1. VANDERBILT SURGERY Impact of Initiation of a Pediatric Surgery Fellowship on General Surgery Resident Operative Volume ♦ ♦ ♦ Rebecca A. Snyder, MD Sharon E. Phillips, MSPH Kyla P. Terhune, MD Vanderbilt University School of Medicine

2. VANDERBILT SURGERY Background  Operative volume among general surgery (GS) residents and programs varies significantly  Residents in programs that are larger, university-affiliated, or in the Northeast report lower case numbers 1 and may feel less confident in their operative skills than residents at other programs 2 1. Bell RH et al. Ann Surg. 2009. 2. Bucholz EM et al. Arch Surg. 2011.

3. VANDERBILT SURGERY Background  80% of graduating GS residents are pursuing a fellowship 1  Volume traditionally captured by residents is often diverted towards fellows 2 1. Borman KR et al. J Am Coll Surg. 2008. 2. Bell RH et al. Ann Surg. 2009.

4. VANDERBILT SURGERY Background  Prior studies of the effects of coexisting fellowships on GS residents show mixed results  Minimally invasive (MIS) fellowships 1,2  2009: multiple programs with colorectal, vascular, MIS, and endocrine fellowships 3  No difference in resident CRS volume  Decline in MIS and vascular volume  Specifically: open colectomy and lap chole 1. Kothari SN et al. J Surg Educ. 2008. 2. Linn JG et al. Surgery. 2011. 3. Hanks JB et al. Ann Surg. 2011.

5. VANDERBILT SURGERY Purpose  To determine the impact of initiation of a new pediatric surgery fellowship on general surgery resident operative volume at a major academic institution

6. VANDERBILT SURGERY Methods  Retrospective Review of ACGME operative logs:  GS residents: July 1, 2003 to June 30, 2011  Pediatric surgery fellows: July 1, 2007 to June 30, 2011  Collected data including:  Pediatric index cases  All pediatric cases  Total number of primary surgeon cases to date  Number pediatric surgeons, RVUs, admissions, CPTs

7. VANDERBILT SURGERY Results  109 resident rotations  78 residents  7 fellow rotations (years)  4 fellows

8. VANDERBILT SURGERY YearSurgeonsRVUsAdmissionsCPTs 2003451,3002,4253,488 2004455,4372,4313,572 2005559,5032,8753,823 2006765,0813,2104,294 2007766,3273,5564,684 2008764,9953,7724,850 2009664,1753,8604,953 2010864,5793,6024,671

9. VANDERBILT SURGERY PrePostp-value Pediatric index cases34 (27, 48) 23.5 (17, 29.5) <0.001 Total cases on peds74 (63, 103) 53 (43, 71) <0.001 Miscellaneous pediatric cases 12 (7, 18) 15 (7, 19) 0.559 Total primary surgeon cases to date: PGY 3 579 (498, 614) 555.5 (410.5, 623) 0.363 Total primary surgeon cases to date: PGY 4 868 (791.5, 916) 831 (786-936) 0.820

12. VANDERBILT SURGERY PrePostp-value Index cases 16.911.7<0.001 Total cases 37.529.2<0.001 Mean cases per 28 resident days

13. VANDERBILT SURGERY Limitations  Single institution  Intern data not captured  Dependent on ACGME log accuracy  Case volume only one measure of educational experience  Inpatient/ward experience  Outpatient clinic  Educational Conferences

14. VANDERBILT SURGERY Conclusions  General Surgery resident operative volume in pediatric surgery decreased significantly after the addition of a fellowship.  Careful preparation is necessary to anticipate and protect the general surgery resident experience when new surgical fellowships are implemented.

15. VANDERBILT SURGERY Acknowledgements  Margaret Tarpley, MLS  John Tarpley, MD, FWACS, FACS  Stephanie Rowe, Program Coordinator, General Surgery  Jennifer Wilkins, Program Coordinator Pediatric Surgery Fellowship  Dai Chung, MD

16. VANDERBILT SURGERY Questions?