Trends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log Data

doi:10.1016/j.arthro.2015.11.015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 32, Issue 4, April 2016, Pages 645-650

https://doi.org/10.1016/j.arthro.2015.11.015 Get rights and content

Purpose

To analyze orthopaedic resident case log data to report temporal trends in performing arthroscopic procedures and to assess variability in arthroscopic case volume among residents.

Methods

Accreditation Council for Graduate Medical Education orthopaedic surgery resident case logs were reviewed from 2007 to 2013. The mean number of wrist, elbow, shoulder, knee, and ankle arthroscopic procedures performed by graduating residents was analyzed. The median number of arthroscopic procedures reported by the 70th and 30th percentiles of graduating residents (by arthroscopic case volume) was also recorded. Temporal trends were assessed using a linear regression model.

Results

From 2007 to 2013, there were significant increases in the mean number of wrist (5.8 to 6.3; P = .038), elbow (2.5 to 3.2; P < .001), shoulder (93.5 to 133.8; P < .001), knee (170.6 to 185.1; P = .011), and ankle (5.8 to 7.4; P < .001) arthroscopies performed per resident. Residents in the 70th percentile of caseload performed significantly more wrist (7 v 2; P < .001), elbow (3.3 v 1; P < .001), shoulder (134.1 v 70.6; P < .001), knee (205 v 128.7; P < .001), and ankle (7.9 v 2.9; P < .001) arthroscopies than residents in the 30th percentile.

Conclusions

Our findings indicate that arthroscopic caseload is increasing among orthopaedic residents. However, resident experience performing arthroscopic procedures is substantially disparate. Although the educational implications of this disparity are not well understood, our findings may aid in efforts to optimize arthroscopic training during orthopaedic residency.

Section snippets

Methods

ACGME case log data for orthopaedic residents were analyzed for graduating years 2007 to 2013.⁴ The annual number of orthopaedic residency programs and number of graduating orthopaedic residents was noted. The mean number of wrist, elbow, shoulder, hip, knee, and ankle arthroscopic procedures performed by graduating residents during this duration was recorded. In addition, the median number of procedures reported by graduating residents in the 70th and 30th percentiles of case volume were

Results

Over the 7-year period, the number of orthopaedic residency programs increased from 149 to 150 (P = .38). During this time, the number of graduating orthopaedic residents increased significantly from 616 to 678 (P < .001).

Discussion

Our investigation revealed significant variability in case volume among residents performing arthroscopic procedures, supporting our study hypothesis. Residents in the 70th percentile by case volume performed 3.5 times more wrist arthroscopies, 3.3 times more elbow arthroscopies, 1.9 times more shoulder arthroscopies, 1.6 times more knee arthroscopies, and 2.7 times more ankle arthroscopies than residents in the 30th percentile The cause of this disparity in case volume among residents is not

Conclusions

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Cited by (23)

