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Original Investigation
August 2016

Understanding the Operative Experience of the Practicing Pediatric SurgeonImplications for Training and Maintaining Competency

Author Affiliations
  • 1Department of Surgery, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
  • 2Department of Surgery, University of Maryland Medical Center, Baltimore
  • 3Department of Surgery, University of Michigan Health System, Ann Arbor
  • 4American Board of Surgery, Philadelphia, Pennsylvania
  • 5Department of Surgery, Oregon Health and Science University, Portland
  • 6Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
  • 7Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
  • 8Department of Surgery, Stanford School of Medicine, Stanford, California
  • 9Department of Surgery, Indiana University School of Medicine, Indianapolis
  • 10Department of Surgery, University of Washington, Seattle
  • 11Department of Surgery, Brown University, Providence, Rhode Island
  • 12Department of Surgery, University of Louisville, Louisville, Kentucky
  • 13Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan
JAMA Surg. 2016;151(8):735-741. doi:10.1001/jamasurg.2016.0261
Abstract

Importance  The number of practicing pediatric surgeons has increased rapidly in the past 4 decades, without a significant increase in the incidence of rare diseases specific to the field. Maintenance of competency in the index procedures for these rare diseases is essential to the future of the profession.

Objective  To describe the demographic characteristics and operative experiences of practicing pediatric surgeons using Pediatric Surgery Board recertification case log data.

Design, Setting, and Participants  We performed a retrospective review of 5 years of pediatric surgery certification renewal applications submitted to the Pediatric Surgery Board between 2009 and 2013. A surgeon’s location was defined by population as urban, large rural, small rural, or isolated. Case log data were examined to determine case volume by category and type of procedures. Surgeons were categorized according to recertification at 10, 20, or 30 years.

Main Outcome and Measure  Number of index cases during the preceding year.

Results  Of 308 recertifying pediatric surgeons, 249 (80.8%) were men, and 143 (46.4%) were 46 to 55 years of age. Most of the pediatric surgeons (304 of 308 [98.7%]) practiced in urban areas (ie, with a population >50 000 people). All recertifying applicants were clinically active. An appendectomy was the most commonly performed procedure (with a mean [SD] number of 49.3 [35.0] procedures per year), nonoperative trauma management came in second (with 20.0 [33.0] procedures per year), and inguinal hernia repair for children younger than 6 months of age came in third (with 14.7 [13.8] procedures per year). In 6 of 10 “rare” pediatric surgery cases, the mean number of procedures was less than 2. Of 308 surgeons, 193 (62.7%) had performed a neuroblastoma resection, 170 (55.2%) a kidney tumor resection, and 123 (39.9%) an operation to treat biliary atresia or choledochal cyst in the preceding year. Laparoscopy was more frequently performed in the 10-year recertification group for Nissen fundoplication, appendectomy, splenectomy, gastrostomy/jejunostomy, orchidopexy, and cholecystectomy (P < .05) but not lung resection (P = .70). It was more frequently used by surgeons recertifying in the 10-year group (used in 11 375 of 14 456 procedures [78.7%]) than by surgeons recertifying in the 20-year (used in 6214 of 8712 procedures [71.3%]) or 30-year group (used in 2022 of 3805 procedures [53.1%]).

Conclusions and Relevance  Practicing pediatric surgeons receive limited exposure to index cases after training. With regard to maintaining competency in an era in which health care outcomes have become increasingly important, these results are concerning.

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