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Impact of Initiation of a Pediatric Surgery Fellowship

on General Surgery Resident

Operative Volume ♦ ♦ ♦

Rebecca A. Snyder, MDSharon E. Phillips, MSPH

Kyla P. Terhune, MD

Vanderbilt University School of Medicine

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Background

Operative volume among general surgery (GS) residents and programs varies significantly

Residents in programs that are larger, university-affiliated, or in the Northeast report lower case numbers1 and may feel less confident in their operative skills than residents at other programs2

1. Bell RH et al. Ann Surg. 2009.2. Bucholz EM et al. Arch Surg. 2011.

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Background

80% of graduating GS residents are pursuing a fellowship1

Volume traditionally captured by residents is often diverted towards fellows2

1. Borman KR et al. J Am Coll Surg. 2008.2. Bell RH et al. Ann Surg. 2009.

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Background

Prior studies of the effects of coexisting fellowships on GS residents show mixed results

Minimally invasive (MIS) fellowships1,2

2009: multiple programs with colorectal, vascular, MIS, and endocrine fellowships3

No difference in resident CRS volume Decline in MIS and vascular volume Specifically: open colectomy and lap chole

1. Kothari SN et al. J Surg Educ. 2008.2. Linn JG et al. Surgery. 2011.3. Hanks JB et al. Ann Surg. 2011.

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Purpose

To determine the impact of initiation of a new pediatric surgery fellowship on general surgery resident operative volume at a major academic institution

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Methods Retrospective Review of ACGME operative

logs: GS residents: July 1, 2003 to June 30, 2011 Pediatric surgery fellows: July 1, 2007 to June

30, 2011 Collected data including:

Pediatric index cases All pediatric cases Total number of primary surgeon cases to date

Number pediatric surgeons, RVUs, admissions, CPTs

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Results

109 resident rotations 78 residents

7 fellow rotations (years) 4 fellows

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Year Surgeons RVUs Admissions CPTs

2003 4 51,300 2,425 3,488

2004 4 55,437 2,431 3,572

2005 5 59,503 2,875 3,823

2006 7 65,081 3,210 4,294

2007 7 66,327 3,556 4,684

2008 7 64,995 3,772 4,850

2009 6 64,175 3,860 4,953

2010 8 64,579 3,602 4,671

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Pre Post p-value

Pediatric index cases 34 (27, 48)

23.5 (17, 29.5)

<0.001

Total cases on peds 74 (63, 103)

53 (43, 71)

<0.001

Miscellaneous pediatric cases

12 (7, 18)

15 (7, 19)

0.559

Total primary surgeon cases to date: PGY 3

579 (498, 614)

555.5 (410.5, 623)

0.363

Total primary surgeon cases to date: PGY 4

868 (791.5, 916)

831 (786-936)

0.820

2003 2004 2005 2006 2007 2008 2009 20100

100

200

300

400

500

600

700

800

402

481

646614

530

266303

270

185

311295

276

402

481

646614

715

577

598

546

Total Index Cases

Resident Index Cases Fellow Index Cases Combined Index Cases

2003 2004 2005 2006 2007 2008 2009 20100

200

400

600

800

1000

1200

1400

1600

1800

2000

9061051

14661407

1245

634

759710

550

914

10531011

906

1051

14661407

1795

1548

1812

1721

Total Operative Cases

Resident Total Cases Fellow Total Cases Combined Total Cases

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  Pre Post p-value

Index cases

16.9 11.7 <0.001

Total cases

37.5 29.2 <0.001

Mean cases per 28 resident days

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Limitations Single institution Intern data not captured Dependent on ACGME log accuracy Case volume only one measure of

educational experience Inpatient/ward experience Outpatient clinic Educational Conferences

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Conclusions

General Surgery resident operative volume in pediatric surgery decreased significantly after the addition of a fellowship.

Careful preparation is necessary to anticipate and protect the general surgery resident experience when new surgical fellowships are implemented.

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Acknowledgements

Margaret Tarpley, MLS John Tarpley, MD, FWACS,

FACS Stephanie Rowe, Program

Coordinator, General Surgery

Jennifer Wilkins, Program Coordinator Pediatric Surgery Fellowship

Dai Chung, MD

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Questions?