Training Inadequacies Among Accreditation Council for Graduate Medical Education (ACGME) Surgical Specialties

Abstract

<h3>Study Objective</h3> To compare general trends in residency training operative experience between Obstetrics & Gynecology (OBGYN), Urology, and General Surgery as determined by ACGME, the governing body that sets the standards for US graduate medical education training programs. <h3>Design</h3> All available ACGME residency case log data was collected. OBGYN data was available from 2002-2019, Urology from 2015-2019, and General Surgery from 1999-2019. Operative experience was assessed, with particular attention to retroperitoneal dissection/ureterolysis and small bowel repair. The mean case numbers reported per resident were compared between the 2 groups using unpaired 2-tailed t tests, with P values < .05 considered significant. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> We reviewed data from approximately 865 ACGME-accredited institutions. Case log data was self-reported by residents as cases were performed each year of their training program. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> The mean number of total gynecologic cases logged by OBGYN residents was 315.48 (SD 46.09). The mean number of cases logged by urology residents was as follows: intestinal diversion 5.25 (SD 1.02); ureteral exposure 207.23 (SD 3.44); gynecologic cases 35.9 (SD 1.22). The mean number of cases logged by general surgery residents was as follows: small bowel repair 14.13 (2.78); ureteral exposure 11.08 (2.54); gynecologic cases 4.19 (1.33). <h3>Conclusion</h3> Notably, both urology and general surgery training programs require cross-specialty exposure and familiarity with retroperitoneal dissection, ureterolysis, bladder and bowel repairs, whereas OBGYN training does not. We propose multiple potential solutions for addressing these inadequacies in surgical training among OBGYN residents, including amending the base ACGME requirements for graduation to include some exposure to retroperitoneal dissection and bowel surgery in order to increase comfort level with operating in these spaces frequently encountered by gynecologic surgeons.