Transcript Impact of Initiation of a Pediatric Surgery Fellowship on General Surgery Resident Operative Volume ♦ ♦ ♦ Rebecca A.

Impact of Initiation of a
Pediatric Surgery Fellowship
on General Surgery Resident
Operative Volume
♦
♦
♦
Rebecca A. Snyder, MD
Sharon E. Phillips, MSPH
Kyla P. Terhune, MD
Vanderbilt University School of Medicine
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Background
 Operative volume among general surgery
(GS) residents and programs varies
significantly
 Residents in programs that are larger,
university-affiliated, or in the Northeast
report lower case numbers1 and may feel
less confident in their operative skills than
residents at other programs2
1. Bell RH et al. Ann Surg. 2009.
2. Bucholz EM et al. Arch Surg. 2011.
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Background
 80% of graduating GS residents are pursuing
a fellowship1
 Volume traditionally captured by residents is
often diverted towards fellows2
1. Borman KR et al. J Am Coll Surg. 2008.
2. Bell RH et al. Ann Surg. 2009.
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Background
 Prior studies of the effects of coexisting fellowships
on GS residents show mixed results

Minimally invasive (MIS) fellowships1,2
 2009: multiple programs with colorectal, vascular,
MIS, and endocrine fellowships3



No difference in resident CRS volume
Decline in MIS and vascular volume
Specifically: open colectomy and lap chole
1. Kothari SN et al. J Surg Educ. 2008.
2. Linn JG et al. Surgery. 2011.
3. Hanks JB et al. Ann Surg. 2011.
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Purpose
 To determine the impact of initiation of a
new pediatric surgery fellowship on general
surgery resident operative volume at a major
academic institution
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Methods
 Retrospective Review of ACGME operative logs:
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
GS residents: July 1, 2003 to June 30, 2011
Pediatric surgery fellows: July 1, 2007 to June 30, 2011
 Collected data including:
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
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Pediatric index cases
All pediatric cases
Total number of primary surgeon cases to date
 Number pediatric surgeons, RVUs, admissions,
CPTs
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Results
 109 resident rotations

78 residents
 7 fellow rotations (years)

4 fellows
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Year
Surgeons
RVUs
Admissions
CPTs
2003
4
51,300
2,425
3,488
2004
4
55,437
2,431
3,572
2005
5
59,503
2,875
3,823
2006
7
65,081
3,210
4,294
2007
7
66,327
3,556
4,684
2008
7
64,995
3,772
4,850
2009
6
64,175
3,860
4,953
2010
8
64,579
3,602
4,671
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Pediatric index cases
Total cases on peds
Miscellaneous
pediatric cases
Total primary surgeon
cases to date: PGY 3
Pre
Post
p-value
34
(27, 48)
74
(63, 103)
23.5
(17, 29.5)
53
(43, 71)
<0.001
12
(7, 18)
15
(7, 19)
0.559
579
(498, 614)
555.5
(410.5, 623)
0.363
831
(786-936)
0.820
Total primary surgeon
868
cases to date: PGY 4 (791.5, 916)
<0.001
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Total Index Cases
800
715
700
646
646
600
614
614
598
577
530
481
500
400
402
546
481
402
311
300
303
295
266
270
276
185
200
100
0
2003
2004
2005
Resident Index Cases
2006
2007
Fellow Index Cases
2008
2009
2010
Combined Index Cases
Total Operative Cases
2000
1800
1812
1795
1721
1600
1548
1466
1400
1407
1245
1200
1407
1051
1000
1053
1466
1011
914
906
800
906
1051
759
710
634
600
550
400
200
0
2003
2004
2005
Resident Total Cases
2006
2007
Fellow Total Cases
2008
2009
Combined Total Cases
2010
Mean cases per 28 resident days
Pre
Post
p-value
Index
cases
16.9
11.7
<0.001
Total
cases
37.5
29.2
<0.001
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Limitations




Single institution
Intern data not captured
Dependent on ACGME log accuracy
Case volume only one measure of
educational experience


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Inpatient/ward experience
Outpatient clinic
Educational Conferences
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Conclusions
 General Surgery resident operative volume in
pediatric surgery decreased significantly after the
addition of a fellowship.
 Careful preparation is necessary to anticipate and
protect the general surgery resident experience
when new surgical fellowships are implemented.
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Acknowledgements
 Margaret Tarpley, MLS
 John Tarpley, MD, FWACS,
FACS
 Stephanie Rowe, Program
Coordinator, General Surgery
 Jennifer Wilkins, Program
Coordinator Pediatric Surgery
Fellowship
 Dai Chung, MD
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Questions?
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