Neurosurgical Resident Exposure to Pediatric Neurosurgery: An Analysis of Resident Case Logs

Abstract

<b><i>Introduction:</i></b> The purpose of this study is to identify the national trends of exposure to pediatric procedures during neurosurgical residency and to subsequently evaluate how neurosurgery residents’ experiences correlate with the minimum requirements set forth by the American College of Graduate Medical Education (ACGME). <b><i>Methods:</i></b> ACGME resident case logs from residents graduating between 2013 and 2017 were retrospectively reviewed. These reports were analyzed to determine trends in resident operative experience in pediatric procedures. The number of cases performed by residents was compared to the required minimums set by the ACGME within each pediatric surgical category. A linear regression analysis and <i>t</i> tests were utilized to analyze the change in cases performed over the study period. <b><i>Results:</i></b> A mean of 98.8 procedures were performed for each of the 877 residents graduating between 2013 and 2017. The total number of pediatric procedures declined at a rate of 1.7 cases/year (<i>r</i><sup>2</sup> = 0.77, <i>p</i> = 0.05). Spine and cerebrospinal fluid diversion procedures showed decreasing trends at rates of 1.9 (<i>r</i><sup>2</sup> = 0.70, <i>p</i> = 0.08) and 1.2 (<i>r</i><sup>2</sup> = 0.70, <i>p</i> = 0.08) cases/year, respectively. The number of trauma and brain tumor cases were shown to have increasing rates at 1.0 (<i>r</i><sup>2</sup> = 0.86, <i>p</i> = 0.02) and 0.3 (<i>r</i><sup>2</sup> = 0.69, <i>p</i> = 0.08) cases/year, respectively, with trauma cases showing significant increases. There was also a trend of increasing cases logged as the lead resident surgeon by 12.9 cases/year (<i>r</i><sup>2</sup> = 0.99, <i>p</i> < 0.001). The number of cases performed by the average graduating resident was also significantly higher than the minimums required by the ACGME; residents, on average, performed 3 times the required minimum number of pediatric cases. <b><i>Conclusion:</i></b> Neurosurgical residents graduating from 2013 to 2017 reported significantly higher volumes of pediatric neurosurgery cases than the standards set for by the ACGME. During this time, there was also a significant trend of increasing cases logged as the lead resident surgeon, suggesting more involvement in the critical portions of pediatric cases. There was also a significant, but not clinically impactful, decrease in pediatric case volumes during this time. However, the overall data indicate that residents are continuing to gain valuable pediatric experience during residency training.

The effect of COVID-19 on trainee operative experience at a multihospital academic neurosurgical practice: A first look at case numbers

“…[1,2,9,12] White et al found that the average number of pediatric neurosurgical cases performed per resident between the years 2013 and 2017 was 98.8, which was less than the average numbers for operations on adult patients. [13] At our practice, the lockdown did not seem to significantly impact the number of cases for the rotating resident and is unlikely to affect the ACGME requirements of pediatric cases for graduation. e pediatric rotation here is a bridge from junior residency to senior residency and is often when our residents learn to hone their microsurgical skills operating under a microscope.…”

Pediatric neurosurgery training during residency in the United States: a program director survey

“…The current study demonstrates that although residents on average log more than three times the required number of pediatric cases, 8 pediatric neurosurgery exposure during residency training remains extremely variable. Much of this is probably due to the institution-dependent exposure to pediatric neurosurgery and the lack of a stan- Our study was limited by the subjective nature of a survey and an incomplete cohort (77.4% response rate).…”

“…Of note, the study also demonstrated a significant decrease in the number of cases logged during this interval. 8 Case volumes alone may not provide enough information, given the significant variability in case volume measurements that have been reported across multiple fields, especially in increasingly subspecialized fields. In a sur- 9 Exposure to pediatric surgery is also quite varied among programs.…”