ON THE NATURE OF THINGS STILL GOING BANG IN THE NIGHT - AN ANALYSIS OF RESIDENCY TRAINING IN TRAUMA

In the 1982 Presidential Address to the Society of University Surgeons , Trunkey reported on the inadequacy of surgical education in trauma c are. His conclusions were based on American Board of Surgery operative experience data compiled from residents completing surgical training in 1980. The purpose of this study was to compare current resident ope rative experience in trauma surgery with the American Board of Surgery data from 1980. Yearly resident operative experience data obtained fr om the Residency Review Committee from 1987 through 1991 were analyzed . The relationship between the percentile rank and the number of opera tive cases was defined using linear regression. The percentile rank of residents performing a specified number of operative cases was comput ed using a linear regression coefficient. The results were then compar ed with previously published 1980 American Board of Surgery summary da ta. Resident operative experience in trauma surgery was stable over th e 5-year period investigated and no significant trends were identified . Comparison of the data from 1980 to 1991 revealed that the percentag e of residents performing less than ten cases decreased markedly, from 18% to 9%. Moreover, the percentage of residents claiming fewer than 50 cases declined from 86% to 29%. Based on this analysis, it appears that resident operative experience dramatically increased from 1980 to 1987 and has since remained stable. The reasons for this are unclear but undoubtedly involve the accuracy of reporting operative experience , Residency Review Committee operative trauma definitions, and the act ual number of trauma surgery cases available for trainees. Although re sident operative experience may have increased, questions still exist regarding the appropriate level and distribution of both operative and nonoperative cases for optimal surgical training.