Farivar Daniel, Illingworth Kenneth D, Narendran Nakul, Paiement Guy D, Skaggs David L
Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Pediatr Soc North Am. 2024 Feb 28;6:100009. doi: 10.1016/j.jposna.2024.100009. eCollection 2024 Feb.
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.
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.
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).
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.
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.
III, Cross-Sectional Study.
2013年，毕业后医学教育认证委员会（ACGME）对骨科住院医师制定了最低病例数要求。目前尚不清楚这一变化对小儿骨科病例数量和变异性有何影响。
使用2007年至2020年ACGME骨科手术病例记录数据，评估毕业住院医师记录的小儿骨科手术数量和类型。使用学生t检验比较最低病例数实施前（2007 - 2013年）和实施后（2014 - 2020年）记录的病例平均数和中位数。
在最低病例数实施后的时期，住院医师记录的总体病例数（2080.6 - 1639.2；P <.001）和小儿病例数（328.7 - 264.7；P <.001）均显著减少。然而，某些领域的小儿病例数量显著增加。小儿肱骨/肘部手术增加了19.7%（29.4 - 35.2；P <.001），这是由于骨折和脱位治疗数量增加（21.5 - 28.17，增加31.0%；P <.001）。同样，小儿前臂/腕部手术增加了31.7%（33.7 - 44.5；P <.001），这是由于手法操作数量增加（19.0 - 31.9，增加67.8%；P <.001）。除肩部外，所有其他解剖区域的病例数量均显著减少，包括脊柱手术，减少幅度最大：52.1%（28.4 - 13.5；P <.001）。
自相矛盾的是，自2013年实施最低病例数要求以来，住院医师记录的总体病例数和小儿骨科病例数减少。有人可能会推测，当要求住院医师提交一定数量的最低病例数时，提交额外病例的动力就很小了。
1）ACGME自2013年起对骨科手术住院医师制定了最低病例数要求。2）自2013年以来，住院医师记录的小儿骨科病例数减少。3）自2013年以来，住院医师记录的总体骨科病例数减少。
III，横断面研究。
