American Surgical Association

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Feast or Famine? The Effect of Co-Existing Fellowship Programs on General Surgery Resident Operative
Volumes

John B Hanks, MD1, Thomas W Biester, MD*2, Stanley W Ashley, MD3, David M Mahvi, MD4, J Wayne Meredith, MD5, Steven C Stain, MD6, Karen R Borman, MD7
1Department of Surgery University of Virginia, Charlottesville, VA;2American Board of Surgery, Philadelphia, PA;3Department of Surgery Brigham and Women's Hospital, Boston, MA;4Department of Surgery Northwestern University, Chicago, IL;5Department of Surgery Wake Forest University, Winston Salem, NC;6Department of Surgery Albany Medical College, Albany, NY;7Department of Surgery Abington Memorial Hospital, Abington, PA

OBJECTIVE(S): 80% of general surgery residents (GSR) pursue Fellowship training. We hypothesized fellowship-bound residents (FBR) select cases in their chosen specialty (“early tracking”) and programs with coexisting fellowships may decrease GSR cases.
METHODS: We analyzed ACGME Operative Log of GSR applicants to the 2009 ABS Qualifying Examination (N=976). General Surgery programs coexisted with 35 Colorectal (CR), 97 Vascular (Vasc), 80 Minimally Invasive (MIS) and 12 Endocrine (Endo) fellowships. We analyzed: 1. Operative cases of FBR in their chosen specialty compared to all other GSR (Table 1), and 2. Operative cases for GS Programs with and without a co-existing Fellowship, comparing FBR cases to all GSR (Table 2). Case means compared by ANOVA, significance p< .01
RESULTS: FBR performed significantly more cases in chosen subspecialties than GSR counterparts for Endo, CR and VASC, (not MIS), consistent with pre-fellowship tracking (Table 1). This increase appears not at the expense of other GSR cases. Coexisting fellowships (F+) had minimal impact on GSR cases. Endocrine fellowships enhanced case volumes for all residents; MIS and Vascular fellowships had slight differences (Table 2).
CONCLUSIONS: Our data uniquely show that FBR seek cases in future subspecialties (“early tracking”). Additionally, established Fellowships have minimal impact on GSR cases.
Table 1
EndoVascColorectalMIS
FBRAll GSRFBRAll GSRFBRAll GSRFBRAll GSR
Total Cases64*36165*123204*163227217
% of Total Cases6*314*1017*1420*18


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