A Multicenter Analysis of the Early Impact of COVID-19 on Junior Resident Operative Case Volume

Abstract

Introduction: Institutions have reported decreases in operative volume due to COVID-19. Junior residents have fewer opportunities for operative experience and COVID-19 further jeopardizes their operative exposure. This study quantifies the impact of the COVID-19 pandemic on resident operative exposure using resident case logs focusing on junior residents and categorizes the response of surgical residency programs to the COVID-19 pandemic.

Materials and methods: A retrospective multicenter cohort study was conducted; 276,481 case logs were collected from 407 general surgery residents of 18 participating institutions, spanning 2016-2020. Characteristics of each institution and program changes in response to COVID-19 were collected via surveys.

Results: Senior residents performed 117 more cases than junior residents each year (P < 0.001). Prior to the pandemic, senior resident case volume increased each year (38 per year, 95% confidence interval 2.9-74.9) while junior resident case volume remained stagnant (95% confidence interval 13.7-22.0). Early in the COVID-19 pandemic, junior residents reported on average 11% fewer cases when compared to the three prior academic years (P = 0.001). The largest decreases in cases were those with higher resident autonomy (Surgeon Jr, P = 0.03). The greatest impact of COVID-19 on junior resident case volume was in community-based medical centers (246 prepandemic versus 216 during pandemic, P = 0.009) and institutions which reached Stage 3 Program Pandemic Status (P = 0.01).

Conclusions: Residents reported a significant decrease in operative volume during the 2019 academic year, disproportionately impacting junior residents. The long-term consequences of COVID-19 on junior surgical trainee competence and ability to reach cases requirements are yet unknown but are unlikely to be negligible.

Keywords: COVID-19; Case volume; Multicenter; Resident; Surgical education.

Fig. 1

Total number of cases per resident reported per year between academic years 2016 and 2020 stratified by junior and senior residents. Scatter points represent individual academic years. ∗ P < 0.05.

Fig. 2

Total number of cases per resident reported per year between academic years 2016-2019 compared to 2019-2020, stratified by resident level. Scatter points represent individual residents. ∗ P < 0.05.

Fig. 3

Total number of cases per junior resident reported during PGY 1 and PGY 2 across academic years 2016-2019 compared to 2019-2020. ∗P < 0.05, ∗∗P < 0.01.

Fig. 4

A paired analysis comparing junior resident case volume changes between PGY1 and PGY2 during academic years 2016-2019 and 2019-2020. Scatter points represent individual residents change in case volume between PGY1 and PGY2. ∗∗ P < 0.01.

Fig. 5

Total number of Surgeon Jr cases per resident reported per year prior to the COVID-19 pandemic versus during the COVID-19 pandemic. Scatter points represent individual residents. ∗ P < 0.05.

Fig. 6

Total cases per resident, in programs who reported Stage 3 ACGME program pandemic status, prior to the COVID-19 pandemic versus during the COVID-19 pandemic. Scatter points represent individual residents. ∗P < 0.05.