Declining operative experience for junior-level residents: Is this an unintended consequence of minimally invasive surgery?

Matthew G. Mullen, Elise P. Salerno, Alex D. Michaels, Traci L. Hedrick, Min Woong Sohn, Philip W. Smith, Bruce D. Schirmer, Charles M. Friel

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Introduction Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. Methods A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. Results A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). Conclusions Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education.

Original languageEnglish
Pages (from-to)609-615
Number of pages7
JournalJournal of Surgical Education
Volume73
Issue number4
DOIs
StatePublished - Jul 1 2016

Bibliographical note

Publisher Copyright:
© 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Keywords

  • education
  • junior resident
  • laparoscopy
  • operative volume
  • residency training
  • surgery
  • surgical residency

ASJC Scopus subject areas

  • Surgery
  • Education

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