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Operative Experience in the Era of Duty Hour Restrictions: Is Broad-Based General Surgery Training Coming to an End?

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Since the institution of Accreditation Council for Graduate Medical Education (ACGME) resident work hour restrictions, conflicting evidence exists regarding the impact on resident case volume with most data from single-institution studies. We examined the effect of restrictions on national resident operative experience. After permission from the ACGME, we reviewed the publicly available national resident case log data (1999 through 2008) maintained on the ACGME web site (, including total major cases with subanalysis of the ACGME-specified categories. The mean cases per resident were compared before (1999 to 2003) and after (2003 to 2008) restrictions. After the implementation of duty hour restrictions, the mean number of total cases per resident significantly decreased (949 ± 18 vs 911 ± 14, P = 0.004). Subanalysis showed a significant increase in alimentary tract (217 ± 7 vs 229 ± 3, P = 0.004), skin/soft tissue (31 ± 3 vs 36 ± 1, P = 0.01), and endocrine (26 ± 2 vs 31 ± 2, P = 0.006) cases. However, we observed a significant decrease in head and neck (21 ± 0.3 vs 20 ± 0.3, P = 0.01), vascular (164 ± 29 vs 126 ± 5, P = 0.01), pediatric (41 ± 1 vs 37 ± 2, P = 0.006), genitourinary (10 ± 2 vs 7 ± 1, P = 0.004), gynecologic surgery (5 ± 1 vs 3 ± 0.6, P = 0.002), plastics (16 ± 0.3 vs 15 ± 0.7, P = 0.03), and endoscopy (91 ± 3 vs 82 ± 2, P < 0.001) procedures. Analysis of the ACGME-compiled national data confirms that duty hour restrictions have significantly impacted resident operative experience. Importantly, experience in specialty areas, including vascular and endoscopy, appears to have been sacrificed for consolidation of resources into general surgery services as indicated by the increase in alimentary tract and endocrine cases. These findings raise the following question: Is the era of truly broad-based general surgery training coming to an end?
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Document Type: Research Article

Affiliations: Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA

Publication date: 2010-06-01

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  • The Southeastern Surgical Congress owns and publishes The American Surgeon monthly. It is the official journal of the Congress and the Southern California Chapter of the American College of Surgeons, which all members receive each month. The journal brings up to date clinical advances in surgical knowledge in a popular reference format. In addition to publishing papers presented at the annual meetings of the associated organizations, the journal publishes selected unsolicited manuscripts. If you have a manuscript you'd like to see published in The American Surgeon select "Information for Authors" from the Related Information options below. A Copyright Release Form must accompany all manuscripts submitted.
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