Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents

Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents

Herbert P. Stride, Brian C. George, Reed G. Williams, Jordan D. Bohnen, Megan J. Eaton, Mary C. Schuller, Lihui Zhao, Amy Yang, Shari L. Meyerson, Rebecca Scully, Gary L. Dunnington, Laura Torbeck, John T. Mullen, Samuel P. Mandell, Michael Choti, Eugene Foley, Chandrakanth Are, Edward Auyang, Jeffrey Chipman, Jennifer Choi, Andreas Meier, Douglas Smink, Kyla P. Terhune, Paul Wise, Debra DaRosa, Nathaniel Soper, Jay B. Zwischenberger, Keith Lillemoe, Jonathan P. Fryer

Surgery, December 22, 2017



Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements.


Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents.


Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training.


We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents’ readiness for independent practice.

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