EP1031 - Shifting Exposure to Colorectal Cases Amongst General Surgery Residents: A 16-Year Review of ACGME Trends

ePoster Presenter(s)

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  Marnie Abeshouse, MD

  Colon and Rectal Surgery Fellow
  University Hospitals Cleveland Medical Center
  University Hospitals Cleveland Medical Center
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

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Author(s)

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  Emily F. Simon, MD (she/her/hers)

  General Surgery Resident
  University Hospitals Cleveland Medical Center, Department of Surgery
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• 

  Kayvan Barekatain, MD (he/him/his)

  Resident Physician
  Case Western Reserve University Hospitals
  University Hospitals, Cleveland Medical Center
  Cleveland, OH, United States

  Disclosure information not submitted.
• 

  Kristen Westfall, MD, MPH (she/her/hers)

  Assistant Professor of Surgery
  University Hospitals/Cleveland Medical Center
  Case Western Reserve University
  Cleveland, OH, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose
• ES

  Emily Steinhagen, MD, FACS, FASCRS

  Associate Professor of Surgery
  University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
  Cleveland, Ohio, United States

  All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

Senior Author(s)

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  Ronald Charles, MD (he/him/his)

  Assistant Professor of Surgery
  University Hospitals Cleveland Medical Center, Department of Surgery, Division of Colorectal
  Cleveland, OH, United States

  Disclosure information not submitted.

Purpose/Background: Residency case-logs reflect the typical operative experience and educational opportunities available for residents. However, as general surgical residency and management of colorectal conditions have evolved, case minimums have not substantially changed. It is not known whether factors such as duty hour restrictions, increasing numbers of advanced trainees, increasing numbers of cases done at ambulatory surgery centers, or changes in management paradigms have impacted the training experience. This study examines national trends in colorectal case volumes amongst graduating general surgery residents and considers the implications for colorectal residencies.

Methods/Interventions: A retrospective analysis of ACGME summary case logs for all U.S. general surgery residents from 2008 to 2024 was performed. These logs report average case numbers by defined category. Key colorectal procedures were analyzed, including stoma creation, colectomies/proctectomies (laparoscopic and open), anorectal cases, abdominoperineal resection, and ileal pouches. Case volumes over time were evaluated to assess trends in procedural exposure and fellowship readiness.

Results/Outcomes: Residents reported increased exposure to abdominal procedures: stoma creation (7.2 to 12.1 cases), anorectal procedures (26.4 to 40.0), and colectomy/proctectomies (56.4 to 62.9 cases), with laparoscopic colectomies/proctectomies doubling (12.7 to 24.9). However, there was a decline in open colectomies/proctectomies (43.7 to 38.0) and exposure to pelvic cases, as evidenced by both ileal pouch (~0.5 to 0.3) and abdominoperineal resection (3.0 to 2.0) volume.

Conclusion/Discussion: General surgery residents are exposed to more laparoscopic colectomies and other abdominal procedures than in the past, but their exposure to pelvic cases has decreased over time. This suggests that the educational needs of incoming colorectal residents may be evolving, which has implications for colorectal residency programs. In addition, many general surgeons continue to perform colorectal procedures in practice and thus may have different experiences and comfort levels with these cases compared to prior generations. The impact of these findings on skill, confidence, and patient outcomes have yet to be determined.

Average Case Volumes for Colorectal Procedures Among General Surgery Residents
General Surgery Resident Colorectal Case Trends Over Time by Procedure Type