ABSTRACT
BACKGROUND: Teaching assistant (TA) cases are a training mainstay, due to increased resident autonomy. Since 2014, the American Board of Surgery (ABS) requires a 25 TA case minimum for graduating resident eligibility for board certification. Herein, we analyze our institution's experience compared with the national average, for any change effected by the requirement. STUDY DESIGN: ACGME case log data were obtained for the July 2001 to June 2018 academic years. We compared average TA cases of our program against the national average and national 50th percentile: 2001 to 2014, and 2014 to 2018 academic years. The program TA cases were also broken down by category, with a comparison before and after 2014. Values of p were calculated using a t-test and Mann-Whitney U test. RESULTS: From July 2001 to June 2018, our program averaged 30.1 TA cases/resident, and national 50th percentile average was 28.1. For July 2001 to June 2014 AY (aka pre-2014) and July 2014 to June 2018 AY (aka post-2014) cases per resident, our program averages were 24.9 and 46.1, respectively, and the national 50th percentile averages were 24.4 and 40.3, respectively-both statistically significant increases. Average program percentiles were 46.4 (pre-2014), and 61.5 (post-2014), and 59.6% of program cases logged were biliary, large intestine, and hernia (2001 to 2018 AY), with a statistically significant increase in several case subcategories post-2014. CONCLUSIONS: Teaching assistant cases are an invaluable resource for residents, fostering increased autonomy. Since the 2014 minimum, a statistically significant increase in TA cases was noted in our program and nationally. The majority of sub-categories logged were core procedures. Unequivocally, the TA case minimum requirement has made a difference. This will hopefully lead to increased autonomy and therefore, more comfortable and capable general surgeons. Wide variability is noted in what counts as a TA case, with further clarification needed by the ACGME and ABS.
Subject(s)
Certification , Education, Medical, Graduate/methods , Forecasting , General Surgery/education , Internship and Residency/organization & administration , Registries , Teaching/organization & administration , Accreditation/methods , Clinical Competence , Follow-Up Studies , Humans , United StatesSubject(s)
Hernia, Obturator/complications , Intestinal Obstruction/complications , Intestinal Obstruction/diagnosis , Pain/etiology , Thigh/diagnostic imaging , Aged, 80 and over , Emergency Service, Hospital/organization & administration , Female , Hernia, Obturator/diagnosis , Humans , Pain/complications , Tomography, X-Ray Computed/methods , Vomiting/etiologyABSTRACT
BACKGROUND: Despite significant improvement in operative mortality rates following pancreaticoduodenectomy (PD), morbidity remains high. Outcomes following PD may be improved in high-volume centers and with high-volume surgeons. We sought to evaluate the association between surgeon experience and postoperative outcomes after PD. METHODS: An online database search of MEDLINE and EMBASE was performed; key bibliographies were reviewed. Studies comparing operative outcomes of high-volume surgeon (HVS) and low-volume surgeon (LVS) performing PD were included. Odds ratios with the corresponding 95% confidence intervals (CI) by random fixed effects models of pooled data were calculated. Definition of HVS varied among the studies, ranging from 6 to >20 PD/year. The primary endpoint was 30-day mortality, and secondary outcomes were complication rates, length of stay (LOS), hospital costs, and readmission rates. Study quality was assessed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) criteria. RESULTS: Search strategy yielded 360 publications. Eleven studies met the inclusion criteria comprising 36,449 patients. Among these patients, 12,512 (34.3%) PDs were performed by HVS and 23,937 (65.7%) by LVS. Meta-analysis of included studies showed that HVS had significantly lower mortality rates than LVS (2.4 vs. 6.7%, OR 2.88; 95% CI 2.51-3.27, p < 0.001). They also had significantly lower overall complication rates (36.3 vs. 50.3%, OR 1.71; 95% CI 1.62-1.81, p < 0.001), hospital costs (range $10,818-141,322 vs. $12,114-198,678, OR 0.13; 95% CI 0.07-0.19, p < 0.001), and LOS (range 11-35 vs. 14-38 days, OR 2.86; 95% CI 2.03-3.68, p < 0.001). CONCLUSIONS: HVS performing PD have significantly better outcomes than LVS in terms of decreased mortality, morbidity, LOS, and hospital costs. Efforts toward increased regionalization of care should be discussed. Consensus regarding definition of HVS needs to be undertaken.
