Association of Women Surgeons
General surgery resident rotations in surgical critical care, trauma, and burns: what is optimal for residency training?

https://doi.org/10.1016/j.amjsurg.2016.07.016Get rights and content

Abstract

Background

There are no specific Accreditation Council for Graduate Medical Education General Surgery Residency Program Requirements for rotations in surgical critical care (SCC), trauma, and burn. We sought to determine the experience of general surgery residents in SCC, trauma, and burn rotations.

Methods

Data analysis of surgical rotations of American Board of Surgery general surgery resident applicants (n = 7,299) for the last 8 years (2006 to 2013, inclusive) was performed through electronic applications to the American Board of Surgery Qualifying Examination. Duration (months) spent in SCC, trauma, and burn rotations, and postgraduate year (PGY) level were examined.

Results

The total months in SCC, trauma and burn rotations was mean 10.2 and median 10.0 (SD 3.9 months), representing approximately 16.7% (10 of 60 months) of a general surgery resident's training. However, there was great variability (range 0 to 29 months). SCC rotation duration was mean 3.1 and median 3.0 months (SD 2, min to max: 0 to 15), trauma rotation duration was mean 6.3 and median 6.0 months (SD 3.5, min to max: 0 to 24), and burn rotation duration was mean 0.8 and median 1.0 months (SD 1.0, min to max: 0 to 6). Of the total mean 10.2 months duration, the longest exposure was 2 months as PGY-1, 3.4 months as PGY-2, 1.9 months as PGY-3, 2.2 months as PGY-4 and 1.1 months as PGY-5. PGY-5 residents spent a mean of 1 month in SCC, trauma, and burn rotations. PGY-4/5 residents spent the majority of this total time in trauma rotations, whereas junior residents (PGY-1 to 3) in SCC and trauma rotations.

Conclusions

There is significant variability in total duration of SCC, trauma, and burn rotations and PGY level in US general surgery residency programs, which may result in significant variability in the fund of knowledge and clinical experience of the trainee completing general surgery residency training. As acute care surgery programs have begun to integrate emergency general surgery with SCC, trauma, and burn rotations, it is an ideal time to determine the optimal curriculum and duration of these important rotations for general surgery residency training.

Section snippets

Methods

We analyzed de-identified data of the surgical rotations of applicants to the American Board of Surgery (ABS) Qualifying Examination (QE) over an 8-year period, from 2006 to 2013, inclusive. General surgery resident rotation data submitted through electronic applications were examined. We determined the number of months spent in SCC, trauma, and burn rotations and at what PGY level for general surgery residents using candidate rotation lists and analyzed by the ABS psychometrician (T.W.B.).

Data

Results

Table 2 reports residents' total months in all SCC, trauma, and burn rotations during general surgery residency. The mean number of months in SCC, trauma, and burn rotations for general surgery residents was 10.2 months (SD 3.9 months), representing approximately 16.7% (10 of 60 months) of residency training. However, there was wide variability reported, as reflected by the minimum to maximum range of 0 to 29 months. It should be noted that the mean total number of months has been constant over

Comments

In this study, we have identified that there is significant variability in the duration of rotations in SCC, trauma, and burn during general surgery residency. It is unclear whether the current rotations provide competency-based education to meet the Surgical Council on Resident Education (SCORE) Curriculum General Surgery requirements in these 3 areas (SCC, trauma, and burn). Almost all the SCORE modules in these 3 areas are delineated as “core” patient care topics.11

Since one of the goals of

Conclusions

There is significant variability in total duration of SCC, trauma, and burn rotations and PGY level in US general surgery residency programs, which may result in significant variability in the fund of knowledge and clinical experience of the trainee completing general surgery residency training. As acute care surgery programs have begun to integrate emergency general surgery with SCC, trauma, and burn rotations, it is an ideal time to determine the optimal curriculum and duration of these

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    There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs.

    The authors declare no conflicts of interest.

    Members of the Trauma, Burns and Critical Care Board of the American Board of Surgery: Roxie M. Albrecht, M.D., F.A.C.S., Karen J. Brasel, M.D., F.A.C.S., Eileen M. Bulger, M.D., F.A.C.S., Martin A. Croce, M.D., F.A.C.S., David G. Greenhalgh, M.D., F.A.C.S., Pamela A. Lipsett, M.D., F.A.C.S., Frederick A. Luchette, M.D., F.A.C.S., Robert C. Mackersie, M.D., F.A.C.S., Anne G. Rizzo, M.D., F.A.C.S., Ronald M. Stewart, M.D., F.A.C.S., David A. Spain, M.D., F.A.C.S.

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