A colorectal curriculum for general surgery residents: are we ready for needs assessment?

The traditional scope of general surgery (GS) has been broadly encompassing. Although it is generally accepted that we need a more defined curriculum for GS training, the criteria for limiting its scope remain controversial. One approach is to perform a needs assessment, defined based on an analysis of current GS practice. The purpose of this study was to use such a needs assessment to model a subset of the GS curriculum in colon and rectal surgery.

The numbers of colon and anorectal procedures performed in the prior 24 months by 982 GS taking the 2004 ABS Recertification Examination in Surgery were examined to determine the mean number of procedures per surgeon along with the percentage of surgeons who had performed at least 1 of the identified procedures. The impact of using these numbers to define a general surgical curriculum was then examined.

Procedures performed frequently and by >60% GS included appendectomies, colostomies, colectomies, hemorrhoidectomies, and anorectal abscess procedures. Procedures performed infrequently, yet performed by >30% of surgeons at least once, included subtotal colectomies, abdominoperineal resections, transanal excisions, sphincterotomies, and anorectal fistulotomies. The procedures performed rarely included ileoanal pouch anastomoses and procedures for incontinence and rectal prolapse.

Based on this analysis, a colorectal surgical curriculum would include the treatment of diseases that led to commonly performed operations such as colon cancer, diverticular disease, lower gastrointestinal bleeding, mesenteric ischemia, inflammatory bowel disease (IBD), hemorrhoids, and anorectal diseases. The management of low rectal cancer, complex IBD, rectal prolapse, and fecal incontinence might not be essential content. A curriculum based on needs assessment would deemphasize or even eliminate some areas traditionally considered within the realm of GS. Although this might appropriately serve as a basis for defining the scope of GS, the indirect consequences will need to be defined.