"Do one, teach one": the new paradigm in general surgery residency training.

OBJECTIVE There is literature examining the total number of procedures performed by surgery residents before and after duty hour restrictions (DHR). There is insufficient literature addressing the effect of DHR on the number of procedures in which residents directly participate as an assistant, rather than as the primary operating surgeon. METHODS The operative experience of general surgery residents completing training at the University of Mississippi Medical Center from 2002 to 2008 was retrospectively examined. Data collected included all procedures entered into the General Surgery Operative Log of the American Council on Graduate Medical Education web site in each of the following categories: Surgeon Chief (SC), Surgeon Junior (SJ), Teaching Assistant (TA), and First Assistant (FA). RESULTS A total of 31 residents completed the program during the study period. Linear regression analysis revealed a significant decrease in the total number of operative procedures (p < 0.05, slope = -55.23, r = -0.99) and the number of procedures reported as FA (p < 0.05, slope = -75, r = -0.89) over the 7-year period. The number of procedures in which residents functioned as the primary surgeon (SJ and SC) or TA remained constant. CONCLUSIONS Since the implementation of DHR at our institution, the number of procedures in which residents participate as a FA has declined. A surgeon is the sum of his or her cumulative operative experience, whether as the operating surgeon or assistant surgeon; one must conclude that the surgical residents' total operative experience at our institution has declined since the inception of the DHR.