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Kim Y, Cui CL, Williams ZF, Long CA. Impact of Integrated Vascular Surgery Residency on General Surgery Resident and Vascular Fellow Operative Volume: A National Analysis. Vasc Endovascular Surg 2024; 58:302-307. [PMID: 37918823 DOI: 10.1177/15385744231213299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND The impact of integrated vascular surgery (VS) residency (0 + 5) programs on general surgery (GS) resident and VS fellow (5 + 2) operative volume has not been investigated on a national scale. METHODS Accreditation Council for Graduate Medical Education (ACGME) case logs were reviewed for GS resident, VS resident, and VS fellow operative volume from 2001-2021. Integrated VS resident data was available from 2012-2021, corresponding with the introduction of the 0 + 5 paradigm. Trends in operative volume were evaluated via linear regression analysis. RESULTS The national cohort of chief GS resident graduates increased from 1005 to 1357 per year. Total operative volume also increased from 932 to 1039 cases (+7.4 cases/yr, R2 = .80, P < .0001) among GS residents. Major vascular cases decreased among GS residents from 138 to 101 cases (-2.4 cases/yr, R2 = .58, P < .0001) with a decrease in proportion of chief-level vascular cases from 30.4% to 11.9% (-1.0%/yr, R2 = .92, P < .0001). Palliative procedures (amputations and hemodialysis access) comprised a significant proportion of GS cases (median 44.7%). Concurrently, integrated VS graduates increased from 11 to 37 per year, with an increase in major vascular case volume from 506 to 658 cases (+18.4 cases/yr, R2 = .63, P = .01). Total VS fellow major case volume also increased from 369 to 444 cases (+3.5 cases/yr, R2 = .73, P < .0001). CONCLUSIONS The introduction of the 0 + 5 intgrated VS residency paradigm has correlated with a significant decrease in GS operative experience in major vascular procedures on a national level. Traditional VS fellow case volume does not appear to be impacted by 0 + 5 integrated residents. Further analysis with program-level data may help to explain the causative relationship of these findings.
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Affiliation(s)
- Young Kim
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Christina L Cui
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Zachary F Williams
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC, USA
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Ore AS, Liu BS, Chen HW, Kent TS, Parsons CS, Narula N. General Surgery Trainee Cases Over Time: Postgraduate Year Matters. Am Surg 2023; 89:5325-5331. [PMID: 36564886 DOI: 10.1177/00031348221146932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Trainees and attending surgeons alike have concerns about resident and fellow operative volume/breadth, competency, and overall readiness for practice. This is an important topic within surgical graduate medical education. Our goal was to analyze the change in general surgery trainee operative experience over time by postgraduate year. METHODS Institutional operative records from two corresponding three-month time periods in 2009 and 2018 at the residency program's main hospital site were reviewed. Cases assisted on by general, vascular, or thoracic surgery trainees were included. The number of cases per level, combination of trainees in each case, and categories of cases were compared over time. RESULTS There were 1940 cases in 2009 and 1967 cases in 2018 over the respective time periods. The distribution of trainees was different (P < .001), with a similar number of PGY-1 and fellow cases, a decrease in PGY-2 and PGY-5 cases, and an increase in PGY-3 and PGY-4 cases. The number of cases with two trainees, double scrubbed cases, increased from 19.6% to 26.8% (P < .001). In addition, there were differences in the resident years that double scrubbed cases together, an increase in robotic and endovascular surgery, and a decrease in open cases. CONCLUSIONS This analysis of cases shows that resident operative volume over approximately a decade has been largely preserved, with some change in the distribution of cases based on trainee level, an increase in cases with more than one trainee, and a rise of minimally invasive surgery with a corresponding decrease in open cases.
