The Resident Experience on Trauma: Declining Surgical Opportunities and Career Incentives? Analysis of Data from a Large Multi-institutional Study

Abstract

Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.

Has the trauma surgeon become house staff for the surgical subspecialist?

“…In a multi-institutional Eastern Association for the Surgery of Trauma (EAST) study, Fakhry and Watts estimated that the average surgical resident would have to care for more than 500 blunt trauma victims before having the chance to participate in one operative liver or spleen repair. [8] The decrease in penetrating trauma observed in most centers since 1993 has also reduced the need for trauma surgeon intervention to a historic low [9,10] and the emergence of surgical sub-specialists has diverted thoracic and vascular procedures away from the trauma surgeon at many centers. Concurrently, the demand for trauma surgeon presence in the ED has increased.…”

Effect of an acute care surgical service on the timeliness of care

“…In the United States, the number of operations performed by trauma surgeons has declined, and thus the interest of surgical trainees in trauma has also declined. [1][2][3][4] The American acute care surgery model, integrating trauma and emergency surgery, has been implemented to provide an increased operative workload for trauma surgeons and more efficient care for the increasing emergent surgical patient population.…”

Nonoperative Management of Solid Organ Injury Diminishes Surgical Resident Operative Experience: Is It Time for Simulation Training?

“…Tools and techniques, including ultrasound, computed tomography (CT), angiography, and percutaneous catheter-based interventions serve to decrease health care expenditures, hospital length of stay, and operative morbidity, as well as time to return to work and possibly infectious risk to the operating team [7][8][9][10][11]. However, NOM of traumatic spleen and liver injuries negatively affects surgeon reimbursement, resident operative trauma experience, and student and resident interest in the field of trauma surgery [4,[12][13][14][15][16][17].…”

“…The ongoing success of NOM for SAOI also impacts accredited general surgery residency programs in the United States [16]. With an increasing number of spleen and liver injuries treated nonoperatively, residency graduates garner less operative trauma experience with SAOI and may be faced with more complicated and technically challenging cases when operation is required [4,[14][15][16].…”