Analysis of Neurosurgery Resident Operative Experience: Training Tomorrow's Neurosurgeon

Abstract

Abstract INTRODUCTION The Accreditation Council for Graduate Medical Education (ACGME) maintains self-reported logs of cases completed by US residents. This study analyzes trends in the operative experience of neurosurgical residents within the context of national case trends in neurosurgery over the past decade. METHODS ACGME case logs from 2013 to 2018 were reviewed. Operative domains were categorized as adult cranial, adult spinal, pediatrics, and epilepsy. Mean operative volume was recorded, as well as cases performed as senior or lead surgeon. As a measure of US national operative trends, the PearlDiver database was queried for operative volume between 2007 and 2016. Statistical analysis was performed using linear regression, and statistical significance was set at P < .05. RESULTS During the study period, the total case volume for neurological surgery residents increased by 61 cases every residency year (P < .001). Cases logged as lead surgeon increased by 173 cases every year, while cases logged as senior surgeon decreased by 112 cases every year (P < .05). The operative volume for adult spine and cranial increased (P < .05), while that for extracranial vascular and pediatric decreased (P < .05). Brain tumor, transsphenoidal, radiosurgery, shunting, and epilepsy volume remained stable over the study period (P > .05). These resident operative trends paralleled trends nationwide where there were increases in adult cranial, adult spine, and epilepsy (P < .001) but decreases in pediatric cases (P < .05). CONCLUSION Over the past decade, neurosurgical residents have been completing an increasing number of cases every year in the majority of operative domains. While an increased experience is beneficial, what is more important is that the resident operative experience appears to closely mirror trends for commonly performed operations in the United States. This is reassuring for surgical educators that tomorrow's neurosurgeons will have the competency to meet our nation's neurosurgical needs.