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Affiliation(s)
- Ana Sofia Ore
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Betty S Liu
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Hao W Chen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Charles S Parsons
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Nisha Narula
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Shaban L, Mkandawire P, O'Flynn E, Mangaoang D, Mulwafu W, Stanistreet D. Quality Metrics and Indicators for Surgical Training: A Scoping Review. J Surg Educ 2023; 80:1302-1310. [PMID: 37481412 DOI: 10.1016/j.jsurg.2023.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/17/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Surgical training quality is critical to ensure that trainees receive adequate preparation to perform surgical procedures independently and that patients receive safe, effective, and high-quality care. Numerous surgical training quality indicators have been proposed, investigated and implemented. However, the existing evidence base for these indicators is limited, with most studies originating from English-speaking, high-income countries. OBJECTIVES This scoping review aimed to identify the range of quality indicators that have been proposed and evaluated in the literature, and to critically evaluate the existing evidence base for these indicators. METHODS A systematic literature search was conducted using MEDLINE and Embase databases to identify studies reporting on surgical training quality indicators. A total of 68 articles were included in the review. RESULTS Operative volume is the most commonly cited indicator and has been investigated for its effects on trainee exam performance and career progression. Other indicators include operative diversity, workplace-based assessments, regular evaluation and feedback, academic achievements, formal teaching, and learning agreements, and direct observation of procedural skills. However, these indicators are largely based on qualitative analyses and expert opinions and have not been validated quantitatively using clear outcome measures for trainees and patients. CONCLUSIONS Future research is necessary to establish evidence-based indicators of high-quality surgical training, including in low-resource settings. Quantitative and qualitative studies are required to validate existing indicators and to identify new indicators that are relevant to diverse surgical training environments. Lastly, any approach to surgical training quality must prioritize the benefit to both trainees and patients, ensuring training success, career progression, and patient safety.
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Affiliation(s)
- Lawa Shaban
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland.
| | - Payao Mkandawire
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Eric O'Flynn
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Deirdre Mangaoang
- Institute of Global Surgery, School of Population Health, RCSI, Dublin, Ireland
| | - Wakisa Mulwafu
- Department of Surgery, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Debbi Stanistreet
- Department of Public Health and Epidemiology, School of Population Health, RCSI, Dublin, Ireland
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Tarawneh OH, Garay-Morales S, Liu IZ, Pakhchanian H, Kazim SF, Roster K, McDaniel L, Tabaie SA, Vellek J, Raiker R, Schmidt MH, Bowers CA, Tannoury T, Tannoury C. Impact of COVID-19 on Spinal Diagnosis and Procedural Volume in the United States. Global Spine J 2023:21925682231153083. [PMID: 36688402 PMCID: PMC9892815 DOI: 10.1177/21925682231153083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
STUDY DESIGN Retrospective analysis of a national database. OBJECTIVES COVID-19 resulted in the widespread shifting of hospital resources to handle surging COVID-19 cases resulting in the postponement of surgeries, including numerous spine procedures. This study aimed to quantify the impact that COVID-19 had on the number of treated spinal conditions and diagnoses during the pandemic. METHODS Using CPT and ICD-10 codes, TriNetX, a national database, was utilized to quantify spine procedures and diagnoses in patients >18 years of age. The period of March 2020-May 2021 was compared to a reference pre-pandemic period of March 2018-May 2019. Each time period was then stratified into four seasons of the year, and the mean average number of procedures per healthcare organization was compared. RESULTS In total, 524,394 patient encounters from 53 healthcare organizations were included in the analysis. There were significant decreases in spine procedures and diagnoses during March-May 2020 compared to pre-pandemic levels. Measurable differences were noted for spine procedures during the winter of 2020-2021, including a decrease in lumbar laminectomy and anterior cervical arthrodesis. Comparing the pandemic period to the pre-pandemic period showed significant reductions in most spine procedures and treated diagnoses; however, there was an increase in open repair of thoracic fractures during this period. CONCLUSIONS COVID-19 resulted in a widespread decrease in spinal diagnosis and treated conditions. An inverse relationship was observed between new COVID-19 cases and spine procedural volume. Recent increases in procedural volume from pre-pandemic levels are promising signs that the spine surgery community has narrowed the gap in unmet care produced by the pandemic.
