Wide variability of shoulder and elbow case volume in orthopedic surgery residency

Despite the growing popularity of certain shoulder and elbow procedures (eg, shoulder arthroplasty), resident exposure to these surgeries remains unclear. This study sought to evaluate trends in graduating orthopedic resident case volumes of commonly performed shoulder and elbow procedures.

The Accreditation Council for Graduate Medical Education (ACGME) surgical case log data from 2016 to 2020 for graduating US orthopedic surgery residents was assessed. Procedures of the shoulder and humerus/elbow were categorized into predefined ACGME categories: repair/revision/reconstruction, fracture/dislocation, and arthroscopy. The average number of cases performed per resident in each of these categories was directly compared from 2016 to 2020. The 10th and 90th percentiles of case volumes within each category of procedures was compared from 2016 and 2020.

There was a 31% increase in the number of shoulder repair/revision/reconstruction cases between 2016 and 2020 (average: 27.5 to 36.1; P < .001), followed by a 23% increase for elbow fracture/dislocation (24.4 to 30; P < .001), 21% increase for elbow repair/revision/reconstruction (10.6 to 12.8; P < .001), and 16% increase for shoulder arthroscopy (69 to 79.7; P < .001). No significant changes were found for shoulder fracture/dislocation and elbow arthroscopy. There was a wide case volume variability for each procedure, particularly for shoulder repair/revision/reconstruction, where there was a nearly 5-fold difference in the number of cases performed between the 10th and 90th percentiles of residents in 2020 (13 vs. 62 cases, respectively).

The case category shoulder repair/revision/reconstruction has seen the largest relative increase in the shoulder and elbow case volume of graduating orthopedic surgery residents, most likely reflecting the national rising trends of shoulder arthroplasty. However, our study shows that there is wide variability in resident exposure to these cases. Implementation of shoulder arthroplasty case minimum requirements might help reduce case variability and discrepancies in resident education.