Concerning Trends in Acute Care Surgeries Among General Surgery Trainees

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.