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Current Teaching in United States

Current Teaching in United States. Feza H. Remzi,M.D. F.A.C.S., F.A.S.C.R.S., F.T.S.S. ( Hon). Department of Colorectal Surgery Digestive Disease Institute Cleveland Clinic, Ohio. Aim: To demonstrate trends in CR practice from 1989 to 1996

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Current Teaching in United States

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  1. Current Teaching in United States Feza H. Remzi,M.D. F.A.C.S., F.A.S.C.R.S., F.T.S.S. ( Hon) Department of Colorectal Surgery Digestive Disease Institute Cleveland Clinic, Ohio

  2. Aim: • To demonstrate trends in CR practice from 1989 to 1996 • To compare the 1 year technical experience of a CR resident with the 5 years total of a GS resident • CR resident performs • more anorectal operations • more endoscopic procedures • more index abdominal operations in 1 year than GS resident does in 5 years • 1 year of training in CR trains a true specialist with unique expertise Schoetz DCR 1998

  3. Data from American Board of Colon and Rectal Surgery (ABCRS) database (1994 to 2005) • CR training programs increased from 28 to 39 (28% increase) • CR residency positions increased from 50 to 66 (24% increase) • Anorectal patients per resident remained constant over the study period • Sigmoidoscopy decreased substantially • Rigid (67 to 44 per resident) • Flexible (135.5 to 39 per resident) • Colonoscopy increased (209 to 264 per resident) Schoetz J Am Coll Surg 2006

  4. Perineal procedures for rectal prolapse consistently comprise 50% to 60% of the total procedures for prolapse • Low anterior resection APR ratio=3/1 • Coloanal anastomoses have steadily increased • Radical cancer operations continue to make up a sizeable portion of abdominal surgery volume in training programs • Surgery for colon cancer have been between 52.4% and 57.9% of the total number of resections for colorectal cancer Schoetz Jr J Am Coll Surg 2006

  5. General Surgery Colorectal Surgery Colectomy 14.9 62.2 IPAA 1.5 10.7 APR 3.2 7.3 Gen Surgery versus Colon Rectal Surgery Residents Colon Procedures 1995-1996

  6. Laparoscopic Colorectal Surgery • 3.6% laparoscopic procedures performed in 1994, vs. 24.3% in 2005 • The greatest increase being in diverticular resections (6.5 % in 1994 vs. 44.7% in 2005) • In 1994 5.6% of colon resections performed laparoscopically for cancer vs. 41.1% in 2005 Schoetz Jr J Am Coll Surg 2006

  7. Data from Accreditation Council for GME • General surgery residents (2000-2004) • The average number of LAP colectomy/GS resident/career increased from 1.84 to 4.61 • Colorectal surgery residents (1994-2005) • Number of CR residents steadily increased to 66 by 2005 • The total number of open or LAP cases increased from 8342 to 13267 • The average LAP cases/CR resident increased from 6.3 in 1993-1994 to 45.3 in 2004-2005 Charron DCR 2007

  8. Colorectal surgery residents (1994-2005) • A total of 2987 LAP cases were performed in 2005 • Average CR resident recorded 45.3 LAP cases in 2005 (colon=30, rectal=9.4, other=5.9) • 1999-2000, 3098 segmental colectomy performed (LAP=330) • 2004-2005, 4394 segmental colectomy performed (LAP=1771) • LAP low anterior resection increased from 32 to 248 (1999 to 2005) • LAP APR increased from 11 to 48 (1999 to 2005) Charron DCR 2007

  9. Comparison of LAP colon resection experience for GS vs. CR residents • 2003-2004 • The average number of laparoscopic colon resections by GS vs. CR (4.61 vs. 20.2) • The majority of GS resident experience was acquired in the chief year , with an average of 2.69 of 4.61 cases Charron DCR 2007

  10. Conclusions • Learning curves for LAP colectomy are reported in the range of 20 to 60 cases • CR resident experience is trending toward this threshold • Recent general surgery graduates may be lacking the appropriate volume to reach proficiency in LAP colorectal surgery Charron DCR 2007

  11. Minimum Numbers ABCRS • Segmental Colectomy 37 • LAR 11 • APR 4 • IPAA 7

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