Purpose: Concerns persist regarding operative case experience as the number of pediatric surgical trainees has increased over the past decade. We hypothesize that critical index case experience has declined as the number of trainees increased.
Methods: Public data from Accreditation Council for Graduate Medical Education (ACGME) of self-reported pediatric surgical trainee operative experience (2004-2016) were analyzed for reported volumes for eight index procedures: esophageal atresia (EA), diaphragmatic hernia (DH); thyroglossal cyst, neuroblastoma, sacrococcygeal teratoma (SCT), choledochal cyst; portoenterostomy; and nephrectomy for tumor. Descriptive statistics of temporal trends were calculated and linear trends in mean reported case volumes computed.
Results: The total number of trainees reporting procedures was 447 (yearly mean 34.4) and ranged from 24 (2004) to 45 (2013). Total index cases performed was 20,699 (mean of 46 cases per trainee). Considerable variability was noted in the range of cases reported. Downward trends in mean case volumes for portoenterostomy and SCT were noted. No statistically significant associations were identified between mean case volumes and calendar year or number of trainees reporting. Examining the lower bounds of case volumes, one or more trainees reported zero cases performed in at least one year for all cases except DH. With the exception of EA and DH, all other index cases included trainees with case totals of zero for more than half of the years in which this data is reported. SCT, choledochal cyst, and portoenterostomy had trainees with case totals of zero every year (Figure 1).
Conclusion: Variability affecting the breadth and complexity of pediatric surgical training remains evident in case totals reported by ACGME. Although the number of programs and trainees increased over the time-period, case volumes were not statistically different.
Figure 1: Temporal trends in critical index cases, stratified by case category.