Orthopedic surgery residents reported increased shoulder procedure volumes during the COVID-19 pandemic
2023, JSES Reviews, Reports, and Techniques
The purpose of this study is to evaluate the impact of the COVID-19 pandemic on shoulder procedure volumes reported to the Accreditation Council for Graduate Medical Education by orthopedic surgery residents.
We performed a retrospective review of Accreditation Council for Graduate Medical Education case logs reporting data from graduating orthopedic surgery residents during the academic years of 2006-2022. Data were queried for all patients for the following shoulder Current Procedural Terminology codes: incision, excision, intro or removal, repair/revision/reconstruction, fracture and/or dislocation, manipulation, arthroscopy, trauma, and total procedures performed. Individual t-tests were used to compare case log trends of graduating academic years before (classes of 2018 and 2019) and during (classes of 2020, 2021, and 2022) the COVID-19 pandemic. Statistical significance was established to be P <.05 for total procedure types, but at P <.005 during category comparisons to protect against alpha errors.
Reported mean total shoulder procedures per resident steadily increased each year from 2017 to 2022, but the only significant increase was seen when comparing the graduating classes of 2020 to 2021 (157.9 vs. 165.7, P =.02). Stratification of these procedures by subgroup revealed a significant increase in manipulation procedures from 2021 to 2022 (7.3 vs. 8.8, P =.001).
COVID-19 did not have a negative impact on logged shoulder procedure volume. Orthopedic surgery residents graduating during the COVID-19 pandemic reported more shoulder procedures than those graduating prepandemic. However, shoulder procedure log trends should be longitudinally investigated, as preceding years of procedural opportunities may underestimate the pandemic’s impact.
What is the place of wrist arthroscopy in surgical residents’ training? Wrist Arthroscopy in Residents Survey (WARS)
2022, Orthopaedics and Traumatology: Surgery and Research
Wrist arthroscopy has become an essential method in the management of patients suffering from wrist pathologies. This technique must be mastered by residents wishing to specialize in upper limb surgery. However, no study has evaluated residents’ access to wrist arthroscopy.
Residents have difficulty accessing wrist arthroscopy surgery during their training.
We sent out an online questionnaire to all orthopedic and plastic surgery referents in France. Data were collected over a 6-month period from December 2020 to May 2021. A descriptive statistical analysis was performed.
Regarding the 98 responses obtained, we observed that 77.54% of residents have seen between 0 and 10 wrist arthroscopies and 35.71% have never seen a wrist arthroscopy. In addition, only 23.80% of residents have had access to training on cadavers, and 57.14% of residents were trained in private facilities.
Access to the operating room remains difficult for residents in upper limb surgery. Our results suggest that wrist arthroscopy training could be improved. New training methods could be adapted for wrist arthroscopy and to overcome the lack of access to wrist arthroscopy for residents.
IV.
What is the place of wrist arthroscopy in surgical residents’ training? Wrist Arthroscopy in Residents Survey (WARS)
2022, Revue de Chirurgie Orthopedique et Traumatologique
L’arthroscopie du poignet est devenue une technique incontournable dans la prise en charge des patients atteints de pathologies du poignet. Cette technique doit être maîtrisée par les internes qui souhaitent se spécialiser en chirurgie du membre supérieur. Cependant, aucune étude n’a évalué l’accès des internes à l’arthroscopie du poignet.
Les internes accèdent difficilement à des chirurgies par arthroscopie du poignet durant leur formation.
Nous avons envoyé un questionnaire en ligne à tous les référents de chirurgie orthopédique et plastique en France. Les données ont été recueillies sur une période de 6 mois de décembre 2020 à mai 2021. Une analyse statistique descriptive a été réalisée.
Sur les 98 réponses obtenues, nous avons observé que 77,54 % des internes ont vu entre 0 et 10 arthroscopies du poignet et 35,71 % n’ont jamais vu d’arthroscopie du poignet. De plus, seuls 23,80 % des internes ont eu accès à une formation sur les cadavres et 57,14 % des internes ont été formés dans des structures privées.
L’accès au bloc opératoire reste difficile pour les internes en chirurgie du membre supérieur. Nos résultats suggèrent que la formation à l’arthroscopie du poignet pourrait être améliorée. De nouvelles méthodes de formation pourraient être adaptées pour l’arthroscopie du poignet et pallier le manque d’accès à l’arthroscopie du poignet pour les internes.
IV.
Ankle Arthroscopy Procedural Volume Is Low Among Graduating Orthopaedic Surgery Residents
2022, Arthroscopy, Sports Medicine, and Rehabilitation
To evaluate graduating orthopaedic resident case volume and variability for ankle arthroscopy from 2016 to 2020.
The Accreditation Council for Graduate Medical Education surgical case log data from 2016 to 2020 for graduating United States orthopaedic surgery residents was assessed. Arthroscopy procedures of the leg/ankle were categorized. The average number of cases performed per resident was compared from 2016 to 2020 to determine the percent change in case volume. The 10th, 30th, 50th, 70th, and 90th percentiles of case volumes from 2016 to 2020 were presented to demonstrate case volume variability.
There was no significant change in the average number of leg/ankle arthroscopy cases from 2016 to 2020 (6.2 ± 5 [range 0-35] vs 6.1 ± 6 [range 0-76] P = .732), despite a 19% increase in the average number of total leg/ankle procedures performed over time (168.4 ± 47 [range 55-414] in 2016; 200.8 ± 57 in 2020 [range 67-601], P < .001). There was wide variability in ankle arthroscopy case volume among residents. The 90th percentile of residents performed 13 cases in 2020, compared with 5 in 50th percentile, and 1 in the 10th percentile.
