These data pose important problems for surgical educators. Methods will have to be developed to allow surgeons to reach a basic level of competence in procedures which they are likely to experience only rarely during residency. Even for more commonly performed procedures, the numbers of repetitions are not very robust, stressing the need to determine objectively whether residents are actually achieving basic competency in these operations. Finally, the large variations in experience between individuals in our residency system need to be explored, understood, and remedied.
This unique database will be useful in tracking trends over time. More importantly, it demonstrates that general surgery practice in the United States is extremely heterogeneous, a fact that must be acknowledged in any future workforce deliberations.
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