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Factors Influencing the Decision of Surgery Residency Graduates to Pursue General Surgery Practice or Fellowship
Mary E. Klingensmith1, Thomas H Cogbill2, Fred A Luchette3, Thomas A Biester*4, Kelli Samonte*4, Andrew Jones*4, Mark A Malangoni4
1Washington University in Saint Louis, Saint Louis, MO;2Gundersen Health System, LaCrosse, WI;3Loyola University Medical Center, Chicago, IL;4American Board of Surgery, Philadelphia, PA

Objective: Surgery residency serves two purposes - prepare graduates for general surgery (GS) practice or post-residency surgical fellowship (SF). This study was undertaken to elucidate factors influencing career choice for these two groups.
Methods: All U.S. allopathic surgery residency graduates 2009-2013 (n= 5512) were surveyed by the American Board of Surgery regarding confidence, autonomy and reasons for career selection between GS and SF. Surveys were distributed by mail in November 2013 with follow up mailings to non-respondents.
Results: 3354 graduates (68%) completed the survey; 26% pursued GS and 74% SF. GS expressed greater levels of confidence than SF across the common surgical procedures queried. Confidence improved with years after completion of residency for GS but not SF. The decision to pursue GS or SF was made during residency by 77% and 74%, respectively. 57% of those who chose GS indicated a GS mentor significantly influenced their decision. GS rated procedural variety, opportunity for practice autonomy, choice of practice location, and influence of a mentor as reasons to pursue GS practice. SF listed control over scope of practice, prestige, salary, and specialty interest as reasons to pursue SF. Both groups expressed a high degree of satisfaction with their career choice (GS, 94%; SF, 90%).
Conclusions: Most graduates who pursue GS practice are confident and content. The decision to pursue GS is strongly influenced by a GS mentor. Lack of confidence may be a more significant factor for choosing SF. These findings suggest opportunity for improvements in confidence and mentorship during residency.


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