Orthopaedic surgery resident exposure to ankle arthroscopy has remained low and highly variable overtime, despite an overall increase in the total number of leg/ankle procedures performed.
Understanding ankle arthroscopy in case volume and variability is important for programs to ensure that orthopaedic residents are gaining adequate exposure to increasingly popular procedures. Orthopaedic surgery residency programs should explore methods to increase resident exposure to ankle arthroscopy.
ACGME Case Volume Minimums Decrease the Number of Shoulder and Knee Arthroscopies Performed by Residents
2021, Arthroscopy, Sports Medicine, and Rehabilitation
The purpose of this study was to examine how the implementation of Accreditation Council of Graduate Medical Education (ACGME) case minimums in 2013 has affected the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents during their clinical training.
The ACGME orthopaedic surgery case log data from graduation years 2007 to 2019 was used to evaluate the number of shoulder and knee arthroscopies performed. The mean and median number of cases performed per resident were compared for the years prior to implementation of the ACGME case minimum (2007-2012) and after (2013-2019).
The ACGME orthopaedic surgery case minimums resulted in a significant decrease in the mean number of shoulder and knee arthroscopies performed. The mean number of shoulder arthroscopies performed in the years before and after the case minimum requirement were 109.8 and 82.0 (P = .025), respectively. The mean number of knee arthroscopies performed in the years before and after the case minimum requirement were 178.6 and 124.8 (P = .006), respectively. Residents in the tenth percentile of cases performed still met the required ACGME case minimums each year. The mean total of all cases performed in the years before and after the case minimum requirement were 2045.5 and 1699.3 (P = .038), respectively.
The number of shoulder and knee arthroscopies performed by orthopaedic surgery residents significantly decreased after the implementation of ACGME case minimums, which may be due to underreporting of cases.
This study may demonstrate the effect of the implementation of the ACGME case minimums on the number of shoulder and knee arthroscopies performed by orthopaedic surgery residents.
Decrease in Resident Arthroscopic Case Volume After 2013 Implementation of Minimum Case Requirements
2021, Arthroscopy, Sports Medicine, and Rehabilitation
Citation Excerpt :
Finally, we found that variability in arthroscopy caseload volume among residents has decreased since 2013. Previous studies found a large disparity in caseload volume between residents in the 10th and 90th percentiles.1-4,11 Our data show a shrinking gap between the number of arthroscopy cases reported by residents with high-volume versus low-volume caseloads.
To analyze graduating U.S. orthopaedic resident case logs to determine temporal trends in knee and shoulder arthroscopic case volumes, as well as changes in the variability of caseload volumes since the implementation of Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements (“case minimums”) in 2013.
We abstracted ACGME-published case log data for all U.S. orthopaedic surgery residents who graduated from 2007 to 2013 (before implementation of case minimums) and from 2014 to 2019 (after implementation). Using a case–control study design, we compared mean numbers of arthroscopic knee and shoulder cases reported per resident between the 2 time periods by using unpaired 2-tailed t tests. P values < .05 were considered significant.
The mean number of arthroscopy knee cases reported by residents decreased from 164 before implementation of case minimums to 107 after implementation (P < .001). The mean number of shoulder cases decreased similarly from 98 to 66 (P < .001). Among residents with caseload volumes in the 90th percentile (“high-volume caseloads”) the decrease was greatest, with 38% fewer knee cases and 41% fewer shoulder cases logged. The ratio of the number of cases in the 90th percentile of caseload to the number in the 10th percentile decreased significantly after implementation of case minimums (P < .001).
After implementation of ACGME case minimums in 2013, the numbers of arthroscopic knee and shoulder cases reported by graduating U.S. orthopaedic surgery residents decreased significantly. The disparity between the number of cases that constitutes a high-volume caseload and the number that constitutes a low-volume caseload narrowed, suggesting greater uniformity in resident exposure to these procedures across training programs.
Level III, retrospective comparative study.

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: The authors report that they have no conflicts of interest in the authorship and publication of this article.

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Original ArticleTrends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log Data

Purpose

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Arthroscopy

J Surg Educ

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Arthroplasty

Objective structured assessment of technical skill in upper extremity surgery

J Hand Surg Am

Variability in spine surgery procedures performed during orthopaedic and neurological surgery residency training: An analysis of ACGME case log data

J Bone Joint Surg Am

Arthroscopic training resources in orthopedic resident education

J Knee Surg

Original Article
Trends in Arthroscopic Procedures Performed During Orthopaedic Residency: An Analysis of Accreditation Council for Graduate Medical Education Case Log Data