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Tuma F, Malgor RD, Kapila N, Kamel MK. Trends of core versus subspecialty operative procedures completed in general surgery residency training programs. Postgrad Med J 2021; 98:772-777. [PMID: 37062995 DOI: 10.1136/postgradmedj-2021-140503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION General surgery residency involves performing subspecialty procedures in addition to the core general procedures. However, the proportion of core general surgery versus subspecialty procedures during training is variable and its temporal changes are unknown. The goal of our study was to assess the current trends in core general surgery and subspecialty procedure distributions during general surgery residency training. METHODS Data were collected from the ACGME core general surgery national resident available report case logs from 2007 to 2019. Descriptive and time series analyses were used to compare proportions of average procedures performed per resident in the core general surgery category versus the subspecialty category. F-tests were conducted to show whether the slopes of the trend lines were significantly non-zero. RESULTS The mean of total procedures completed for major credit by the average general surgery resident increased from 910.1 (SD=30.31) in 2007 to 1070.5 (SD=37.59) in 2019. Over that same period, the number of general, cardiothoracic, plastic and urology surgery procedures increased by 24.9%, 9.8%, 76.6% and 19.3%, respectively. Conversely, vascular and paediatric surgery procedures decreased by 7.6% and 30.7%, respectively. The neurological surgery procedures remain stable at 1.1 procedures per resident per year. A significant positive correlation in the trend reflecting total (p<0.0001), general (p<0.0001) and plastic (p<0.0016) surgery procedures and the negative correlation in the trend lines for vascular (p<0.0006) and paediatric (p<0.0001) surgery procedures were also noted. CONCLUSIONS Trends in overall surgical case volume performed by general surgery residents over the last 12 years have shown a steady increase in operative training opportunity despite the increasing number of subspecialty training programmes and fellowships. Further research to identify areas for improvement and to study the diversity of operative procedures, and their outcomes is warranted in the years to come.
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Affiliation(s)
- Faiz Tuma
- Central Michigan University College of Medicine, Saginaw, Michigan, USA
| | - Rafael D Malgor
- University of Colorado Denver Anschutz Medical Center Bookstore, Aurora, Colorado, USA
| | - Nikit Kapila
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
| | - Mohamed K Kamel
- General Surgery, Central Michigan University College of Medicine East Campus, Saginaw, Michigan, USA
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Vaysburg DM, Wells D, Lynch C, Kassam AF, Cortez AR, Potts JR, Starnes SL, Quillin RC, Van Haren RM. Impact of Integrated Thoracic Residency on General Surgery Residents' Thoracic Operative Volume. Ann Thorac Surg 2021; 113:302-307. [PMID: 33600789 DOI: 10.1016/j.athoracsur.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Integrated thoracic surgery (I-6) programs have become popular over traditional general surgery (GS) pathways since their inception in 2007. However the effect of I-6 programs on GS resident training remains unknown. The purpose of this study was to evaluate the effect of I-6 programs on the thoracic operative experience of co-located GS residents. METHODS Thoracic surgery cases recorded by residents in GS programs co-located with I-6 programs until 2019 were analyzed. Cases were reviewed 5 years before (TSR-5) through 5 years after (TSR-5) the matriculation of the first thoracic resident in the co-located I-6 program. To contextualize the overall trends in the field Accreditation Council for Graduate Medical Education GS resident case logs from 1990 to 2018 were analyzed and total thoracic surgery cases recorded. Statistical analysis was performed with linear regression. RESULTS Residents in 19 GS programs with co-located I-6 programs showed an increase in total thoracic cases from 3710 to 4451 (Δ/year of +85.05 cases a year; P = .03) balanced by an increase in GS residents from 107 to 126 (Δ/year of +1.45; P = .01) with no significant overall change in the median thoracic operative case volume (31.00 at both thoracic residency before and after 5 years). Nationally from 1990 to 2018 there was no change in the total thoracic operative experience for GS graduates. CONCLUSIONS The introduction of I-6 programs did not negatively impact thoracic operative experience for residents in co-located GS programs. Adequate training of both I-6 and GS residents at the same institution is feasible.
