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Autonomy during residency is crucial to the training and development of confident, well-rounded surgeons in the operative room. One vital dimension of resident autonomy is teaching assistant (TA) cases, an indispensable opportunity for residents to gain confidence and hone intraoperative teaching skills. However, high-quality data on the volume and diversity of cases that most graduates perform are scarce.


A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006-2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume.


Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6% increase; τ=0.610, p=0.001). There was a concurrent 72.7% increase in TA cases from a median of 22 to 38 (τ=0.574, p= 0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018-2019 and 2016-2017.

The uptrend in TA cases can be largely attributed to the significant increase in colorectal (τ=0.559, p=0.001), general surgery-other (τ=0.404, p=0.018), and hepatopancreatobiliary (HPB) (τ=0.596, p=0.001) subspecialties. Trauma and vascular surgery did not change significantly. With regards to total chief cases, general surgery-other (τ=0.956, p=

The procedural category with the highest chief and TA volume was colorectal tract – large intestine. Most procedural categories (53.49%) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018-2023.


Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.


Poster presented at HSC Education Day 2024



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