Understanding the operative experience of the practicing pediatric surgeon implications for training and maintaining competency

Fizan Abdullah, Jose H. Salazar, Colin D. Gause, Samir Gadepalli, Thomas W. Biester, Kenneth S. Azarow, Mary L. Brandt, Dai H. Chung, Dennis P. Lund, Frederick J. Rescorla, John H T Waldhausen, Thomas F. Tracy, Mary E. Fallat, Michael D. Klein, Frank R. Lewis, Ronald B. Hirschl

Research output: Research - peer-reviewArticle

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Abstract

IMPORTANCE The number of practicing pediatric surgeons has increased rapidly in the past 4 decades, without a significant increase in the incidence of rare diseases specific to the field. Maintenance of competency in the index procedures for these rare diseases is essential to the future of the profession. OBJECTIVE To describe the demographic characteristics and operative experiences of practicing pediatric surgeons using Pediatric Surgery Board recertification case log data. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review of 5 years of pediatric surgery certification renewal applications submitted to the Pediatric Surgery Board between 2009 and 2013. A surgeon's location was defined by population as urban, large rural, small rural, or isolated. Case log data were examined to determine case volume by category and type of procedures. Surgeons were categorized according to recertification at 10, 20, or 30 years. MAIN OUTCOME AND MEASURE Number of index cases during the preceding year. RESULTS Of 308 recertifying pediatric surgeons, 249 (80.8%) were men, and 143 (46.4%) were 46 to 55 years of age. Most of the pediatric surgeons (304 of 308 [98.7%]) practiced in urban areas (ie, with a population >50 000 people). All recertifying applicants were clinically active. An appendectomy was the most commonly performed procedure (with a mean [SD] number of 49.3 [35.0] procedures per year), nonoperative trauma management came in second (with 20.0 [33.0] procedures per year), and inguinal hernia repair for children younger than 6 months of age came in third (with 14.7 [13.8] procedures per year). In 6 of 10 "rare" pediatric surgery cases, the mean number of procedures was less than 2. Of 308 surgeons, 193 (62.7%) had performed a neuroblastoma resection, 170 (55.2%) a kidney tumor resection, and 123 (39.9%) an operation to treat biliary atresia or choledochal cyst in the preceding year. Laparoscopy was more frequently performed in the 10-year recertification group for Nissen fundoplication, appendectomy, splenectomy, gastrostomy/jejunostomy, orchidopexy, and cholecystectomy (P < .05) but not lung resection (P = .70). It was more frequently used by surgeons recertifying in the 10-year group (used in 11 375 of 14 456 procedures [78.7%]) than by surgeons recertifying in the 20-year (used in 6214 of 8712 procedures [71.3%]) or 30-year group (used in 2022 of 3805 procedures [53.1%]). CONCLUSIONS AND RELEVANCE Practicing pediatric surgeons receive limited exposure to index cases after training. With regard to maintaining competency in an era in which health care outcomes have become increasingly important, these results are concerning.

LanguageEnglish (US)
Pages735-741
Number of pages7
JournalJAMA Surgery
Volume151
Issue number8
DOIs
StatePublished - Aug 1 2016

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Pediatrics
Surgeons
Appendectomy
Rare Diseases
Orchiopexy
Choledochal Cyst
Jejunostomy
Biliary Atresia
Fundoplication
Gastrostomy
Urban Population
Inguinal Hernia
Herniorrhaphy
Certification
Cholecystectomy
Splenectomy
Neuroblastoma
Laparoscopy
Maintenance
Demography

ASJC Scopus subject areas

  • Surgery

Cite this

Abdullah, F., Salazar, J. H., Gause, C. D., Gadepalli, S., Biester, T. W., Azarow, K. S., ... Hirschl, R. B. (2016). Understanding the operative experience of the practicing pediatric surgeon implications for training and maintaining competency. JAMA Surgery, 151(8), 735-741. DOI: 10.1001/jamasurg.2016.0261

Understanding the operative experience of the practicing pediatric surgeon implications for training and maintaining competency. / Abdullah, Fizan; Salazar, Jose H.; Gause, Colin D.; Gadepalli, Samir; Biester, Thomas W.; Azarow, Kenneth S.; Brandt, Mary L.; Chung, Dai H.; Lund, Dennis P.; Rescorla, Frederick J.; Waldhausen, John H T; Tracy, Thomas F.; Fallat, Mary E.; Klein, Michael D.; Lewis, Frank R.; Hirschl, Ronald B.

In: JAMA Surgery, Vol. 151, No. 8, 01.08.2016, p. 735-741.

Research output: Research - peer-reviewArticle

Abdullah, F, Salazar, JH, Gause, CD, Gadepalli, S, Biester, TW, Azarow, KS, Brandt, ML, Chung, DH, Lund, DP, Rescorla, FJ, Waldhausen, JHT, Tracy, TF, Fallat, ME, Klein, MD, Lewis, FR & Hirschl, RB 2016, 'Understanding the operative experience of the practicing pediatric surgeon implications for training and maintaining competency' JAMA Surgery, vol 151, no. 8, pp. 735-741. DOI: 10.1001/jamasurg.2016.0261
Abdullah, Fizan ; Salazar, Jose H. ; Gause, Colin D. ; Gadepalli, Samir ; Biester, Thomas W. ; Azarow, Kenneth S. ; Brandt, Mary L. ; Chung, Dai H. ; Lund, Dennis P. ; Rescorla, Frederick J. ; Waldhausen, John H T ; Tracy, Thomas F. ; Fallat, Mary E. ; Klein, Michael D. ; Lewis, Frank R. ; Hirschl, Ronald B./ Understanding the operative experience of the practicing pediatric surgeon implications for training and maintaining competency. In: JAMA Surgery. 2016 ; Vol. 151, No. 8. pp. 735-741
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AU - Salazar,Jose H.

