery experience. These shifts may be disproportionally impacting trainees, as observation-based learners were found to operate less than action-based learners in select categories. Residency programs should therefore incorporate methods such as learning style assessment to identify residents at risk of having a suboptimal training experience.
