Cross-Specialty Training: An Opportunity to Expand the General Surgery Resident's Operative Repertoire

Many hospitals have general surgery (GS) residents without other surgical subspecialty residents, creating opportunity to scrub on cases beyond traditional GS. The purpose of this study was to describe and quantify subspecialty case coverage by GS residents at Veterans Affairs (VA) Hospitals without subspecialty resident coverage. Retrospective study utilizing the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database. Subspecialty operative cases without subspecialty resident coverage within the VASQIP database from July 1, 2010 to February 28, 2020 were analyzed. All adult patients who underwent any ENT, Plastic Surgery, or GYN surgical procedures performed at VA teaching hospitals with GS resident coverage but without subspecialty resident coverage from July 1, 2010, to February 28, 2020. The most common cases by current procedural terminology (CPT) code were selected for study inclusion. Cases were further coded by level of resident supervision prospectively recorded at the time of surgery; attending performing the case with/without a resident (AP); resident performing most of the case with attending scrubbed (AR); resident operating without attending scrubbed (RP). Subspecialty cases with a supervision code AR or RP were considered to have been covered by GS residents at institutions without corresponding subspecialty residents. A total of 14,636 subspecialty cases were performed at VA Hospitals without subspecialty resident coverage. Of 92 VA teaching hospitals with GS resident coverage, there are 50 hospitals without GYN, 24 without ENT, and 28 without PS. The case coverage by GS residents were highest in Plastic surgery at 17.2%. Only 6.8% of ENT cases and 14.7% of GYN cases involved a GS resident even though the ten most common off service operative cases are ACGME defined category cases for GS residency training. The VA offers a significant number of subspecialty cases each year, including several index cases, which fulfill GS operative requirements. GS residents appear to be involved in only a small percentage of available subspecialty cases, leaving a large untapped opportunity for training programs at these VA Hospitals to provide major cases and build a diverse operative experience for trainees. The opportunity to scrub with other surgical specialties enriches the GS residents’ training experiences, and there may be additional opportunities to take advantage of such teaching cases within the VA hospital system.