Evaluation Of Trainee Parathyroidectomy Experience Based On The Collaborative Endocrine Surgery Quality Improvement Program (cesqip) Data
*Tim Beck, *Talia Burneikis, *Judy Jin
Cleveland Clinic, Cleveland, OH
BackgroundFellowship in a general surgery subspecialty is becoming more common after completion of residency training. Previous studies suggested that resident experience can be negatively affected by an increasing number of fellowship programs. A 50% increase was noted in the number of endocrine surgery fellowship programs in the last decade. Furthermore, a change in the approach for parathyroidectomy has evolved in the last few decades from routine bilateral to a more focused exploration. The purpose of this study is to assess operative experience in parathyroidectomy for the general surgery residents versus endocrine surgery fellows.MethodsThe parathyroid module from the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) was used between 2014 to 2019. Data reviewed included surgical approaches (focal vs bilateral) for patients with primary hyperparathyroidism as well as trainee (resident versus fellow) involvement for each case.Results13,279 parathyroidectomy procedures were included. The number of annual cases increased significantly (1,453 in 2014 vs 2,543 in 2019; P = 0.02). The overall distribution of focal vs bilateral parathyroidectomy remained stable (2014: 54%, 46% vs 2019: 55%, 45%). Ninety three percent of procedures were covered by trainees in 2014, this dropped to 74% in 2019 (P < 0.005). Resident coverage was unchanged over the time period (2014 62% vs 2019 57%, P>0.05). The resident exposure to focal versus bilateral approach was similar to the overall trend observed in the study period. Fellow coverage, on the other hand, decreased significantly from 31% to 17% (p<0.05) over the six years.ConclusionsCESQIP, a national quality tracking program dedicated to endocrine surgery, was used to offer a snapshot of trainee experience in parathyroidectomy. While the overall percentage of case coverage by trainee decreased significantly over time, resident coverage remained stable. At least amongst CESQIP participants, resident exposure to parathyroidectomies mirrored that of the practicing endocrine surgeons and has not been adversely impacted by expanding fellowship programs. The opportunities to capture the uncovered procedures by trainees in general should be further investigated.
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