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Affiliation(s)
| | | | - Ivan Z. Liu
- The Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Haig Pakhchanian
- George Washington University School of Medicine, Washington, DC, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Katie Roster
- New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Lea McDaniel
- George Washington University School of Medicine, Washington, DC, USA
| | - Sean A. Tabaie
- Department of Orthopedic Surgery, Children’s National Hospital, Washington, DC, USA
| | - John Vellek
- New York Medical College, School of Medicine, Valhalla, NY, USA
| | - Rahul Raiker
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Meic H. Schmidt
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Christian A. Bowers
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Tony Tannoury
- Department of Orthopaedic Surgery, Boston University, Boston, MA, USA
| | - Chadi Tannoury
- Department of Orthopaedic Surgery, Boston University, Boston, MA, USA
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George EL, Arya S, Ho VT, Stern JR, Sgroi MD, Chandra V, Lee JT. Trends in annual open abdominal aortic surgical volumes for vascular trainees compared to annual national volumes in the endovascular era. J Vasc Surg 2022; 76:1079-1086. [PMID: 35598821 DOI: 10.1016/j.jvs.2022.03.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Prior analysis predicted a shortfall in open abdominal aortic repair (OAR) experience for vascular trainees resulting from the rapid adoption of and increased anatomic suitability of endovascular aortic repair (EVAR) technology. We explored how EVAR has transformed contemporary open aortic surgical education for vascular trainees. METHODS We examined ACGME case volumes of open abdominal aortic aneurysm (AAA) repair and reconstruction for aorto-iliac occlusive disease (AIOD) via aorto-iliac/femoral bypass (AFB) from integrated vascular surgery residents (VSR) and fellows (VSF) graduating 2006-2017 and compared them to national estimates of total OAR (open AAA repair + AFB) in the Agency for Healthcare Research and Quality National Inpatient Sample based on ICD-9 and ICD-10 procedural codes. Changes over time were assessed using Chi-square test, Student's t-test, and linear regression. RESULTS During the twelve-year study period, the national annual total OAR and open AAA repair estimates decreased: total OAR by 72.5% (2006: estimate (standard error) 24,255 (1185) vs. 2017: 6,690 (274); p<0.001) and open AAA repair by 84.7% (2006: 18,619 (924) vs. 2017: 2,850 (168); p<0.001); AFB estimates decreased by 33.0% (p<0.001). The percentage of total OAR, open AAA repair, and AFB performed at teaching hospitals significantly increased from ∼55 to 80% (all p<0.001). There was a 40.9% decrease in open AAA repairs logged by graduating VSF (mean 18.6 vs. 11) but only a 6.9% decrease in total OAR cases (mean 27.6 vs. 25.7) due to increasing AFB volumes (mean 9.0 vs. 14.7). VSR graduates consistently logged an average of ∼10 open AAA repairs and there was a 31.0% increase in total OAR (mean 23.2 vs. 30.4), again secondary to rising AFB volumes (mean 11.4 vs 17.5). Although there was an absolute decrease in open aortic experience for VSF, the rate of decline for total OAR case volumes was not significantly different after VSR programs were established (p=0.40). CONCLUSIONS As incidence decreases nationally, OAR is shifting towards teaching hospitals. While open AAA procedures for trainees are declining due to EVAR, open aortic reconstruction for AIOD is rising and plays an important role in ensuring that vascular trainees continue to have satisfactory OAR experience sufficient for meeting minimum graduation requirements. Strategies to maintain and maximize the education and experience from these cases should be top priority for vascular surgery program directors.
