Quantitative Analysis of Surgical Residency Reform: Using Case-Logs to Evaluate Resident Experience

Area of Science:

• Medical Education
• Surgical Training
• Curriculum Development

Background:

• Surgical training programs face challenges in balancing education and service demands.
• A mid-sized program implemented curricular changes to optimize rotations, reduce team sizes, and enhance apprenticeship.
• This study evaluates the impact of these changes on operative experience.

Purpose of the Study:

• To quantify changes in surgical operative case volume before and after curriculum reform.
• To assess the impact of curriculum changes on inter-resident variability in case logs.
• To explore factors contributing to variability in surgical training case logs.

Main Methods:

• Retrospective analysis of surgical case-log data.
• Inclusion of data from Accreditation Council for Graduate Medical Education (ACGME) and National Surgical Quality Improvement Program (NSQIP).
• Comparison of case volumes and inter-resident variability pre- and post-curriculum intervention.

Main Results:

• Overall average operative case volume per resident slightly decreased post-intervention (291 to 263 cases).
• Significant increase in case volume for postgraduate year 3 (PGY3) residents and a decrease for PGY4 residents.
• High inter-resident variability in case volume persisted, with coefficients of variation ranging from 6.0% to 66.8%.

Conclusions:

• Curriculum changes did not eliminate inter-resident variability in surgical case load.
• Variability may stem from personal preferences and case selection choices, not solely logging behavior.
• The observed shift in case load from PGY4 to PGY3 requires further investigation and validation.