Variation in pediatric orthopaedic case volume and type during residency: An updated report after Accreditation Council of Graduate Medical Education case volume minimums.

BACKGROUND

In 2013, the Accreditation Council of Graduate Medical Education (ACGME) instituted a case minimum requirement for orthopaedic residents. It is unknown how pediatric orthopaedic case volume and variability have been affected by this change.

METHODS

The ACGME orthopaedic surgery case log data from 2007 to 2020 were used to evaluate the number and type of pediatric orthopaedic procedures logged by graduating residents. The mean and median number of cases logged were compared for the years before (2007-2013) and after (2014-2020) the case minimum implementation using a Student -test.

RESULTS

In the period after case minimum implementation, there were significant decreases in both overall cases (2080.6-1639.2;  < .001) and pediatric cases (328.7-264.7;  < .001) logged by residents. However, pediatric case volumes in certain areas significantly increased. Pediatric humerus/elbow procedures went up by 19.7% (29.4-35.2;  < .001), driven by an increase in fracture and dislocation treatments (21.5-28.17, 31.0%;  < .001). Similarly, pediatric forearm/wrist procedures went up by 31.7% (33.7-44.5;  < .001), driven by an increase in manipulation (19.0-31.9, 67.8%;  < .001). All other anatomic areas besides the shoulder experienced significant decreases in case volume, including spine procedures, which experienced the greatest decrease: 52.1% (28.4-13.5;  < .001).

CONCLUSIONS

Paradoxically, since the implementation of case minimums in 2013, residents have logged fewer overall cases and pediatric orthopaedic cases. One may hypothesize that, when residents are required to submit a certain minimum number of cases, there is little incentive to submit additional cases.

KEY CONCEPTS

1)The ACGME instituted a case minimum requirement for Orthopaedic surgery residents starting in 2013.2)Since 2013, residents have logged fewer pediatric orthopaedic cases.3)Since 2013, residents have logged fewer overall orthopaedic cases.

LEVEL OF EVIDENCE

III, Cross-Sectional Study.