Does Residency Prepare Surgeons for Early Orthopaedic Practice?

One goal of an orthopaedic surgery residency is to prepare residents for the procedures they will perform when they are attendings. Yet, until the retrospective cohort study by Kohring et al. in the April 4, 2018 issue of The Journal, it remained unclear how similar a resident’s surgical case mix was compared to the cases attendings saw in early practice.  Kohring et al. used data from both the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Orthopaedic Surgery (ABOS) to compare the types of procedures residents performed between 2010 and 2012 to the cases junior attendings submitted for the ABOS Part II examination between 2013 and 2015. The authors then categorized the cases by CPT codes and split them into adult and pediatric categories to allow for further comparison.

Here are a few interesting findings from the study:

• More than half of all adult and pediatric procedures performed during residency and by early-career attendings fell within the top 10 CPT code categories.
• Knee and shoulder arthroscopy were the most commonly performed cases in adults during both residency and early practice.
• Residents take part in total knee and total hip arthroplasties much more frequently than do attendings in early practice.
• Attendings in early practice treat more than twice the number of proximal femur fractures than do residents during residency.
• Residents are exposed to a much higher rate of spinal fusion cases than are seen by early-practice attendings.

Although the authors conclude that the “similarity between residency and early practice experience is generally strong,” this study highlights some of the disparities between the two cohorts, and these findings may inform further research aimed at improving training for orthopaedic surgeons. By themselves, however, these results should not be used to change the experience residents have during their training. The authors mention the limitations inherent when comparing these two cohorts, and I can testify that my clinical practice has evolved tremendously in the 3 years since I started as an attending.

Furthermore, with more than 90% of orthopaedic residents going on to complete a subspecialty fellowship immediately after residency, it is safe to say that the degree of similarity between residency and attending case experience will vary from surgeon to surgeon.

Chad A. Krueger, MD
JBJS Deputy Editor for Social Media