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A Decades Review: A Disturbing Decrease In Case Volume At A Core Clinical Site Affecting Fellows Training Experience
Luke D. Perry, Kevin D. Engledow, Michael Hurst, Matthew Sideman, Lori D. Pounds.
UT Health San Antonio, San Antonio, TX, USA.
Objectives: The correlation between training program case volume has been validated by Shaban as a predictable objective training metric to generate a competent surgeon. Each training program must keep due diligence regarding the yearly trends on their training sites to monitor the case volume and quality of cases (index cases and appropriate autonomy) to ensure that the trainee is receiving the best rounded and largest exposure possible. This study aims to identify case gaps in a single training program and the need for consistent rotation re-evaluation.
Methods: A ten-year retrospective review of ACGME case logs from 8 graduated and 2 current fellowship level trainees was completed. The total number of cases were recorded at one and 12 months with the category of the case recorded. Fellows 1-6 had a one-year rotation at that clinical training site, but Fellows 7-10 only had 9 months, so their cases were extrapolated to one year.
Results: From 2015-2020, 1-month case numbers average 53.5. There was a zenith to eighty-seven in 2021 (mid-COVID) with a continual decline for fellows 8-10 (79, 53, and 23 respectively). Equalized 12-month case data showed a change in graduating case volume for fellows 6-8 from 548 to 332 to 265 respectively. All case categories showed a decline in volume, the most pronounced being aneurysms.
Conclusions: The pathway to teaching competence has been shown to be repetitive case volume, and it is the responsibility of the education leadership to find the best clinical partner for that goal. One clinical partner’s decline began with COVID that did not allow a full rebound, but there were multiple staff changes, new directives with increased bureaucratic obstacles and a malfunctioning sterilization department that shut down the entire OR and had all surgery transferred to other institutions. These findings have led to the program leadership reviewing case numbers monthly and looking for alternative arrangements. The authors suggest that all programs stay diligent and constantly re-evaluate their rotational cycle and quality that the different sites provide.
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