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Affiliation(s)
- Elizabeth L George
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California; Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California
| | - Shipra Arya
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California; Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California; Surgical Service Line, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Vy T Ho
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California
| | - Jordan R Stern
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California
| | - Michael D Sgroi
- Division of Vascular Surgery, Santa Clara Valley Medical Center, Santa Clara, California
| | - Venita Chandra
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California
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Madenci AL, Wanis KN, Cooper Z, Haneuse S, Subramanian SV, Hofman A, Hernán MA. Strengthening Health Services Research Using Target Trial Emulation: An Application to Volume-Outcomes Studies. Am J Epidemiol 2021; 190:2453-2460. [PMID: 34089045 DOI: 10.1093/aje/kwab170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/30/2021] [Accepted: 06/02/2021] [Indexed: 01/11/2023] Open
Abstract
The number of operations that surgeons have previously performed is associated with their patients' outcomes. However, this association may not be causal, because previous studies have often been cross-sectional and their analyses have not considered time-varying confounding or positivity violations. In this paper, using the example of surgeons who perform coronary artery bypass grafting, we describe (hypothetical) target trials for estimation of the causal effect of the surgeons' operative volumes on patient mortality. We then demonstrate how to emulate these target trials using data from US Medicare claims and provide effect estimates. Our target trial emulations suggest that interventions on physicians' volume of coronary artery bypass grafting operations have little effect on patient mortality. The target trial framework highlights key assumptions and draws attention to areas of bias in previous observational analyses that deviated from their implicit target trials. The principles of the presented methodology may be adapted to other scenarios of substantive interest in health services research.
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Lund S, MacArthur T, Fischmann MM, Maroun J, Dang J, Markos JR, Zielinski M, Stephens D. Impact of COVID-19 Governmental Restrictions on Emergency General Surgery Operative Volume and Severity. Am Surg 2021:31348211011113. [PMID: 33861672 DOI: 10.1177/00031348211011113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND To describe the effect of the COVID-19 pandemic on emergency general surgery operative volumes during governmental shutdowns secondary to the pandemic and characterize differences in disease severity, morbidity, and mortality during this time compared to previous years. METHODS This retrospective cohort study compares patients who underwent emergency general surgery operations at a tertiary hospital from March 1st to May 31st of 2020 to 2019. Average emergent cases per day were analyzed, comparing identical date ranges between 2020 (pandemic group) and 2019 (control group). Secondary analysis was performed analyzing disease severity, morbidity, and mortality. RESULTS From March 1st to May 31st, 2020, 2.5 emergency general surgery operations were performed on average daily compared to 3.0 operations on average daily in 2019, a significant decrease (P = .03). No significant difference was found in presenting disease severity, morbidity, or mortality between the pandemic and control groups. DISCUSSION This study demonstrates a decrease of 65% in emergency general surgery operations during governmental restrictions secondary to the COVID-19 pandemic. This decrease in operations was not associated with worse disease severity, morbidity, or mortality.
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Affiliation(s)
- Sarah Lund
- Department of General Surgery, 4352Mayo Clinic Rochester, MN, USA
| | - Taleen MacArthur
- Department of General Surgery, 4352Mayo Clinic Rochester, MN, USA
| | | | - Justin Maroun
- Alix School of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Johnny Dang
- Alix School of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - James R Markos
- Alix School of Medicine, 4352Mayo Clinic Rochester, MN, USA
| | - Martin Zielinski
- Department of Trauma, Critical Care, and General Surgery, 4352Mayo Clinic Rochester, MN, USA
| | - Daniel Stephens
- Department of Trauma, Critical Care, and General Surgery, 4352Mayo Clinic Rochester, MN, USA
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Gazivoda V, Greenbaum A, Roshal J, Lee J, Reddy L, Rehman S, Kangas-Dick A, Gregory S, Kowzun M, Stephenson R, Laird A, Alexander HR, Berger AC. Assessing the immediate impact of COVID-19 on surgical oncology practice: Experience from an NCI-designated Comprehensive Cancer Center in the Northeastern United States. J Surg Oncol 2021; 124:7-15. [PMID: 33765341 PMCID: PMC8250700 DOI: 10.1002/jso.26475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
Background The effects of the coronavirus disease 2019 (COVID‐19) pandemic on surgical oncology practice are not yet quantified. The aim of this study was to measure the immediate impact of COVID‐19 on surgical oncology practice volume. Methods A retrospective study of patients treated at an NCI‐Comprehensive Cancer Center was performed. “Pre‐COVID” era was defined as January–February 2020 and “COVID” as March–April 2020. Primary outcomes were clinic visits and operative volume by surgical oncology subspecialty. Results Abouyt 907 new patient visits, 3897 follow‐up visits, and 644 operations occurred during the study period. All subspecialties experienced significant decreases in new patient visits during COVID, though soft tissue oncology (Mel/Sarc), gynecologic oncology (Gyn/Onc), and endocrine were disproportionately affected. Telehealth visits increased to 11.4% of all visits by April. Mel/Sarc, Gyn/Onc, and Breast experienced significant operative volume decreases during COVID (25.8%, p = 0.012, 43.6% p < 0.001, and 41.9%, p < 0.001, respectively), while endocrine had no change and gastrointestinal oncology had a slight increase (p = 0.823) in the number of cases performed. Conclusions The effects of the COVID‐19 pandemic are wide‐ranging within surgical oncology subspecialties. The addition of telehealth is a viable avenue for cancer patient care and should be considered in surgical oncology practice.
