The resident experience on trauma: Declining surgical opportunities and career incentives? analysis of data from a large multi-institutional study

Samir M. Fakhry, Dorraine D. Watts, Christopher Michetti, John P. Hunt, Thomas Scalea, Carnell Cooper, Brian Daley, Blaine Enderson, Keith D. Clancy, Andrew B. Peitzman, Michael D. Pasquale, Stanley J. Kurek, Ajai K. Malhotra, Timothy C. Fabian, Wendy L. Wahl, Karla S. Ahrns, Jeffrey Morken, Arthur L. Ney, Terrence H. Liu, Frederick A. MooreEddy Carrillo, James Lukan, Bernard Boulanger, F. Barry Knotts, Wendy Sue Shreve, John F. Bilello, James W. Davis, Ivan Puente, Sharon S. Cohen, John C. Layke, Scott Monk, Robert Marburger, Tiffany Bee, William F. Pfeifer, April Settell, Scott H. Norwood, Van L. Vallina, Pamela A. Nichols, Charles E. Wiles, Larry M. Jones, Victor L. Landry, Fred A. Luchette, Scott B. Frame, Lisa A. Patterson, Kathy Coon, Daniel Powers, Anne Kuzas, David G. Jacobs, Jennifer Sarafin, Ronald G. Albuquerque, Charles J. Yowler, Mitchell Scott Farber, Farouck N. Obeid, Jeffrey P. Salomone, Grace S. Rozycki, Sherry Melton, James M. Cross, Michael Haraschak, Michael C. Chang, Curt S. Koontz, Mauricio Lynn, Lonnie W. Frei, Antoinette Kanne, Dennis Wang, Peter Rhee, Benjamin D. Mosher, David Kam, Pascal O. Udekwu, Dale Oller, James V. Yuschak, Robert A. Jubelelirer, David J. Dries, Michael D. McGonigal, Uretz J. Oliphant, James S. Gregory, Mark Gestring, Paul Dabrowski, Juan A. Asensio, Walter Forno, Gustavo Roldan, Joan Huffman, Raymond Talucci, Gary Welch, Barbara Esposito, Jose A. Acosta, Pablo Rodriguez, C. M. Buechler, Leanne Adams, Dennis W. Ashley, Macram Ayoub, Stuart Chow, Kwang Suh, Gerard Fulda, Dennis C. Gore, William J. Mileski, Carl P. Valenziano, Anne O'Neill, Imtiaz A. Munshi, Wayne Vander Kolk, Paul Kemmeter, Jon Walsh, Mary B. Myers, Lewis J. Kaplan, Thomas Santora, Judith Johnson, Paula Griner, Nirav Patel, Thomas Cogbill, Michael F. Rotondo, Scott G. Sagraves, Daniel C. Cullinane, Susan Schrage, Andrew J. Kerwin, Raymond P. Bynoe, Lawrence Lottenberg, Robert Holtzman, Vicki J. Bennett-Shipman, Michael Schurr, Monica Newton, Jeffery Rosen, Christopher Salvino, Paul Bankey, Brian J. Norkiewicz, Robert A. Cherry, Eliza Enriquez, Juan L. Peschiera, W. Michael Johnson, John B. Holcomb, Russell Dumire, John R. Hall, George M. Testerman, Donald H. Jenkins, John D. Josephs, Christopher Wohltmann, A. Jay Raimonde, Arthur B. Dalton, Leonard J. Weireter, Frederic J. Cole, William Marx, Emily M. Sposato, Richard Pomerantz, Om P. Sharma, Michael Oswanshi, Faran Bokhari, Kimberly Nagy, Mary E. Fallat, Vicki Hardwick-Barnes, Deborah Baker, Judith Phillips, Don R. Fishman, Pauline Park, Murray Cohen, Mary Jo Wright, John Hunt, Michael Moncure, Jeff Strickler, John A. Bonadies, Judith A. O'Connor, John E. Sutton, Eileen Corcoran, Frederick B. Rogers, Jonathan Kohn, Dennis B. Dove, Dan A. Galvan, Kathleen P. O’hara, Hans Joseph Schmidt, Leon Pachter, Juan Grau, Kathleen A. LaVorgna, J. P. Dineen, Sheila Staib, L. F. Diamelio, Sharon Buchro, Patrick A. Dietz, Diane Higgins, J. Martin Perez, Collin E.M. Brathwaite, Karyn Butler, Karlene Sinclair, S. M. Siram, Hani Seoudi

Research output: Contribution to journalArticle

89 Scopus citations

Abstract

Purpose The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S). Methods Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998-1999). Results A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair. Conclusion Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalJournal of Trauma
Volume54
Issue number1
DOIs
StatePublished - Jan 2003

Keywords

  • Operative experience
  • Operative procedures
  • Surgical resident education, andNA
  • Surgical training
  • Trauma, Career choices

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Fakhry, S. M., Watts, D. D., Michetti, C., Hunt, J. P., Scalea, T., Cooper, C., Daley, B., Enderson, B., Clancy, K. D., Peitzman, A. B., Pasquale, M. D., Kurek, S. J., Malhotra, A. K., Fabian, T. C., Wahl, W. L., Ahrns, K. S., Morken, J., Ney, A. L., Liu, T. H., ... Seoudi, H. (2003). The resident experience on trauma: Declining surgical opportunities and career incentives? analysis of data from a large multi-institutional study. Journal of Trauma, 54(1), 1-8. https://doi.org/10.1097/00005373-200301000-00001