Trends in Routine and Complex Hepatobiliary Surgery Among General and Pediatric Surgical Residents: What is the Next Generation Learning and is it Enough?
*Christine J. Park, *Sarah J. Armenia, Robert A. Cowles
Yale University, New Haven, CT
Objective: To evaluate the volume and trends for routine and complex hepatobiliary surgery reported by general and pediatric surgery trainees.
Design: Retrospective analysis of the frequency of routine and complex hepatobiliary operations performed by general and pediatric surgery trainees using the Accreditation Council for Graduate Medical Education case logs for years 2000-2017 (Surgery) and 2004-2017 (Pediatric Surgery).
Setting: General and pediatric surgical trainees at ACGME-accredited institutions.
Participants: Surgical trainees.
Main Outcome Measures: We analyzed the mean, standard deviation, median, mode, maximum and minimum number of routine and complex hepatobiliary cases performed by surgical trainees.
Results: The number of trainees increased over the study period for both groups. Mean case volumes for laparoscopic cholecystectomy increased by 36% in Surgery graduates and by 115% in Pediatric Surgery graduates. In Surgery, the mean volumes for choledochoenteric anastomosis procedures decreased by 50% from 3.0 to 1.4 procedures/year between 2000 and 2017 while volumes for hepatic lobectomy increased by 65% from 3.4 to 5.7 procedures/year. In Pediatric Surgery, case volumes for complex procedures (hepatic lobectomy, biliary atresia, and choledochal cyst) were low (mean < 4/year), highly variable among trainees, and overall appear unchanged between 2004 and 2017. In every year reported, at least one Pediatric Surgery trainee reported doing zero cases in one of these categories.
Conclusions: Case volumes for routine hepatobiliary surgery appear to be rising, especially for Pediatric Surgery training programs. Case logs suggest that the volume of complex hepatobiliary surgery remains quite low and highly variable in both disciplines with some trainees obtaining minimal or no exposure to certain cases. The relationship between these trends and the development of competency is worthy of further study.