Disparity between reality and the perception of case volume needed to train competent general surgeons Fariha Sheikh MD 1, Richard J. Gray MD 1, John Ferrara MD 2, Kevin Foster MD 3, Alyssa Chapital MD 1 1 From the Department of Surgery, Mayo Clinic in Arizona, Phoenix, AZ 2 Department of Surgery, Banner Good Samaritan Medical Center, Phoenix, AZ 3 Department of Surgery, Maricopa Integrated Health Systems, Phoenix, AZ

Introduction Each year approximately 1000 general surgery residents complete their residency training Each year approximately 1000 general surgery residents complete their residency training The RRC requires completion of >750 cases in 36 categories The RRC requires completion of >750 cases in 36 categories 27.5% of surgery residents do not feel confident performing procedures independently 27.5% of surgery residents do not feel confident performing procedures independently 1 1 Yeo H, Viola K, Berg D, et al. Attitudes, Training Experiences, and Professional Expectations of US General Surgery Residents. JAMA. 2009; 302(12):

Questions How many cases do residents believe they should complete in order to feel competent? How many cases do residents believe they should complete in order to feel competent? Does this differ from the faculty? Does this differ from the faculty? Does this differ from the actual number of cases residents are completing nationally and within local programs? Does this differ from the actual number of cases residents are completing nationally and within local programs?

Methods Anonymous electronic surveys completed by faculty and residents at 3 Phoenix programs Anonymous electronic surveys completed by faculty and residents at 3 Phoenix programs 34 items selected from list of RRC recommended case numbers 34 items selected from list of RRC recommended case numbers Participants indicated number cases of each item they thought should be completed during training in order to be a competent general surgeon Participants indicated number cases of each item they thought should be completed during training in order to be a competent general surgeon

Examples of Case Items RRC Area Item on Survey Alimentary Tract: Colon Colon Resection (open) Alimentary Tract: Colon Colon Resection (laparoscopic) Abdomen: Hernia Inguinal Hernia Repair (open) Abdomen: Hernia Inguinal Hernia Repair (laparoscopic) EndocrineThyroidectomy Trauma Non-operative Trauma Trauma Operative Trauma Pediatric Pediatric Operations

Results TotalNumber Number Responded Percent Responded Resident845565% Faculty374680% Mean resident responses exceeded faculty judgments in 88% of the categories Mean resident responses exceeded faculty judgments in 88% of the categories Mean resident responses exceeded faculty by at least 20% in half of the categories Mean resident responses exceeded faculty by at least 20% in half of the categories

Discordance Between Resident and Faculty Responses

Comparison of Resident and Faculty Recommended Numbers of Cases to Actual Programs' Averages

Comparison of Resident and Faculty Recommended Numbers of Cases to Actual National Averages

Discordance Between Resident Responses and National/Program Averages

Discordance Between Faculty Responses and National/Program Averages

Conclusions Compared with faculty, residents perceive the need for a greater number of cases during training to be competent general surgeons Compared with faculty, residents perceive the need for a greater number of cases during training to be competent general surgeons Residents and faculty both generally perceive the need for a greater number of cases during training to be competent than then number of actual cases done locally and nationally Residents and faculty both generally perceive the need for a greater number of cases during training to be competent than then number of actual cases done locally and nationally

Discussion Mismatch between residents’ perceptions and reality Mismatch between residents’ perceptions and reality –Frustration –Lack of confidence –Illusion of incompetence Areas in which faculty and residents both perceive a need for fewer cases Areas in which faculty and residents both perceive a need for fewer cases -Modification of education structure -Shift efforts into areas that were considered underrepresented

Summary Gap in Expectations Deficiency in training Improve Curriculum Unrealistic expectations Reset expectations

Thank You