US General Surgery Residents Log More Cases but Less Advanced Operative Experience

An observational study in the Journal of the American College of Surgeons examined national Accreditation Council for Graduate Medical Education operative log reports from 2009–2010 through 2024–2025. Researchers classified 352 procedures across 23 operative domains as core, advanced, or undefined using the 2025 Surgical Council on Resident Education (SCORE) curriculum and assessed temporal trends with linear regression.

The annual number of graduating residents increased from 1,040 to 1,577, while mean operative volume, including endoscopy, rose from 1,090 to 1,223 cases (+12%). Core procedures accounted for a mean 74.5% of volume and advanced procedures for 12.2%. Core volume increased by 7.2 cases per year (p<0.001), whereas advanced volume decreased by 0.9 cases per year (p=0.01). Chief and junior residents showed similar patterns.

Core volume increased in eight of 13 general surgery domains but declined in nine of 10 subspecialty domains. Twenty-four procedures reclassified from core to advanced between the 2018 and 2025 curricula had already shown declining volume before reclassification.

The findings suggest that rising case totals can coexist with narrowing operative exposure. The authors suggest targeted strategies to preserve training breadth. However, this analysis of national logs describes volume trends rather than demonstrating effects on operative competence or patient outcomes, and classifications were based on the 2025 curriculum.