Don’t Fix It If It Isn’t Broken: A Survey of Preparedness for Practice among Graduates of Fellowship Council Accredited Fellowships

Yusuke Watanabe, MD1, Amin Madani, MD1, Katherine M McKendy, MD1, Ghada Enani, MBBS1, Elif Bilgic, BSc1, Iman Ghaderi, MD2, Gerald M Fried, MD1, Liane S Feldman, MD1, Melina C Vassiliou, MD, MEd1. 1Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 2Department of Surgery, Section of Minimally Invasive & Robotic Surgery, University of Arizona

OBJECTIVE: The majority of general surgery residents are extending their training through fellowships. No studies have examined whether Fellowship Council-accredited fellowships (FCAF) adequately prepare surgeons for independent practice and help them achieve their career goals. The objectives of this mixed-methods study were to identify the factors that are important to trainees as they seek fellowships and enter the work force, and then to determine their perceived preparedness for clinical practice, while identifying gaps in fellowship training.

METHODS: We conducted 14 semi-structured interviews of graduated fellows and 2 focus groups of previous fellows and program directors. An online survey was then developed, based on an iterative qualitative analysis of interviews and focus groups, using Grounded Theory. The survey was then circulated by email to fellows who graduated from FCAF from 2011 to 2014.

RESULTS: Five central themes emerged from the qualitative data and were used as a framework for the survey: professional development, job marketability, autonomy, networking, and practice management. There was an overall response rate of 41% (n=201/498; 2013-2014 graduates: 50%, 2012-2013 graduates: 37%, and 2011-2012 graduates: 33%). Of 201 respondents, 97% were highly satisfied with their operative and non-operative experiences; 83% acquired jobs aligned with their skills and expectations, while 13% sought additional training after fellowship. Respondents who intended to learn a given procedure felt competent after fellowship to perform 51(85%) of the 60 procedures listed. They would have liked more experience in advanced therapeutic endoscopy [23/56 (41%)], complex and revisional bariatric surgery [laparoscopic BPD-DS: 8/15 (53%), laparoscopic revisional procedures: 29/94 (31%)], and uncommon laparoscopic procedures such as common bile duct exploration [34/90 (38%)], esophagectomy [14/32 (44%)], and adrenalectomy [39/106 (37%)]. Thirty-one percent expressed the desire for more autonomy in the management of complications. Educational gaps existed mostly in areas of coding and billing (43%), hiring administrative staff (42%), and managing insurance issues (34%).

CONCLUSIONS: FCAF seem to adequately prepare surgeons for independent practice. Graduates acquire jobs that are aligned with their career goals and expectations, and they are highly satisfied with their individualized training experiences. Fellowships address most of the gaps identified in residency training. Future efforts should focus on the remaining identified gaps to improve the programs further. 

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