Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions
Resident experience with hysterectomy is on the decline
Key clinical point: Current ob.gyn. residents are less experienced at performing hysterectomies than those in past years.
Major finding: The median number of abdominal hysterectomies performed per resident over 4 years of training decreased by 57% between 2002-2003 and 2017-2018 (from 85 cases to 37), and the median number of vaginal hysterectomies decreased by 36% (from 31 to 20 cases).
Study details: A study of case log data from the Accreditation Council for Graduate Medical Education database to assess trends in residents’ operative experience from 2002 to 2018.
Disclosures: One coauthor is a full-time employee of Accreditation Council for Graduate Medical Education, and another receives funds as a director for the American Board of Obstetrics and Gynecology. The remaining authors had no relevant financial disclosures. There was no outside funding for the study.
Gressel GM et al. Obstet Gynecol. 2020 Feb;135(2):268-73.
This excellent paper by Dr. Gressel and coauthors shows decreasing numbers of hysterectomies – especially open and vaginal approaches – being performed by ob.gyn. residents. Considering also the 2015 publication by Guntupalli et al. showing the low numbers of incoming fellows able to perform hysterectomy, as well as Dr. Guntupalli’s editorial on this new research, we all must question how our patients will be able to undergo safe and effective surgery in the future.
In his editorial, Dr. Guntupalli mentions the Cleveland Clinic’s model of allowing residents to track per their desires and future plans. We believe this approach only offers a band-aid to remedy the concern of shrinking hysterectomy numbers, and for that matter all gynecologic surgical procedure numbers. While the ability to choose a major field of interest during residency certainly has been proven to be effective at the Cleveland Clinic, we believe this would be difficult to achieve in smaller programs or programs where there is a huge burden in obstetrics coverage.
Furthermore, it would truly be disheartening and disconcerting for a young physician to choose a residency with the desire of a specific track, only to lose that choice to a coresident.
In his presidential address to the AAGL some years ago, Javier Magrina, MD, of the Mayo Clinic in Phoenix, discussed separating the “O from the G” (J Minim Invasive Gynecol. 2014;21[4]:501-3). Among his points: From 1979 to 2006, there was a 46% decrease in the number of gynecologic operations (2,852,000 vs. 1,309,000), a 54% increase in the number of American College of Obstetricians and Gynecologists’ fellows (21,364 vs. 51,123), and an 81% decrease in the number of gynecologic operations performed per ACOG fellow (132 vs. 25).
In 1980, he pointed out, the total number of hysterectomy procedures performed in the United States was 647,000. In 2007, this total was 517,000. The total number of ACOG fellows in 1980 was 22,516, compared with 52,385 in 2007. And the total number of hysterectomies performed per ACOG fellow was 28, compared with 9.8 hysterectomies per fellow in 2007.
Dr. Magrina’s data goes hand in hand with Dr. Gressel’s new study. The surgical experience of the gynecologic surgeon certainly is on the wane. The result of this lack of experience is noted by Dr. Guntupalli in his 2015 publication. To us, it is readily apparent that Dr. Magrina is right: The only true solution is to finally realize that we must separate the O from the G.
Charles E. Miller, MD, is director of minimally invasive gynecologic surgery, and director of the AAGL fellowship in minimally invasive gynecologic surgery, at Advocate Lutheran General Hospital, Park Ridge, Ill. Kirsten Sasaki, MD, is associate director of the AAGL fellowship in minimally invasive gynecologic surgery at Advocate Lutheran. They have no other conflicts of interest.