Are We Narrowing the Scope? 16-year Analysis of General Surgery Resident Operative Experience

General surgery training has evolved under the Surgical Council on Resident Education (SCORE) curriculum, yet whether operative experience continues to narrow despite increasing case volume remains uncertain. We evaluated national trends in SCORE-defined core and advanced operative experience among graduating U.S. general surgery residents.

National Accreditation Council for Graduate Medical Education operative log reports from academic years 2009-2010 through 2024-2025 were analyzed. All 352 procedures were assigned to 23 operative domains and classified as core, advanced, or undefined using the 2025 SCORE curriculum. Temporal trends were assessed with linear regression.

During the 16-year study period, graduating residents increased from 1,040 to 1,577 (+52%), while mean operative volume (including endoscopy) increased from 1,090 to 1,223 cases (+12%). Core procedures comprised a mean 74.5% of operative volume versus 12.2% for advanced procedures. Core operative volume increased (+7.2 cases/year; p<0.001), whereas advanced volume decreased (-0.9 cases/year; p=0.01). Similar trends occurred among chief (core +3.5/year; advanced -0.6/year; both p<0.001) and junior residents (core +3.7/year, p<0.001; advanced -0.6/year, p=0.02). Core volume increased across 8 of 13 general surgery domains but declined in 9 of 10 subspecialty domains. Between the 2018 and 2025 SCORE curricula, 24 procedures were reclassified from core to advanced, and these procedures demonstrated declining operative volume before reclassification.

National operative experience continues to shift toward high-frequency core procedures despite increasing overall case volume, with declining advanced and subspecialty exposure. Residency programs may require targeted strategies to preserve operative breadth and prepare graduates for diverse practice environments.