Trends in General Surgery Operative Experience Obtained by Integrated Vascular Surgery Residents

Integrated vascular training may not prepare graduates to care for vascular trauma patients

BACKGROUND

Vascular surgery board eligibility may be secured through 5+0 integrated programs (IV) as well as 5+2 general surgery/vascular fellowship pathway (VF). We hypothesized that IV graduates accrue less experience relevant to vascular trauma than VF graduates. We assessed the first decade of IV graduate experience and compared it to contemporaneous VF graduates.

METHODS

The 2013-2022 Accreditation Council for Graduate Medical Education case log data were collected for IV and VF graduates. Vascular fellows' data were combined with synchronousgeneral surgery residency data. Open vascular cases were classed as cerebrovascular, upper extremity, thoracic, abdominopelvic, infrainguinal, and infrapopliteal. Nonvascular open cases were categorized as neck, thoracic, and abdominopelvic. Nonoperative trauma and critical care data were recorded.

RESULTS

There were 1,224 VF and 397 IV graduates. In 2012, 8.3% of graduating vascular surgeons trained in IV programs. By 2022, this proportion was 32.6%. The number of IV programs increased by 4.4 programs per year over the study period ( p < 0.05), whereas VF programs remained unchanged. Integrated vascular chiefs logged significantly more lower extremity cases, and VFs logged more upper extremity cases ( p < 0.05). IV graduates reported a fraction of the VF open nonvascular cases. Integrated vascular graduates logged 5% of the abdominopelvic, 18% of the thoracic, and 3% of the neck cases of VFs ( p < 0.05). Vascular fellows' critical care and nonoperative trauma were each higher than those of IV fellows ( p < 0.05). Integrated vascular graduates logged six vascular repairs for every vascular exposure.

CONCLUSION

The proportion of vascular surgeons trained through IV programs has nearly quadrupled. Integrated vascular graduates have a fraction of the experience in critical care, trauma, and nonvascular surgery compared with VF graduates. Relative inexperience with open surgical anatomy and with critically ill patients may limit IV graduates' ability to care for the patient with vascular trauma.

LEVEL OF EVIDENCE

Diagnostic Test/Criteria; Level IV.

A propensity score matching analysis: Impact of senior resident versus fellow participation on outcomes of complex surgical oncology

BACKGROUND

Teaching hospitals that train both general surgery residents and fellows in complex general surgical oncology have become more common. This study investigates whether participation of a senior resident versus a fellow has an impact on outcomes of patients undergoing complex cancer surgery.

METHODS

Patients who underwent esophagectomy, gastrectomy, hepatectomy, or pancreatectomy between 2007 and 2012 with assistance from a senior resident (post-graduate years 4-5) or a fellow (post-graduate years 6-8) were identified from the ACS NSQIP. Based on age, sex, body mass index, ASA classification, diagnosis of diabetes mellitus, and smoking status, propensity-scores were created for odds of undergoing the operation assisted by a fellow. Patients were matched 1:1 based on propensity score. Postoperative outcomes including risk of major complication were compared after matching.

RESULTS

In total, 6934 esophagectomies, 13,152 gastrectomies, 4927 hepatectomies, and 8040 pancreatectomies were performed with assistance of a senior resident or fellow. After matching, overall rates of major complications were equivalent across all four anatomic locations between cases performed with the participation of a senior resident versus a surgical fellow: esophagectomy (37.0%% vs 31.6%, p = 0.10), gastrectomy (22.6% vs 22.3%, p = 0.93), hepatectomy (15.8% v 16.0%, p = 0.91), and pancreatectomy (23.9% vs 25.2%, p = 0.48). Operative time was shorter for gastrectomy (212 vs. 232 min; p = 0.004) involving a resident compared to a fellow, but comparable for esophagectomy (330 vs. 336 min; p = 0.41), hepatectomy (217 vs. 219 min; p = 0.85), and pancreatectomy (320 vs. 330 min; p = 0.43).

CONCLUSIONS

Senior resident participation in complex cancer operations does not appear to negatively impact operative time or postoperative outcomes. Future research is needed to further assess this domain of surgical practice and education, particularly with regard to case selection and operative complexity.

Experience of surgical subspecialty residents on general surgery rotations

BACKGROUND

Surgical subspecialty residents complete 5-6 years of training which includes general surgery rotations. A lack of data exists evaluating these rotations. This study aims to identify discrepancies in subspecialty training and improve the quality of surgical education.

METHODS

Case logs for surgical subspecialty residents and general surgery residents at our institution were analyzed and queried for cases performed on general surgery rotations. A survey was distributed to subspecialty residents regarding their perceptions of these rotations.

RESULTS

50 residents were included in the study and the majority were male (n = 27, 54%). Subspecialty residents perform fewer cases per month compared to general surgery residents (13 vs 21, p < 0.001). 75% of subspecialty residents were satisfied with their experience on general surgery rotations.

CONCLUSIONS

Subspecialty residents perform fewer operations on general surgery rotations. Despite this, most are satisfied with off-service rotations and believe they are an important part of their education.