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Affiliation(s)
- Victor Gazivoda
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Alissa Greenbaum
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Joshua Roshal
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jenna Lee
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Lekha Reddy
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Shahyan Rehman
- Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Aaron Kangas-Dick
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Stephanie Gregory
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Maria Kowzun
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ruth Stephenson
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Amanda Laird
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - H R Alexander
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Adam C Berger
- Department of Surgical Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Cortez AR, Winer LK, Kassam AF, Hanseman DJ, Kuethe JW, Quillin RC, Potts JR. See None, Do Some, Teach None: An Analysis of the Contemporary Operative Experience as Nonprimary Surgeon. J Surg Educ 2019; 76:e92-e101. [PMID: 31130507 DOI: 10.1016/j.jsurg.2019.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/08/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The operative experience of today's general surgery resident has changed, but little is known about the modern experience as nonprimary surgeon. We set out to explore changes in the operative experience of general surgery residents as first assistant (FA) and teaching assistant (TA). DESIGN, SETTING, AND PARTICIPANTS This is a review of ACGME national operative log reports from 1990 to 2018. TA and FA cases were analyzed. Statistical analysis was performed using polynomial regression analysis and Kruskal-Wallis test. Statistical significance was set at p < 0.05. RESULTS 30,260 individuals completed general surgery residency during the study period with medians of 951 (interquartile range: 929-974) total major, 63 (31-184) FA, and 32 (25-48) TA cases. As a proportion of total cases completed, FA cases decreased from 21.8% of the total operative experience in 1990 to 2.5% in 2018, and TA cases declined from 7.4% of the total operative experience in 1990 to 3.5% in 2018. Regression modeling demonstrated that both operative roles decreased over time, but at a progressively decreasing rate, with FA cases reaching a "floor" around 2010 and TA cases reaching a "breakpoint" in 2008 at which time operative volume rebounded and began to increase. Among the core general surgery domains of abdomen and alimentary tract, compositional analysis revealed a decrease across each of the 11 operative subcategories (all p < 0.05) for FA, and for TA, a decrease in 6 of the 11 operative subcategories (stomach, small intestine, large intestine, anorectal, hernia, and biliary, all p < 0.05). CONCLUSIONS Over the past 3 decades, the resident operative experience as nonprimary surgeon has decreased dramatically, with today's residents graduating with fewer FA and TA cases. As surgical training has traditionally relied heavily on an apprenticeship model for learning technical skills, it is essential that surgical educators recognize and rectify these trends.
