Establishing Benchmarks for Case Minimum Requirements During Accreditation Council for Graduate Medical Education–Accredited Orthopaedic Sports Medicine Fellowship Training

Abstract

Background:

Accrediting bodies and professional societies for surgical education are increasingly recognizing the need for case minimum requirements to enhance standardized training.

Purpose:

To determine case volume benchmarks for operative training during Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic sports medicine fellowships in the United States.

Study Design:

Cross-sectional analysis; Level of evidence, 3.

Methods:

Case volume percentiles were calculated across ACGME-defined case categories and temporal changes analyzed with linear regression. Variability was defined as the fold difference between the 90th and 10th percentiles by case volume. Sensitivity analyses were performed to identify potential targets for case minimum requirements.

Results:

Case logs from 1281 orthopaedic sports medicine fellows were analyzed. There was an increase in the mean reported case volume over the study period (from 323.3 ± 125.0 to 375.6 ± 144.0; P = .049). Pediatric patients accounted for a minority of cases (annual range, 6%-7%). The bottom 10th and 30th percentiles of fellows reported a total of 179 and 239 cases, respectively. Most cases were reported in the rotator cuff (29%), meniscus (26%), and knee instability (21%) categories. Variability in the reported case volume was greatest in hip arthroscopic surgery (37.0), patellofemoral instability (15.5), the foot and ankle (12.9), and elbow instability (10.7). Variability decreased for knee instability (P = .006) and total (P = .028) cases over the study period but increased for foot and ankle (P = .002), knee multiligament repair/reconstruction (P = .008), and knee osteotomy (P = .025) cases.

Conclusion:

Surgical benchmarks can assist future trainees and faculty identify areas to improve the operative experience and reduce variability during fellowship training. The operative experience of recent fellows suggests a potential case minimum target between 179 and 239 cases to achieve the 10th and 30th percentiles, respectively. However, further research is needed to establish evidence-based case minimum requirements for ACGME-accredited orthopaedic sports medicine fellowship training.