Changing patterns of resident operative experience from 1990 to 1997

Abstract

Hypothesis: Resident operative experience has increased or decreased with respect to 12 specific operations.

Design: A retrospective analysis of resident operative experience reported to the Accreditation Committee for Graduate Medical Education for academic years 1990-1997.

Subjects: Residents completing an Accreditation Committee for Graduate Medical Education surgical program.

Main outcome measures: The total number of residents, average number of operations performed per resident, and the most common operations performed.

Results: The number of house staff completing surgical residency training programs has remained constant, while operative volume has increased from 1991 to 1997. Comparison of the frequencies of 12 selected operative procedures performed in academic years 1990-1991 and 1996-1997 found increases in the following procedures: carotid endarterectomy (137%), pancreaticoduodenectomy (66.7%), laparoscopic cholecystectomy (64.8%), parathyroidectomy (51.2%), thyroidectomy (19.2%), colectomy (14.1% to 44.4% depending on subtype), and elective infrarenal aortic aneurysm repair (10.7%). Conversely, frequencies decreased for open cholecystectomy (63.4%), open parietal cell vagotomy (40%), modified radical mastectomy (15.2%), gastroesophageal antireflux procedure (10.4%), and subtotal gastric resection (8.93%). Resident experience was essentially unchanged for emergent infrarenal aortic aneurysm repair and laparoscopic proximal gastric vagotomy.

Conclusions: The number and variety of operative interventions in surgical therapeutics is changing. Continued analysis of the operative experience during surgical training will indicate the need for changing requirements for surgical resident experience. The causes of these shifts are not specifically addressed by this study. Perhaps technological advances in the diagnosis and management of surgical patients or the increase in subspecialty training programs have affected the experience of general surgery trainees.