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Affiliation(s)
- Dennis M Vaysburg
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Dennis Wells
- Division of Thoracic Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Caroline Lynch
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - John R Potts
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Sandra L Starnes
- Division of Thoracic Surgery, University of Cincinnati, Cincinnati, Ohio
| | - R Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Robert M Van Haren
- Cincinnati Research on Education in Surgical Training (CREST), Department of Surgery, University of Cincinnati, Cincinnati, Ohio.
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Kassam AF, Lynch CA, Cortez AR, Vaysburg D, Potts JR, Quillin RC. Where Has All the Complexity Gone? An Analysis of the Modern Surgical Resident Operative Experience. JOURNAL OF SURGICAL EDUCATION 2021; 78:9-16. [PMID: 32616451 DOI: 10.1016/j.jsurg.2020.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/13/2020] [Accepted: 06/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The operative experience of today's general surgery (GS) residents are changing. The Surgical Council on Resident Education (SCORE) was founded to provide a standardized, competency-based curriculum. We set out to evaluate resident operative experience in core and advanced operations. DESIGN Accreditation Council for Graduate Medical Education (ACGME) national operative log reports from 2010 to 2018 were reviewed. Operative volume data for 344 operations were extracted and analyzed. Operations were designated as core, advanced, or undefined as listed by SCORE, and stratified as GS or subspecialty. SETTING National analysis utilizing ACGME operative log reports. PARTICIPANTS All graduating general surgery residents between 2010 and 2018. RESULTS A total of 10,118 residents completed GS training with an average of 1121.5 ± 29.3 total cases. Core operations comprised 80.5% of total volume while advanced comprised only 8.0%. The total core experience increased (+7.0 cases/year), while total advanced experience decreased (-1.4 cases/year) (p < 0.01 each). Compositional analysis among core operations revealed an increase in 9/13 GS domains and a decrease in 8/10 subspecialty domains (all p < 0.05). CONCLUSIONS There has been an increase in core operative experience with a concurrent decrease in advanced operative experience of graduating GS residents. These findings highlight the continued narrowing of the operative experience for trainees, with increasing focus on GS and less on subspecialty domains. Ongoing efforts to look beyond operative volume to ensure competency of graduates will prove beneficial.
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Affiliation(s)
- Al-Faraaz Kassam
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio.
| | - Caroline A Lynch
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexander R Cortez
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - Dennis Vaysburg
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio
| | - John R Potts
- Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - R Cutler Quillin
- Cincinnati Research on Education in Surgical Training (CREST), Cincinnati, Ohio; University of Cincinnati, Department of Surgery, Cincinnati, Ohio
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Kilcoyne MF, Do-Nguyen CC, Han JJ, Coyan GN, Sultan I, Roberts MB, Carpenter AJ. Clinical Exposure to Cardiothoracic Surgery for Medical Students and General Surgery Residents. JOURNAL OF SURGICAL EDUCATION 2020; 77:1646-1653. [PMID: 32522562 DOI: 10.1016/j.jsurg.2020.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The introduction of integrated 6-year cardiothoracic surgery (CTS) residency programs has shifted recruitment efforts to encompass not only general surgery (GS) residents, but also medical students. OBJECTIVE The aim of this paper is to assess medical student and GS resident clinical exposure to CTS. DESIGN Data from the Association of American Medical Colleges Visiting Student Application Service and the Accreditation Council for Graduate Medical Education Case Log Reports were collected from 2010 to 2017 and 2010 to 2018, respectively. The data extracted included medical students who applied and received an offer for elective rotations and the cases performed as a GS resident. RESULTS A mean of 95 ± 28.5 medical students applied for CTS rotations annually and the applicants for CTS rotations increased by an average of 11.8% per year. However, significantly less students received an offer compared to other specialties (53.4% CTS vs 74.1% GS, 79.3% plastic surgery, 86.3% urology, 85.7% otolaryngology, 88.6% neurological surgery, and 89.6% orthopedic surgery) (p < 0.001). GS residents performed a mean of 39.3 ± 0.8 CTS procedures during residency: 32.9 ± 1.0 performed as a junior resident and 6.3 ± 0.7 as a chief resident. Out of all CTS procedures, 7.3% were cardiac procedures, with rates increasing from 5.6% to 8.4% during the study period (p = 0.001). CONCLUSIONS Elective rotation opportunities in CTS are high in demand for medical students while GS residents receive limited CTS exposure, especially cardiac cases. Increasing clinical opportunities in both groups will aid in recruiting young talent to the field.
