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Evolving practice patterns in colon and rectal surgery.

David J Schoetz1

  • 1Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA 01805, USA.

Journal of the American College of Surgeons
|August 26, 2006
PubMed
Summary
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The American Board of Colon and Rectal Surgery (ABCRS) prospective database reveals evolving colorectal surgery training. Colonoscopy volume increased, while sigmoidoscopy decreased, reflecting changes in practice patterns.

Area of Science:

  • Colorectal Surgery
  • Surgical Education
  • Medical Informatics

Background:

  • The American Board of Colon and Rectal Surgery (ABCRS) has established minimum case numbers for certification based on a prospective database since 1989.
  • These data reflect the longitudinal evolution of practice patterns within tertiary colorectal training programs.

Purpose of the Study:

  • To analyze trends in colorectal surgical training case volumes and operative approaches.
  • To inform the development of needs-based educational programs and maintenance of certification processes.

Main Methods:

  • Analysis of a prospective database from the American Board of Colon and Rectal Surgery (ABCRS) covering 1994-2005.
  • Inclusion of operative and endoscopic case numbers for 673 residents across 39 training programs.

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Main Results:

  • Colonoscopy volume per resident increased significantly (209 to 264), while rigid and flexible sigmoidoscopy volumes decreased.
  • Laparoscopic approaches for abdominal operations, particularly diverticular resections, saw substantial increases.
  • Low anterior resections for rectal cancer became more common than abdominoperineal resections (3:1 ratio).

Conclusions:

  • Prospective data collection by ABCRS enables the calculation of minimum operative case numbers for training colorectal surgeons.
  • The rolling average of case data reflects evolving practice patterns, aiding in educational program planning.
  • These analyses can contribute to the design of future maintenance of certification processes.