Defining Targets for Case Minimum Requirements During Accreditation Council for Graduate Medical Education Accredited Pediatric Orthopaedic Surgery Fellowship Training.

BACKGROUND

Increasingly, professional societies and accrediting bodies in orthopaedic surgery recognize the role of case minimum requirements to assess and enhance fellowship training. This study analyzes targets for case minimum requirements during Accreditation Council for Graduate Medical Education (ACGME)-accredited pediatric orthopaedic surgery fellowship training.

METHODS

This was a cross-sectional study of ACGME-accredited pediatric orthopaedic surgery fellows who graduated between 2018 and 2024. Means, SDs, and percentiles for recorded case volumes were calculated across ACGME-defined case categories. Variability was defined as the fold-difference between the 90th and 10th percentiles of case volume. Potential targets for case minimum requirements were identified through sensitivity analyses.

RESULTS

There were 258 ACGME-accredited pediatric orthopaedic surgery fellows included in this study. Mean annual case volume increased over the study period (254.9±70 to 285.2±82, P =0.456). The most frequently reported cases were in spine deformity (19%), foot and ankle deformity (16%), hip reconstruction (13%), and limb deformity (12%). Variability in total reported case volume was 2.0 and was greatest in clubfoot (78.4), soft tissue: transfer, lengthen, release (15.4), and treatment of infection (10.6). The 10th and 30th percentiles of fellows reported 18 and 26 hip reconstruction cases, 17 and 30 foot and ankle deformity cases, 14 and 23 limb deformity cases, 12 and 25 spine deformity cases, 11 and 19 trauma lower limb cases, and 8 and 14 trauma upper limb cases before graduation, respectively.

CONCLUSIONS

Case volumes of recently graduated fellows may help inform future case minimum requirements for ACGME-accredited pediatric orthopaedic surgery fellowship training. Future investigation is needed to refine proposed targets for case minimum requirements through elucidation of surgical learning curves and other clinical competency metrics.

CLINICAL RELEVANCE: Case minimum requirements may facilitate operative training during pediatric orthopaedic surgery fellowship training and promote greater standardization across programs. Case minimum requirements may also promote clinical competency assessments and patient safety in pediatric orthopaedic surgery.