Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study

Abstract

Background Surgical subspecialty training aims to meet the needs of practicing surgeons and their communities. This study investigates career preparedness of Complex General Surgical Oncology (CGSO) fellowship graduates, identifies factors associated with practice readiness, and explores potential opportunities to improve the current training model. Methods The Society of Surgical Oncology partnered with the National Cancer Institute to conduct a 36-question survey of CGSO fellowship graduates from 2012 to 2022. Results The overall survey response rate was 38% (221/582) with a slight male predominance (63%). Forty-six percent of respondents completed their fellowship after 2019. Factors influencing fellowship program selection include breadth of cancer case exposure (82%), mentor influence (66%), and research opportunities (38%). Overall, graduates reported preparedness for practice; however, some reported unpreparedness in research (18%) and in specific clinical areas: thoracic (43%), hyperthermic intraperitoneal chemotherapy (HIPEC) (15%), and hepato-pancreato-biliary (15%) surgery. Regarding technical preparedness, 70% reported being “very prepared”. Respondents indicated lack of preparedness in robotic (63%) and laparoscopic (33%) surgery approaches. Suggestions for training improvement included increased autonomy and case volumes, program development, and research infrastructure. Current practice patterns by graduates demonstrated discrepancies between ideal contracts and actual practice breakdowns, particularly related to the practice of general surgery. Conclusions This study of CGSO fellowship graduates demonstrates potential gaps between trainee expectations and the realities of surgical oncology practice. Although CGSO fellowship appears to prepare surgeons for careers in surgical oncology, there may be opportunities to refine the training model to better align with the needs of practicing surgical oncologists.

Practice Patterns and Outcomes Among Surgical Oncology Fellowship Graduates Performing Complex Cancer Surgery in the United States Across Different Career Stages

“…A recent survey of CGSO graduates from 2012 to 2022 demonstrated that 90% of graduates generally felt clinically prepared for independent practice, yet there were areas in which trainees felt unprepared both clinically and technically. 4 Specifically, 43% of CGSO graduates felt clinically unprepared for thoracic operations, and 15% felt clinically unprepared for hepatobiliary operations. 4 Similarly, 46% of CGSO graduates reported being technically unprepared for thoracic operations and 24% reported being technically unprepared for hepatobiliary operations upon fellowship completion.…”

“…The establishment of surgical oncology fellowships was driven by the growing complexity of cancer operations and the need for specialized training to provide high-quality, multidisciplinary care to cancer patients. 4 Despite the well-established curriculum of surgical oncology fellowship training, 3 no real-world assessment of outcomes exists among new surgical oncology fellowship graduates or their more experienced colleagues. The current study was important because we assessed outcomes of patients undergoing complex cancer surgery by surgical oncology fellowship graduates across different years of independent practice.…”

“…Transition to independent practice is a critical time in the development of new surgeons. 1 , 4 , 5 After graduation from a fellowship, surgeons are expected to perform the operations themselves, assume responsibility for patient selection, and direct pre- and postoperative care. 1 , 4 Surgical oncology fellowships were developed to help equip surgeons with the necessary skill set for independent practice in a field that involves technically challenging cancer operations.…”

“…1 , 4 , 5 After graduation from a fellowship, surgeons are expected to perform the operations themselves, assume responsibility for patient selection, and direct pre- and postoperative care. 1 , 4 Surgical oncology fellowships were developed to help equip surgeons with the necessary skill set for independent practice in a field that involves technically challenging cancer operations. 1 , 2 To date, there is a lack of information regarding practice patterns and outcomes of new surgical oncologists compared with more experienced surgeons.…”

Teaching Uncommon Diseases in Surgery: Conceptual Framework for the Development of a Peritoneal Surface Malignancy Curriculum

“…7 Notably, graduates of surgical oncology fellowships in the United States express diminished readiness to manage PSM compared to other oncologic conditions. 8 Central issues include the absence of standardized recommendations due to inter-institutional PSM practice variability, varying expectations of attending surgeons concerning disease principles across trainee levels, and time constraints limiting trainees' engagement with traditional learning methods. Consequently, exploring the expectations, perceptions, and educational needs surrounding PSM among attending surgeons and trainees is imperative for optimizing teaching methodologies.…”