Podium IIA - Program Evaluation / Wellness / Recruitment
A 10-YEAR ANALYSIS OF SURGICAL SUBSPECIALTY RESIDENCY PROGRAM CAPACITY
Caroline E Baker, BSE1, Lasya P Marla, BS2, Ronald D Ford, MD, FACS1; 1Corewell Health West Michigan Plastic Surgery, 2Michigan State University College of Human Medicine
BACKGROUND: Graduate medical education (GME) programs play a critical role in shaping the physician workforce and healthcare disparities across the U.S. Growth within surgical subspecialty programs may a variety of factors, but little is known about how specific program characteristics relate to expansion over time. This study aims to characterize growth within diverse, high-volume surgical specialties and to examine how program and geographic factors may be associated.
METHODS: This is a cross-sectional observational study. Neurosurgery, orthopedic surgery, otolaryngology (ENT), and integrated plastic surgery residency quotas were obtained from the National Residency Matching Program (NRMP) match reports from 2016-2025. Program characteristics were derived from the institution locations, NRMP, 2023 AAMC State Physician Workforce Data Report, and 2023 Rural-Urban Continuum Codes (RUCC). Univariate and multivariable linear regression models were fitted to assess program growth patterns according to institutional factors. Continuous variables are non-normal per Shapiro-Wilk and presented as median [interquartile range].
RESULTS: From 2016-2025, the examined surgical residency positions increased by 30.9% including 115 new programs and 10 dissolutions. ENT and orthopedic surgery saw the highest growth (30.2%), taking into account the loss of independent plastic surgery programs (overall, 23.0%), and neurosurgery saw the least (23.8%). Median state GME per capita and RUCC were 48.8 [37.1-75.5] and 1.0 [1.0-2.0] (large metropolitan), respectively. Programs were located 32.8% in the South, 27.0% Northeast, 24.0% Midwest, and 16.3% West. Programs were 50.2% private. Multivariable linear regression revealed no program factors to be significantly associated with growth in ENT, neurosurgery, or plastic surgery. However, growth in orthopedic surgery was significantly associated with private sponsorship, lower state GME per capita, and higher RUCC (all p<0.05).
CONCLUSION: ENT, neurosurgery, orthopedic surgery, and plastic surgery residencies have expanded substantially in the last 10 years. Contributing factors likely include U.S. population growth and increased procedural demand.?While institutional?factors were non-significant for other specialties, orthopedic surgery training is growing into less urban, less medically dense areas primarily through private sponsorship. These meaningful strides in orthopedic surgery training expansion improve healthcare accessibility, and other surgical specialties may be able to learn from this model. Future studies should explore additional surgical subspecialties.
HOW THE ACS QUALITY-IN-TRAINING-INITIATIVE HELPS QI EDUCATION FOCUSING ON SAFETY: A REVIEW OF 1,098,264 SURGEON TRAINEE CASES
Caroline O Smolkin, MD1, Geoffrey Hobika, MD1, Arielle Grieco, PhD, MPH1, Alaina Matthews, RN1, Matthew J Fordham1, Rachel R Kelz, MD, MSCE, MBA2, Clifford Y Ko, MD, MS, MSHS1; 1American College of Surgeons, 2Perelman School of Medicine of the University of Pennsylvania
Introduction:
In 2011, the American College of Surgeons (ACS) developed the Quality In-Training Initiative (QITI) to help training surgeons address gaps in safety. QITI is embedded within ACS NSQIP, a nationwide, data-driven program that collects patient demographics, preoperative risk factors, and postoperative outcomes. This analysis evaluates how cases and findings support QI education for training surgeons from first to chief years.
Methods:
This retrospective descriptive analysis included NSQIP cases from July 2013–July 2025 with completed QITI variables. Incomplete cases were excluded. Descriptive statistics and trend analyses of NSQIP results were undertaken, focusing on comparative analytics by year of resident training.
Results:
From a historical total of 190 participating sites, 1,412,068 cases met inclusion criteria – 1,098,264 for PGY1-5. There were 2,782 unique CPT codes; the top 25 comprised 50.3% of cases (n=709,545). The most common PGY-1 CPTs were laparoscopic appendectomy, lumpectomy, laparoscopic cholecystectomy, mastectomy, and various hernia repairs. The most common PGY-5 CPTs were laparoscopic appendectomy, laparoscopic cholecystectomy, various colectomies, hepatectomy, and pancreaticoduodenectomy.
Complications were analyzed for cases up to 2024 Across PGY levels, rates for all complication types increased (p<0.001) (Table 1). After risk adjustment, PGY5 cases were still more likely to experience certain complications (i.e., tube placement, prolonged ventilation, renal, cardiac, readmission, morbidity, and mortality). Sensitivity analysis performed for years 2022-2024 decreased the number of complications with significant results.
