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Variability in the Orthopaedic Residency Trainee Trauma Surgical Experience
Todd Phillips1, Benjamin Fiedler, Joshua T Morrow
1From the Levy Shoulder to Hand Center at the Paley Orthopedic & Spine Institute, Boca Raton, FL (Dr. Phillips), and the Department of Orthopaedics, Baylor College of Medicine, Houston, TX (Dr. Fiedler, Mr. Morrow, Mr. Gugala, Dr. Harrington, and Dr. Dirschl).
Background:
The aim of this study was to analyze fracture fixation case logs from residents training at a level 1 trauma center to assess variability across residents' surgical experiences within a single residency program. The authors hypothesize that notable variability exists between residents' surgical experiences in fracture care.
Methods:
A retrospective case series was conducted at a single, urban residency program with a level 1 trauma center. Completed case logs were collected from program graduates from 2022 to 2024. All surgical cases involving fracture fixation at the level 1 trauma center were included for analysis. The anatomic region of the fracture surgery was determined by translating the case log current procedural terminology (CPT) code entry into the corresponding "bone" and "segment" per the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association fracture classification system. For external validation and generalizability, resident cases were compared with those from a recent multicentered epidemiologic study using a two-proportion z-test. Variations in resident case logs were tested using analysis of covariance.
Results:
A total of 4,616 fracture fixation cases were identified across the 14 graduate case logs. The average number of fracture cases per resident was 329.7 (SD = ±80.3). No significant difference was observed in resident surgical experience at the home institution when comparing the anatomic region of the fracture surgery (P = 0.189). When compared with a multicenter epidemiologic study, our institution had significantly fewer proximal femur fractures (P < 0.001) and significantly more ankle fractures (P < 0.001).
Conclusion:
While assuring consistency of clinical experience within orthopaedic resident training is an exceptionally difficult task, it seems that residents in this program received similar exposure to varying fracture trauma pathologies. However, there may exist regional differences or other variables that contribute to differences in fracture location and/or volume from one institution to another. It remains essential for residents to take an active role in ensuring that they gain sufficient surgical volume to achieve clinical competence.
