Accreditation Council for Graduate Medical Education Compliance and Resident Competence in Hepatopancreaticobiliary Surgery during General Surgery Residency: A Program Director Review.

OBJECTIVE: A survey of general surgery (GS) program directors (PD) was performed to determine how Accreditation Council for Graduate Medical Education (ACGME) hepatopancreatobiliary (HPB) requirements are met and compare the findings with previous national averages. The objectives were to establish whether GS residencies are in compliance with ACGME recommendations. Secondary objectives aimed to determine if fellowship affects residency training.

METHODS: A 30-question survey was sent out to GS PDs registered with Association of Program Directors in Surgery. Analysis of the responses was then completed using statistical software (GraphPad) and compared with the ACGME data.

RESULTS: Although HPB training and exposure has changed, most programs continue to meet HPB requirements at their main institution (73%). Overall, 27% of PDs now send residents to outside facilities or have hired new HPB faculty to manage the shift in caseload. GS graduates have HPB numbers comparable to the national resident averages of 2010 to 2011, and many programs graduate residents exceeding ACGME HPB requirements. Although 69% of residents complete >50% of HPB cases, only 50% of PDs felt residents were competent. Altogether, 30% of programs had HPB fellowships; few PDs felt fellows positively affected residency training.

CONCLUSIONS: PDs feel that residents achieve more than minimum required HPB numbers required by the ACGME but not all are competent. Fellows reduce resident exposure to HPB cases. More simulation and autonomy may improve HPB education in GS residency.