Effect of New Fellowship Programs on Resident Case Volume in Pediatric Surgery

The effect of subspecialty programs on associated general surgery programs is largely undocumented. This study examined the effect of new pediatric surgery fellowship (PSF) programs on the pediatric surgical experience of residents in the associated general surgery programs.

Pediatric surgery fellowship programs established after 2002-2003 (earliest available ACGME caselogs) were identified. The number of pediatric surgery cases reported by each completing resident as surgeon in the associated general surgery programs from academic year (AY)2002-2003 to AY2016-2017 were recorded and examined before and after entry of the first fellow into associated pediatric surgery programs.

Fifteen general surgery residency programs associated with new PSF programs were reviewed. First fellows entered the new PSF programs from 2002-2003 to 2013-2014. General surgery caselog availability before and after fellow matriculation varied accordingly. Data were available from 12 programs through the 5 years before matriculation of the first fellow into the associated PSF program. Over that time, the number of pediatric surgery cases performed by residents in those general surgery programs increased from 54.56 ± 2.98 to 68.71 ± 4.12 (p = 0.003). In 12 general surgery programs with resident caselogs available for the first 5 years after matriculation of the first fellow into the associated PSF programs, the mean number of resident pediatric surgery cases declined from 56.75(± 3.42) to 47.15(± 2.73) (p = 0.015).

Establishment of a new PSF program results in a significant decline in the pediatric surgery experience as surgeon for residents in the associated general surgery program. This outcome should be carefully weighed in the decision to establish a new PSF program.