Impact of implementation of a pediatric surgery fellowship on general surgery resident operative volume

Objective: The purpose of this study was to determine the impact of the initiation of a pediatric surgery fellowship on general surgery resident operative volume at 1 major academic institution.

Design: Retrospective review of operative records obtained from the Accreditation Council for Graduate Medical Education (ACGME) general surgery resident and pediatric surgery fellow case logs. Data collected included number and type of pediatric index cases per year, number of total pediatric surgery cases per year, and number of total cases logged as primary surgeon to date.

Setting: Vanderbilt University School of Medicine Department of Surgery, which has an accredited general surgery program, finishes 7 chief residents per year during the study period, and instituted a new pediatric surgery fellowship in 2007.

Participants: Case logs submitted by third and fourth year general surgery residents and first and second year pediatric surgery fellows were studied.

Results: The number of pediatric attending surgeons, relative value units (RVUs), and hospital admissions increased from 2003 to 2011. The median number of pediatric index cases performed by a resident decreased after the onset of fellowship from 34 cases to 23.5 cases per year (p < 0.001). The median number of total cases that residents performed on the pediatric surgery rotation also decreased from 74 to 53 cases per year after onset of the fellowship (p < 0.001).

Conclusions: Even with an increase in the number of attending surgeons, RVUs, and admissions, the fellowship resulted in a decrease in general surgery resident index and overall case volume in pediatric surgery. Although operative volume is only 1 measure of surgical educational value, these findings suggest that the addition of surgical fellowships affects the educational experience of general surgery residents. We recommend that residency programs establish goals and calculate any potential impact on general surgery resident case volume before initiating a new surgical fellowship.