Twenty-year analysis of surgical resident operative trauma experiences

Abstract

Background: The Accreditation Council for Graduate Medical Education (ACGME) implemented new work-hour rules for all U.S. residency programs beginning on July 1, 2003. The ACGME-mandated work-hour reform may have affected operative trauma case volumes of general surgery residents.

Methods: Using ACGME aggregate data collected from general surgery residency programs from 1990 to 2010, we examined the effect of the 2003 work-hour reform on resident operative trauma case volumes.

Results: Overall trauma cases per year declined from 78.28 in 1990 to 38.73 in 2010. From 1990 to 2003, laparotomy, burn, and upper-gastrointestinal trauma cases fell at least 50%, from 9.97 to 4.85 cases/resident by 0.46 cases/y (95% confidence interval [CI], 0.456-0.459), 10.05 to 3.30 cases/resident by 0.61 cases/y (95% CI, 0.609-0.617), and 3.34 to 1.01 cases/resident by 0.189 cases/y (95% CI, 0.188-0.189), respectively. After 2003, laparotomy and burn cases began to rise by 0.23 cases/y (95% CI, 0.228-0.231) and 0.36 cases/y (95% CI, 0.358-0.368). Vascular trauma cases continued to decline from 8.63 cases/resident by 0.197 (95% CI, 0.196-0.198) pre-reform, but by 0.102 (95% CI, 0.099-0.105) post-reform. Junior surgical residents were increasingly involved in trauma operative cases from 67% in 1990 to 79% in 2010. Cardiac, pancreatic, genitourinary, and neurosurgical cases did not peak more than 1.95 cases/resident pre-reform.

Conclusions: Secular trends before the 2003 work-hour reform caused a 50% decrease in operative trauma experience among general surgery residents. Since 1990, junior residents have increasingly performed operative trauma. Rare trauma subspecialty cases remain rare. Post work-hour reform, operative trauma volumes have stabilized.