Trends in Research Time, Fellowship Training, and Practice Patterns Among General Surgery Graduates

Ellis, Michelle C.; Dhungel, Birat; Weerasinghe, Roshanthi; Vetto, John T.; Deveney, Karen E.

doi:10.1016/j.jsurg.2011.01.008

Cited by 83 publications

(31 citation statements)

References 8 publications

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“…Recent literature has shown an increasing number of general surgery residents pursuing fellowship training after graduation 1–2 . This trend of seeking additional training may result from residents’ lack of confidence in their readiness for independent operative performance 3–7 .…”

Section: Introductionmentioning

confidence: 99%

Use of decision-based simulations to assess resident readiness for operative independence

D’Angelo

Cohen

Kwan

et al. 2015

The American Journal of Surgery

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Section: Introductionmentioning

confidence: 99%

Use of decision-based simulations to assess resident readiness for operative independence

D’Angelo

Cohen

Kwan

et al. 2015

The American Journal of Surgery

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“…The vast majority of residents start their dedicated research time after two or three years of clinical training [10]. Although residents engaged in dedicated research training are significantly more likely to pursue fellowship training and less likely to hold private practice positions, little is known about how this research time affects operative performance [10–11]. …”

Section: Introductionmentioning

confidence: 99%

Residents' perception of skill decay during dedicated research time

D’Angelo

Ray

Jenewein

et al. 2015

Journal of Surgical Research

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Introduction Surgery residents may take years away from clinical responsibilities for dedicated research time. As part of a longitudinal project, the study aim was to investigate residents’ perceptions of clinical skill reduction during dedicated research time. Our hypothesis was that residents would perceive a greater potential reduction in skill during research time for procedures they were less confident in performing. Materials and methods Surgical residents engaged in dedicated research training at multiple training programs participated in four simulated procedures: urinary catheterization, subclavian central line, bowel anastomosis and laparoscopic ventral hernia (LVH) repair. Using pre and post-procedure surveys, participants rated procedures for confidence and difficulty. Residents also indicated the perceived level of skills reduction for the four procedures as a result of time in the laboratory. Results Thirty-eight residents (55% female) completed the four clinical simulators. Participants had between 0–36 months in a laboratory (M=9.29 months, SD=9.38). Pre-procedure surveys noted lower confidence and higher perceived difficulty for performing the LVH repair followed by bowel anastomosis, central line insertion, and urinary catheterization (p<.05). Residents perceived the greatest reduction in bowel anastomosis and LVH repair skills compared to urinary catheterization and subclavian central line insertion (p<.001). Post-procedure surveys showed significant effects of the simulation scenarios on resident perception for urinary catheterization (p<.05) and LVH repair (p<.05). Conclusion Residents in this study expected greater skills decay for the procedures they had lower confidence performing and greater perceived difficulty. In addition, carefully adapted simulation scenarios had a significant effect on resident perception and may provide a mechanism for maintaining skills and keeping confidence grounded in experience.

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“…33 The self-confidence, autonomy, and competency that was traditionally gained in residency seems to have shifted toward fellowship training. 34,35 This shift effectively has extended clinical surgery training from 5 years to 7 or more, depending on the fellowship chosen. Recently, the Flexibility in Surgical Training (FIST) program of the American Board of Surgery has begun to examine the benefit of earlier subspecialization.…”

Section: Discussionmentioning

confidence: 99%

Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: Is the operative experience enough?

Sachs¹,

Ejaz²,

Weiss³

et al. 2014

Surgery

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Introduction Resident operative autonomy and case volume is associated with posttraining confidence and practice plans. Accreditation Council for Graduate Medical Education requirements for graduating general surgery residents are four liver and three pancreas cases. We sought to evaluate trends in resident experience and autonomy for complex hepatopancreatobiliary (HPB) surgery over time. Methods We queried the Accreditation Council for Graduate Medical Education General Surgery Case Log (2003–2012) for all cases performed by graduating chief residents (GCR) relating to liver, pancreas, and the biliary tract (HPB); simple cholecystectomy was excluded. Mean (±SD), median [10th–90th percentiles] and maximum case volumes were compared from 2003 to 2012 using R2 for all trends. Results A total of 252,977 complex HPB cases (36% liver, 43% pancreas, 21% biliary) were performed by 10,288 GCR during the 10-year period examined (Mean = 24.6 per GCR). Of these, 57% were performed during the chief year, whereas 43% were performed as postgraduate year 1–4. Only 52% of liver cases were anatomic resections, whereas 71% of pancreas cases were major resections. Total number of cases increased from 22,516 (mean = 23.0) in 2003 to 27,191 (mean = 24.9) in 2012. During this same time period, the percentage of HPB cases that were performed during the chief year decreased by 7% (liver: 13%, pancreas 8%, biliary 4%). There was an increasing trend in the mean number of operations (mean ± SD) logged by GCR on the pancreas (9.1 ± 5.9 to 11.3 ± 4.3; R2 = .85) and liver (8.0 ± 5.9 to 9.4 ± 3.4; R2 = .91), whereas those for the biliary tract decreased (5.9 ± 2.5 to 3.8 ± 2.1; R2 = .96). Although the median number of cases [10th:90th percentile] increased slightly for both pancreas (7.0 [4.0:15] to 8.0 [4:20]) and liver (7.0 [4:13] to 8.0 [5:14]), the maximum number of cases preformed by any given GCR remained stable for pancreas (51 to 53; R2 = .18), but increased for liver (38 to 45; R2 = .32). The median number of HPB cases that GCR performed as teaching assistants (TAs) remained at zero during this time period. The 90th percentile of cases performed as TA was less than two for both pancreas and liver. Conclusion Roughly one-half of GCR have performed fewer than 10 cases in each of the liver, pancreas, or biliary categories at time of completion of residency. Although the mean number of complex liver and pancreatic operations performed by GCR increased slightly, the median number remained low, and the number of TA cases was virtually zero. Most GCR are unlikely to be prepared to perform complex HPB operations.

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Trends in Research Time, Fellowship Training, and Practice Patterns Among General Surgery Graduates

Cited by 83 publications

References 8 publications

Use of decision-based simulations to assess resident readiness for operative independence

Use of decision-based simulations to assess resident readiness for operative independence

Residents' perception of skill decay during dedicated research time

Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: Is the operative experience enough?

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