(Reuters Health) – Surgical residents logged about one third fewer hours in the OR during the first four months of the COVID-19 pandemic, a new study finds.
A review of operative logs of general surgery residents in 16 U.S. programs from 2017 to 2020 revealed that major surgical cases were reduced by 33.5% in March through June of 2020 compared to the same time period in previous years, according to the report published in JAMA Surgery.
“With the cancellation of elective operations and the restructuring of surgical residencies during the pandemic, surgical resident education has undoubtedly been negatively affected,” write the authors, led by Dr. Amanda Purdy of Harbor-University of California, Los Angeles Medical Center in Torrance. “This is highlighted by the fact that the American Board of Surgery (ABS) took immediate action in anticipation of an operative decline. For general surgery residents graduating in 2020, the ABS modified the usual graduation requirements.”
In normal times, the ABS requires residents to complete 850 total major cases, including 200 during post graduate year (PGY) five, whereas in 2020, the ABS accepted a 10% decrease in total major cases and did not require a minimum of 200 cases during PGY five, the researchers note.
The authors did not respond to requests for comment.
To take a closer look at the pandemic’s impact on surgical residents’ experience in the OR, Dr. Purdy and her colleagues reviewed 1,358 resident case logs from 16 general surgery programs: Brookwood Baptist Health; Cedars-Sinai; Columbia University Medical Center; Harbor-University of California, Los Angeles; Houston Methodist Hospital; Loma Linda University; Santa Barbara Cottage Hospital; Southern Illinois University; Stanford University; University of California, Davis; University of California, Irvine; University of California, Los Angeles; University of California, San Francisco/Fresno; University of Nebraska; University of Southern California; and University of Washington.
The Accreditation Council for Graduate Medical Education (ACGME) logs were collected from July 1, 2017 through June 30, 2020, which represented three consecutive academic years.
In March to June of 2018 and 2019, each resident performed a mean of 67.8 and 67.5 major cases, respectively. That compares with 45.0 major cases in March to June 2020, a 33.5% reduction in operative volume during the pandemic.
Every PGY level had a significant reduction in total major case volume, the researchers report. Compared to pre-pandemic years, PGY one residents in the COVID-19 period performed 30.8% fewer cases; PGY two residents performed 34.7% fewer cases; PGY three residents performed 34.1% fewer cases; PGY four residents performed 34.9% fewer cases; and PGY five residents performed 30.1% fewer cases.
This four-month decrease in case volume was enough to be significantly associated with the overall experience for the 2019-2020 academic year, as residents performed 10.2% fewer cases in the 2019-2020 academic year compared with the two prior academic years, the authors note.
All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases, they add. Level 1 trauma centers also had a significantly lower reduction (27%) in case volume than non-level 1 trauma centers (46%).
“This is a good study in that it nicely documents what I would say most academic surgeons have felt,” said Dr. Peter Angelos, a professor of surgery and associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago. “The impact of the pandemic on resident case numbers has been significant and the authors did a good job of suggesting that. Although they are looking at data from a few months the impact has continued beyond that and even continues today in some places.”
While the situation should be monitored, no one really knows what the impact of the smaller number of cases will be, Dr. Angelos said. “It’s something to keep track of,” he added. “Right now all we have is the numbers.”
The pandemic experience may bring an important question to the fore, Dr. Angelos said. The current educational model relies on the assumption that performing a certain number of cases over a certain number of years means that a resident has gained the skills to practice independently. “The issue is finding a better way to assess competency than counting cases,” Dr. Angelos said.
SOURCE: https://bit.ly/3382Xpc and https://bit.ly/338w0ZF JAMA Surgery, online April 30, 2021.
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