Surgical Case Volume Needed to Achieve Stable Procedural Proficiency in the General Surgery Chief Resident Year

Abstract

Introduction: We have previously reported using a resident’s learning curve based on operative time (OT) plateau could determine their procedural proficiency. In this study we hypothesize case volume in the chief resident (CR) year would influence whether a CR could achieve reproducible procedural proficiency based on OT. Methods: We extracted laparoscopic cholecystectomy (LCh), laparoscopic colectomy (LCo), laparoscopic inguinal hernia (LIH) and open inguinal hernia (OIH) performed by general surgery residents in the CR year from 7/2016 to 6/2020 through hospital records with OT, patient type, and case complexity assessed by DRG. We used variance component analyses as well as generalizability and decision studies (D-Study) to determine number of cases needed to achieve desired reliability (> 0.80). Results: In total 1514 cases (LCh=776, LCo=339, LIH=158, OIH=241) were included. On average, CR overall completed 38.3 LCh, 16.9 LCo, 7.8 LIH, and 11.8 OIH. After controlling for CR effect, case complexity (r=0.004) and procedure type (r<0.0001) significantly influenced OT. To achieve stable/reproducible OT in each procedure upon graduation, our CRs (N = 6) were estimated to perform on average 25 LCh, 30 LCo, 26 LIH, and 17 OIH per person. Individual CR had minimal impact on the estimation of case needed. Conclusion: The case volume needed to achieve stable procedural proficiency in LCo, LIH and OIH exceeds average CR case number in our program. This might be also true in other programs. Prospective measurement of OT may allow for individualized CR case assignments and enhance CR readiness for independent practice in general surgery.