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Objective: Up to 40% of pediatric surgery procedures occur at adult hospitals. We aim to evaluate how competent graduating general surgery residents are to perform common pediatric surgery procedures., Design: Pediatric and adult inguinal (IH) and umbilical (UH) hernia operative evaluations were collected. Ratings were analyzed using Bayesian generalized linear mixed models. The primary outcome was graduating residents' estimated probability of being competent to perform an IH or UH repair., Setting: This study was conducted using operative assessment data from general surgery programs in the Society for Improving Medical and Professional Learning (SIMPL) collaborative., Participants: 113,621 evaluations (2,924 UH, 5,555 IH) from 7,032 categorical general surgery residents were analyzed from 2015-2023., Results: Graduating residents had an adjusted probability of being competent to perform an adult IH of 94.3% (Interquartile Range [IQR] 83.4%-98.3%). In contrast, competence probabilities were 79.5% (IQR 52.7%-93.3%) for a <6 month old, 89.6% (IQR 72.1%-96.9%) for a 6 month to 5 year old, and 89.9% (IQR 71.9%-96.9%) for a >5 year old. For UH repairs, competence probabilities were similar for adult (97.6%, IQR 92.4%-99.3%) and pediatric procedures (97.3% for <5 years old [IQR 91.4%-99.2%]; 97.6% for >5 years old [IQR 92.3%-99.3%])., Conclusions: Nearly all graduating general surgery residents are competent to perform pediatric UH repairs. However, there is variability in competence of general surgery residents performing pediatric IH repairs, especially in children <6 months old., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: Preliminary surgery positions are associated with a negative stigma, and this stigma may persist for those residents who later go on to obtain a categorical position. However, it is currently unknown if general surgery residents who complete a preliminary year perform differently than their categorical peers throughout training. To examine these potential differences, we compared operative performance and autonomy across all 5 years of training for those who completed a nondesignated preliminary training year with those who did not., Design: Faculty ratings of categorical general surgery residents were collected from the Society for Improving Medical and Professional Learning (SIMPL) application. Residents were categorized based on the completion of a nondesignated preliminary year ("Previous Prelim" [PP]) or not ("Traditional Categorical" [TC]). Operative performance and autonomy ratings were tracked over 5 training years and analyzed using generalized mixed effects models. Performance and autonomy outcomes were dichotomized: "not competent" or "competent" and "no meaningful autonomy" or "meaningful autonomy", respectively. Fixed effects included cohort group, academic month, case complexity, resident level (junior [PGYs 1 and 2] vs senior [PGYs 3, 4, and 5] residents), and an interaction term between cohort group and resident level, while random effects included resident, faculty, program, and procedure., Setting: Operative performance and autonomy ratings were collected from the SIMPL application between 2015 and 2023., Participants: A total of 89 general surgery residency programs, which encompassed 1,108 categorical general surgery residents., Results: A total of 42,416 evaluations were analyzed. Of these, 809 evaluations were from PP residents. Faculty ratings of PP vs TC residents revealed no significant differences in adjusted probabilities of achieving a "competent" rating as a junior (5.6%, 95% Confidence Interval [CI] 2.7%-11.1% vs 3.0%, 95% CI 2.4%-3.7%, p = 0.28) or senior (23.7%, 95% CI 12.2%-41% vs 34.1%, 95% CI 29.1%-39.5%, p = 0.59) resident. Similarly, no significant differences were identified in adjusted probabilities of achieving a "meaningful autonomy" rating between PP and TC junior (9.0%, 95% CI 5.4%-14.6% vs 8.1%, 95% CI 6.9%-9.5%, p = 0.97) or senior (42.3%, 95% CI 28.7%-57.1% vs 49.6%, 95% CI 44.9%-54.2%, p = 0.76) residents., Conclusions: PP and TC residents may have similar operative performance and autonomy ratings throughout their residency training. Although further study of more senior residents is warranted, these initial findings could help combat the negative stigma associated with a preliminary year of training., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)