Rural General Surgery Experience as a Valuable Adjunct to an Academic Based General Surgery Residency

Abstract

Objective: Few general surgery residencies offer rural rotations. We aim to evaluate the contribution of our institution's rural rotation to meeting the Accreditation Council for Graduate Medical Education (ACGME) minimum case requirements for graduation, and residents' perceptions of the educational value of this rotation.

Design: ACGME case log data were obtained from categorical general surgery residents who had completed at least 1 month-long rural surgery rotation and 1 month-long general surgery rotation at our academic medical center within the same clinical year. Cases were classified per ACGME defined categories. For each category, the number of cases per month per resident was calculated, and the means for each educational setting were compared using the paired t-test. Residents also completed a 10-question Likert scale survey regarding their perceptions of the rotation.

Setting: Residents rotated at Vidant Medical Center, a tertiary AMC¹ affiliated with East Carolina University in Greenville, NC, and at Vidant Chowan, a critical access hospital within the Vidant Health hospital system located in Edenton, NC.

Participants: Categorical general surgery residents eligible to rotate through the rural surgery rotation and the general surgery rotation at the AMC.

Results: Eleven total residents completed 23 months of rural surgery (mean 2.1 months per resident) and 39 months at the AMC (mean 3.5 months per resident). Significantly more endoscopic cases, hernia repairs, breast cases, and vascular cases were performed on the rural surgery rotation. More abdominal and alimentary tract cases in addition to endocrine, thoracic, and head/neck cases were performed at the AMC. Frequencies of biliary and soft tissue cases were not significantly different. Survey responses regarding the rural rotation were universally positive including more hands-on experience, increased satisfaction with patient care and continuity, and operative confidence and competence.

Conclusions: At our institution, residents benefit from an enriching rural surgery rotation that provides case numbers different from the comparative AMC general surgery rotation.

Keywords: Case log requirements; Curriculum; Rural surgery; Surgical education.