Introduction

1. Local and national trends in general surgery residents’ operative experience: Do work hour limitations negatively affect case volume in small community-based programs? AlexeyMarkelov MD, AniketSakharpe MD, HarjeetKohli MD, David Livert MDEaston Hospital, Drexel University School of Medicine, Easton, PA

2. Introduction • The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003. • New work hour regulations coming in July 2011 • Particular concern about potential negative impact on surgical subspecialties due to limited time to acquire necessary surgical proficiency and skills

4. Introduction • Severalpapers claimed decrease in total number operative cases performed by graduating residents (Feany et al, Kairyset al), whereas other studies failed to reveal statistically significant difference (Bland et al, Simien et al). • No studies specifically investigated changes in residents’ operative experience in small community-based programs

6. Methods • We retrospectively analyzed annual ACGME generated national and comparative operative log reports for from 2005 to 2009 academic years • Data obtained from Easton Hospital General Surgery residency program operative log reports (years 2002-2009) was used for comparison. • In order to increase the statistical power of the study Hierarchical Linear Modeling (HLM) technique was utilized to estimate the overall trend across procedures and deviation of each subcategory from the overall trend.

9. Fig 1: Trend for average number of cases over 5 year period

10. Fig 2: Trends among Subcategories

12. Results • Comparing the national trend to the community hospital we see that there is total increase in cases at the national level while there is decrease in case volume at the community hospital. • Statistically significant decrease (p<0.05) in number of genitourinary (-0.83), gynecology (-0.37) and orthopedics (-0.39) cases performed by residents was seen throughout the country.

13. Discussion • Preservation of educational experience in majority of the programs nationwide becomes possible due to variety of institutional modifications. • Nuthalapatyet al found that 98% of respondents in obstetrics and gynecology training programs reported modifications to program structure.

14. Discussion • Due to traditionally smaller number of residents in the program, community-based programs cannot easily implement certain structural changes: - night float system - restructuring call schedule (decreasing call frequency) - modification of resident assignment to clinical services • Small programs can not afford hiring physician extenders to decrease work load on residents

15. Conclusions • Despite maintaining the level of absolute case volume in resident training programs, there are major trends that have and will continue to alter the operative experience and case mix of surgical trainees . • Work hour restrictions have been favorable for the larger programs, as these programs were able to better integrate the night float system, restructure their call schedule and implement institutional modifications which might be too resource demanding for smaller training programs .