Operative experience of surgery residents: trends and challenges.

To evaluate trends in operative experience and to determine the effect of establishing the Surgical Council on Resident Education (SCORE) operative classification system on changes in operative volume among graduating surgery residents. The general surgery operative logs of graduating surgery residents from 2005 were retrospectively compared with residents who completed training in 2010 and 2011. Nonparametric statistical analyses were used (Mann-Whitney and median test) with significance set at p<0.01. A total of 1022 residents completing residency in 2005 were compared with 1923 residents completing training in 2010-2011. Total operations reported increased from a median of 1023 to 1238 (21%) between 2005 and 2010-2011 (p<0.001). Cases increased in most SCORE categories. The median numbers of total, basic, and complex laparoscopic operations increased by 49%, 37%, and 82%, respectively, over the 5-year interval (p<0.001). Open cavitary (thoracic + abdominal) operations decreased by 5%, whereas other major operations increased by 35% (both p<0.001). The frequency of discrete operations done at least 10 times during residency did not change. The median number of SCORE essential-common operations performed ranged from 1 to 107, whereas essential-uncommon operations ranged from 0 to 4. Twenty-three of 67 SCORE essential-common operations (34%) had a median of less than 5 and 4 had a median of 0. The operative volume of graduating surgical residents has increased by 21% since 2005; however, the number of operations done 10 times or greater has not changed. Although open cavitary procedures continue to decline, there has been a large increase in endoscopy, complex laparoscopic, and other major operations. Some essential-common operations continue to be performed infrequently. These results suggest that education in the operating room must improve and alternate methods for teaching infrequently performed procedures are needed.

Malangoni MA ，Biester TW ，Jones AT ，Klingensmith ME ，Lewis FR Jr ... -  《-》

Cumulative operative experience is decreasing during general surgery residency: a worrisome trend for surgical trainees?

Kairys JC ，McGuire K ，Crawford AG ，Yeo CJ ... -  《-》

Are open abdominal procedures a thing of the past? An analysis of graduating general surgery residents' case logs from 2000 to 2011.

Since the introduction of laparoscopic surgery for cholecystectomy in 1989, the growth of minimally invasive surgery (MIS) has increased significantly in the United States. There is a growing concern that the pendulum has now shifted too far toward MIS and that current general surgery residents' exposure to open abdominal procedures is lacking. We sought to analyze trends in open vs MIS intra-abdominal procedures performed by residents graduating from US general surgery residency programs over the past twelve years. We conducted a retrospective analysis of the data from the ACGME national resident case log reports for graduating US general surgery residents from 2000 to 2011. We analyzed the average number of cases per graduating chief resident for the following surgical procedures: appendectomy, inguinal/femoral hernia repair, gastrostomy, colectomy, antireflux procedures, and cholecystectomy. For all the procedures analyzed, except antireflux procedures, a statistically significant increase in the number of MIS cases was seen. The increases in MIS procedures were as follows: appendectomy, 8.5 to 46 (542%); inguinal/femoral hernia repair, 7.6 to 23.3 (265%); gastrostomy, 1.4 to 3 (114%); colectomy, 1.8 to 18.2 (1011%); and cholecystectomy, 84 to 105.7 (26%). The p value was set at <0.001 for all procedures. There has been a concomitant decrease in the number of open procedures. The numbers of open appendectomy decreased from 30.9 to 15.5 (p < 0.0001), open inguinal/femoral hernia repair from 52.1 to 48 (p = 0.0038), open gastrostomy from 7.7 to 4.9 (p = 0.0094), open colectomy from 48 to 40.7 (p < 0.0001), open cholecystectomy from 15.5 to 10.4 (p = 0.0005), and open antireflux procedures from 4.7 to 1.7 (p < 0.001). An analysis conducted over time reveals that the rates of increase in MIS procedures in 5 of the 6 categories continue to rise, whereas the rates of open appendectomy, open colectomy, and open antireflux procedures continue to decrease. However, the rates of decline of open hernia repairs and open gastrostomies seem to have plateaued. The performance of open procedures in general surgery residency has declined significantly in the past 12 years. The effect of the decline in open cases in surgical training and practice remains to be determined.

McCoy AC ，Gasevic E ，Szlabick RE ，Sahmoun AE ，Sticca RP ... -  《-》

0 + 5 Vascular Surgery Residents' Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs.

Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p < 0.0001). This difference was consistent over the first 3 years of training. The most frequently logged open general surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees.

Smith BK ，Kang PC ，McAninch C ，Leverson G ，Sullivan S ，Mitchell EL ... -  《-》

National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development?

The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P < .0001), with a proportional decrease in open cases. An increase in minimally invasive procedures with a proportional decrease in open procedures was noted in subcategories such as alimentary tract, abdominal, vascular, thoracic, and pediatric surgery (P < .0001). The results of this study demonstrate that general surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions.

Carson JS ，Smith L ，Are M ，Edney J ，Azarow K ，Mercer DW ，Thompson JS ，Are C ... -  《-》