Trends in Thoracic Case Volumes Among General Surgery Residents

Thoracic surgery is a core component of general surgery education. Given the advancement of minimally invasive techniques and the development of integrated thoracic surgery programs, we investigated whether thoracic surgical opportunities are diminishing for general surgery residents.

Retrospective review of aggregated annual case log data from the Accreditation Council for Graduate Medical Education (ACGME) National Resident Report.

ACGME-accredited general surgery and integrated thoracic surgery residency programs in the United States.

General surgery residents graduating from 2012 to 2023 and integrated thoracic surgery residents graduating from 2016 to 2023.

Thoracic surgery is a core component of general surgery education. Given the advancement of minimally invasive techniques and the development of integrated thoracic surgery programs, we investigated whether thoracic surgical opportunities are diminishing for general surgery residents.

A retrospective review of the Accreditation Council for Graduate Medical Education case log database was performed for graduating general surgery residents from 2012 to 2023. Cases were analyzed by resident level and operative approach. Linear regression was performed to analyze temporal trends in thoracic case volumes for general surgery residents.

From 2012 to 2023, the average number of thoracic surgery cases performed per resident per graduating year decreased significantly, from 40.4 to 37.0 (p < 0.01). Chief residents on average performed 6.6 thoracic surgeries throughout the study period. The average number of thoracic operations performed as a junior resident decreased significantly, from 34.6 to 30.5 (p < 0.01). When analyzing the operative approach for thoracic cases performed by graduating residents during their entire residency, the number of open thoracotomy cases (4.1 to 4.4 cases/year, p < 0.01) and thoracoscopic lobectomies and segmental resections (2.8 to 4.0 cases/year, p < 0.01) performed increased significantly, while the number of open lobectomies and segmental resections (4.5 to 2.0 cases/year, p < 0.01) and open wedge resections decreased significantly (1.2 to 0.2 cases/year, p < 0.01).

The thoracic surgery experience for chief residents has remained consistent, but the junior residents' experience has significantly diminished. Evolution in thoracic surgery and the diminished experience at the junior resident level may adversely impact knowledge, skills, and interest in thoracic surgery.