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Original Investigation |

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

Fizan Abdullah, MD, PhD1; Jose H. Salazar, MD2; Colin D. Gause, MD1; Samir Gadepalli, MD3; Thomas W. Biester, MS4; Kenneth S. Azarow, MD5; Mary L. Brandt, MD6; Dai H. Chung, MD7; Dennis P. Lund, MD8; Frederick J. Rescorla, MD9; John H. T. Waldhausen, MD10; Thomas F. Tracy, MD11; Mary E. Fallat, MD12; Michael D. Klein, MD13; Frank R. Lewis, MD4; Ronald B. Hirschl, MD3
[+] 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.
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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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Data on Number of Pediatric Surgery Cases Performed by General Surgeons, Number of Board-Certified Pediatric Surgeons, and Increase in Pediatric Surgery Training Programs
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