Prospective Monitoring of Surgical Trainee Endoscopy Volumes

Introduction: Despite a recent increase in endoscopic surgery requirements for graduate surgical trainees by the Residency Review Committee for Surgery (RRC-S), there is still a question of competence: is the endoscopic volume achieved by surgical trainees sufficient for the procedural competence needed by practicing surgeons in academic centers and community hospitals? Prospective monitoring of trainee endoscopy volume has been identified as an important next step toward standardizing endoscopic training in order to better reflect the practice patterns of general surgeons and achieve the goals for endoscopic competency set forth by the RRC-S. This investigation prospectively monitors trainee endoscopy volume to review changes in volume in response to changes in the surgical curriculum and endoscopic surgery requirement and to characterize the endoscopic experience obtained by surgical trainees at a large urban academic medical center.

Methods: Surgical endoscopy volumes were prospectively collected over an eight-year period (2001-2008) for surgical residents at the University of Maryland Medical Center (UMMC). From February 2005 until June 2006, the surgical curriculum ceased to include a rotation in surgical endoscopy. In July 2006, the rotation was re-implemented in response to the new endoscopic surgery requirements of the RRC-S. Endoscopic experience was obtained through one-on-one instruction with surgeons, gastroenterologists, and an experienced physician assistant. Residents participated in procedures in four hospital settings- a large academic medical center, an acute care trauma hospital, a veterans administration hospital, and an urban community hospital. Clinical practice patterns were inferred from annual billing data of credentialed surgeons at UMMC for fiscal years 2004-2008.

Results: The endoscopy experience of 38 surgical trainees was prospectively collected over an eight year period, totaling 2,714 cases. On average, each resident performed 72 endoscopic cases over the course of residency training. Esophagogastroduodenoscopy (EGD) and percutaneous endoscopic gastrostomy (PEG) comprised the majority of cases. Residents who participated in a surgical endoscopy rotation (n=31, mean number of cases=78) did significantly more cases than those who did not (n=7, mean number of cases=44, p=0.002). In the absence of a dedicated rotation in surgical endoscopy, the endoscopic volume of surgeons at UMMC in one year, a surrogate of clinical practice pattern, exceeded the five year residency experience of surgical trainees (Figure 1). Since implementation of the new rotation and requirements, trainee experience has increased 233% and more appropriately resembles the clinical practice pattern of surgical endoscopists (Figure 2).

Conclusions: Backed by increased endoscopic surgery requirements, a dedicated endoscopic surgery rotation produced higher surgical trainee endoscopy volumes, bringing trainees closer to the annual endoscopy volumes of practicing surgeons.

Session: Podium Presentation

Program Number: S102

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