Accreditation Council for Graduate Medical Education Case Log: General Surgery Resident Thoracic Surgery Experience

Abstract

Background General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time. Methods The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989–1990 to 2011–2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05. Results A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V. Conclusions General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons.

Clinical guidelines on perioperative management strategies for enhanced recovery after lung surgery

“…Careful preoperative planning optimizes the surgical procedure and thus helps to shorten the operative time and reduce surgical trauma (24,70). Minimally invasive techniques are recommended; in particular using incisions that limit muscle trauma and reduce postoperative pain are preferred (71).…”

Experience With the Cardiac Surgery Simulation Curriculum: Results of the Resident and Faculty Survey

“…Changes to general surgery training have resulted in a diminished open surgery experience as a result of a proliferation of endovascular and minimally invasive approaches to disease management. Further, exposure to cardiothoracic surgery has decreased nationwide during general surgery training, and junior resident operative experience has suffered because of a proliferation of fellowship training programs [3,4]. Recognizing these challenges, technical and cognitive skills training for cardiothoracic surgery may benefit from an increased use of simulation-based learning for both the new trainee as well as the experienced trainee needing refinement of advanced skills.…”

Changes in Thoracic Surgery Experience During General Surgery Residency: A Review of the Case Logs From the Accreditation Council for Graduate Medical Education

“…Data indicate that thoracic surgeons achieve superior outcomes compared with general and cardiac surgeons in the field of thoracic oncology [2][3][4][5], and other work has shown that residents' interest in cardiothoracic surgery as a field is strongly linked to mentorship and exposure during general surgery residency [4], making this period critical to engaging the future workforce. Although the total number of thoracic cases logged during general surgery residency has not significantly changed over the last 20 years [6], data about specific procedures, and how procedures are logged by general surgery residents, may describe subtle but important trends over time. We sought to examine the data for differences in types of procedures coded by general surgery residents over time.…”