Education of pediatric surgery residents over time: Examining 15 years of case logs

Abstract

Background/purpose: Surgical indications and techniques have changed over the last 15 years. The number of Pediatric Surgery training programs has also increased. We sought to examine the effect of these changes on resident education by examining case log data.

Methods: Accreditation Council for Graduate Medical Education (ACGME) case logs for graduating Pediatric Surgery residents were examined from 2004 to 2018. Using the summary statistics provided, linear regression analysis was conducted on each case log code and category.

Results: In 2004, there were 24 Pediatric Surgery training programs and 24 Pediatric Surgery residents graduating with an average of 979.8 total cases logged. In 2018, there were 36 programs with 38 residents graduating with an average of 1260.2 total cases logged. Total case volume of graduating residents significantly increased over the last 15 years (p < 0.001). Significant increases were demonstrated in skin/soft tissue/musculoskeletal (p < 0.01), abdominal (p < 0.001), hernia repair (p < 0.001), genitourinary (p < 0.01), and endoscopy (p < 0.001). No significant changes were seen in the head and neck, thoracic, cardiovascular, liver/biliary, and non-operative trauma categories. No categories significantly decreased over the time period. No significant changes were seen in the number of multiple index congenital cases, including tracheoesophageal fistula/esophageal atresia repair, omphalocele, gastroschisis, choledochal cyst excision, perineal procedure for imperforate anus, and major hepatic resections for tumors. Pertinent increases in specific procedures include diaphragmatic hernia repair (p < 0.01), ECMO cannulation/decannulation(p < 0.05), thyroidectomy (p < 0.001), parathyroidectomy (p < 0.001), biliary atresia (p < 0.001), and circumcision (p < 0.001) as well as most laparoscopic abdominal procedures. Specific procedure codes with significant decreases include tracheostomy (p < 0.05), minimally invasive decortication/pleurectomy/blebectomy (p < 0.001), laparoscopic splenectomy (p < 0.001), as well as most open abdominal procedures.

Conclusion: Despite increasing numbers of Pediatric Surgery residents and training programs, the number of cases performed by each graduating resident has increased. This increase is primarily fueled by increase in abdominal, skin/soft tissue/musculoskeletal, hernia repair, genitourinary, and endoscopic cases.

Level of evidence: Level II.

Keywords: Accreditation Council for Graduate Medical Education; Pediatric surgery residency; Surgical education.

Figure 1:

Summary Statistics. Total surgical and endoscopic cases for all graduating Pediatric Surgery residents from 2004-2018. Surgical cases are plotted along the left axis and endoscopic cases are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 2:

Select Skin/Soft Tissue/Musculoskeletal Procedures. Total skin/soft tissue/musculoskeletal, breast, pilonidal cyst excision, and other skin/soft tissue musculoskeletal cases for all graduating Pediatric Surgery residents from 2004-2018. Total category skin/soft tissue/musculoskeletal is plotted along the left axis and the procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 3

Select Head and Neck Procedures. Total head and neck, thyroidectomy, parathyroidectomy, other head and neck, branchial cleft cyst/sinus, and cystic hygroma/lymphangioma cases for all graduating Pediatric Surgery residents from 2004-2018. Total category head and neck is plotted along the left axis and the procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 4:

Select Thoracic Procedures. (A) Total thoracic, excision mediastinal cyst, pulmonary resection: scope, esophageal resection/replacement, other thoracic and (B) Total thoracic, tracheostomy, pulmonary resection: open, excision mediastinal tumor, open decortication/pleurectomy/blebectomy, laparoscopic decortication/pleurectomy/blebectomy cases for all graduating Pediatric Surgery residents from 2004-2018. Total category thoracic is plotted along the left axis and the procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 5:

Select Diaphragm Procedures. Total diaphragm, repair diaphragmatic hernia, other diaphragm, transthoracic/retroperitoneal exposure for scoliosis cases for all graduating Pediatric Surgery residents from 2004-2018. Total category diaphragm is plotted along the left axis and the procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 6:

Select Cardiovascular Procedures. Total cardiovascular, cannulate ECMO, patent ductus arteriosus, renal artery reconstruction, construction or take down AVF/shunt, and dialysis access insertion/removal cases for all graduating Pediatric Surgery residents from 2004-2018. Total category cardiovascular is plotted along the left axis and the procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 7:

Select Abdominal Procedures. (A) Total abdominal, appendectomy: scope, exploratory laparotomy: open, open gastrostomy/jejunostomy, laparoscopic gastrostomy/jejunostomy and (B) Total abdominal, repair intestinal atresia, stenosis, web, open appendectomy, excision neuroblastoma/adrenal, excision of omenal/mesenteric cyst, and operation for malrotation cases for all graduating Pediatric Surgery residents from 2004-2018. Total category abdominal is plotted along the left axis and the procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 8:

Select Hernia Repair Procedures. Total hernia repair, inguinal hernia repair greater than 6 months of age, umbilical hernia repair, ventral hernia repair, and hernia repair: scope cases for all graduating Pediatric Surgery residents from 2004-2018. Total category hernia repair is plotted along the left axis and procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 9:

Select Liver/Biliary Procedures. (A) Total liver/biliary, laparoscopic cholecystectomy, biliary atresia, portoenterostomy, laparoscopic splenectomy and (B) Total liver/biliary, pancreatic resection for trauma, pancreatic resection for tumor, lysis of adhesions, and portosystemic shunt cases for all graduating Pediatric Surgery residents from 2004-2018. Total category liver/biliary is plotted along the left axis and procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.

Figure 10:

Select Genitourinary Procedures. (A) Total genitourinary, circumcision (operating room only), oophorectomy, nephrectomy: tumor and (B) Total genitourinary, operation for testicular torsion, renal transplant, ureteral reconstruction/reimplantation, open vaginal procedures, and operation for intersex cases for all graduating Pediatric Surgery residents from 2004-2018. Total category genitourinary is plotted along the left axis and procedures are plotted along the right axis. Significance denoted as follows: *: significantly increased; ^: significantly decreased.