title: Recent trends in the operative experience of junior pediatric surgical attendings: a study of APSA applicant case logs.
abstract: OBJECTIVE
  Pediatric surgical education and workforce have changed significantly in the past decade. To document trends in the operative experiences of junior pediatric surgeons, we examined case logs submitted by applicants for membership to APSA.
  
  
  METHODS
  Case logs for 164 APSA membership applicants from 2006 to 2013 were reviewed. Total case volume, categories, and specific operations were analyzed. Negative binomial regression assessed for significant associations between the number of cases and the application year, presence of a pediatric surgery training program, region of the country, and years since fellowship completion.
  
  
  RESULTS
  Overall case numbers decreased initially after 2006/2007, but have remained stable since. Decreasing trends were seen in a number of specific cases/categories. The number of newborn cases did not change. Significant variations in operative experience were identified depending upon region, presence of a pediatric surgery training program, and years since fellowship completion. Median reported value for several important cases was ≤4 per year, and for some was zero.
  
  
  CONCLUSIONS
  These data describing the experience of young pediatric surgeons supplement recent observations regarding pediatric surgery fellows and general surgery residents. The limited exposure of surgeons to particularly rare conditions appears to be an unresolved problem. This information will be useful in developing future workforce proposals.
authors.affiliation: The Feinstein Institute for Medical Research, Hofstra-North Shore LIJ School of Medicine, Manhasset NY, 11030, USA; Division of Pediatric Surgery, Cohen Children's Medical Center, Hofstra-North Shore LIJ School of Medicine, New Hyde Park NY, 11040, USA. Electronic address: cbehr@nshs.edu.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Behr
authors.affiliation: The Feinstein Institute for Medical Research, Hofstra-North Shore LIJ School of Medicine, Manhasset NY, 11030, USA; Division of Pediatric Surgery, Cohen Children's Medical Center, Hofstra-North Shore LIJ School of Medicine, New Hyde Park NY, 11040, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Hesketh
authors.affiliation: The Feinstein Institute for Medical Research, Hofstra-North Shore LIJ School of Medicine, Manhasset NY, 11030, USA.
authors.forename: Meredith
authors.initials: M
authors.lastname: Akerman
authors.affiliation: Division of Pediatric Surgery, Cohen Children's Medical Center, Hofstra-North Shore LIJ School of Medicine, New Hyde Park NY, 11040, USA.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Dolgin
authors.affiliation: Section of Pediatric Surgery, Yale-New Haven Children's Hospital, Yale School of Medicine, New Haven CT, 06510, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Cowles
mesh_terms: D002648:Child; D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010372:Pediatrics / Q000193:education*; D012042:Registries; D013043:Specialties, Surgical / Q000193:education*; D066231:Surgeons / Q000193:education*; D016526:Workload
keywords: APSA; Attending physician; Case log; Operative experience; Pediatric surgery; Workload