title: Variability in Foot and Ankle Case Volume in Orthopaedic Residency Training.
abstract: Surgical case volume during orthopaedic surgical residency is a concern among trainees and program directors alike. With an ongoing trend toward further subspecialization and the rapid development of new techniques and devices, the breadth of procedures that residents are exposed to continues to increase. Accreditation Council for Graduate Medical Education surgical case logs from 2009 to 2013 for graduating orthopaedic surgery residents were examined to assess the national averages of orthopaedic procedures logged by graduating orthopaedic surgery residents in the leg/ankle and foot/toes categories. This investigation revealed that there was an 8% increase in the total number of leg/ankle cases and 12% increase in foot/toes cases performed by graduating orthopaedic surgery residents, which has not significantly increased from 2009 to 2013. Across years examined in this study, significant variability existed between the 10th and 90th percentiles for total foot and ankle resident case exposure (P < .05), particularly within ankle arthroscopy, where there was a 15-fold difference in the number of arthroscopy cases performed by residents in the 90th percentile compared with the 10th percentile. The overall volume of foot and ankle cases performed by graduating orthopaedic surgery residents has increased despite not being statistically significantly from 2009 to 2013.
  
  
  METHODS
  Level III: Cohort study.
authors.affiliation: Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island (SFD, JAG).|Department of Orthopaedics, Division of Foot and Ankle Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (BDB).|Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (AHD).
authors.forename: Steven F
authors.initials: SF
authors.lastname: DeFroda
authors.affiliation: Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island (SFD, JAG).|Department of Orthopaedics, Division of Foot and Ankle Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (BDB).|Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (AHD).
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Gil
authors.affiliation: Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island (SFD, JAG).|Department of Orthopaedics, Division of Foot and Ankle Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (BDB).|Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (AHD).
authors.forename: Brad D
authors.initials: BD
authors.lastname: Blankenhorn
authors.affiliation: Department of Orthopaedics, Alpert Medical School of Brown University, Providence, Rhode Island (SFD, JAG).|Department of Orthopaedics, Division of Foot and Ankle Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (BDB).|Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island (AHD).
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
mesh_terms: D000843:Ankle Joint / Q000601:surgery; D002102:Cadaver; D002983:Clinical Competence; D004503:Education, Medical, Graduate / Q000379:methods / Q000706:statistics & numerical data*; D005528:Foot / Q000601:surgery; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D009985:Orthopedics / Q000193:education* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D000066908:Simulation Training; D014481:United States; D016526:Workload
keywords: ACGME; case volume; education; resident training