Discussion:
As residents progress through training, involvement in cases becomes increasingly complex. Concomitantly, complication rates increase. These findings align with both the educational strategy of graded responsibility and expanded learning as residents progress in their surgical training. With plans in place for NSQIP to offer 100% case capture, QITI participation by training programs could further enhance its role in competency-based assessment, quality improvement training, and promote outcome-focused resident education.
LONGITUDINAL ANALYSIS OF THORACIC SURGERY MILESTONES 2.0 AMONG CARDIOTHORACIC SURGERY TRAINING PATHWAYS
Chase C Marso, MD1, Kenji Yamazaki, PhD2, Sean Hogan, PhD2, Alex Lekdee, MS, MBA2, Jonah Thomas, MD1, Christopher Morse, MD1, Roy Phitayakorn, MD, MHPE1, Dandan Chen, PhD1; 1Massachusetts General Hospital, 2Accreditation Council for Graduate Medical Education
Background: Cardiothoracic surgery implemented Version 2.0 of their Milestones in 2021 to provide a refined competency based medical education framework for assessing residents. The three primary training pathways in cardiothoracic surgery vary in duration and clinical requirements. Therefore, using a standardized Milestone framework promotes consistent biannual evaluation by clinical competency committees (CCC) across programs and training paradigms. To our knowledge, this is the first study to examine longitudinal trends in cardiothoracic surgery Milestones 2.0 across training pathways.
Methods: We obtained Milestone Version 2.0 ratings for trainees in two-year independent (Y2), three-year independent (Y3), and six-year integrated (I6) residency programs from 2021-2024. Residents were included from programs that reported complete Milestone Version 2.0 ratings. Descriptive statistics were calculated to analyze longitudinal trends by training pathways.
Results: From 2021-2025, a total of 959 resident assessments were completed using Milestones Version 2.0 (n=365, Y2; n=217, Y3; n=377, I6). After six consecutive months of strict cardiothoracic training (mid-year evaluation of year 1 for Y2 and Y3 programs, mid-year evaluation of year 4 for I6 programs), I6 program CCCs rated their residents higher than Y2 or Y3 program CCCs across most competency domains. At the final reporting period, I6 program CCCs continued to assign higher ratings (mean=4.32) compared with Y2 (mean=4.15) and Y3 (mean=4.10) programs. Over time, trainees at Y2 programs were rated with the greatest advancement rate (Figure).
Conclusions: CCCs of I6 programs tended to view their trainees as more competent than Y2 and Y3 program CCCs, while Y2 program CCCs reported more rapid growth in competency. This heterogeneity may reflect variation in program structure, clinical experience, and CCC continuity. Future studies should explore factors contributing to rating variations and examine correlations between milestone ratings and other competency assessments to better understand the implications of rating discrepancies among training pathways.
TRENDS IN SURGERY SHELF EXAM SCORES PRE- AND POST-COVID: A LONGITUDINAL INSTITUTIONAL ANALYSIS (2016–2025)
Caroline Rhodes, MBA, APACS; Tulane School of Medicine
Background:
The COVID-19 pandemic disrupted traditional clinical education and assessment in undergraduate medical education. While prior studies have examined short-term effects, longitudinal data on shelf-exam performance remain limited. This study evaluates trends in NBME Surgery Shelf scores from Academic Years 2016–17 through 2024–25, comparing pre- and post-COVID performance and exploring associations with institutional changes such as Step 1 policies, pre-clinical attendance, and assessment requirements.
Methods:
A retrospective review of de-identified NBME Surgery Shelf data was conducted for all third-year medical students between May 2016 and October 2025. The pre-COVID cohort (2016–2020) included four academic years prior to March 2020; the post-COVID cohort (2020–2025) included five academic years in which pre-clinical and clinical years were in a hybrid or in-person format. Summary statistics (mean, SD, min, max) were calculated for each year. Institutional data on Step 1 scheduling indicated that students delaying Step 1 until after the clerkship year frequently overlapped with those who failed the Surgery Shelf.
Results:
Surgery Shelf scores decreased from a mean of 74.9 ± 0.6 pre-COVID to 71.6 ± 0.8 post-COVID (Δ ≈ –3.3 points, 4%). The decline persisted across all five post-COVID years, with the lowest mean (70.5) in AY 2024–25. The number of students scoring below the 5th percentile (considered a pass) likewise spiked post-COVID. An informal record review revealed consistent overlap between delayed Step 1 and shelf failure, suggesting shared academic vulnerability or reduced access to preparation resources.
Conclusions:
Surgery Shelf performance declined and remained lower in the five years following COVID-19, even after pre-clinical courses and clerkships returned to standard formats. The maintained decrease may reflect gaps in foundational knowledge, altered study habits, or disparities in access to support and resources. These findings highlight the need for early, equitable academic interventions, enhanced advising for students postponing Step 1, and the development of individualized learning plans for students needing remediation. Ongoing analysis will examine correlations between Step 1 timing and shelf outcomes and cross-clerkship trends in the NBME Shelf Exam.