Changes in Thoracic Surgery Experience During General Surgery Residency: A Review of the Case Logs From the Accreditation Council for Graduate Medical Education

Abstract

Although exposure to thoracic surgery is mandated in general surgery residency, little is known about the mix of cases that residents use to meet this requirement and how this has changed over time. We report the experience of general thoracic surgery among general surgery residents using the Accreditation Council for Graduate Medical Education (ACGME) database. We performed a retrospective review of the prospectively maintained ACGME resident case log database from 2003 to 2013. Thoracic cases were categorized by procedure type, year, and level of resident participation. A linear regression model was used to determine if there was a significant trend in case volumes over time. First assist volumes decreased in the 90th (-1.46 cases/year, p= 0.0012), 70th (-0.77 cases/year, p= 0.0005), 50th (-0.46 cases/year, p= 0.0013), and 30th percentiles (-0.16 cases/year, p= 0.0187). Pneumonectomy volumes decreased for surgeons junior (-0.01 cases/year, p= 0.0013) and chief residents (-0.01 cases/year, p= 0.005), as did open lobectomy (surgeon junior, -0.202 cases/year, p < 0.0001; chief, -0.08 cases/year, p ≤ 0.0013). Video-assisted (VATS) lobectomy increased for the surgeons junior (0.22 cases/year, p < 0.0001) and chief residents (0.045 cases/year, p < 0.0001). Surgeons junior also had increased volumes of VATS exploratory thoracoscopy (0.11 cases/year, p= 0.0003) and VATS pleurodeisis (0.13 cases/year, p < 0.0001). Whereas total thoracic volumes on the whole have not changed significantly, resident participation as a first assistant and in key thoracic cases has decreased over the last 11 years, while participation in VATS and minor cases has increased.