Effect of New Fellowship Programs on Resident Case Volume in Pediatric Surgery

Infographic · Nov 2019 · 1 min read

In brief

Analysis of 15 general surgery programs found that establishing new pediatric surgery fellowships significantly reduced resident case volume as surgeon, declining from 56.75 to 47.15 cases over 5 years post-fellowship launch. Programs considering new fellowships should carefully evaluate impact on general surgery resident training experience.

New pediatric surgery fellowships reduce general surgery resident case volume by ~17% (from 56.75 to 47.15 cases) in first 5 years
Before fellowship establishment, resident pediatric case volume naturally increased 26% over 5 years (54.56 to 68.71 cases)
Programs should assess impact on general surgery training before launching new pediatric surgery fellowships
Study analyzed 15 general surgery programs associated with fellowships started between 2002-2014 using ACGME caselogs
Fellows compete with residents for pediatric cases, creating measurable educational trade-offs in surgical training

Written by the GCMD Library team from the infographic.

A blue-toned infographic featuring a large triangle diagram with 'PEDIATRIC SURGERY' labeled at the peak. The triangle shows a 'before' and 'after' comparison with a downward arrow indicating a 30% decrease. A small figure icon appears to be falling from the right side of the triangle. The left side contains explanatory text in white, while the bottom includes journal citation and institutional logos.

The effect of subspecialty programs on associated general surgery programs is largely undocumented. This study examined the effect of new pediatric surgery fellowship (PSF) programs on the pediatric surgical experience of residents in the associated general surgery programs.

Study Design

Pediatric surgery fellowship programs established after 2002–2003 (earliest available ACGME caselogs) were identified. The number of pediatric surgery cases reported by each completing resident as surgeon in the associated general surgery programs from academic year (AY)2002–2003 to AY2016–2017 were recorded and examined before and after entry of the first fellow into associated pediatric surgery programs.

Results

Fifteen general surgery residency programs associated with new PSF programs were reviewed. First fellows entered the new PSF programs from 2002–2003 to 2013–2014. General surgery caselog availability before and after fellow matriculation varied accordingly. Data were available from 12 programs through the 5 years before matriculation of the first fellow into the associated PSF program. Over that time, the number of pediatric surgery cases performed by residents in those general surgery programs increased from 54.56 ± 2.98 to 68.71 ± 4.12 (p = 0.003). In 12 general surgery programs with resident caselogs available for the first 5 years after matriculation of the first fellow into the associated PSF programs, the mean number of resident pediatric surgery cases declined from 56.75(± 3.42) to 47.15(± 2.73) (p = 0.015).

Conclusions

Establishment of a new PSF program results in a significant decline in the pediatric surgery experience as surgeon for residents in the associated general surgery program. This outcome should be carefully weighed in the decision to establish a new PSF program.

Visual abstract created by Alejandra M Casar Berazaluce, MD - Pediatric Surgery Research Fellow at Cincinnati Children's Hospital Medical Center.

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