Agarwal Nitin, White Michael D, Cohen Jonathan, Lunsford L Dade, Hamilton D Kojo
J Neurosurg. 2018 Jul 13;130(6):2025-2031. doi: 10.3171/2018.2.JNS172734. Print 2019 Jun 1.
The purpose of this study was to analyze national trends in adult cranial cases performed by neurological surgery residents as logged into the Accreditation Council for Graduate Medical Education (ACGME) system.
The ACGME resident case logs were retrospectively reviewed for the years 2009-2017. In these reports, the national average of cases performed by graduating residents is organized by year, type of procedure, and level of resident. These logs were analyzed in order to evaluate trends in residency experience with adult cranial procedures. The reported number of cranial procedures was compared to the ACGME neurosurgical minimum requirements for each surgical category. A linear regression analysis was conducted in order to identify changes in the average number of procedures performed by residents graduating during the study period. Additionally, a 1-sample t-test was performed to compare reported case volumes to the ACGME required minimums.
An average of 577 total cranial procedures were performed throughout residency training for each of the 1631 residents graduating between 2009 and 2017. The total caseload for graduating residents upon completion of training increased by an average of 26.59 cases each year (r2 = 0.99). Additionally, caseloads in most major procedural subspecialty categories increased; this excludes open vascular and extracranial vascular categories, which showed, respectively, a decrease and no change. The majority of cranial procedures performed throughout residency pertained to tumor (mean 158.38 operations), trauma (mean 102.17 operations), and CSF diversion (mean 76.12 operations). Cranial procedures pertaining to the subspecialties of trauma and functional neurosurgery showed the greatest rise in total procedures, increasing at 8.23 (r2 = 0.91) and 6.44 (r2 = 0.95) procedures per graduating year, respectively.
Neurosurgical residents reported increasing case volumes for most cranial procedures between 2009 and 2017. This increase was observed despite work hour limitations set forth in 2003 and 2011. Of note, an inverse relationship between open vascular and endovascular procedures was observed, with a decrease in open vascular procedures and an increase in endovascular procedures performed during the study period. When compared to the ACGME required minimums, neurosurgery residents gained much more exposure to cranial procedures than was expected. Additionally, a larger caseload throughout training suggests that residents are graduating with greater competency and experience in cranial neurosurgery.
本研究旨在分析登录毕业后医学教育认证委员会（ACGME）系统的神经外科住院医师所进行的成人颅脑病例的全国趋势。
对2009 - 2017年ACGME住院医师病例记录进行回顾性审查。在这些报告中，按年份、手术类型和住院医师级别对毕业住院医师所进行病例的全国平均数量进行了整理。对这些记录进行分析，以评估成人颅脑手术住院医师培训经历的趋势。将报告的颅脑手术数量与ACGME对每个手术类别的神经外科最低要求进行比较。进行线性回归分析，以确定研究期间毕业住院医师平均手术数量的变化。此外，进行单样本t检验，以比较报告的病例数量与ACGME要求的最低数量。
2009年至2017年毕业的1631名住院医师中，每人在整个住院医师培训期间平均进行了577例颅脑手术。培训结束时毕业住院医师的总病例数平均每年增加26.59例（r2 = 0.99）。此外，大多数主要手术亚专业类别的病例数增加；这排除了开放性血管和颅外血管类别，这两个类别分别显示下降和无变化。整个住院医师培训期间进行的大多数颅脑手术涉及肿瘤（平均158.38例手术）、创伤（平均102.17例手术）和脑脊液分流（平均76.12例手术）。与创伤和功能性神经外科亚专业相关的颅脑手术总例数增加最多，分别以每年8.23例（r2 = 0.91）和6.44例（r2 = 0.95）的速度增加。
神经外科住院医师报告称，2009年至2017年期间大多数颅脑手术的病例数有所增加。尽管2003年和2011年设定了工作时间限制，但仍观察到这种增加。值得注意的是，观察到开放性血管手术和血管内手术之间存在反比关系，在研究期间开放性血管手术减少，血管内手术增加。与ACGME要求的最低数量相比，神经外科住院医师接触颅脑手术的机会比预期多得多。此外，整个培训期间更多的病例数表明住院医师毕业时在颅脑神经外科方面具有更高的能力和经验。
