Impact of a Pediatric Ambulatory Surgical Center on Surgery Resident Education

Abstract

Objective: Most operative education for surgery trainees occurs in primary academic hospitals. The impact of ambulatory surgery centers (ASCs) on resident operative experience with adult procedures is variable but has not been reported regarding pediatric cases. We hypothesized that the introduction of a pediatric ASC in our health system led to decreased opportunities for surgery residents to participate in ACGME-required cases.

Design: We performed a retrospective analysis of operative data from the electronic health record (EHR) and resident-reported case logs for procedures performed at an academic children's hospital (CH) and its pediatric ASC from 2018 to 2023. Pediatric surgery first performed operations at the ASC in May 2020. Operative cases analyzed were those performed at both the ASC and the CH. The presence of trainees in overlapping case types was analyzed, and descriptive statistics were performed.

Setting: Vanderbilt University Medical Center, General Surgery training program and Vanderbilt Children's Hospital, both quaternary care centers.

Participants: General surgery residents rotating on the Pediatric Surgery service between 2018 and 2023.

Results: Overlapping cases included inguinal, umbilical, and epigastric herniorrhaphies, as well as subcutaneous lesion excisions. Of 17,012 cases performed by pediatric surgeons during the study period, 5,413 (31.8%) were overlapping cases, and 599 (3.5%) were performed at the ASC. Retrospective review of the EHR demonstrated resident presence in 82.9% of CH cases before the ASC and 81.8% afterwards. Resident presence in ASC cases was minimal (n = 9). Categorical General Surgery and Pediatric Surgery residents had no decrease in case volume after ASC initiation based on EHR data or case logs.

Conclusions: The introduction of a pediatric ASC did not reduce resident operative experience but represents a missed educational opportunity in the ambulatory setting.

Keywords: ACGME; ambulatory; case log; electronic health record; pediatric surgery; resident education.