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Single-Port Robotic-assisted Transaxillary Breast-conserving Surgery: A Prospective, Single-arm, Non-randomized Phase IIa Clinical Trial
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Fifteen-Year Decrease in General Surgery Resident Breast Operative Experience: Are We Training Proficient Breast

Kelsey E Larson1, Stephen R Grobmyer1, Mika A B Reschke1

  • 1Department of General Surgery, Cleveland Clinic, Cleveland, Ohio.

Journal of Surgical Education
|August 19, 2017
PubMed
Summary
This summary is machine-generated.

General surgery resident breast case volume decreased 17% from 2000-2015, despite rising overall operative experience. This decline in breast surgery cases raises concerns about surgeon proficiency in essential procedures.

Keywords:
ACGMEMedical KnowledgePatient CarePractice-Based Learning and ImprovementSystems-Based Practicebreast surgeryoperative Volumeresident education

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Area of Science:

  • Surgical Education
  • Oncology
  • Medical Training Trends

Background:

  • General surgery residency programs are crucial for training future surgeons.
  • Accurate tracking of resident case experience is vital for ensuring surgical competency.
  • Trends in operative case volumes can indicate shifts in surgical practice and training needs.

Purpose of the Study:

  • To analyze the trends in the number of breast-related surgical cases performed by general surgery residents over a 15-year period.
  • To identify specific breast procedures that have shown significant changes in resident case logs.
  • To assess the impact of these trends on the overall operative experience of graduating general surgery residents.

Main Methods:

  • Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) Case Logs Statistics Reports from 2000 to 2015.
  • Analysis of average breast-specific case numbers, including excisional biopsy/lumpectomy, simple mastectomy, modified radical mastectomy, and sentinel lymph node excision.
  • Comparison of breast case volume trends against overall residency case volume trends.

Main Results:

  • Overall residency case volume increased by 2% from 2000 to 2015.
  • Breast-specific case volume decreased significantly by 17.1% during the same period.
  • Notable decreases were observed in modified radical mastectomy (-61.5%) and excisional biopsy/lumpectomy (-25.8%), while simple mastectomy increased (+80%). Sentinel lymph node excision showed a recent downward trend (-67.3% from 2010-2015).

Conclusions:

  • General surgery residents are experiencing a substantial decline in breast case operative volume, contrasting with an increase in overall surgical training volume.
  • The reduction in experience with advanced procedures like axillary management raises concerns about the proficiency of graduating surgeons.
  • Establishing national minimums for resident breast operative experience is recommended to ensure adequate training for future practice.