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JAMA Surg. 2013 Sep;148(9):841-7. doi: 10.1001/jamasurg.2013.2919.

The general surgery chief resident operative experience: 23 years of national ACGME case logs.

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1
Department of Surgery, University of Washington Medical Center, Seattle.

Abstract

IMPORTANCE:

The chief resident (CR) year is a pivotal experience in surgical training. Changes in case volume and diversity may impact the educational quality of this important year.

OBJECTIVE:

To evaluate changes in operative experience for general surgery CRs.

DESIGN, SETTING, AND PARTICIPANTS:

Review of Accreditation Council for Graduate Medical Education case logs from 1989-1990 through 2011-2012 divided into 5 periods. Graduates in period 3 were the last to train with unrestricted work hours; those in period 4 were part of a transition period and trained under both systems; and those in period 5 trained fully under the 80-hour work week. Diversity of cases was assessed based on Accreditation Council for Graduate Medical Education defined categories.

MAIN OUTCOMES AND MEASURES:

Total cases and defined categories were evaluated for changes over time.

RESULTS:

The average total CR case numbers have fallen (271 in period 1 vs 242 in period 5, P < .001). Total CR cases dropped to their lowest following implementation of the 80-hour work week (236 cases), but rebounded in period 5. The percentage of residents' 5-year operative experience performed as CRs has decreased (30% in period 1 vs 25.6% in period 5, P < .001). Regarding case mix: thoracic, trauma, and vascular cases declined steadily, while alimentary and intra-abdominal operations increased. Recent graduates averaged 80 alimentary and 78 intra-abdominal procedures during their CR years. Compared with period 1, in which these 2 categories represented 47.1% of CR experience, in period 5, they represented 65.2% (P < .001). Endocrine experience has been relatively unchanged.

CONCLUSIONS AND RELEVANCE:

Total CR cases declined especially acutely following implementation of the 80-hour work week but have since rebounded. Chief resident cases contribute less to overall experience, although this proportion stabilized before the 80-hour work week. Case mix has narrowed, with significant increases in alimentary and intra-abdominal cases. Broad-based general surgery training may be jeopardized by reduced case diversity. Chief resident cases are crucial in surgical training and educators should consider these findings as surgical training evolves.

PMID:
23864049
PMCID:
PMC4237586
DOI:
10.1001/jamasurg.2013.2919
[Indexed for MEDLINE]
Free PMC Article
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