A. R. Marcadis1, T. Spencer1, D. Sleeman1, O. C. Velazquez1, J. I. Lew1 1University Of Miami,DeWitt Daughtry Family Department Of Surgery,Miami, FL, USA
Introduction:
In the current era of surgical sub-specialization and duty hour restrictions, many General Surgery (GS) residents desire additional training in their area of future specialty. This study examines the relationship between distribution of cases performed by GS residents during their 5 years of clinical residency training and their area of chosen future fellowship.
Methods:
A retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs from 101 graduated GS residents at a single academic institution (2002-2018) was performed. Area of fellowship specialization as well as total number of major / minor cases performed overall and in specific ACGME-defined categories were recorded for each resident. Average number of cases performed in each defined category were compared between groups of residents with differing areas of future fellowship specialization, using multiple t-test comparison. Only fellowship areas pursued by 3 or more residents during the study period were included in the analysis, and residents in accelerated specialty track programs (plastic, cardiothoracic, vascular) were excluded.
Results:
On average, surgical residents performed 1416 major and minor cases during their GS residency. Residents pursuing fellowships in cardiothoracic or thoracic surgery (n=8), endocrine surgery (n=5), surgical oncology (n=3), transplant surgery (n=3), trauma /critical care (n=21), and vascular surgery (n=8) performed significantly more thoracic (61 vs. 41; p<.001), endocrine (63 vs. 32; p<.001), biliary (135 vs. 108; p<.05), transplant (23 vs. 13; p<.05), trauma (83 vs. 71; p<.05), and vascular surgery (225 vs. 162; p<.001) cases respectively when compared to the program average. Residents pursuing fellowships in breast or colorectal surgery performed higher than the average (though non-statistically significant) number of cases in breast (94 vs. 78; p>.05) and anorectal /large intestinal (38 vs. 35/132 vs. 125; p>.05) surgery respectively when compared to peers. Residents who chose a career in GS (no fellowship) performed significantly more endoscopy cases (131 vs. 105; p<.05) compared to peers. Residents who chose fellowships in minimally invasive surgery (n=11), pediatric surgery (n=10), and plastic surgery (n=15) did not perform significantly more cases in any particular discipline compared to peers.
Conclusion:
GS residents pursuing fellowships in many surgical sub-specialty disciplines are performing more cases than their peers in their respective areas of future specialization. This may be the result of GS residents seeking additional focused training and preparation for fellowship, while still meeting ACGME defined category minimums and work-hour restrictions.
