Anesthesiology Residency Case Volumes Through the COVID-19 Pandemic: National Trends in Training Experience and Gender Equity (2018-2023).

BACKGROUND: Whereas procedural volume has often been used as a proxy for experience, Accreditation Council for Graduate Medical Education (ACGME) case logs and minimum case requirements are designed primarily to document resident exposure and to help determine whether training programs provide sufficient breadth and volume of clinical experiences for their approved complement of residents. However, concerns persist regarding variability in clinical exposure across training institutions, the significant disruption to procedural training during the COVID-19 pandemic when elective cases were suspended nationwide, and potential gender-based differences in procedural experience as recent large-scale studies in general surgery, urology, and ophthalmology have consistently shown that female residents log significantly fewer cases than male residents. Contemporary national data describing anesthesiology case trends and equity across cohorts remain limited.

METHODS: We conducted a retrospective descriptive cohort study of anesthesiology resident case logs across 5 graduating cohorts (2018-2019 through 2022-2023) from all ACGME-accredited programs in the United States. Deidentified resident-level procedural data were obtained from the ACGME case log system and linked to gender data from the Association of American Medical Colleges under a secure data-use agreement. Mean case volumes and 95% confidence intervals were calculated for major procedural categories. Independent-samples t-tests were used to compare case volumes by gender with effect sizes quantified using Cohen d. Minimum case requirement attainment was assessed across cohorts.

RESULTS: Among 8879 residents (67% male, 33% female), 99.78% met all ACGME minimum requirements with no significant gender difference in compliance (P = .086). Case volumes declined during 2019-2020 but recovered by 2022-2023, consistently exceeding national minimums across all categories. Male residents logged significantly higher volumes overall and in specific categories (peripheral nerve blocks, cardiac, vascular, epidurals, life-threatening pathology) though effect sizes were small (Cohen d: 0.11-0.19). Gender differences in failing to meet minimum requirements were not statistically significant overall or within any individual procedural category (all Ps > .05).

CONCLUSIONS: Anesthesiology residency training demonstrates remarkable resilience with near-universal achievement of procedural minimums despite pandemic disruptions. However, persistent gender-based differences in case volumes, coupled with known limitations of self-reported logging, highlight variability in residents' procedural exposure and reinforce the limitations of using case volume alone as a proxy for clinical competence. These findings support transitioning to automated data-capture methods that provide a more accurate and reliable measure of residents' procedural exposure, using competency-based assessments to determine clinical competence and readiness for independent practice.