National Trends in General Surgery Resident Exposure to Complex Oncology-Relevant Cases

Area of Science:

• Surgical Oncology
• Medical Education
• Graduate Medical Training

Background:

• Surgical resident training aims to equip graduates with comprehensive skills for complex procedures.
• Trends in resident case exposure are crucial for evaluating training efficacy and identifying potential gaps.

Purpose of the Study:

• To analyze trends in surgical resident exposure to complex oncologic procedures.
• To determine if current training adequately prepares residents for oncologic surgery.
• To assess the necessity of additional fellowship training based on case volume trends.

Main Methods:

• Observational study utilizing national Accreditation Council for Graduate Medical Education (ACGME) case log data from 2000-2016.
• Analysis of average case numbers for oncology-relevant procedures in United States general surgery residency programs.
• Linear regression, Cusick trend tests, and instrumental variable estimation to assess temporal trends and the impact of duty-hour restrictions.

Main Results:

• A decrease in average exposure to lymphadenectomies (-7.8 cases/decade) and low rectal procedures (-0.9 cases/decade) was observed.
• No significant change in complex soft-tissue resections or foregut cases; however, hepatopancreaticobiliary procedures increased (+3.9 cases/decade).
• Duty-hour restrictions were associated with a modest decline in cancer-relevant cases per decade (-5.0 cases/decade).

Conclusions:

• Case volumes for several complex oncologic procedures remain low for graduating surgical residents.
• The observed trends indicate a potential deficit in resident exposure to critical oncologic operations.
• Further fellowship training may be necessary to ensure competency in specific areas of surgical oncology, depending on individual resident experience.