2005 APDS spring meetingPart 1Effect of Work-hour Reforms on Operative Case Volume of Surgical Residents
Introduction
Work-hour limitations are a reality that every training program has had to deal with. Among the many concerns regarding the educational effects of such limitation, perhaps the most concerning and easily evaluated is number of operative procedures performed. Numbers of operative cases is used by the Residency Review Committee for Surgery as a measure of adequacy of residency programs and by the American Board of Surgery as a measure of adequacy of training of individual surgeons. Although simple case numbers certainly are not an adequate measure of competency in operative surgery, they do represent an important component of adequate training. Many authors have expressed concern about the potential for decrease in case numbers as a result of limitation of work hours, and it certainly seems to be of great concern to surgical residents and medical students concerning careers in surgery.1, 2 Because of this concern, the authors designed the work-hour limitations of residency in a fashion to minimize any effect on case volume, preserve optimal patient care, and maximize resident education. This report summarizes the effect the work-hour limitations have had on operative case volume by residents.
Section snippets
Methods
Massachusetts General Hospital Department of Surgery has a 5 clinical year residency in surgery. A 2-year leave of absence for research is an elective chosen by, on average, 7 of the 8 residents per year, but it is not required. Residents on research are supported by the department, but they have no clinical responsibilities within the department. Clinical residents are not allowed to moonlight, but those on research may moonlight if they so choose. Moonlighting is not used to cover services
Results
Total case volume for the general surgical services (private, Churchill, and trauma) was unchanged over this period (5905 in 02, 5930 in 03) and likewise for the vascular service (1101 vs 1196). Overall, there was no change in mean operative volume per year for surgical residents in this program (231 in 2002, 246 in 2003; p = 0.61) (Table 1). For PGY5 residents, the case volume increased (339 cases 02, 390 in 03, p = 0.05). Mean case volume for PGY5 residents increased on the private general
Discussion
Although technical operative surgery will always represent only a single part of surgical education, it is certainly an important part. Residents tend to consider performance of operations the sine qua non of surgical education, and with the emphasis placed on case counting by the Residency Review Committee and American Board of Surgery, it would seem that many surgical educators do as well. Thus, as one designs changes in surgical residency to decrease time spent in the hospital, it is
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