The growing discrepancy between resident training in colonic surgery and the rising number of general surgery graduates

  • Samuel A. Käser
  • Andreas Rickenbacher
  • Daniela Cabalzar-Wondberg
  • Marcel Schneider
  • Daniel Dietrich
  • Benjamin Misselwitz
  • Pierre-Alain Clavien
  • Matthias TurinaEmail author
Original Article



The decrease in resident operative experience due to working-hour directives and sub-specialization within general surgery is the subject of growing debate. This study aims to examine how the numbers of colectomies used for resident training have evolved since the introduction of working-hour directives and to place these results within the context of the number of new general surgeons.


Based on the nationwide database of the Swiss association for quality management in surgery, all segmental colectomies performed at 86 centers were analyzed according to the presence or absence of residents and compared to national numbers of surgical graduates.


Of 19,485 segmental colectomies between 2006 and 2015, 36% were used for training purposes. Residents performed 4%, junior staff surgeons 31%, senior staff surgeons 55%, and private surgeons 10%. The percentage performed by residents decreased significantly, while the annual number of graduates increased from 36 to 79. Multivariate analysis identified statutory (non-private) health insurance (OR 7.6, CI 4.6–12.5), right colon resection (OR 3.5, CI 2.5–4.7), tertiary referral center (OR 1.9, CI 1.5–2.6), emergency surgery (OR 1.7, CI 1.3–2.3), and earlier date of surgery (OR 1.1, CI 1.0–1.1) as predictors for resident involvement.


Only a low and declining percentage of colectomies is used for resident training, despite growing numbers of trainees. These data imply that opportunities to obtain technical proficiency have diminished since the implementation of working-hour directives, indicating the need to better utilize suitable teaching opportunities, to ensure that technical proficiency remains high.


Education Surgical training Resident Colon Resection 



We thank the ACQ (Swiss association for quality management in surgery; Arbeitsgemeinschaft für Qualitätssicherung in der Chirurgie) for providing the data to perform this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Samuel A. Käser
    • 1
  • Andreas Rickenbacher
    • 1
  • Daniela Cabalzar-Wondberg
    • 1
  • Marcel Schneider
    • 1
  • Daniel Dietrich
    • 2
  • Benjamin Misselwitz
    • 3
  • Pierre-Alain Clavien
    • 1
  • Matthias Turina
    • 1
    Email author
  1. 1.Department of SurgeryUniversity Hospital ZurichZürichSwitzerland
  2. 2.Swiss Group for Clinical Cancer Research (SAKK)BernSwitzerland
  3. 3.Department of GastroenterologyUniversity Hospital ZurichZürichSwitzerland

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