J. M. Healy1, M. W. Maxfield1, D. J. Solomon1, W. E. Longo1, P. S. Yoo1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA
Introduction: Among surgical educators, the multitude of duty hour restrictions have led to widespread concern regarding the adequacy of operative experience during residency. This concern is exacerbated when the demands of service and education are imbalanced, as is commonly seen during junior resident rotations. To address this issue, the American Board of Surgery (ABS) recently instituted guidelines stating that residents must perform “a minimum of 250 operations by the end of the PGY-2 year for applicants who began residency in July 2014 or thereafter”. At our institution, a series of programmatic and institutional changes were implemented to augment the junior resident operative experience and to exceed compliance with this mandate.
Methods: Operative data from ACGME case logs for categorical and non-designated preliminary interns at Yale-New Haven Hospital were identified for 5 consecutive academic years, 2011 until 2016. American Board of Surgery In-Training Exam (ABSITE) scores were collected in an anonymous fashion. In response to the ABS requirement for 250 cases, our program systematically instituted a number of changes to augment the junior resident operative experience for the 2015-2016 academic year: minimization of night float, identification of new surgical opportunities within the institution, efficient utilization of midlevel care providers, identification of rotations with sub-optimal operative experiences, maximizing rotations with involvement of junior residents in the OR, and systematic review of case logs and progress.
Results: After the 250-case rule was announced and the above changes were implemented, average total cases for residents completing PGY-2 increased from 176 to 330 (ANOVA, p<0.001). Specifically, there was an 18% increase for interns (p=0.059) and a 118% increase for PGY-2 residents (p<0.001). There were statistically significant increases in the number of skin and soft tissue cases, vascular cases, endoscopy, and complex laparoscopic cases. There was no difference in case volumes for senior residents during this time. There was a statistically significant decrease in the weeks of night float in 2015-2016 (5.7 vs 3.4; p=0.04). There was no significant difference in mean ABSITE percentile score for the groups studied before and after the intervention.
Conclusion: Prior to the implementation of these interventions, our program would have had 0% compliance with the 250 junior resident case rule. Within 12 months of implementation, total case volumes for residents completing PGY-2 were increased by 88%—far exceeding minimum standards. 100% programmatic compliance was achieved. Our program’s experience exemplifies how a mandate from the ABS can lead to programmatic changes that improve the experience of the surgical house officer.