General Surgery Residency Inadequately Prepares Trainees for Fellowship

TLDR

To assess the readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America. A multidomain survey of 91 program directors across minimally invasive, bariatric, colorectal, hepatobiliary, and thoracic specialties, comprising 46 quantitative questions and reflective qualitative items, achieved a 63 % response rate. Program directors reported that 21 % of new fellows were unprepared for the operating room, 38 % lacked patient ownership, 30 % could not perform a laparoscopic cholecystectomy, and 66 % could not conduct a major procedure unsupervised for 30 minutes, with additional deficits in laparoscopic skills, therapeutic knowledge, complication recognition, and research capability, underscoring gaps in operative autonomy, progressive responsibility, longitudinal follow‑up, and scholarly focus.

Abstract

To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program directors. Respondents spanned minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties. There were 46 quantitative questions distributed across 5 domains and 1 or more reflective qualitative questions/domains.There was a 63% response rate (n = 91/145). Of respondent program directors, 21% felt that new fellows arrived unprepared for the operating room, 38% demonstrated lack of patient ownership, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. With regard 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/academic projects. Thematic clustering of qualitative data revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education.