An analysis of the operative experience of North American pediatric surgical training programs and residents.

There has been a rapid increase in the number of pediatric surgical training programs. To meet the goals of quality patient care and surgical education, training and practice activities must be objectively monitored. The aim of this study was to collect and analyze the experience of American and Canadian Pediatric Surgical training centers and residents. The authors collected the 1-year operative experience of 31 American and six Canadian training programs and the 2-year operative experience of the 25 most recently graduated residents. Categories analyzed included total cases, defined categories (neonatal, important, and tumor cases), routine cases, thoracic, cardiac, urologic reconstructive, head and neck, endoscopy, vascular, plastics and burn procedures. From these data six assumptions about the training in pediatric surgery were addressed. (1) The operative activity of the United States and Canadian training programs and residents are comparable. The results show that there are few major differences in operative experience. (2) There should be variability in operative experience between programs but little variability between residents. The North American operative experience for both residents and institutions are marked by high variability and leftward shift in the frequency distributions. (3) A resident's training should consist of a significant portion of "index cases" and fewer routine cases. The residents perform 28% of their total cases in the three defined categories (index cases) and 26% as routine cases. (4) Pediatric surgeons are the true general surgeons, performing operations in areas such as cardiac, reconstructive genitourinary, plastic, and burn surgery. Examination of the data shows that most programs and residents perform few cases in these four areas. (5) Certain procedures such as thoracic, genitourinary, vascular, head and neck, and endoscopy remain within the domain of pediatric surgery. The results show that this assumption is true for thoracic, vascular, head and neck, and endoscopy but not for genitourinary, and there is wide variability between institutions and between residents. (6) "Core" pediatric surgical conditions such as esophageal atresia, biliary atresia, and intersex are still available in significant numbers to train residents. The data show that a surprising number of programs and residents perform few or none of the core operations. This analysis is the first step toward monitoring of pediatric surgical resident education. A future study is underway to evaluate the current experience of practicing pediatric surgeons who have taken the recertification examination.