title: Understanding the Operative Experience of the Practicing Pediatric Surgeon: Implications for Training and Maintaining Competency.
abstract: The number of practicing pediatric surgeons has increased rapidly in the past 4 decades, without a significant increase in the incidence of rare diseases specific to the field. Maintenance of competency in the index procedures for these rare diseases is essential to the future of the profession.
  
  
  
  To describe the demographic characteristics and operative experiences of practicing pediatric surgeons using Pediatric Surgery Board recertification case log data.
  
  
  
  We performed a retrospective review of 5 years of pediatric surgery certification renewal applications submitted to the Pediatric Surgery Board between 2009 and 2013. A surgeon's location was defined by population as urban, large rural, small rural, or isolated. Case log data were examined to determine case volume by category and type of procedures. Surgeons were categorized according to recertification at 10, 20, or 30 years.
  
  
  
  Number of index cases during the preceding year.
  
  
  
  Of 308 recertifying pediatric surgeons, 249 (80.8%) were men, and 143 (46.4%) were 46 to 55 years of age. Most of the pediatric surgeons (304 of 308 [98.7%]) practiced in urban areas (ie, with a population >50 000 people). All recertifying applicants were clinically active. An appendectomy was the most commonly performed procedure (with a mean [SD] number of 49.3 [35.0] procedures per year), nonoperative trauma management came in second (with 20.0 [33.0] procedures per year), and inguinal hernia repair for children younger than 6 months of age came in third (with 14.7 [13.8] procedures per year). In 6 of 10 "rare" pediatric surgery cases, the mean number of procedures was less than 2. Of 308 surgeons, 193 (62.7%) had performed a neuroblastoma resection, 170 (55.2%) a kidney tumor resection, and 123 (39.9%) an operation to treat biliary atresia or choledochal cyst in the preceding year. Laparoscopy was more frequently performed in the 10-year recertification group for Nissen fundoplication, appendectomy, splenectomy, gastrostomy/jejunostomy, orchidopexy, and cholecystectomy (P < .05) but not lung resection (P = .70). It was more frequently used by surgeons recertifying in the 10-year group (used in 11 375 of 14 456 procedures [78.7%]) than by surgeons recertifying in the 20-year (used in 6214 of 8712 procedures [71.3%]) or 30-year group (used in 2022 of 3805 procedures [53.1%]).
  
  
  
  Practicing pediatric surgeons receive limited exposure to index cases after training. With regard to maintaining competency in an era in which health care outcomes have become increasingly important, these results are concerning.
authors.affiliation: Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Fizan
authors.initials: F
authors.lastname: Abdullah
authors.affiliation: Department of Surgery, University of Maryland Medical Center, Baltimore.
authors.forename: Jose H
authors.initials: JH
authors.lastname: Salazar
authors.affiliation: Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Gause
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor.
authors.forename: Samir
authors.initials: S
authors.lastname: Gadepalli
authors.affiliation: American Board of Surgery, Philadelphia, Pennsylvania.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Biester
authors.affiliation: Department of Surgery, Oregon Health and Science University, Portland.
authors.forename: Kenneth S
authors.initials: KS
authors.lastname: Azarow
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.affiliation: Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Dai H
authors.initials: DH
authors.lastname: Chung
authors.affiliation: Department of Surgery, Stanford School of Medicine, Stanford, California.
authors.forename: Dennis P
authors.initials: DP
authors.lastname: Lund
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis.
authors.forename: Frederick J
authors.initials: FJ
authors.lastname: Rescorla
authors.affiliation: Department of Surgery, University of Washington, Seattle.
authors.forename: John H T
authors.initials: JH
authors.lastname: Waldhausen
authors.affiliation: Department of Surgery, Brown University, Providence, Rhode Island.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Tracy
authors.affiliation: Department of Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fallat
authors.affiliation: Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Klein
authors.affiliation: American Board of Surgery, Philadelphia, Pennsylvania.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Lewis
authors.affiliation: Department of Surgery, University of Michigan Health System, Ann Arbor.
authors.forename: Ronald B
authors.initials: RB
authors.lastname: Hirschl
mesh_terms: D000328:Adult; D000368:Aged; D002568:Certification; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data / Q000639:trends; D008297:Male; D008875:Middle Aged; D010372:Pediatrics / Q000193:education / Q000592:standards*; D011365:Professional Practice Location / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000706:statistics & numerical data; D013043:Specialties, Surgical / Q000193:education / Q000592:standards*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data