TY - JOUR
T1 - Blunt solid organ injury
T2 - Resident operative experience on the decline
AU - de Angelis, Paolo
AU - Chandramouli, Mathangi
AU - An, Anjile
AU - Gupta, Aakanksha
AU - Barie, Philip S.
AU - Winchell, Robert J.
AU - Narayan, Mayur
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2023
Y1 - 2023
N2 - Introduction: Duty-hour restrictions, improved non-operative management of injured patients, new or expanded fellowship programs, and the coronavirus disease 2019 (COVID-19) pandemic have hindered resident exposure to operative trauma in the United States. In this study, we investigated trends in resident operative experience in blunt trauma over a 22-year period. Methods: Accreditation Council for Graduate Medical Education (ACGME) logs from 1999 to 2021 were reviewed. The yearly number of major trauma cases, trauma splenectomies (TS), and liver drainage/repairs (LDR) were extracted. We used the non-parametric Mann–Kendall test to analyze trends. Data are reported as mean ± standard deviation or median (estimated interquartile range, eIQR); alpha = 0.05. Results: Records from 24,062 respondents were examined. The average number of trauma cases performed by all residents decreased from 42 ± 22 in 1999–2000 to 31 ± 18 in 2020–2021 (p <.01); median number of cases decreased from 36 (30, 47) to 27 (22, 36). The proportion of TS performed by chief and junior residents among all trauma cases decreased from 9.5% to 7.1% (trend test, p <.01), and from 6.6% to 6.1% (trend test, p =.03) respectively. The proportion of LDR performed by chief and junior residents decreased from 6.9% to 4.7% (trend test, p <.01), and from 4.3% to 3.9% (trend test, p =.03) respectively. Conclusions: Number of major trauma cases and two common procedures for blunt solid organ injury decreased significantly over the past two decades. These findings should serve as an indicator that structural changes in surgery residency training programs in the United States may be necessary to safeguard resident exposure to operative trauma cases.
AB - Introduction: Duty-hour restrictions, improved non-operative management of injured patients, new or expanded fellowship programs, and the coronavirus disease 2019 (COVID-19) pandemic have hindered resident exposure to operative trauma in the United States. In this study, we investigated trends in resident operative experience in blunt trauma over a 22-year period. Methods: Accreditation Council for Graduate Medical Education (ACGME) logs from 1999 to 2021 were reviewed. The yearly number of major trauma cases, trauma splenectomies (TS), and liver drainage/repairs (LDR) were extracted. We used the non-parametric Mann–Kendall test to analyze trends. Data are reported as mean ± standard deviation or median (estimated interquartile range, eIQR); alpha = 0.05. Results: Records from 24,062 respondents were examined. The average number of trauma cases performed by all residents decreased from 42 ± 22 in 1999–2000 to 31 ± 18 in 2020–2021 (p <.01); median number of cases decreased from 36 (30, 47) to 27 (22, 36). The proportion of TS performed by chief and junior residents among all trauma cases decreased from 9.5% to 7.1% (trend test, p <.01), and from 6.6% to 6.1% (trend test, p =.03) respectively. The proportion of LDR performed by chief and junior residents decreased from 6.9% to 4.7% (trend test, p <.01), and from 4.3% to 3.9% (trend test, p =.03) respectively. Conclusions: Number of major trauma cases and two common procedures for blunt solid organ injury decreased significantly over the past two decades. These findings should serve as an indicator that structural changes in surgery residency training programs in the United States may be necessary to safeguard resident exposure to operative trauma cases.
KW - Graduate surgical education
KW - blunt trauma
KW - operative volume
KW - resident autonomy
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U2 - 10.1177/14604086231205162
DO - 10.1177/14604086231205162
M3 - Article
AN - SCOPUS:85180862865
SN - 1460-4086
JO - Trauma (United Kingdom)
JF - Trauma (United Kingdom)
ER -