Recent trends in the operative experience of junior pediatric surgical attendings: a study of APSA applicant case logs

doi:10.1016/j.jpedsurg.2014.10.040

Journal of Pediatric Surgery

Volume 50, Issue 1, January 2015, Pages 186-190

https://doi.org/10.1016/j.jpedsurg.2014.10.040 Get rights and content

Abstract

Purpose

Pediatric surgical education and workforce have changed significantly in the past decade. To document trends in the operative experiences of junior pediatric surgeons, we examined case logs submitted by applicants for membership to APSA.

Methods

Case logs for 164 APSA membership applicants from 2006 to 2013 were reviewed. Total case volume, categories, and specific operations were analyzed. Negative binomial regression assessed for significant associations between the number of cases and the application year, presence of a pediatric surgery training program, region of the country, and years since fellowship completion.

Results

Overall case numbers decreased initially after 2006/2007, but have remained stable since. Decreasing trends were seen in a number of specific cases/categories. The number of newborn cases did not change. Significant variations in operative experience were identified depending upon region, presence of a pediatric surgery training program, and years since fellowship completion. Median reported value for several important cases was ≤ 4 per year, and for some was zero.

Conclusion

These data describing the experience of young pediatric surgeons supplement recent observations regarding pediatric surgery fellows and general surgery residents. The limited exposure of surgeons to particularly rare conditions appears to be an unresolved problem. This information will be useful in developing future workforce proposals.

Section snippets

Materials and methods

All study procedures were conducted in compliance with North Shore-LIJ institutional review board policy. Applicants for full membership to APSA complete a standardized case log form supplied by the organization [5]. These logs delineate 226 separate procedures performed as attending surgeons, divided under 13 categories/types (skin and soft tissues, thoracic, alimentary tract, etc.). Procedures are further subdivided according to surgeon involvement (surgeon, assistant or teaching assistant)

Results

The majority of surgeons submitting case logs (69%) had completed their fellowship training within the previous 3 years or less and 47% were practicing at medical centers associated with pediatric surgery fellowship programs. Regions of the United States were proportionally represented in our study (West: n = 39, Southwest: 27, Midwest: 33, Southeast: 28, Northeast: 31) with significantly fewer case logs (n = 6) coming from surgeons practicing internationally (including Canada).

The average case

Discussion

Recent studies documenting surgical case volumes have been almost exclusively focused on residency and fellowship experiences and have shown variable results. Studies of general surgery resident and pediatric surgery fellow case logs demonstrated a trend of decline in the number of pediatric cases for general surgery residents, whereas pediatric surgery fellows have seemed to maintain a consistent overall operative experience [1], [2]. Other studies have shown that there has been little change

Acknowledgments

The authors appreciate the encouragement and support this project received from APSA, with particular thanks to Marina Petrulla for her administrative skills.

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The Canadian Association of Paediatric Surgeons launched a 10-year prospective assessment of the Canadian pediatric surgery workforce and training environment, beginning in 2013. The results of the first 5 years (2013–2017) were previously published. Here, we present the results of the last 5 years (2018–2022), and the cumulative results of the past decade.
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Complete responses were received from all 18 divisions (100% response rate). Over the decade studied, the number of pediatric surgeons and full-time equivalent positions increased from 73 to 81, and 65 to 82, respectively. Thirty positions were vacated (15 retirement, 6 new Canadian practice, 8 leaving Canada, 1 other), and 38 were filled (20 new Canadian fellowship graduates, 8 Canadian surgeons moving from other sites in Canada, 10 surgeons coming from outside Canada). Seventy-five fellows completed training eligible for North American certification, including 34 Canadians, 31 Americans, and 10 non-North American foreign nationals (9 of whom left North America after training). The proportion of Canadian graduates who desired, but could not find, a Canadian position improved from 44% in the first 5 years to 20% in the second 5 years.
The Canadian pediatric surgery workforce has experienced a modest increase over a decade. A mismatch still exists between Canadian pediatric surgery graduates and attending staff positions, but the situation has improved during the last 5 years.
Survey.
5.
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Inpatient GT placements in patients < 18 years old at a tertiary children's hospital from 9/2014 to 2/2020 were included. The primary outcome was GT use <6 months (short-term). Secondary outcomes included age at placement, indication for GT, and operations for GT-related issues.
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Fundoplication for gastro-esophageal reflux disease (GERD) has been commonly performed by pediatric surgeons, however there are no recent data documenting fundoplication trends. Changes in fundoplication volume impact pediatric surgical training and may reflect changes in care for children with severe GERD.
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Mean institutional fundoplication case volume decreased from 50 in 2010 to 17 in 2019. Trends were similar between institutions with and without fellowship programs when corrected by total operative volume. Patient characteristics were relatively unchanged between 2010 and 2019. Fundoplication volume reported in fellow case logs decreased from 46 in 2010 to 26 in 2019, mirroring national data.
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Retrospective study.
Level II.
Bolus versus continuous feeding regimens post gastrostomy tube placement in children
2021, Journal of Pediatric Surgery
Owing to the frequency of gastrostomy tube placement in children and the numerous regimens used to start feeds after placement we attempted to see if it matters if the initial feeds after a gastrostomy tube placement are provided in a bolus or continuous manner.
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APSA PaperRecent trends in the operative experience of junior pediatric surgical attendings: a study of APSA applicant case logs

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

J Pediatr Surg

J Pediatr Surg

J Surg Educ

J Pediatr Surg

Am J Surg

Operative experience in the era of duty hour restrictions: is broad-based general surgery training coming to an end?

Am Surg

Application for Regular Membership

APSA Paper
Recent trends in the operative experience of junior pediatric surgical attendings: a study of APSA applicant case logs