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Affiliation(s)
- Maxwell F Kilcoyne
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
| | - Chi Chi Do-Nguyen
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Jason J Han
- Department of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Garrett N Coyan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael B Roberts
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Andrea J Carpenter
- Department of Cardiothoracic Surgery, University of Texas Health San Antonio, San Antonio, Texas
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Keilin CA, Sandhu G, Matusko N, Reddy RM. Ten Years Into the Integrated Residency Era: A Pilot Study Shows Many Cardiothoracic Surgery Faculty Still Favor the Traditional Pathway. Semin Thorac Cardiovasc Surg 2019; 32:756-762. [PMID: 31302237 DOI: 10.1053/j.semtcvs.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 06/24/2019] [Indexed: 11/11/2022]
Abstract
The first integrated cardiothoracic surgery residents (I-6) graduated in 2013. Predominantly, there is still the option to pursue a traditional training pathway via general surgery residency followed by 2-3 years of specialized cardiothoracic surgery training. Our aim was to understand the perspectives of academic cardiothoracic faculty on the various training models. An anonymous web-based survey was distributed to all academic cardiothoracic surgeons in the United States. Respondents were asked about their perceptions of the 2 training models (I-6 and traditional). Descriptive statistics and Fisher exact test were used to analyze the data. A total of 15.4% (111/719) of faculty completed responses. When comparing training models, 23.4% of faculty believe the I-6 is a superior structure, 31.5% believe they are about the same, and 45.0% believe the traditional model is better. Also, 51.4% of the faculty said they would still apply into a traditional fellowship, with 27.9% picking an I-6 program and 20.7% picking a 4 + 3 model. A total of 40.5% believe the I-6 is good for the specialty and 55.0% think the I-6 attracts higher achieving applicants, but 26.1% and 19.8% believe it is improving training or increasing the scholarly activity of residents, respectively. When asked about resident experience, 56.4% of I-6 faculty feel there is a bias against their residents on the general surgery service, which some believe leads to poor educational outcomes for I-6 residents. The integrated residency represents a major shift in cardiothoracic surgery training. Faculty opinions vary regarding the quality and effectiveness of this model with many preferring the traditional model.
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Affiliation(s)
| | - Gurjit Sandhu
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Niki Matusko
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
| | - Rishindra M Reddy
- Division of Thoracic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan
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Cobb AN, Kuo MC, Kuo PC. New docs on the block: A profile of applicants and subsequent PGY1 trainees of categorical general surgery programs (2013–2016). Am J Surg 2019; 218:218-224. [DOI: 10.1016/j.amjsurg.2018.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/04/2018] [Accepted: 11/24/2018] [Indexed: 11/15/2022]
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Anderson GA, Albutt K, Holmer H, Muguti G, Mbuwayesango B, Muchuweti D, Gidiri MF, Mugapathyay S, Iverson K, Roa L, Sharma S, Jeppson B, Jönsson K, Lantz A, Saluja S, Lin Y, Citron I, Meara JG, Hagander L. Development of a Novel Global Surgery Course for Medical Schools. JOURNAL OF SURGICAL EDUCATION 2019; 76:469-479. [PMID: 30185383 DOI: 10.1016/j.jsurg.2018.07.