Trauma training during general surgery residency has changed dramatically over the past two decades. Although we like to blame the 80-hour work week rule on everything, there are other factors that may be at play. Increasing use of nonoperative management, availability and increasing scope of interventional radiologists, and the increasing number of surgical subspecialists are certainly significant.
The surgical group at LAC+USC looked at changes in operative caseloads, type of surgery performed, and the impact that concurrent subspecialty training has had on trauma operative volumes. The authors reviewed 16 years of ACGME data on resident surgical procedures in various body regions by year of training. They specifically looked at the impact of implementation of the 80-hour work week.
Here are the factoids:
- There was a trend only (p=0.07) toward decreased operative trauma cases
- The number of trauma laparotomies increased, vascular procedures decreased, and neck explorations and thoracotomies remained stable
- Trauma vascular procedures decreased for surgical residents, but increased for vascular fellows
- Individual resident operative volumes in chest, abdomen, solid organ, and extremities decreased after implementation of the 80-hour work week
- Based on this, the authors recommend residents who are interested in a career in trauma and acute care surgery have fellowship training (??)
Bottom line: Well, it was a catchy title, at least. Or is it a promotion for trauma fellowships? I hope the authors have some really good statistics to help this paper out. You may not be able to read the table above well, but the differences between pre-80 hour and post-80 hour are not that impressive, and the SD or SEM (can’t tell what they are) are uncommonly narrow, which amplifies the p values. And other than the number of laparotomies going up, the other numbers looked fairly constant. I look forward to the presentation and critique of this paper at the meeting. Not sure it will escape unscathed.
Reference: Is your graduating general surgery resident qualified to take trauma call? A 15-year appraisal of the changes in general surgery education for trauma. AAST 2016, Paper 39.