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Defining Benchmarks for Case Minimums During Accreditation Council for Graduate Medical Education-Accredited Total
Jason Silvestre1, Antonia F Chen2, Jay R Lieberman3
1Department of Orthopaedic Surgery and Rehabilitation, Medical University of South Carolina, Charleston, South Carolina.
Background:
Professional societies and accrediting bodies for arthroplasty training increasingly recognize the need for minimum case numbers to enhance surgical training in the United States. This study elucidated benchmarks for case minimum requirements during Accreditation Council for Graduate Medical Education (ACGME)-accredited arthroplasty fellowship training.
Methods:
This was a retrospective cohort study of ACGME-accredited arthroplasty fellows who graduated between 2018 and 2023. Case volume percentiles were calculated across ACGME-defined case categories, and temporal changes were assessed with linear regression. Variability was defined as the fold difference between the 10th and 90th percentiles by case volume. Benchmarks for the case minimum requirements were identified via sensitivity analyses.
Results:
There were 341 arthroplasty fellows included in this study. Mean total reported case volume increased over the study period (452.6 ± 128 to 501.4 ± 131, P = 0.095). The bottom 10th and 30th percentiles of fellows reported a total of 319 and 399 cases, respectively. This included between 52 and 148 primary total knee arthroplasty (TKA) cases, 41 and 125 primary total hip arthroplasty (THA) cases, nine and 29 revision TKA cases, and six and 26 revision THA cases to achieve the 10th and 30th percentiles, respectively. The most frequently reported cases were primary TKA (n = 182, 39%), primary THA (n = 155, 34%), revision TKA (n = 37, 8%), and revision THA (n = 32, 7%). Variability in reported case volume was greatest in revision THA (9.1) and revision TKA (6.6). Approximately 102 arthroplasty fellows (30% of 341 total) reported zero cases of unicompartmental knee arthroplasty.
Conclusions:
Reported case volumes from recently graduated ACGME-accredited arthroplasty fellows may help inform future case minimum requirements for graduation. Future research is needed to determine evidence-based case minimum requirements that are tied to clinical competency during arthroplasty fellowship training.
