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Trends in Pediatric Surgery Operative Volume among Residents and Fellows
*Stephanie D Talutis1, David McAneny1, *Catherine Chen2, Gerard Doherty1, *Teviah Sachs1
1Department of Surgery, Boston University School of Medicine, Boston, MA;2Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
Objective: To determine trends in pediatric operative experience among graduating General Surgery Residents (GSR) and Pediatric Surgery Fellows (PSF).
Design: We queried the ACGME General Surgery (1999-2014) and Pediatric Surgery (2003-2014) Case Logs for all pediatric operations performed during training. Means (±SD) and medians [10th:90th percentiles] were compared. R2 was calculated for all trends.
Main Outcome Measure(s) Case volume, trends
Results: The number of PSF increased 63%(23 to 39:R2=0.82), while GSR number increased 12%(989 to 1105:R2=0.77). Total and average pediatric surgery case volume for GSR decreased from 39,309 to 32,156(R2=0.90) and 39.7±13 to 29.1±10(R2=0.91), respectively. Meanwhile, average PSF case volume increased from 980±208 to 1137±202(R2=0.83)[Figure]. These trends persisted for: inguinal/umbilical hernia (GSR:22.1±13 to 15.6±10;R2=0.93 | PSF:90.5±17.6 to 104.4±20.7;R2=0.34), pyloric stenosis (GSR:3.9±3 to 2.8±3;R2=0.60 | PSF:29.6±15 to 39.7±16.8;R2=0.69), and intestinal atresia (GSR:1.3±2 to 1.1±2;R2=0.34 | PSF:4.3±4 to 11.8±8;R2=0.21). The mean number of GSR pediatric operations diminished for both junior (39.7±19 to 27.3±16;R2=0.92) and chief (2.6±5 to 1.7±5;R2=0.75) years.
Teaching cases in pediatric surgery decreased at all levels. While the percentage of GSR cases performed during chief years fell modestly (6.6% to 4.7%;R2=0.53), median teaching cases dropped [2(0:11) to 0(0:0)]. Mean PSF teaching cases declined (100.7±396 to 44.5±42;R2=0.72), while the percentage of PSF operations that were teaching cases decreased more sharply (10.3% to 3.5%;R2=0.82).
Conclusions: Overall pediatric surgery and PSF volume has increased, while GSR volume has decreased. Opportunities may exist to increase GSR participation while providing further teaching opportunities for PSF, improving the quality of both GSR and PSF training.
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