Featured Article|Articles in Press

Trends in pancreatic surgery experience in general surgery residency in the US, 1990–2021


      • Resident operative volume in pancreatic operations has declined over the last decade.
      • The mean total resident performance of distal pancreatic resections and pancreaticoduodenectomies have also declined in the past decade.
      • The decrease in pancreatic cases was seen at both the Surgeon-Chief and Surgeon-Junior levels.



      We hypothesized a decline in resident pancreatic operative experience. The study assesses trends in that experience since 1990.


      Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residency graduates from 1990 to 2021 were reviewed. Collected and analyzed were the mean and median total number of pancreatic operations per resident, the mean number of specific case types performed, and the annual number of residency graduates. For selected procedures, the mean number of cases by resident role (Surgeon-Chief and Surgeon-Junior) was also analyzed.


      Both the mean and median total number of resident pancreatic operations has declined since 2009 as have the mean number of several specific pancreatic case types, including resections. The annual number of residency graduates has significantly increased since 1990, and particularly since 2009.


      Resident volume in pancreatic operations has significantly declined over the last decade.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. ACGME Program Requirements for Graduate Medical Education in General Surgery Effective July 1. 2022
      2. The American board of surgery booklet of information 2021-2022.
        • Lewis F.R.
        • Klingensmith M.E.
        Issues in general surgery residency training--2012.
        Ann Surg. 2012; 256: 553-559
        • Cortez A.R.
        • Potts 3rd, J.R.
        More of less: general surgery resident experience in biliary surgery.
        J Am Coll Surg. 2020; 231: 33-42
        • Marcadis A.R.
        • Spencer T.
        • Sleeman D.
        • Velazquez O.C.
        • Lew J.I.
        Case distributions in general surgery residency: subspecialization occurs before fellowship.
        Surgery. 2020; 167: 717-723
        • Woeste M.R.
        • Salyer C.E.
        • Hammaker A.C.
        • et al.
        Do general surgery residents begin specializing before fellowship? A multi-institutional study from the us rope consortium.
        J Am Coll Surg. 2022; 235: 799-808
        • American Medical Association
        2004-2005 Graduate Medical Education Directory Including Programs Accredited by the Accreditation Council for Graduate Medical Education.
        American Medical Association, Chicago, IL2004
        • Drake F.T.
        • Aarabi S.
        • Garland B.T.
        • et al.
        Accreditation Council for Graduate Medical Education (ACGME) surgery resident operative logs: the last quarter century.
        Ann Surg. 2017; 265: 923-929
        • Cortez A.R.
        • Katsaros G.D.
        • Dhar V.K.
        • et al.
        Narrowing of the surgical resident operative experience: a 27-year analysis of national ACGME case logs.
        Surgery. 2018; 164: 577-582
        • Accreditation Council for Graduate Medical Education
        Surgery case logs national data report.
        (Available at)
        • Drake F.T.
        • Horvath K.D.
        • Goldin A.B.
        • Gow K.W.
        The general surgery chief resident operative experience: 25 years of national ACGME case logs.
        JAMA Surg. 2013; 148: 841-847
        • Sachs T.E.
        • Pawlik T.M.
        See one, do one, and teach none: resident experience as a teaching assistant.
        J Surg Res. 2015; 195: 44-51
        • Mahmoud A.
        • Ward C.
        • Padmesh H.
        • Daher M.
        Safety and feasibility of the teaching assistant role of senior surgical residents: a prospective randomized study.
        J Surg Educ. 2012; 69: 249-252
        • Kantor O.
        • Schneider A.B.
        • Rojnica M.
        • et al.
        Implementing a resident acute care surgery service: improving resident education and patient care.
        Surgery. 2017; 161: 876-883
        • Cortez A.R.
        • Winer L.K.
        • Kassam A.F.
        • et al.
        See none, do some, teach none: an analysis of the contemporary operative experience as nonprimary surgeon.
        J Surg Educ. 2019; : 1-10
        • Robson A.J.
        • Parks R.W.
        HPB fellowship training: consensus and convergence.
        HPB. 2016 2016; 18: 397-399
        • Sohn T.A.
        • Yeo C.J.
        • Cameron J.L.
        • et al.
        Pancreaticoduodenectomy: role of interventional radiologists in managing patients and complications.
        J Gastrointest Surg. 2003; 7: 209-219
        • Sion M.K.
        • Davis K.A.
        Step-up approach for the management of pancreatic necrosis: a review of the literature.
        Trauma Surg Acute Care Open. 2019; 4 (Published 2019 May 19)e000308
        • Rogers B.H.
        • Cicurel N.J.
        • Seed R.W.
        Transgastric needle aspiration of pancreatic pseudocyst through an endoscope.
        Gastrointest Endosc. 1975; 21: 133-134
        • Anderson E.M.
        • Thomassian S.
        • Gong J.
        • Hendifar A.
        • Osipov A.
        Advances in pancreatic ductal adenocarcinoma treatment.
        Cancers. 2021; 13 (Published 2021 Nov 3): 5510
        • Sachs T.E.
        • Ejaz A.
        • Weiss M.
        • et al.
        Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: is the operative experience enough?.
        Surgery. 2014; 156: 385-393
        • Tseng J.F.
        • Pisters P.W.
        • Lee J.E.
        • et al.
        The learning curve in pancreatic surgery.
        Surgery. 2007; 141: 694-701
        • Kairys J.C.
        • McGuire K.
        • Crawford A.G.
        • Yeo C.J.
        Cumulative operative experience is decreasing during general surgery residency: a worrisome trend for surgical trainees?.
        J Am Coll Surg. 2008; 206 (discussion 811–13): 804-811
        • Fillmore W.J.
        • Teeples T.J.
        • Cha S.
        • Viozzi C.F.
        • Arce K.
        Chief resident case experience and autonomy are associated with resident confidence and future practice plans.
        J Oral Maxillofac Surg. 2013; 71: 448-461
        • Borman K.R.
        • Vick L.R.
        • Biester T.W.
        • Mitchell M.E.
        Changing demographics of residents choosing fellowships: longterm data from the American Board of Surgery.
        J Am Coll Surg. 2008; 206 (discussion 788–9): 782-788
        • Ellis M.C.
        • Dhungel B.
        • Weerasinghe R.
        • Vetto J.T.
        • Deveney K.
        Trends in research time, fellowship training, and practice patterns among general surgery graduates.
        J Surg Educ. 2011; 68: 309-312
        • Mattar S.G.
        • Alseidi A.A.
        • Jones D.B.
        • et al.
        General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors.
        Ann Surg. 2013; 258: 440-449
        • Kassam A.F.
        • Lynch C.A.
        • Cortez A.R.
        • Vaysburg D.
        • Potts 3rd, J.R.
        • Quillin 3rd, R.C.
        Where has all the complexity gone? An analysis of the modern surgical resident operative experience.
        J Surg Educ. 2021; 78: 9-16
        • Kim S.C.
        • Fisher J.G.
        • Delman K.A.
        • Hinman J.M.
        • Srinivasan J.K.
        Cadaver-based simulation increases resident confidence, initial exposure to fundamental techniques, and may augment operative autonomy.
        J Surg Educ. 2016; 73 (–e41): e33
        • Potts J.R.
        Surgical program accreditation and case logs: what is the meaning of the minimal?.
        J Am Coll Surg. 2019; 229: 431e435