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Feast or Famine?: The Variable Impact of Coexisting Fellowships on General Surgery Resident Operative Volumes

Hanks, John B. MD*; Ashley, Stanley W. MD; Mahvi, David M. MD; Meredith, Wayne J. MD§; Stain, Steven C. MD; Biester, Thomas W. MS; Borman, Karen R. MD**

doi: 10.1097/SLA.0b013e31822aa4d5
Papers of the 131st ASA Annual Meeting

Objectives: Nearly 80% of general surgery residents (GSR) pursue Fellowship training. We hypothesized that fellowships coexisting with general surgery residencies do not negatively impact GSR case volumes and that fellowship-bound residents (FBR) preferentially seek out cases in their chosen specialty (“early tracking”).

Methods: To test our hypotheses, we analyzed the Accreditation Council for Graduate Medical Education Surgical Operative Log data from 2009 American Board of Surgery qualifying examination applicants (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 for general surgery residency programs with and without coexisting Fellowships, comparing caseloads for FBR and all GSR and (2) operative cases of FBR in their chosen specialties compared to all other GSR. Group means were compared using ANOVA with significance set at P < 0.01.

Results: Coexisting fellowships had minimal impact on GSR caseloads. Endocrine fellowships actually enhanced case volumes for all residents. CR impact was neutral while MIS and vascular fellowships resulted in small declines. Endo, CR, and Vasc but not MIS FBR performed significantly more cases in their future specialties than their GSR counterparts, consistent with self-directed, prefellowship tracking. Tracking seems to be additive and FBR do not sacrifice other GSR cases.

Conclusions: Our data establish that the impact of Fellowships on GSR caseloads is minimal. Our data confirm that FBR seek out cases in their future specialties (“early tracking”).

American Board of Surgery data are used to analyze the impact of four separate fellowships on general surgery resident operative caseloads. Fellowships coexisting with general surgery residencies do not negatively impact case volumes for residents in the fellowship specialties. General surgery residents appear to be self selecting cases of interest in their chosen future specialties.

*Division of General Surgery, University of Virginia, Charlottesville, VA

Department of Surgery, Brigham and Women's Hospital, Boston, MA

Department of Surgery, Northwestern University, Chicago, IL

§Department of Surgery, Wake Forest University, Winston-Salem, NC

Department of Surgery, Albany Medical College, Albany, NY

The American Board of Surgery, Inc., Philadelphia, PA

**Department of Surgery, Abington Memorial Hospital, Abington, PA.

Reprints: John B. Hanks, MD, Department of Surgery, University of Virginia Health System, PO Box 800709, Charlottesville, VA 22908. E-mail:

Presented at the American Surgical Association Meeting, April 2011, Boca Raton, Florida.

Disclosure: The authors declare that they have nothing to disclose.

© 2011 Lippincott Williams & Wilkins, Inc.