An Analysis of Operative Experiences of Junior General Surgical Residents and Correlation With the SCORE Curriculum

Objective

Junior surgical resident education at academic institutions is traditionally focused to preoperative and postoperative patient management. Our objective was to investigate the number and type of surgical procedures performed by junior general surgery residents in comparison with the American Board of Surgery requirements and the Surgical Council on Resident Education (SCORE) curriculum.

Design

This was a retrospective study using the Accreditation Counsel for Graduate Medical Education (ACGME) operative case logs of junior surgical residents.

Setting

The Ohio State University Wexner Medical Center, Columbus, OH; a tertiary academic medical center.

Participants

We performed, an institutional review board approved, retrospective review of logged surgical cases from general surgical residents during postgraduate year (PGY) 1 and 2 from 2009 to 2015 at an academic medical center. Summary case logs were accessed from the ACGME. Procedures were extracted from the SCORE curriculum and correlated to corresponding ACGME defined procedures for total cases, major cases, and endoscopy. Minor cases and patient care cases were excluded as they were not clearly defined on the category report. SCORE procedures were excluded if there was not a corresponding ACGME procedure on the summary report. SCORE procedures and ACGME procedures were combined with each other if there was overlap with correlation. Statistics were performed on individual and total resident data. One-sample student’s t-test was used to compare total number of cases logged with the 250 case log ABS requirement and to compare the total major cases and endoscopy performed with those represented on SCORE.

Results

Overall, 26 residents completed both PGY-1 and 2 years from 2009 to 2015, and remained at the same institution for case logs to be accessed during the study period. A total of 21 residents (80.76%) completed 250 cases or more after their first 2 years of residency. Across all years, the mean case log was 349 cases (p = 0.20), and was statistically more than than 250 cases in 3 of the 5 class years. Junior residents completed a total mean of 312 major and endoscopy cases (89%) at the end of 2 years, which was statistically higher than the 75% testing hypothesis across all years (p < 0.01). Of major and endoscopy cases performed in total by the completion of the PGY-2 year, a mean of 275 cases (88%) were included in the SCORE curriculum. Using one-sample t-test, SCORE procedures represented more than 85% of the major and endoscopy cases logged (p < 0.01). Of all major and endoscopy cases logged that correlate to a SCORE procedure, 95% were found to be “core” and 5% were “advanced.”

Conclusions

Our study demonstrates that junior surgical residents meet the 250 case log requirement put forth by the ABS, and most major procedures and endoscopy performed correspond with the core cases of the SCORE curriculum at our institution. This study aid in the confirmation of the SCORE curriculum for junior residents, and those procedures which should be designated as core.

Introduction

Junior surgical resident education at academic institutions is predominantly focused on preoperative and postoperative patient management. There has been recent literature correlating a decrease in junior resident case volume in conjunction with new work-hour restrictions.¹ To ensure adequate exposure to the operating room early in residency, the American Board of Surgery (ABS) mandated surgical trainees who began residency in July 2014 or thereafter to perform 250 major or minor operations by the end of their second year of training.² Residents submit their operative case log to the Accreditation Council for Graduate Medical Education (ACGME), the supervising body of approved graduate medical education programs in the United States.³

The Surgical Council on Resident Education (SCORE) was founded in 2009 to provide general surgery residency programs with a structured online program curriculum.⁴ SCORE outlines a basic surgery curriculum for all the first-year surgical residents, and a comprehensive technical skills curriculum for all levels of general surgical training with detailed operative procedures.⁵ The curriculum currently divides these operations into “core” and “advanced.” The ABS has endorsed the integration of the SCORE curriculum in general surgical training curriculums nationwide.⁶

The quantity and type of operative procedures performed by junior residents has not been well described. Our primary objective was to investigate the number of total cases performed by junior surgical residents in comparison with the 250 case log requirement set forth by the ABS. Our secondary objective was to classify the surgical operations recorded by junior general surgery residents at the completion of their second year of training and compare these to the SCORE curriculum.