Rebecca A. Snyder, MD Sharon E. Phillips, MSPH Kyla P. Terhune, MD

1. 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

2. 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.

3. 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.

4. 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.

5. Purpose • To determine the impact of initiation of a new pediatric surgery fellowship on general surgery resident operative volume at a major academic institution

6. 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

7. Results • 109 resident rotations • 78 residents • 7 fellow rotations (years) • 4 fellows

12. Mean cases per 28 resident days

13. 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

14. 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.

15. 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

16. Questions?