Evolution in Fellowship Selection during General Surgery ...
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Evolution in Fellowship Selection during General Surgery ... Presentation Transcript

  • 1. Evolution in Fellowship Selection during General Surgery Residencies Laura R. Vick, MD Karen R. Borman, MD University of Mississippi Medical Center, Jackson, MS
  • 2.
    • Increasing numbers of graduating residents are pursuing fellowships
    • PGY-5 choices are heterogeneous
      • Individual variables
      • (e.g. - gender)
      • Residency characteristics
      • (e.g. - program location)
      • Over time
    Background
  • 3.
    • PGY-1 fellowship choices unreported
    • For this study
      • PGY-1 future fellowship choices from ‘93 - ‘07
      • Changes in preferences
        • over time
        • as residents progress during training
      • Fellowship choices as related to demographic variables
        • Gender
        • Program type, size and location
    Background
  • 4.
    • ABSITE examination data – last 15 years
    Methods = “Any Fellowship” Other Specialty SCC split from Trauma/Burn Vascular Surgery Endoscopy Transplantation Endocrine Surgery Thoracic Surgery Bariatric Surgery Plastic Surgery Additional choices for 2007 Pediatric Surgery Oncology Breast Surgery SCC/Trauma/Burn Hepatobiliary Surgery Colon & Rectal Advanced GI Surgery Undecided Minimally Invasive Surgery No Fellowship Additional choices for 2006 Choices for 1993-2005
  • 5. Methods - Datasets PGY-5 1993 - 2005 PGY-1 1993 - 2003 All residents 1993 - 2007 Dataset 1 Remove Designated Preliminary / Hand Dataset 3 Paired PGY-1 and PGY-5 responses Residents applying for ABS Qualifying Exam by July 2007 Dataset 2
  • 6.
    • Dataset 1: > 80,000 responses
      • > 20,000 PGY-1 responses
    Results Undecided Responses 1993, 2000, 2007 all PGY levels 2007 2000 1993 PGY-1 responses 38% 42% 46% Any Fellowship 7% 11% 8% No Fellowship 55% 46% 46% Undecided PGY-1 PGY-2 PGY-3 PGY-4 PGY-5
  • 7.
    • Any Fellowship for PGY-1
    Results 1% 2% 2% Transplant 2% 2% 2% CRS 8% 5% 3% Other 4% 4% 4% Oncology 3% 3% 4% Pediatric 5% 4% 4% SCC/Trauma/ Burn 3% 3% 5% Vascular 9% 11% 10% Plastic 3% 7% 10% Thoracic 2007 2000 1993 2007 2000 1993 PGY-1 responses 38% 42% 46% Any Fellowship 7% 11% 8% No Fellowship 55% 46% 46% Undecided
  • 8.
    • Any Fellowship for all PGY years
    Results PGY-1 PGY-2 PGY-3 PGY-4 PGY-5
  • 9.
    • No Fellowship for all PGY years
    Results PGY-1 PGY-2/3 PGY-4 PGY-5 2007 2000 1993 PGY-1 responses 38% 42% 46% Any Fellowship 7% 11% 8% No Fellowship 55% 46% 46% Undecided
  • 10. Results
    • Dataset 2: > 19,000 responses
      • 9,000 PGY-1 responses
    Responses by Gender for all years 1993 - 2003 Female % Male %
  • 11. Results 2% 1% 1% 4% 4% 2% Other Specialty 4% 5% 7% 2% 3% 1% Vascular Surgery 2% 4% 2% 1% 1% 2% Transplantation 11% 10% 16% 4% 3% 2% Thoracic Surgery 10% 3% 6% 15% 3% 8% Plastic Surgery 3% 3% 5% 4% 8% 9% Pediatric Surgery 4% 5% 4% 6% 12% 8% Oncology 4% 6% 6% 2% 5% 3% SCC/Trauma/Burn 5% 2% 3% 2% 1% 4% Colon & Rectal 51% 56% 46% 57% 57% 55% Undecided 5% 5% 5% 5% 4% 7% No Fellowship 2003 1998 1993 2003 1998 1993 Male Female
  • 12. Results
    • Program Type
    2% 2% 1% 3% 2% 1% Other Specialty 2% 4% 7% 4% 4% 5% Vascular Surgery 1% 3% 2% 2% 3% 2% Transplantation 9% 6% 10% 10% 10% 16% Thoracic Surgery 11% 3% 8% 10% 3% 5% Plastic Surgery 1% 2% 3% 5% 5% 7% Pediatric Surgery 2% 6% 3% 6% 7% 6% Oncology 3% 6% 8% 4% 5% 2% SCC/Trauma/Burn 4% 1% 4% 4% 2% 2% Colon & Rectal 60% 61% 47% 47% 54% 49% Undecided 5% 6% 8% 5% 4% 4% No Fellowship 2003 1998 1993 2003 1998 1993 Independent University
  • 13. Results
    • Program Size
    3% 2% 1% 5% 13% 0% 3% 3% 3% 59% 7% 2003 3% 4% 1% 8% 4% 2% 4% 8% 1% 58% 10% 1998 1% 6% 2% 12% 10% 3% 1% 8% 5% 42% 10% 1993 Small 2% 2% 3% 3% 1% 1% Other Specialty 2% 3% 2% 4% 5% 6% Vascular Surgery 1% 4% 1% 2% 3% 2% Transplantation 9% 6% 5% 12% 10% 12% Thoracic Surgery 13% 3% 13% 8% 3% 6% Plastic Surgery 3% 6% 0% 5% 4% 6% Pediatric Surgery 8% 7% 3% 3% 7% 6% Oncology 2% 3% 3% 4% 6% 5% SCC/Trauma/Burn 4% 2% 3% 4% 2% 2% Colon & Rectal 52% 46% 59% 49% 57% 50% Undecided 3% 20% 7% 5% 3% 5% No Fellowship 2003 1998 1993 2003 1998 1993 Large Medium
  • 14. Results
    • Program Location over all years
  • 15. Results
    • Dataset 3: 12,259 paired responses
      • 6,111 PGY-1 chose Undecided (50%)
      • Of the Undecided
        • No Fellowship (24%)
        • Vascular Surgery (12%)
        • Other Fellowship (12%)
    • Only 22% of all PGY-1 residents
    • accurately identified their final
    • post-residency plans
  • 16. Conclusions
    • Majority of incoming residents are Undecided
    • Fellowship choices evolve as PGY level advances
    • Evolution occurs at variable rates
    • Uncertainty for PGY-1 residents is desirable, reflecting open-mindedness
    • Junior residents should experience the full spectrum of potential fellowship areas
  • 17. Discussion
    • The number of residents choosing fellowships are increasing
    • Fellowships chosen have changed over time
    • PGY-1 residents unsure whether to pursue fellowship
    • Alternative educational pathways are being evaluated and implemented
  • 18. Discussion
    • Educational models featuring early specialty tracking continue to proliferate
    • These models should include exposure to all areas of specialization
    • Examination of PGY-1 fellowship training choices could contribute to the ongoing process of residency redesign
    • Further studies underway to determine the final plans of the 78% percent of residents who change their mind
  • 19. University of Mississippi Medical Center