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Estimating minimum program volume needed to train surgeons: when 4 × 15 really equals 90.

Jennifer Chung¹, Andrea Obi², Ryan Chen³

¹University of Michigan Medical School, Ann Arbor, Michigan.

Journal of Surgical Education

|December 3, 2014

Summary

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This summary is machine-generated.

Surgical resident certification for rare cases like cardiothoracic transplants is challenging due to work-hour restrictions. Simulation shows current systems achieve only 55% certification, requiring more transplants for adequate training.

Area of Science:

Surgical Education
Medical Simulation
Transplant Surgery

Background:

Work-hour restrictions impact resident training flexibility and exposure to rare surgical cases.
Certification requirements, especially for infrequent procedures like cardiothoracic transplants, may be difficult to meet under current regulations.
A computer-based simulation model was developed to assess factors influencing resident certification in rare operative cases.

Purpose of the Study:

To develop and utilize a computer-based simulation model to evaluate the probability of surgical residents attaining certification in rare, unscheduled cases.
To analyze the impact of program size, case volume, and scheduling constraints on resident certification rates.
To use cardiothoracic transplants as a specific case study for evaluating resident certification probabilities.

Keywords:

Medical Knowledge Practice-Based Learning and Improvement Scheduling Systems-Based Practice graduate medical education surgery transplant

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Main Methods:

A simulator was constructed to predict certification probabilities for surgical residents.
The model incorporated variables such as operating times, call schedules, procurement travel times, and transplant frequency distributions.
Simulations were run using current program parameters and Accreditation Council for Graduate Medical Education-compliant call schedules.

Main Results:

Despite sufficient case volume for lung transplants, the simulation demonstrated a certification rate of only 55% due to scheduling constraints and work-hour restrictions.
Achieving minimum transplant certification requirements for all residents would necessitate at least 1.5 times the current annual transplant volume.
The model highlighted the significant impact of logistical factors (arrival time, call schedules) on training opportunities.

Conclusions:

The developed simulation model provides a tool to analyze a program's capacity for resident certification based on its size and case volume.
Findings suggest that alternative scheduling paradigms could enhance resident certification rates without compromising training standards or program size.
The study underscores the need for innovative solutions to ensure adequate training exposure for rare surgical procedures.