title: See one, do one, and teach none: resident experience as a teaching assistant.
abstract: BACKGROUND
  Training of surgical residents depends on graduated autonomy in and out of the operating room. We sought to define trends in operative volume and number of teaching cases in graduating surgical residents over time.
  
  
  METHODS
  We queried the Accreditation Council for Graduate Medical Education general surgery case log (1999-2012) for all case categories in which graduating chief residents performed a median of 20 or more cases during their training. Median (10th and 90th percentiles) number of cases performed as surgeon chief, surgeon junior and teaching assistant (TA) were analyzed using R(2) for all trends.
  
  
  RESULTS
  The median number of cases performed by graduating chief residents remained stable over time (965-971; R(2) = 0.01). Surgeon junior cases increased slightly (718-725; R(2) = 0.07), whereas surgeon chief cases decreased slightly (246-235; R(2) = 0.08). The most frequently performed cases were in the categories of the large intestine (125 [85,167], biliary (109 [74,167]), and abdominal hernia (99 [67.5,139]). The median number of TA cases decreased by 79% (126-27; R(2) = 0.34), with the most significant decrease occurring early in the study period (median: 126-22; R(2) = 0.91). The number of median teaching cases decreased in every category analyzed, with the most pronounced occurring in the categories of thoracic (9-0 [100%]; R(2) = 0.37) and breast (6-0 [100%]; R(2) = 0.55). The only categories with a median number of teaching cases >1 in 2012 were the large intestine (5), biliary (4), and abdominal hernia repairs (3).
  
  
  CONCLUSIONS
  Despite a relative stability of case volume over time, GSRs are graduating with relatively few cases recorded as TA. Improved opportunities for trainees to take on the role of TA while in residency may lead to improved confidence as surgeons on graduation.
authors.affiliation: Department of Surgery, Boston Medical Center, Boston, Massachusetts. Electronic address: teviah.sachs@bmc.org.
authors.forename: Teviah E
authors.initials: TE
authors.lastname: Sachs
authors.affiliation: Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
mesh_terms: D013502:General Surgery / Q000193:education* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013663:Teaching / Q000706:statistics & numerical data*
keywords: ACGME; General surgery; Resident autonomy; Resident education; Teaching assistant