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General Surgery Residency Inadequately Prepares Trainees for Fellowship: Results of a North American Survey of Program Directors
Samer Mattar*1, Rebecca M. Minter*2, Adnan Alseidi*3, D. Rohan Jeyarajah*4, Lee L. Swanstrom5, Steven D. Wexner6, Ralph W. Aye*7, Jose Martinez*1, Morris E. Franklin*8, Sharona B. Ross*9, Maurice E. Arregui*10, Dan B. Jones11, Bruce D. Schirmer12
1Indiana University, Indianapolis, IN;2University of Michigan, Ann Arbor, MI;3Virginia Mason Medical Center, Seattle, WA;4Methodist Dallas Medical Center, Dallas, TX;5Oregon Health and Science University, Portland, OR;6Cleveland Clinic Florida, Westin, FL;7University of Pittsburgh, Pittsburgh, PA;8Texas Endosurgical Institute, San Antonio, TX;9Florida Hospital, Tampa, FL;10St Vincent's Hospital, Indianapolis, IN;11Harvard University, Boston, MA;12University of Virginia, Charlottesville, VA

OBJECTIVE: Assess readiness of general surgery trainees entering accredited surgical sub-specialty fellowships in North America.
METHODS: A multi-domain, global assessment survey designed by the Fellowship Council (FC) research committee was sent to all sub-specialty program directors (PDs). Respondents spanned MIS, Bariatric, Colorectal, Hepatobiliary and Thoracic specialties. There were 46 quantitative questions distributed across 5 domains and >1reflective qualitative questions/domain.
RESULTS: There was a 63% response rate (n=91/145). Of respondent PDs, 21% felt that new fellows arrived unprepared to the operating room, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. With regards to laparoscopic skills, 30% could not atraumatically manipulate tissue, 26% could not recognize anatomical planes, and 56% could not suture. Furthermore, 28% of fellows were not familiar with therapeutic options and 24% were unable to recognize early signs of complications. Finally, it was felt that the majority of new fellows were unable to conceive, design, and conduct research and/or academic projects. Thematic clustering of qualitative data revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after GS education.
CONCLUSIONS: This high-response rate survey reveals variable deficiencies across all five educational domains in graduates of GS programs. An educational and experiential gap exists that should be addressed for trainees considering sub-specialty training. More focused preparation of residents during their final years may result in a more productive fellowship.


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