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Quantitative Analysis of Surgical Residency Reform; are case logs a valid tool for assessment?
*Sarah B Cairo1,2, *Wendy Craig3, *Caitlin Gutheil3, *Paul K. J. Han3,4, *Kristiina Hyrkas3, *Hannah Kay3, *Lynda Macken3, James F Whiting2,5
1Women and Children's Hospital of Buffalo, Buffalo, NY;2Maine Medical Center, Department of Surgery, Portland, ME;3Center for Outcomes Research and Evaluation and Maine Medical Center Research Institute, Portland, ME;4Palliative Medicine, Hospice of Southern Maine, Scarborough, ME;5Tufts University School of Medicine at Maine Medical Center, Portland, ME

Objective: Curricular changes to surgical residency, developed to rebalance clinical rotations, optimize education over service, decrease the size of service teams, and integrate apprenticeship-type experiences, were implemented in June 2015. This study quantifies the operative experience before and after implementation as part of a mixed-methods program evaluation. Design: Retrospective review of the Accreditation Council for Graduate Medical Education (ACGME) case-log data entered by categorical general surgery residents and data from the American College of Surgeons National Surgical Quality Improvement Program: Quality In-Training Initiative (NSQIP-QITI) pre- and post-intervention at a mid-sized surgical training program. Results: Case logs were reviewed for all categorical residents pre-intervention (2014-15) and post-intervention (2015-16). A total of 11,365 cases, excluding “first-assistant” and “endoscopic” cases were logged for an average of 291 and 263 cases/resident pre- and post-intervention, respectively. The average increased significantly for PGY 3 residents and decreased significantly for PGY 4 residents (table 1). Significant variability was observed between residents at the same PGY level and appeared greatest for PGY 1 and senior (PGY 4, PGY 5) trainees. At the senior level, variability is attributed to resident preference/career choice. When compared to data from QITI, the variability at the PGY 1 level dissipated and was attributed to errors in resident case log behavior. Conclusion: Large variability within PGY level suggests that resident preference may be as influential as curriculum design in dictating operative experience. Statistically significant differences in total average cases/resident for PGY 3/4 trainees were observed and are of uncertain clinical significance.

Table 1. ACGME Log case distribution before and after curriculum change, by post-graduate year (PGY)
2014 – 2015 (pre-curriculum change)2015 – 2016 (post-curriculum change)
TotalAverage cases per residentMedian cases per residentMinMaxTotalAverage cases per residentMedian cases per residentMinMaxt-testa
Total cases excluding first assist, endoscopy
PGY 13759495.5551293969985.535190p = 0.891
PGY 2978244221218318746186181.5146237p = 0.135
PGY 31,047262256.52502841,413353363301382p = 0.005
PGY 41,4693673553404241,131283278253341p = 0.037
PGY 52,2414484743035511,569392367.5361480p = 0.387
Colectomy
PGY 11000192.3107p = 0.276
PGY 2143.53171642012p = 0.877
PGY 3266.55.5411379.38516p = 0.386
PGY 411528.829203713132.8352041p = 0.542
PGY 519739.440295518245.542.53067p = 0.543
All Hernia Repairs (pediatric and adult)
PGY 15112.8122255012.57135p = 0.979
PGY 29724.32420298120.319340p = 0.627
PGY 31203029.5184313533.837.51644p = 0.671
PGY 49423.520.5183513433.5312943p = 0.103
PGY 527955.8451410718546.3463261p = 0.625
aStudent’s t-test to compare mean pre- and post-curriculum change. Due to small sample size, high risk type I error


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