Readiness of Graduating General Surgery Residents To Perform Common Pediatric Surgery Procedures

Abstract

Objective

Up to 40% of pediatric surgery procedures occur at adult hospitals. We aim to evaluate how competent graduating general surgery residents are to perform common pediatric surgery procedures.

Design

Pediatric and adult inguinal (IH) and umbilical (UH) hernia operative evaluations were collected. Ratings were analyzed using Bayesian generalized linear mixed models. The primary outcome was graduating residents’ estimated probability of being competent to perform an IH or UH repair.

Setting

This study was conducted using operative assessment data from general surgery programs in the Society for Improving Medical and Professional Learning (SIMPL) collaborative.

Participants

113,621 evaluations (2,924 UH, 5,555 IH) from 7,032 categorical general surgery residents were analyzed from 2015-2023.

Results

Graduating residents had an adjusted probability of being competent to perform an adult IH of 94.3% (Interquartile Range [IQR] 83.4%-98.3%). In contrast, competence probabilities were 79.5% (IQR 52.7%-93.3%) for a <6 month old, 89.6% (IQR 72.1%-96.9%) for a 6 month to 5 year old, and 89.9% (IQR 71.9%-96.9%) for a >5 year old. For UH repairs, competence probabilities were similar for adult (97.6%, IQR 92.4%-99.3%) and pediatric procedures (97.3% for <5 years old [IQR 91.4%-99.2%]; 97.6% for >5 years old [IQR 92.3%-99.3%]).

Conclusions

Nearly all graduating general surgery residents are competent to perform pediatric UH repairs. However, there is variability in competence of general surgery residents performing pediatric IH repairs, especially in children <6 months old.