Resigned to history? Exploring the decline of American Board of Surgery core procedures

The American Board of Surgery includes nearly 150 operations to satisfy the 6 main competencies of the Accreditation Council for Graduate Medical Education. We aimed to analyze the core curriculum procedures to identify procedures that may be more suitable for categorization at the advanced level.

The core procedures for the general surgery curriculum were reviewed to identify procedures uncommonly performed including cystostomy, vagotomy, and common bile duct exploration. Patients ages ≥18 years with a Current Procedural Terminology code for one of the procedures of interest were identified in the American College of Surgeons National Surgical Quality Improvement Program database from 2012 to 2023. These case volumes were compared to the number of graduating chief residents, approximated by the number of first attempts at the American Board of Surgery general surgery qualifying exam. These ratios were also compared to Accreditation Council for Graduate Medical Education national case logs for general surgery residents.

Laparoscopic common bile duct exploration had the largest increase in the number of cases performed from 2012 to 2023. When looking at the procedures per graduating chief resident, cystostomies declined from 0.03 to 0.02 per resident, vagotomies decreased from 0.12 to 0.06, and open common bile duct explorations decreased 0.18-0.09. Accordingly, in 2023, for every 33 residents, 16 residents, 9 residents, and 3 residents, it is possible only one of them performed a cystostomy, vagotomy or open common bile duct exploration, respectively.

The core curriculum procedures should be given close consideration, and low-volume procedures should be reevaluated for either removal or elevation to the fellowship/advanced level.