More of less: General Surgery Resident Experience in Biliary Surgery

The scope of operations performed by surgery residents has progressively narrowed. This analysis was undertaken to determine the degree to which that narrowing has occurred in one particular operative domain-biliary surgery.

The total numbers of major cases and biliary cases by resident role were abstracted from annual ACGME national case log reports from 1989 to 1990 through 2017 to 2018, as were the number of total operations performed by residents in each biliary case category. Trends were analyzed.

The total numbers of major cases and biliary cases performed throughout residency have increased considerably. For chief residents, the total number of major cases has declined, but the total number of biliary cases has increased slightly. The increase in the total number of biliary cases performed is due entirely to laparoscopic cholecystectomy. All other types of biliary operations have decreased substantially in number and are now performed rarely. For 2018 graduates, laparoscopic cholecystectomy accounted for 11.2% of all major operations throughout residency and 11.7% of chief resident operations.

Resident operative experience in biliary surgery has increased considerably both in absolute numbers and as a proportion of overall operative experience, but is increasingly limited to laparoscopic cholecystectomy.