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Alignment of training curriculum and surgical practice: implications for competency, manpower, and practice modeling
1Department of Pediatric Surgery, The Children's Hospital of Colorado, University of Colorado Denver, Aurora, Colorado 80045, USA. stig.somme@childrenscolorado.org
Summary
Pediatric surgery (PS) residents handle significantly more cases annually than practicing PS surgeons. This decline in case volume from training to practice necessitates new strategies for continued learning and regionalization to maintain surgical quality.
Area of Science:
- Surgical Education
- Healthcare Workforce Analysis
- Pediatric Surgical Outcomes
Background:
- Pediatric surgery (PS) is a critical specialty for managing complex pediatric diseases.
- Understanding the transition of surgical case volume from residency to practice is essential for maintaining surgical expertise.
Purpose of the Study:
- To compare the quantity and quality of operative cases performed by pediatric surgery residents versus practicing pediatric surgeons.
- To identify changes in case volume during the transition from training to independent practice.
Main Methods:
- Utilized 2006 Accreditation Council for Graduate Medical Education (ACGME) PS resident Current Procedural Terminology (CPT) codes and the Kids' Inpatient Database (KID) ICD-9 procedure codes.
- Categorized 26,077 resident cases and 230,504 practitioner cases into 84 procedure types.
- Calculated annual case volume per surgeon using a denominator of 691 practicing pediatric surgeons, focusing on PS index cases.
Main Results:
- Pediatric surgery residents perform an average of 501 cases annually.
- Significant differences in case volume per surgeon were observed between training and practice for most pediatric surgery index cases.
- The quantity of pediatric surgery index cases significantly declined from training to practice.
Conclusions:
- A substantial decrease in pediatric surgery index case volume occurs from residency training to practice.
- A volume-to-outcome relationship suggests that continued learning paradigms are crucial for sustaining post-training clinical quality.
- Re-evaluation of optimal surgical manpower and enhanced regionalization of care are warranted for the pediatric surgery specialty.
