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Local and National Trends in General Surgery Residents’ Operative Experience: Do Work Hour Limitations Negatively Affect Case Volume in Small Community-Based Programs?
Journal article   Open access   Peer reviewed

Local and National Trends in General Surgery Residents’ Operative Experience: Do Work Hour Limitations Negatively Affect Case Volume in Small Community-Based Programs?

Alexey Markelov, Aniket Sakharpe, Harjeet Kohli and David Livert
The American surgeon, v 77(12), pp 1675-1680
Dec 2011
PMID: 22273229
url
https://doi.org/10.1177/000313481107701242View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze) Open

Abstract

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was —1.20 ( P = 0.52) vs 1.78 ( P = 0.07) for the national program average with statistically significant difference on comparison ( P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 ( P < 0.01) vs -1.08 ( P = 0.54)], abdomen [8.48 ( P < 0.01) vs -6.29 ( P < 0.01)], breast [1.91 ( P = 0.89) vs -3.6 ( P = 0.02)], and vascular [4.03 ( P = 0.02) vs -3.98 ( P = 0.01)]. Comparing the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement institutional modifications which are too resource demanding for smaller training programs.

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Surgery
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