Elective Surgery Shutdown due to CoVID-19 Did Not Decrease Vascular Integrated Resident Nor Vascular Fellow Operative Experience
Besher Tolaymat, Joseph V Lombardi, Bruce L Tjaden, Philip Batista, Jeffrey Carpenter, Katherine K McMackin
Cooper University Hospital, Philadelphia, PA
Background: In March of 2020, in order preserve hospital beds and personal protective equipment due to the COVID-19 pandemic, the Center for Medicare and Medicaid Services announced the delay of all elective and non-essential medical, surgical and dental procedures. Multiple hospital-based and regional publications reported dramatic decreases in numbers of operative cases during that time. The purpose of this study is to examine the graduation case logs of vascular trainees to determine what effect this shutdown had on vascular trainee operative experience on a national level.
Methods: The Accreditation Council for Graduate Medical Education (ACGME) case logs average case number and standard deviation for each major category was compiled for vascular integrated residents (VR) and vascular fellows (VF) graduating the year of the COVID-19 shutdown (2019-2020) and compared to the year prior (2018-2019). One-year, 2019-2020 “surgeon chief” case log data was collected for VRs, whereas VF “surgeon fellow” case log data was only available for the aggregate duration of the 2-year fellowship (2018-2020). Statistical significance was determined with an unpaired student t-test. The coefficient of variation (Cv) for each category was then calculated to assess regional volatility in the data.
Results: Aggregate case log data for 56 VRs and 120 VFs graduating in 2019 were compared to those for 54 VRs and 123 VFs graduating in 2020. There was a 6.6% increase in VR cases and a 4.1% decrease in VF cases. There was no statistically significant difference among the two years in any of the 12 ACGME-required categories among VRs nor VFs (each p > 0.05, Table 1). Despite differences in regional experiences based on COVID-19 prevalence during this time period, coefficients of variation did not differ significantly (average Cv 0.95 and 0.90 for VRs and 0.62 and 0.59 for VFs for 2018-2019 and 2019-2020, respectively), suggesting a consistent distribution of operative experience overall. Conclusions: Even with the previously published decrease in operative cases during COVID-19 pandemic, this did not translate to significant changes in operative cases for graduating VRs and VFs compared to the year prior to the pandemic. This could be attributed to a shift in operative volume from non-teaching to teaching hospitals with trainees, the high proportion of vascular operations that are non-elective (emergent or urgent), factors surrounding case log completion independent of operative volume, and/or intra-program shifts in cases toward senior trainees. Further investigation into the operative experience of subsequent training cohorts is warranted.
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