Perception Versus Reality for MIS Fellows: A Survey of Current Fellowship Council Trainees

Jeffrey R Watkins, MD1, Aurora D Pryor, MD2, Frances Lewis1, Michael S Truitt, MD1, D Rohan Jeyarajah, MD1. 1Methodist Dallas Medical Center, 2Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Stony Brook University

Introduction: The aim of our study is to determine minimally invasive trainee motivation and expectations for their respective fellowship.  Minimally Invasive Surgery (MIS) is one of the largest non-ACGME  post-residency training pathways though little is known concerning the process of residents choosing MIS as a fellowship. As general surgery evolves, it is important to understand resident motivation in order to better prepare them for a surgical career.

Methods and Procedures: A survey invitation was sent to current trainees in the Minimally Invasive pathway through the Fellowship Council. The participants were asked to complete a web-based questionnaire detailing demographics, experiences preparing for fellowship, motivation in choosing an MIS fellowship and expectations for surgical practice after fellowship.

Results: Sixty-four MIS trainees responded to the survey out of 160 invitations (40%). The Fellowship Council website, mentors and fellows were cited as the most helpful source of information when applying for fellowship. Trainees were active in surgical societies as residents, with 78% membership in ACS and 60% in SAGES. When deciding to pursue MIS as a fellowship, the desire to increase laparoscopic training was the most important factor followed by a desire to increase professional competitive advantage with 93% of respondents considering these important or very important.  The least important reasons cited were lack of laparoendoscopic training in residency and desire to learn robotic surgery.   When choosing specific fellowship programs, trainees cited large case volume and diversity, program type, and strength of faculty as the most important factors. The majority of trainees believed their exposure to laparoscopy compared to other residents was above average (83%) and that their laparoscopic skill set was above that of fellow residents (81%). After fellowship, the majority of respondents planned on working with residents in some capacity (78%), but only 20% plan on practicing in an exclusively academic environment. The most desired post-fellowship employment model is hospital employee (46%) followed by private practice (27%). Most fellows believe that their actual practice will be less directly related to their fellowship training than their ideal practice. Almost all fellows plan on marketing themselves as MIS surgeons (90%) when in practice.

Conclusions: Residents who choose MIS as a fellowship have a strong exposure to laparoscopy and want to become specialists in their field. Mentors and surgical societies including ACS and SAGES play a vital role in preparing residents for fellowship and practice.

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