LAUSR

OBJECTIVE To determine the relationship between race/ethnicity and case volume among graduating surgical residents. SUMMARY BACKGROUND DATA Racial/ethnic minority individuals face barriers to entry and advancement in surgery; however, no large-scale investigations of the operative experience of racial/ethnic minority residents have been performed. METHODS A multi-institutional retrospective analysis of Accreditation Council for Graduate Medical Education (ACGME) case logs of categorical general surgery residents at 20 ACGME-accredited programs in the US Resident OPerative Experience (ROPE) Consortium database was performed. All residents graduating between 2010-2020 were included. Total, surgeon chief, surgeon junior, and teaching assistant case volumes were compared between racial/ethnic groups. RESULTS The cohort included 1343 residents. There were 211 (15.7%) Asian, 65 (4.8%) Black, 73 (5.4%) Hispanic, 71 (5.3%) "Other" (Native American or Multiple Race), and 923 (68.7%) White residents. On adjusted analysis, Black residents performed 76 fewer total cases (95% CI, -109 to -43, P<0.001) and 69 fewer surgeon junior cases (-98 to -40, P<0.001) than White residents. Comparing adjusted total case volume by graduation year, both Black residents and White residents performed more cases over time; however, there was no difference in the rates of annual increase (10 versus 12 cases per year increase, respectively, P=0.769). Thus, differences in total case volume persisted over the study period. CONCLUSIONS In this multi-institutional study, Black residents graduated with lower case volume than non-minority residents throughout the previous decade. Reduced operative learning opportunities may negatively impact professional advancement. Systemic interventions are needed to promote equitable operative experience and positive culture change.