Number of Procedures during residency

[wa_medic]

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How many (appys, hernia, etc.) does one typically need to gain priveledges out of residency? I'm sure there is not a set number, but a good safe number to shoot for? Does the ACS publish a minimum? Thanks for the help!

 

[Pilot Doc]

How many (appys, hernia, etc.) does one typically need to gain priveledges out of residency? I'm sure there is not a set number, but a good safe number to shoot for? Does the ACS publish a minimum? Thanks for the help!

You need a minimum of 500 cases to graduate, with subcategory requirements for laparoscopy, vacsular, etc. Anyone who finishes a GS residency will have no problem getting appy and hernia privileges. The question that often comes up is getting privileges to do procedures for which you could have done a fellowship. Vascular, thoracic, advanced laparoscopy and certain big abdominal cases (eg whipple) are common points of contention.

There's no hard or fast rule as to numbers. Privileging will depend largely upon the desires of the hospital (eg are they losing business to other hospitals for lack of adequate X services) and the political clout of whomever's patients you would be poaching with your new powers.

 

[FliteSurgn]

Minimum RRC Requirements

Skin, Soft Tissue, Breast 25
Head and Neck 24
G.I. 72
Abdomen 65
Liver 4
Pancreas 3
Vascular 44
Endocrine 8
Trauma
Non-Operative Trauma 20
Operative trauma 10
Thoracic 15
Pediatrics 20
Plastics 5
Endoscopy 29
Laparoscopic, Basic 34
Laparoscopic, Complex 0

Total as Chief Residents 150
Total Major Operations 500

 

[RichL025]

FliteSurgn,

Just out of curiosity, can you count one procedure in more than one category? For example, does a traumatic liver lac that was operatively repaired count as both a "operative trauma" case _and_ a "liver" case?

 

[FliteSurgn]

For the most part, cases can be counted in more than one category. (Carotid endarterectomy counts as head&neck as well as vascular, for example)

Since about 2001, all cases are entered into an online database by their corresponding CPT (Current Procedural Terminology) code. The ACGME runs the site and the computer will assign each case to the appropriate "defined category". It works really well...keeps track of everything and shows you where you sit whenever you want to see your list. The database can even be run on your PDA and then uploaded when you hotsynch.

 

[sandg]

Minimum RRC Requirements

Skin, Soft Tissue, Breast 25
Head and Neck 24
G.I. 72
Abdomen 65
Liver 4
Pancreas 3
Vascular 44
Endocrine 8
Trauma
Non-Operative Trauma 20
Operative trauma 10
Thoracic 15
Pediatrics 20
Plastics 5
Endoscopy 29
Laparoscopic, Basic 34
Laparoscopic, Complex 0

Total as Chief Residents 150
Total Major Operations 500

What types of numbers do you typically finish residency with in each category? As an M1 who knows absolutely nothing about the practice of surgery, some of these requirement numbers seem really low. Can you become comfortable with only 3 pancreas cases, etc.?

 

[Bovie9]

What types of numbers do you typically finish residency with in each category? As an M1 who knows absolutely nothing about the practice of surgery, some of these requirement numbers seem really low. Can you become comfortable with only 3 pancreas cases, etc.?

You have to keep in mind that these are minimum numbers. Actual numbers can get very high.. for example I am in my 2nd year now and have already logged about 25/40 vascular cases. Additionally, only one resident can count a case- so if you scrub as a 2nd set of hands say on a whipple, only the chief will take the credit.. so by the time you are the chief and taking credit you may have already been involved in quite a few, just not as the primary resident.

Some cases are more difficult to get than others depending on your hospital and competing services (for example thyroids and ENT).. This is why it is important to try and match to a program without fellows and little competition, and if you have fellows make sure they don't take too much away from the program.

 

[FliteSurgn]

What types of numbers do you typically finish residency with in each category? As an M1 who knows absolutely nothing about the practice of surgery, some of these requirement numbers seem really low. Can you become comfortable with only 3 pancreas cases, etc.?

Pancreas and liver numbers are the hardest to get most places. These numbers are what the RRC/ACGME considers the minimum to obtain "adequate" experience to practice general surgery. More volume doesn't always equate more ability, but the experience does help. The most important thing to learn is judgement. You should have a pretty good idea when something will require more expertise or technical experience and refer that patient out or get help.

There are a wide range of variables that influence how many cases it takes until you can confidently do any particular one, but you draw on all of this experience to do other cases that may be similar. The ACGME only counts what they consider "major" cases. Hernias, appys, and other smaller cases don't really count in those numbers. IMHO, you should look for programs where you'll get 800-1200 major cases over your 5 years. All programs should give you the last few years' case lists for their graduating chief residents. That will give you something objective to look at when it comes to operative numbers and case distribution.

Using that list you can look for trends or persistently low numbers across the board in certain areas that they may have trouble filling. Please note that there can be a lot of variability between any two residents' case logs due to their individual interests. For example, I had a strong interest in laparoscopy so I sought out those cases. I ended up with about 110 complex laparoscopic cases while my fellow chiefs, who were interested in other areas, averaged 35. Just to clarify for those that are pre-residency, complex laparoscopic cases include Nissens, common bile duct exploration, hernias, gastric bypass, splenectomy, adrenalectomy, colon resection, etc. while basic cases are appys, cholecystectomies, diagnostic laps and so on.