Declining Otolaryngology Resident Training Experience in Tracheostomies: Case Log Trends from 2005 to 2015

Abstract

Objective To evaluate recent tracheostomy surgical experience among otolaryngology residents and general surgery residents. Study Design Retrospective database review. Setting Accreditation Council for Graduate Medical Education otolaryngology and general surgery programs. Subjects and Methods Accreditation Council for Graduate Medical Education case log data from 2005 to 2015 for resident graduates in otolaryngology and general surgery were used to obtain mean graduate tracheostomy numbers, mean graduate composite case numbers, and number of graduating residents. Market share for each specialty was estimated through the derived metric of nationwide total tracheostomy graduate experience, calculated by multiplying the number of graduating residents by the mean number of graduate tracheostomies. Linear regression analysis was used to calculate trends. Multiple linear regression analysis was used for pairwise comparison of trends. Results From 2005 to 2015, mean graduate tracheostomy numbers for otolaryngology residents declined 2.3% per year, while those for general surgery residents increased 1.8% per year. Accounting for changes in number of resident graduates, market share of tracheostomy decreased 1.0% per year for otolaryngology and increased 3.0% per year for general surgery. Mean graduate composite case numbers increased significantly by 1.8% and 1.0% per year for otolaryngology and general surgery residents, respectively. Conclusion Tracheostomy case volume in otolaryngology residency has decreased steadily in comparison with general surgery residency. However, current otolaryngology graduates have more experience in tracheostomy when compared with general surgery graduates. While otolaryngology residents have excellent exposure to tracheostomy, otolaryngology programs should be made aware of this declining trend as well as changing procedural trends, which may affect training needs.

Synthetic Simulator for Surgical Training in Tracheostomy and Open Airway Surgery

“…The challenges of resident work‐hour restrictions, low case volumes, and pressure for increased operating room efficiency limit learning opportunities for surgical trainees in the operating room 2–4 . Although we previously demonstrated that the live porcine model has high face and content validity as a training tool for tracheostomy and LTR, use of animals for training can be limited due to anatomical differences from humans, cost, availability, ethics, a need for specialized facilities and personnel, and a limited ability to archive specimens or preserve progress 5,7,8 .…”

“…The graft is commonly harvested from costal cartilage in older children and adolescents, and thyroid cartilage in neonates. Challenges of resident work‐hour restrictions, low case volumes, and pressure for increased operating room efficiency limit opportunities for surgical trainees to learn these procedures in the operating room 2‐4 …”

Consultation diagnoses and procedures billed among recent graduates practicing general otolaryngology – head & neck surgery in Ontario, Canada

“…Similarly, tracheotomy, a procedure which did not make it onto any of the top 10 lists in any of the subspecialties in our study, is declining among otolaryngology training programs and increasing in general surgery training programs, however, current OHNS trainees continue to perform more of these procedures by the end of training than their GS counterparts. [ 8 ]…”

Live porcine model for surgical training in tracheostomy and open‐airway surgery

“…Tracheostomy and open‐airway surgery are complex, low‐frequency procedures that require advanced training. Challenges of resident work‐hour restrictions and low case volumes limit learning opportunities for surgical trainees in the operating room . Surgical simulation is a growing area of research, as it can provide valuable opportunities for residents and fellows to learn and refine technical skills without risk to patient safety.…”