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/16/2018] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We endeavored to create a comprehensive course in global surgery involving multinational exchange. DESIGN The course involved 2 weeks of didactics, 2 weeks of clinical rotations in a low-resource setting and 1 week for a capstone project. We evaluated our success through knowledge tests, surveys of the students, and surveys of our Zimbabwean hosts. SETTING The didactic portions were held in Sweden, and the clinical portion was primarily in Harare with hospitals affiliated with the University of Zimbabwe. PARTICIPANTS Final year medical students from Lund University in Sweden, Harvard Medical School in the USA and the University of Zimbabwe all participated in didactics in Sweden. The Swedish and American students then traveled to Zimbabwe for clinical work. The Zimbabwean students remained in Sweden for a clinical experience. RESULTS The course has been taught for 3 consecutive years and is an established part of the curriculum at Lund University, with regular participation from Harvard Medical School and the University of Zimbabwe. Participants report significant improvements in their physical exam skills and their appreciation of the needs of underserved populations, as well as confidence with global surgical concepts. Our Zimbabwean hosts thought the visitors integrated well into the clinical teams, added value to their own students' experience and believe that the exchange should continue despite the burden associated with hosting visiting students. CONCLUSIONS Here we detail the development of a course in global surgery for medical students that integrates didactic as well as clinical experiences in a low-resource setting. The course includes a true multilateral exchange with students from Sweden, the United States and Zimbabwe participating regularly. We hope that this course might serve as a model for other medical schools looking to establish courses in this burgeoning field.
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Affiliation(s)
- Geoffrey A Anderson
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
| | - Katherine Albutt
- Massachusetts General Hospital, Department of Surgery, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Hampus Holmer
- WHO Collaborating Centre for Surgery and Public Health, Lund University, Skane University Hospital, Department of Clinical Sciences, Lund, Sweden; Karolinska University Hospital, Solna, Sweden
| | - Godfrey Muguti
- University of Zimbabwe, Department of Surgery, Harare, Zimbabwe
| | | | - David Muchuweti
- University of Zimbabwe, Department of Surgery, Harare, Zimbabwe
| | - Muchabayiwa F Gidiri
- University of Zimbabwe, Department of Obstetrics and Gynecology, Harare, Zimbabwe
| | | | | | - Lina Roa
- Harvard Medical School, Boston, Massachusetts; University of Alberta, Department of Obstetrics and Gynecology, Edmonton, Alberta, Canada
| | | | - Bengt Jeppson
- WHO Collaborating Centre for Surgery and Public Health, Lund University, Skane University Hospital, Department of Clinical Sciences, Lund, Sweden
| | - Kent Jönsson
- Bokamoso Hospital Gaborone, Gaborone, Botswana; WHO Collaborating Centre for Surgery and Public Health, Lund University, Helsingborg Hospital, Department of Orthopedics, Lund, Sweden
| | - Adam Lantz
- WHO Collaborating Centre for Surgery and Public Health, Lund University, Helsingborg Hospital, Department of Orthopedics, Lund, Sweden
| | - Saurabh Saluja
- Harvard Medical School, Boston, Massachusetts; Weill Cornell Medicine, Department of Surgery, New York, New York
| | - Yihan Lin
- Harvard Medical School, Boston, Massachusetts
| | | | | | - Lars Hagander
- WHO Collaborating Centre for Surgery and Public Health, Lund University, Skane University Hospital, Department of Clinical Sciences, Lund, Sweden
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Hunt MF, Zhou X, Lui C, Yang SC. Educational research and training innovation in cardiothoracic surgery: A year in review. J Thorac Cardiovasc Surg 2019; 157:1722-1727. [PMID: 30685178 DOI: 10.1016/j.jtcvs.2018.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/05/2018] [Accepted: 12/06/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Megan F Hunt
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.
| | - Xun Zhou
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Cecillia Lui
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
| | - Stephen C Yang
- Division of Thoracic Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md
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Hicks CW, Kernodle A, Abularrage CJ, Heller JA. A national resident survey about the current state of venous education in vascular surgery training programs. J Vasc Surg Venous Lymphat Disord 2017; 5:897-904.e2. [DOI: 10.1016/j.jvsv.2017.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/04/2017] [Indexed: 11/15/2022]
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