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Affiliation(s)
- Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
| | - Leah K Winer
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Dennis J Hanseman
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Joshua W Kuethe
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Ralph Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - John R Potts
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
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Naik ND, Abbott EF, Aho JM, Pandian TK, Thiels CA, Heller SF, Farley DR. The ACGME Case Log System May Not Accurately Represent Operative Experience Among General Surgery Interns. J Surg Educ 2017; 74:e106-e110. [PMID: 29055744 DOI: 10.1016/j.jsurg.2017.09.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To assess if the Accreditation Council for Graduate Medical Education (ACGME) case log system accurately captures operative experience of our postgraduate year 1 (PGY-1) residents. DESIGN ACGME case log information was retrospectively obtained for 5 cohorts of PGY-1 residents (2011-2015) and compared to the number of operative cases captured by an institutional automated operative case report system, Surgical Access Utility System (SAUS). SAUS automatically captures all surgical team members who are listed in the operative dictation for a given case, including interns. A paired t-test analysis was used to compare number of cases coded between the 2 systems. SETTING Academic, tertiary care referral center with a large general surgery training program. PARTICIPANTS PGY-1 general surgery trainees (interns) from the years 2011-2015. RESULTS Forty-nine PGY-1 general surgery residents were identified over a 5-year period. Mean operative case volume per intern, per year, captured by the automated SAUS was 176.5 ± 28.1 (SD) compared to 126.3 ± 58.0 ACGME cases logged (mean difference = 50.2 cases, p < 0.001). CONCLUSIONS ACGME case log data may not accurately reflect the actual operative experience of our PGY-1 residents. If such data holds true for other general surgery training programs, the true impact of duty hour regulations on operative volume may be unclear when using the ACGME case log data. This current standard approach for using ACGME case logs as a representation of operative experience requires further scrutiny and potential revision to more accurately determine operative experience for accreditation purposes.
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Affiliation(s)
- Nimesh D Naik
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Eduardo F Abbott
- Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota; Department of Internal Medicine, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Johnathon M Aho
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - T K Pandian
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Cornelius A Thiels
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Stephanie F Heller
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - David R Farley
- Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota; Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota.
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Mullen MG, Salerno EP, Michaels AD, Hedrick TL, Sohn MW, Smith PW, Schirmer BD, Friel CM. Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery? J Surg Educ 2016; 73:609-615. [PMID: 27066854 PMCID: PMC4985608 DOI: 10.1016/j.jsurg.2016.02.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. METHODS A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. RESULTS A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). CONCLUSIONS Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education.
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Affiliation(s)
- Matthew G Mullen
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Elise P Salerno
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Alex D Michaels
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Traci L Hedrick
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Min-Woong Sohn
- Department of Public Health Sciences, Health System Old Medical School, University of Virginia, Charlottesville, Virginia
| | - Philip W Smith
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Bruce D Schirmer
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Charles M Friel
- Department of Surgery, University of Virginia, Charlottesville, Virginia.
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Quillin RC, Pritts TA, Hanseman DJ, Edwards MJ, Davis BR. How residents learn predicts success in surgical residency. J Surg Educ 2013; 70:725-730. [PMID: 24209648 DOI: 10.1016/j.jsurg.2013.09.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 09/11/2013] [Accepted: 09/12/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Predictors of success in surgical residency have been poorly understood. Previous studies have related prior performance to future success without consideration of personal attributes that help an individual succeed. Surgical educators should consider how residents learn to gain insight into early identification of residents at risk of failing to complete their surgical training. METHODS We examined our 14-year database of surgical resident learning-style assessments, Accreditation Council for Graduate Medical Education operative log data of graduating residents from 1999 to 2012, first time pass rates on the American Board of Surgery Qualifying and Certifying examinations, and departmental records to identify those residents who did not complete their surgery training at our institution. Statistical analysis was performed using the chi-square test, Wilcoxon rank-sum, and regression analysis with significance set at p < 0.05. RESULTS We analyzed 441 learning-style assessments from 130 residents. Surgical residents are predominantly action-based learners, with converging (219, 49.7%) and accommodating (112, 25.4%) being the principal learning styles. Assimilating (66, 15%) and diverging (44, 10%) learning styles, where an individual learns by observation, were less common. Regression analysis comparing learning style with case volume revealed that residents who are action-based learners completed more cases at graduation (p < 0.05 for each). Additionally, surgical residents who transferred to a nonsurgical residency or nonphysician field were more likely to learn by observation (p = 0.0467). CONCLUSIONS Surgical residents are predominantly action-based learners. However, a subset of surgical residents learn primarily by observation. These residents are at risk for a less robust operative experience and not completing surgical training. Learning-style analysis may be utilized by surgical educators to identify the potential at-risk residents in general surgery.
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Affiliation(s)
- Ralph C Quillin
- Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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