The Impact of a Formal Minimally Invasive Service on the Resident's Ability to Achieve New ACGME Guidelines for Laparoscopy

Purpose: As laparoscopy continues to permeate general surgery, there is an increased need for residents to acquire advanced laparoscopic skills during a surgical training program. To underscore its importance, the Accreditation Council of Graduate Medical Education (ACGME) recently increased the requirements for laparoscopy from 34 to 60 basic cases and from 0 to 25 advanced cases. With this in mind, the purpose of this study is to assess the impact of an organized minimally invasive surgical service on the volume of advanced laparoscopic cases of a general surgery residency program. Methods: In July 2005 an independent minimally invasive surgical service, consisting of a fellowship-trained laparoscopic surgeon and 3 general surgery residents was instituted in an otherwise stable academic general surgery residency program. A retrospective review of the general resident's operative database was performed from 2001 to 2006 to assess the impact of this service on the volume of advanced laparoscopic cases of graduating chief residents. Results: In the 4 years before the initiation of the minimally invasive service, the operative volume remained flat despite a stable training program and steady population growth. In the year after the formation of the dedicated service, the mean number of advanced cases performed by the graduating chief residents more than doubled, from 17.7 cases in each of the 2 years before, to 35.6 cases, fulfilling the ACGME requirements. Conclusion: The number of advanced laparoscopic cases per resident in this otherwise stable general surgery residency program substantially increased with the incorporation of a dedicated minimally invasive service led by a fellowship-trained laparoscopic surgeon. These data suggest that the volume increases needed to satisfy ACGME requirements may only be possible by creation of such a training experience dedicated to advanced laparoscopy.