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