D. J. Lucas1,2, E. Y. Huang1,2, A. Gosain1,2 1University Of Tennessee Health Science Center,Division Of Pediatric Surgery, Department Of Surgery,Memphis, TN, USA 2Children’s Foundation Research Institute, Le Bonheur Children’s Hospital,Division Of Pediatric Surgery,Memphis, TN, USA
Introduction: The number of pediatric surgery fellowship programs has markedly increased since the early 2000’s, with approximately 45 fellows graduating per year currently. There is concern that this change has diluted the training experience, especially for complex or rare index cases. The Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) established minimum case numbers in defined categories in 2015, but this has been a program rather than an individual requirement. The American Board of Surgery (ABS) is considering enacting an individual requirement for minimum case volumes as a condition for board eligibility. The objective of this study was to determine the historical likelihood of pediatric surgery fellows failing to meet minimum RRC case requirements.
Methods: The ACGME National Data Report summary case logs were obtained for graduating fellows in pediatric surgery from 2008-17. Median case volumes were compared to minimum ACGME RRC case numbers. Using Poisson distributions, probabilities of individual fellows failing to meet minimum case numbers were calculated.
Results: The probability that a fellow in a median program would fail to meet minimum case numbers in at least one category ranged from 11.7-36.2% over the 10 years, with no temporal trend (0.46% per year, 95% CI: -1.87% to 2.79%, p=0.661). Using the 10-year average of case medians, the probability was 18.4%. Individual case categories with the highest probability of being below median were pull-through for Hirschsprung disease (8.9%), biliary atresia/choledochal cyst (3.4%), head and neck (1.9%), and tracheoesophageal fistula/esophageal atresia (1.8%) (Table).
Conclusion: The probability that a graduating fellow in a program that possesses national median case volumes would fail to meet minimum numbers in at least one category is 18.4%. This probability is increased for the programs that are below the median. If the ABS defines individual case minimum requirements using similar case mix and volume metrics as the RRC, it is possible that a significant number of graduating pediatric surgery fellows will be adversely impacted by this new individual requirement.
