Case distributions in general surgery residency: Subspecialization occurs before fellowship

Area of Science:

• Surgical Education
• Residency Training
• Subspecialty Surgery

Background:

• General Surgery residents increasingly seek focused training in subspecialty areas.
• Duty-hour restrictions and subspecialization necessitate evaluating resident case experience.
• Understanding case distribution is crucial for preparing residents for fellowship.

Purpose of the Study:

• To examine the relationship between case volumes performed by General Surgery residents and their chosen subspecialty.
• To identify if residents gain additional experience in their intended fellowship areas during residency.

Main Methods:

• Retrospective review of Accreditation Council for Graduate Medical Education (ACGME) case logs from 101 General Surgery residents (2002-2018).
• Comparison of total operative cases and ACGME-defined category cases between residents with different subspecialty interests.
• Analysis of case distribution based on postgraduate year.

Main Results:

• Residents pursuing Endocrine, Cardiothoracic, Vascular, and Trauma/Critical Care Surgery logged significantly more cases in their respective fields compared to the program average.
• General Surgery residents (no fellowship) performed more endoscopic procedures.
• Residents pursuing Breast, Oncology, Colorectal, and Pediatric Surgery fellowships showed numerically higher case volumes in their areas, though not always statistically significant.
• The majority of these additional cases were performed in postgraduate years 3-5.

Conclusions:

• General Surgery residents at this institution often exceed average case volumes in their intended subspecialty areas.
• This trend may reflect a strategy at large academic centers for residents to gain focused fellowship preparation while meeting ACGME requirements.
• Such focused experience can enhance readiness for fellowship training and future practice.