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Medical Education and Training

Factors Associated With General Surgery Residents’ Operative Experience During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Surgery

Published Online: April 30, 2021

Original Investigation

Article Information and Disclosures

Author Affiliations

¹Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
²Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance
³Statistical Editor, JAMA Surgery
⁴Department of Surgery, Brookwood Baptist Medical Center, Birmingham, Alabama
⁵Department of Surgery, Columbia University Medical Center, New York, New York
⁶Department of Surgery, University of Southern California/Los Angeles County Medical Center, Los Angeles
⁷Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California
⁸Department of Surgery, University of California, Los Angeles Health, Los Angeles
⁹Department of Surgery, University of California, Irvine, Medical Center, Orange
¹⁰Department of Surgery, University of California, Davis, School of Medicine, Sacramento
¹¹Department of Surgery, University of Washington Medical Center, Seattle
¹²Department of Surgery, Southern Illinois School of Medicine, Springfield
¹³Department of Surgery, Loma Linda University Health, Loma Linda, California
¹⁴Department of Surgery, Stanford University, Stanford, California
¹⁵Department of Surgery, Houston Methodist Hospital, Houston, Texas
¹⁶Department of Surgery, University of Nebraska Medical Center, Omaha
¹⁷Department of Surgery, University of California, San Francisco, at Fresno, Fresno
¹⁸Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California

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Key Points

Question How did general surgery resident operative volume change during the first 4 months of the US COVID-19 pandemic, and were all postgraduate year levels equally affected?

Findings In this review of 1358 resident case logs, general surgery resident operative volume declined by 33.5% in March to June 2020 compared with March to June 2018 and 2019 and affected residents in every level of training.

Meaning These findings illustrate the significant negative effect of the COVID-19 pandemic on general surgery resident operative experience, highlighting the importance of identifying future mitigation strategies.

Abstract

Importance The suspension of elective operations in March 2020 to prepare for the COVID-19 surge posed significant challenges to resident education. To mitigate the potential negative effects of COVID-19 on surgical education, it is important to quantify how the pandemic influenced resident operative volume.

Objective To examine the association of the pandemic with general surgical residents’ operative experience by postgraduate year (PGY) and case type and to evaluate if certain institutional characteristics were associated with a greater decline in surgical volume.

Design, Setting, and Participants This retrospective review included residents’ operative logs from 3 consecutive academic years (2017-2018, 2018-2019, and 2019-2020) from 16 general surgery programs. Data collected included total major cases, case type, and PGY. Faculty completed a survey about program demographics and COVID-19 response. Data on race were not collected. Operative volumes from March to June 2020 were compared with the same period during 2018 and 2019. Data were analyzed using Kruskal-Wallis test adjusted for within-program correlations.

Main Outcome and Measures Total major cases performed by each resident during the first 4 months of the pandemic.

Results A total of 1368 case logs were analyzed. There was a 33.5% reduction in total major cases performed in March to June 2020 compared with 2018 and 2019 (45.0 [95% CI, 36.1-53.9] vs 67.7 [95% CI, 62.0-72.2]; P < .001), which significantly affected every PGY. All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases. There was a 10.2% reduction in operative volume during the 2019-2020 academic year compared with the 2 previous years (192.3 [95% CI, 178.5-206.1] vs 213.8 [95% CI, 203.6-223.9]; P < .001). Level 1 trauma centers (49.5 vs 68.5; 27.7%) had a significantly lower reduction in case volume than non–level 1 trauma centers (33.9 vs 63.0; 46%) (P = .03).

Conclusions and Relevance In this study of operative logs of general surgery residents in 16 US programs from 2017 to 2020, the first 4 months of the COVID-19 pandemic was associated with a significant reduction in operative experience, which affected every PGY and most case types. Level 1 trauma centers were less affected than non–level 1 centers. If this trend continues, the effect on surgical training may be even more detrimental.

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Article Information

Corresponding Author: Farin Amersi, MD, Department of Surgery, Cedars-Sinai Medical Center, 8700 Beverly Blvd, #8215NT, Los Angeles, CA 90048 (farin.amersi@cshs.org).

Accepted for Publication: March 4, 2021.

Published Online: April 30, 2021. doi:10.1001/jamasurg.2021.1978

Author Contributions: Dr Amersi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Purdy, de Virgilio, Shields Frey, Neville, Donahue, Calhoun, Spain, Amersi.

Acquisition, analysis, or interpretation of data: Purdy, de Virgilio, Kaji, Shields Frey, Lee-Kong, Inaba, Gauvin, Neville, Smith, Salcedo, Calhoun, Poola, Namm, Spain, Dickinson, Tanner, Wolfe, Amersi.

Drafting of the manuscript: Purdy, de Virgilio, Tanner, Amersi.

Critical revision of the manuscript for important intellectual content: Purdy, de Virgilio, Kaji, Shields Frey, Lee-Kong, Inaba, Gauvin, Neville, Donahue, Smith, Salcedo, Calhoun, Poola, Namm, Spain, Dickinson, Wolfe, Amersi.

Statistical analysis: Kaji.

Administrative, technical, or material support: Purdy, Shields Frey, Lee-Kong, Gauvin, Neville, Donahue, Smith, Namm, Spain, Dickinson, Tanner.

Supervision: de Virgilio, Shields Frey, Calhoun, Poola, Amersi.

Conflict of Interest Disclosures: Dr Smith reports personal fees from Stryker Endoscopy outside the submitted work. No other disclosures were reported.

Disclaimer: Dr Kaji is Statistical Editor of JAMA Surgery but was not involved in any of the decisions regarding review of the manuscript or its acceptance.

Meeting Presentation: This study was accepted for presentation at the 92nd Annual Meeting of the Pacific Coast Surgical Association that was planned for February 18-20, 2021, in Monterey, California. However, owing to the COVID-19 pandemic, the meeting was canceled.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.