This 2006 AOA symposium paper asks whether orthopedic residency programs should require minimum surgical case volumes for graduation. It presents pro and con arguments, survey data from program directors and PGY-4 residents, and the ACGME Residency Review Committee's position. The central tension: case counts are measurable and already tracked, but no one knows how many cases actually produce a competent surgeon.
The orthopedic RRC had access to case log data on every resident in the country but, as of 2006, was using it only to compare programs to national averages rather than to enforce any floor. This paper captures the moment when the specialty was being pushed to change that — driven by credentialing pressure from hospitals, who were beginning to require procedure-specific documentation for privileges.
The practical implication for trainees is direct: know your case log numbers. Program directors are increasingly asked to attest to procedure-specific competence, and hospitals requesting initial privileges will scrutinize these records. If you are graduating without 26-100 TKAs, THA, or knee arthroscopies, that gap will matter when you apply for credentialing.
The paper's lasting insight is that quantitative minima are necessary but not sufficient. A resident who hits the number but cannot decide when NOT to operate has not met the bar. Case volume is a floor, not a ceiling.
This 2006 AOA symposium paper asks whether orthopedic residency programs should require minimum surgical case volumes for graduation. It presents pro and con arguments, survey data from program directors and PGY-4 residents, and the ACGME Residency Review Committee's position. The central tension: case counts are measurable and already tracked, but no one knows how many cases actually produce a competent surgeon.
The orthopedic RRC had access to case log data on every resident in the country but, as of 2006, was using it only to compare programs to national averages rather than to enforce any floor. This paper captures the moment when the specialty was being pushed to change that — driven by credentialing pressure from hospitals, who were beginning to require procedure-specific documentation for privileges.
The practical implication for trainees is direct: know your case log numbers. Program directors are increasingly asked to attest to procedure-specific competence, and hospitals requesting initial privileges will scrutinize these records. If you are graduating without 26-100 TKAs, THA, or knee arthroscopies, that gap will matter when you apply for credentialing.
The paper's lasting insight is that quantitative minima are necessary but not sufficient. A resident who hits the number but cannot decide when NOT to operate has not met the bar. Case volume is a floor, not a ceiling.