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AU - Biester,Thomas W.

AU - Azarow,Kenneth S.

AU - Brandt,Mary L.

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N2 - IMPORTANCE The number of practicing pediatric surgeons has increased rapidly in the past 4 decades, without a significant increase in the incidence of rare diseases specific to the field. Maintenance of competency in the index procedures for these rare diseases is essential to the future of the profession. OBJECTIVE To describe the demographic characteristics and operative experiences of practicing pediatric surgeons using Pediatric Surgery Board recertification case log data. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review of 5 years of pediatric surgery certification renewal applications submitted to the Pediatric Surgery Board between 2009 and 2013. A surgeon's location was defined by population as urban, large rural, small rural, or isolated. Case log data were examined to determine case volume by category and type of procedures. Surgeons were categorized according to recertification at 10, 20, or 30 years. MAIN OUTCOME AND MEASURE Number of index cases during the preceding year. RESULTS Of 308 recertifying pediatric surgeons, 249 (80.8%) were men, and 143 (46.4%) were 46 to 55 years of age. Most of the pediatric surgeons (304 of 308 [98.7%]) practiced in urban areas (ie, with a population >50 000 people). All recertifying applicants were clinically active. An appendectomy was the most commonly performed procedure (with a mean [SD] number of 49.3 [35.0] procedures per year), nonoperative trauma management came in second (with 20.0 [33.0] procedures per year), and inguinal hernia repair for children younger than 6 months of age came in third (with 14.7 [13.8] procedures per year). In 6 of 10 "rare" pediatric surgery cases, the mean number of procedures was less than 2. Of 308 surgeons, 193 (62.7%) had performed a neuroblastoma resection, 170 (55.2%) a kidney tumor resection, and 123 (39.9%) an operation to treat biliary atresia or choledochal cyst in the preceding year. Laparoscopy was more frequently performed in the 10-year recertification group for Nissen fundoplication, appendectomy, splenectomy, gastrostomy/jejunostomy, orchidopexy, and cholecystectomy (P < .05) but not lung resection (P = .70). It was more frequently used by surgeons recertifying in the 10-year group (used in 11 375 of 14 456 procedures [78.7%]) than by surgeons recertifying in the 20-year (used in 6214 of 8712 procedures [71.3%]) or 30-year group (used in 2022 of 3805 procedures [53.1%]). CONCLUSIONS AND RELEVANCE Practicing pediatric surgeons receive limited exposure to index cases after training. With regard to maintaining competency in an era in which health care outcomes have become increasingly important, these results are concerning.

AB - IMPORTANCE The number of practicing pediatric surgeons has increased rapidly in the past 4 decades, without a significant increase in the incidence of rare diseases specific to the field. Maintenance of competency in the index procedures for these rare diseases is essential to the future of the profession. OBJECTIVE To describe the demographic characteristics and operative experiences of practicing pediatric surgeons using Pediatric Surgery Board recertification case log data. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective review of 5 years of pediatric surgery certification renewal applications submitted to the Pediatric Surgery Board between 2009 and 2013. A surgeon's location was defined by population as urban, large rural, small rural, or isolated. Case log data were examined to determine case volume by category and type of procedures. Surgeons were categorized according to recertification at 10, 20, or 30 years. MAIN OUTCOME AND MEASURE Number of index cases during the preceding year. RESULTS Of 308 recertifying pediatric surgeons, 249 (80.8%) were men, and 143 (46.4%) were 46 to 55 years of age. Most of the pediatric surgeons (304 of 308 [98.7%]) practiced in urban areas (ie, with a population >50 000 people). All recertifying applicants were clinically active. An appendectomy was the most commonly performed procedure (with a mean [SD] number of 49.3 [35.0] procedures per year), nonoperative trauma management came in second (with 20.0 [33.0] procedures per year), and inguinal hernia repair for children younger than 6 months of age came in third (with 14.7 [13.8] procedures per year). In 6 of 10 "rare" pediatric surgery cases, the mean number of procedures was less than 2. Of 308 surgeons, 193 (62.7%) had performed a neuroblastoma resection, 170 (55.2%) a kidney tumor resection, and 123 (39.9%) an operation to treat biliary atresia or choledochal cyst in the preceding year. Laparoscopy was more frequently performed in the 10-year recertification group for Nissen fundoplication, appendectomy, splenectomy, gastrostomy/jejunostomy, orchidopexy, and cholecystectomy (P < .05) but not lung resection (P = .70). It was more frequently used by surgeons recertifying in the 10-year group (used in 11 375 of 14 456 procedures [78.7%]) than by surgeons recertifying in the 20-year (used in 6214 of 8712 procedures [71.3%]) or 30-year group (used in 2022 of 3805 procedures [53.1%]). CONCLUSIONS AND RELEVANCE Practicing pediatric surgeons receive limited exposure to index cases after training. With regard to maintaining competency in an era in which health care outcomes have become increasingly important, these results are concerning.

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