Abstract
Introduction
There is an increased need for surgical trainees to acquire advanced laparoscopic skills as laparoscopy becomes the standard of care in many areas of general surgery. Since the introduction of minimally invasive surgery (MIS) fellowships, there has been a continuing debate as to whether these fellowships adversely affect general surgery resident exposure to laparoscopic cases. The aim of our study was to examine whether the introduction of an MIS fellowship negatively impacts general surgery residents’ experience at a single academic center.
Methods
We describe the changes following establishment of MIS fellowship at an academic center. Resident case log system from the Accreditation Council for Graduate Medical Education was queried to obtain all PGY 1–5 resident operative case logs. Two-year time period preceding and following the institution of an MIS fellowship at our institution in 2012 was compared. P values less than 0.05 were considered statistically significant.
Results
Following initiation of the MIS fellowship, an MIS service was established. The service comprised of a fellow, midlevel resident, and intern. Operative experience was examined. From 2010–2012 to 2012–2014, residents logged a total of 272 and 585 complex laparoscopic cases, respectively. There were 43 residents from 2010 to 2013 and 44 residents from 2013 to 2014. When the two time periods were compared, a trend of increased numbers for all procedures was noted, except laparoscopic GYN/genito-urinary procedures. Average percent increase in complex general surgery procedures was 249 ± 179.8 %. Following establishment of a MIS fellowship, reported cases by residents were higher or similar to those reported nationally for laparoscopic procedures.
Conclusion
Institution of an MIS fellowship had a favorable effect on general surgery resident operative education at a single academic training center. Residents may benefit from the presence of a fellowship at an academic center because they are able to participate in an increased number of complex laparoscopic cases.
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References
Borman KR, Biester TW, Rhodes RS (2010) Motivations to pursue fellowships are gender neutral. Arch Surg 145(7):671–678
Bell RH Jr (2008) Graduate education in general surgery and its related specialties and subspecialties in the United States. World J Surg 32(10):2178–2184
Leichtle SW, Kaoutzanis C, Mouawad NJ (2014) The five-year general surgery residency: reform or revolution? Bull Am Coll Surg 99(8):49–52
Chen PW (2013) Are today’s new surgeons unprepared? New York Times. December 12, 2013. http://well.blogs.nytimes.com/2013/12/12/are-todays-new-surgeons-unprepared/. Accessed 23 Aug 2015
Kerr B, O’Leary JP (1999) The training of the surgeon: Dr. Halsted’s greatest legacy. Am Surg 65(11):119102
Grober ED, Elterman DS, Jewett MA (2008) Fellow or foe: the impact of fellowship training programs on the education of Canadian urology residents. Can Urol Assoc J 2(1):33–37
Zyromski NJ, Torbeck L, Canal DF, Lillemoe KD, Pitt HA (2010) Incorporating an HPB fellowship does not diminish surgical residents’ HPB experience in a high-volume training centre. HPB 12(2):123–128
Hanks JB, Ashley SW, Mahvi DM, Meredith WJ, Stain SC, Biester TW, Borman KR (2011) Feast or famine? The variable impact of coexisting fellowships on general surgery resident operative volumes. Ann Surg 254(3):76–83 discussion 483–485
Snyder RA, Phillips SE, Terhune KP (2012) Impact of implementation of a pediatric surgery fellowship on general surgery resident operative volume. J Surg Educ 69(6):753–758
Defined category minimum numbers: general surgery. Review committee for surgery. Accreditation council for graduate medical education. May, 2015. http://www.acgme.org/acgmeweb/Portals/0/440_GS_DefinedCategoryMinimumNumbers.pdf. Accessed 23 Aug 2015
Rattner DW, Apelgren KN, Eubanks WS (2001) The need for training opportunities in advanced laparoscopic surgery. Surg Endosc 15(10):1066–1070
McFadden CL, Cobb WS, Lokey JS, Smith DE, Taylor SM (2007) The impact of a formal minimally invasive service on the resident’s ability to achieve new ACGME guidelines for laparoscopy. J Surg Educ 64(6):420–423
Hallowell PT, Dahman MI, Stokes JB, LaPar DJ, Schirmer BD (2013) Minimally invasive surgery fellowship does not adversely affect general surgery resident case volume: a decade of experience. Am J Surg 205(3):307–311
Kothari SN, Cogbill TH, O’Heron CT, Mathiason MA (2008) Advanced laparoscopic fellowship and general surgery residency can coexist without detracting from surgical resident operative experience. J Surg Educ 65(6):393–396
Plerhoples TA, Greco RS, Krummel TM, Melcher ML (2012) Symbiotic or parasitic? A review of the literature on the impact of fellowships on surgical residents. Ann Surg 256(6):904–908
Linn JG, Hungness ES, Clark S, Nagle AP, Wang E, Soper NJ (2011) General surgery training without laparoscopic surgery fellows: the impact on residents and patients. Surgery 150(4):752–758
Acknowledgments
We would like to thank the Foundation for Surgical Fellows for their support of our fellowship program.
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Maria S. Altieri, Catherine Frenkel, Richard Scriven, Deborah Thornton, Caitlin Halbert and Mark Talamini have no conflict of interest of financial ties to disclose. Aurora Pryor declares conflict of interest not directly related to the submitted work, as she serves as a consultant for Apollo, Intuitive and Freehold Medical, in an investigator with Baronova and Obalon, and serves as a speaker for Ethicon and Gore. Dana Telem declares conflict of interest not directly related to the submitted work as she serves as a consultant for Medtronic, Gore and Ethicon and receives research support from Cook and Surgiquest.
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Altieri, M.S., Frenkel, C., Scriven, R. et al. Effect of minimally invasive surgery fellowship on residents’ operative experience. Surg Endosc 31, 107–111 (2017). https://doi.org/10.1007/s00464-016-4935-5
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DOI: https://doi.org/10.1007/s00464-016-4935-5