Trends in the traditional cardiothoracic surgery resident operative experience for cardiac cases: An analysis of Accreditation Council for Graduate Medical Education case logs

Objective: To determine whether the changing cardiac landscape has affected traditional cardiothoracic surgery (CTS) resident case volume, particularly cardiac case volume. Methods: The Accreditation Council for Graduate Medical Education (ACGME) case logs for traditional CTS residents from 2016 to 2019 were reviewed. Using linear and nonlinear regression, trends in the annual volume and proportion of CTS operations were examined. Results: Overall, the average number of total and category-specific CTS resident cases have increased from 2016 to 2019. However, in general, the proportion of thoracic surgery cases has been increasing, and the proportion of cardiac surgery cases has been decreasing. In particular, the proportion of coronary atherosclerosis (-0.2546 per 100 cases/year; P < .001) and valvular heart disease (-0.319 per 100 cases/year; P < .001) procedures demonstrated the greatest downward trends. The average operative experience for residents has increased (28.8 cases/resident/year; P < .001), but cardiac track residents (22.24 cases/resident/year; P < .001) have had a smaller increase than thoracic track residents (35.04 cases/resident/year; P < .001). Nevertheless, cardiac track residents experienced an increase in their average proportion of cardiac cases (0.176 per 100 cases/year; P < .001) compared with average (-0.263 per 100 cases/year; P < .001) and thoracic track (-0.978 per 100 cases/year; P < .001) CTS residents, indicating specialization of the tracks. Conclusions: The overall CTS resident operative experience has increased over the last several years, with cardiac cases increasing more slowly than thoracic cases. The analysis reveals that cardiac operative volume has been asymmetrically allocated to cardiac track residents, indicating a greater specialization of the tracks. Annual evaluation of CTS resident case volume will provide essential insight into the field.