The ACGME case log: general surgery resident experience in pediatric surgery.
BACKGROUND
General surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time.


METHODS
The ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05.


RESULTS
Overall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time.


CONCLUSIONS
GS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended.
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital and the University of Washington, Seattle, WA 98105, USA. Kenneth.gow@seattlechildrens.org
Kenneth W
KW
Gow
F Thurston
FT
Drake
Shahram
S
Aarabi
John H
JH
Waldhausen
D000068:Accreditation; D001934:Branchial Region / Q000601:surgery; D002983:Clinical Competence; D015331:Cohort Studies; D003953:Diagnosis-Related Groups; D004503:Education, Medical, Graduate / Q000592:standards; D005764:Gastroesophageal Reflux / Q000601:surgery; D013502:General Surgery / Q000193:education / Q000706:statistics & numerical data*; D059685:Herniorrhaphy / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007410:Intestinal Diseases / Q000601:surgery; D010535:Laparoscopy / Q000706:statistics & numerical data; D056126:Orchiopexy / Q000706:statistics & numerical data; D010372:Pediatrics / Q000193:education / Q000706:statistics & numerical data*; D011707:Pyloric Stenosis / Q000601:surgery; D012189:Retrospective Studies; D013903:Thoracic Surgery / Q000193:education / Q000706:statistics & numerical data; D013955:Thyroglossal Cyst / Q000601:surgery; D016526:Workload / Q000706:statistics & numerical data*
Case log; Education; General surgery; Pediatric surgery; Resident