Trends in Surgical Critical Care Training Among General Surgery Residents: Pursuing an Ideal Curriculum

Abstract

Background The Accreditation Council for Graduate Medical Education (ACGME) provides no specific guidelines for surgical critical care (SCC) training during general surgery residency. Growing emphasis is placed on this experience with increasing case requirements and dedicated SCC content on board certification exams. Methods A digital survey was distributed to ACGME-accredited general surgery residencies via email. Respondents reported number and setting of critical care months during residency and rated comfort level within 5 critical care principles and overall satisfaction with their SCC experience. Study cohorts were formed to compare experiences and competencies between respondents based on setting, months, postgraduate year (PGY) level, and formal surgical intensive care unit (SICU) experience. Differences between cohorts were compared using the Mantel-Haenszel test ( P < .05). Results Seventy-three residents responded with 45% training at academic centers versus 46% in community hospitals. Approximately 50% completed a formal SICU rotation, while 9% reported no dedicated critical care rotation during residency. Overall, 78% felt satisfied with their SCC experience. Residents training at academic centers were more satisfied overall and felt more comfortable with ventilator management. Those who completed 5 or more months of critical care training reported greater confidence with intravenous sedation and ventilator management, while residents having a formal SICU rotation felt more confident with vasopressor and ventilator management. Discussion Variability remains within SCC training among general surgery residents with perceived benefits seen in training at academic centers and completing a formal SICU rotation. Although limited, these findings offer a foundation for developing an effective SCC curriculum.

Pediatric trauma surgery in Iraq and Afghanistan: Mortality, indicators, and most common operating room interventions from 2007 to 2016

“…Most military surgical teams are manned by general and orthopedic surgeons and certified registered nurse anesthetist/general anesthesiologists, all of whom may not be pediatric subspecialty-trained in their respective specialty fellowships. In addition, the Accreditation Council for Graduate Medical Education allows for variability between General and Orthopedic Surgery residency programs 19,20 regarding trauma, critical care, and pediatric rotations, resulting in an unknown degree of pediatric-specific training among these programs 21–23 . While pediatricians and pediatric surgeons are among those who serve in the deployed settings, up to 32% are deployed as a general medical officer or as a general surgeon rather than in their usual specialty 14 .…”

“…In addition, the Accreditation Council for Graduate Medical Education allows for variability between General and Orthopedic Surgery residency programs 19,20 regarding trauma, critical care, and pediatric rotations, resulting in an unknown degree of pediatric-specific training among these programs. [21][22][23] While pediatricians and pediatric surgeons are among those who serve in the deployed settings, up to 32% are deployed as a general medical officer or as a general surgeon rather than in their usual specialty. 14 While it may be impractical or cost-ineffective to provide in-person pediatric trauma center exposure to all deployed…”