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Concerning Trends in Acute Care Surgeries Among General Surgery Trainees.

Sameh Yousef1, Jin Park1, Franklin Burg1

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General surgery residents have increased total case volumes, but exposure to essential open acute care surgery (ACS) procedures has significantly decreased. This decline raises concerns about graduate preparedness for foundational emergency surgeries.

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acute care surgeryemergency general surgeryminimally invasive surgeryoperativesurgical procedurestrauma surgery

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Area of Science:

  • Surgical Education
  • Acute Care Surgery
  • Operative Experience

Background:

  • Concerns exist regarding general surgery graduates' readiness for independent practice.
  • Evolving surgical techniques (e.g., laparoscopy) impact exposure to traditional open procedures.
  • The effect on acute care surgery (ACS) operative experience is not well-quantified.

Purpose of the Study:

  • To assess temporal trends in general surgery trainees' operative experience within ACS.
  • To quantify changes in exposure to specific ACS procedures over time.

Main Methods:

  • Analysis of ACGME operative case logs for general surgery residents (2000-2023).
  • Identification and categorization of ACS procedures.
  • Mann-Kendall trend test and line plots for trend assessment.

Main Results:

  • Average total case volume increased from 903 (2006) to 1,062 (2023) per trainee.
  • Exposure to key open ACS operations (e.g., splenectomy, perforation repair) declined to critically low levels (<1 case/trainee).
  • Laparoscopic approaches have largely replaced open procedures.

Conclusions:

  • Despite increased total operative volume, exposure to essential open ACS procedures has significantly decreased.
  • This trend raises concerns about preparedness for foundational emergency surgeries.
  • Declining experience may contribute to perceived graduate unreadiness.