B.P. Stewart1, M.D. Shlafstein1, A.S. Cunningham1, R.J. McLoughlin1 1University Of Connecticut, Department Of General Surgery, UConn School Of Medicine, Farmington, CT, USA
Introduction: The American Board of Surgery (ABS) currently includes nearly 150 operations to satisfy the six main competencies of the Accreditation Council for Graduate Medical Education (ACGME). There has also been an emphasis on adherence to duty hours for general surgery residents despite the increasing type and modality of procedures in the curriculum. We aimed to analyze the ABS core curriculum procedures to identify procedures performed less frequently that may be more suitable for advanced/fellowship levels.
Methods: The core procedures for the ABS general surgery curriculum were reviewed to identify procedures that were uncommonly performed in our clinical experience. Patients ages ≥ 18 with a CPT code for one of the procedures of interest (vagotomy, cystostomy, open common bile duct (CBD) exploration, laparoscopic CBD exploration) were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database from 2012-2022. These case volumes were subsequently compared longitudinally to the number of graduating chief residents, approximated by the number of first attempts at the ABS general surgery qualifying exam.
Results: The four procedures of interest were identified as being performed less than 450 times/year in any year from 2012-2022. Laparoscopic CBD exploration was the only procedure with an overall increase (89%) in the number performed from 2012 to 2022. Cystostomy, vagotomy, and open CBD exploration all decreased in overall frequency between 2012-2022. Interestingly, all four procedures showed an increase in frequency between 2021-2022. When looking at the procedures per graduating chief resident, cystostomy had the lowest ratio, which declined over the decade from 0.06 in 2012 to 0.03 in 2022. Vagotomies also decreased in cases per resident from 0.12 in 2012 to 0.06 in 2022. Open CBD explorations decreased in cases per resident from 0.18 to 0.11; however, laparoscopic CBD explorations increased from 0.20 to 0.29 cases per resident, a trend mirrored by total CBD explorations, which increased from 0.38 to 0.40 cases per resident. This correlates, in 2022, for every 33 residents, 16 residents, 9 residents, and 3 residents, it is possible only one of them performed a cystotomy, vagotomy, open CBD exploration, and laparoscopic CBD exploration, respectively.
Conclusion: Close consideration should be given to the ABS core curriculum procedures, with low-volume procedures being reevaluated for elevation to the fellowship or subspecialty level.