Are Esophagectomy Board Requirements Achievable? A Multi-Institutional Analysis

Area of Science:

• Surgical Education
• Thoracic Surgery
• Medical Simulation

Background:

• Duty-hour restrictions impact trainee operative experience.
• Meeting minimum case-volume requirements for esophagectomy is crucial for cardiothoracic surgery trainees.

Purpose of the Study:

• To evaluate the effect of program volume, trainee numbers, and scheduling on achieving adequate esophagectomy case numbers for trainees.
• To determine the necessary institutional esophagectomy volume to ensure trainees meet case requirements.

Main Methods:

• A validated simulation model (ProModel) using probabilistic distributions of operative cases.
• Input data from five 2-year cardiothoracic surgery training programs (2016-2018).
• Generation of 10,000 simulated "trainee 2-year periods" per program.

Main Results:

• Only 60% of programs could adequately expose all trainees to esophagectomy cases based on scheduling and institutional volume alone.
• Programs with adequate volumes had 3.0-3.6 times the minimum required cases.
• Simulation demonstrated programs need >2 times minimum esophagectomies to ensure >90% of trainees meet requirements.

Conclusions:

• Providing adequate esophagectomy volume for trainees is challenging due to institutional volume and scheduling constraints.
• Programs require significantly higher esophagectomy volumes than the minimum to ensure trainee competency.
• Strategies like case selection, reduced fellow numbers, or external subspecialty training may be necessary.