Operative Case Trends in General Surgery Residency: Growth Across All Levels

The expansion of integrated surgical subspecialty residencies and fellowship programs has raised concerns regarding "case migration," whereby operative volume shifts from general surgery residents to subspecialty trainees. Such shifts could reduce exposure to foundational operations for graduating chiefs and limit early operative opportunities for junior residents. This study evaluated national trends in operative case volumes for general surgery residents using the Accreditation Council for Graduate Medical Education Case Log data.

We performed a retrospective analysis of publicly available Accreditation Council for Graduate Medical Education National Case Log data for general surgery residents from academic years 2010-2011 through 2023-2024. Annual counts of accredited programs and graduating categorical residents were recorded. Median case volumes per resident were extracted for total cases, operative role, and major case categories. Temporal trends were assessed using linear regression.

From 2010 to 2024, the number of general surgery programs increased from 240 to 321, and graduating residents increased from 1060 to 1532. Median total documented case volume per resident increased from approximately 940 to more than 1060 cases. Surgeon junior and surgeon chief case volumes increased significantly over time (both P < 0.001). Traditional general surgery case categories, including abdominal and alimentary tract procedures, increased, whereas subspecialty-associated categories declined or demonstrated no proportional growth at the chief level over time.

Despite substantial growth in integrated subspecialty training programs, overall operative volumes increased, driven by traditional case categories. Subspecialty exposure declined or showed no proportional growth at the chief level, suggesting redistribution of operative experience across training levels.