impact of initiation of a pediatric surgery fellowship on general surgery resident operative volume
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Rebecca A. Snyder, MD Sharon E. Phillips, MSPH Kyla P. Terhune, MD

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Impact of Initiation of a Pediatric Surgery Fellowship on General Surgery Resident Operative Volume ♦ ♦ ♦. Rebecca A. Snyder, MD Sharon E. Phillips, MSPH Kyla P. Terhune, MD Vanderbilt University School of Medicine. Background.

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impact of initiation of a pediatric surgery fellowship on general surgery resident operative volume

Impact of Initiation of a Pediatric Surgery Fellowship on General Surgery Resident Operative Volume♦ ♦ ♦

Rebecca A. Snyder, MD

Sharon E. Phillips, MSPH

Kyla P. Terhune, MD

Vanderbilt University School of Medicine

background
Background
  • Operative volume among general surgery (GS) residents and programs varies significantly
  • Residents in programs that are larger, university-affiliated, or in the Northeast report lower case numbers1 and may feel less confident in their operative skills than residents at other programs2

1. Bell RH et al. Ann Surg. 2009.

2. Bucholz EM et al. Arch Surg. 2011.

background1
Background
  • 80% of graduating GS residents are pursuing a fellowship1
  • Volume traditionally captured by residents is often diverted towards fellows2

1. Borman KR et al. J Am Coll Surg. 2008.

2. Bell RH et al. Ann Surg. 2009.

background2
Background
  • Prior studies of the effects of coexisting fellowships on GS residents show mixed results
    • Minimally invasive (MIS) fellowships1,2
  • 2009: multiple programs with colorectal, vascular, MIS, and endocrine fellowships3
    • No difference in resident CRS volume
    • Decline in MIS and vascular volume
    • Specifically: open colectomy and lap chole

1. Kothari SN et al. J Surg Educ. 2008.

2. Linn JG et al. Surgery. 2011.

3. Hanks JB et al. Ann Surg. 2011.

purpose
Purpose
  • To determine the impact of initiation of a new pediatric surgery fellowship on general surgery resident operative volume at a major academic institution
methods
Methods
  • Retrospective Review of ACGME operative logs:
    • GS residents: July 1, 2003 to June 30, 2011
    • Pediatric surgery fellows: July 1, 2007 to June 30, 2011
  • Collected data including:
    • Pediatric index cases
    • All pediatric cases
    • Total number of primary surgeon cases to date
  • Number pediatric surgeons, RVUs, admissions, CPTs
results
Results
  • 109 resident rotations
    • 78 residents
  • 7 fellow rotations (years)
    • 4 fellows
limitations
Limitations
  • Single institution
  • Intern data not captured
  • Dependent on ACGME log accuracy
  • Case volume only one measure of educational experience
    • Inpatient/ward experience
    • Outpatient clinic
    • Educational Conferences
conclusions
Conclusions
  • General Surgery resident operative volume in pediatric surgery decreased significantly after the addition of a fellowship.
  • Careful preparation is necessary to anticipate and protect the general surgery resident experience when new surgical fellowships are implemented.
acknowledgements
Acknowledgements
  • Margaret Tarpley, MLS
  • John Tarpley, MD, FWACS, FACS
  • Stephanie Rowe, Program Coordinator, General Surgery
  • Jennifer Wilkins, Program Coordinator Pediatric Surgery Fellowship
  • Dai Chung, MD
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