title: Local and national trends in general surgery residents' operative experience: do work hour limitations negatively affect case volume in small community-based programs?
abstract: The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council  for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.20 (P = 0.52) vs 1.78 (P = 0.07) for the  national program average with statistically significant difference on comparison (P = 0.027). We also found significant difference in case volume changes at the national level compared with our institution for the following ACGME defined subcategories: alimentary tract [8.19 (P  < 0.01) vs -1.08 (P = 0.54)], abdomen [8.48 (P < 0.01) vs -6.29 (P < 0.01)], breast [1.91 (P = 0.89) vs -3.6 (P = 0.02)], and vascular [4.03 (P = 0.02) vs -3.98 (P = 0.01)]. Comparing  the national trend to the community hospital we see that there is total increase in cases at the national level whereas there is a decrease in case volume at the community hospital. These trends can also be followed in ACGME defined subcategories which form the major case load for a general  surgical training such as alimentary tract, abdominal, breast, and vascular procedures. We hypothesize that work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule, and implement  institutional modifications which are too resource demanding for smaller training programs.
authors.affiliation: Easton Hospital, Drexel University School of Medicine, Easton, Pennsylvania 18042, USA. dr.markelov@gmail.com
authors.forename: Alexey
authors.initials: A
authors.lastname: Markelov
authors.forename: Aniket
authors.initials: A
authors.lastname: Sakharpe
authors.forename: Harjeet
authors.initials: H
authors.lastname: Kohli
authors.forename: David
authors.initials: D
authors.lastname: Livert
mesh_terms: D000068:Accreditation; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000639:trends*; D015397:Program Evaluation / Q000639:trends*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000193:education* / Q000706:statistics & numerical data*; D014481:United States; D016526:Workload / Q000592:standards*