title: Incorporating an HPB fellowship does not diminish surgical residents' HPB experience in a high-volume training centre.
abstract: BACKGROUND
  Surgical residency training is evolving, and trainees who wish to practice hepato-pancreato-biliary (HPB) surgery in the future will be required to obtain advanced training. As this paradigm evolves, it is crucial that HPB fellowship incorporation into an established surgical residency programme does not diminish surgical residents' exposure to complex HPB procedures. We hypothesized that incorporation of a HPB fellowship in a high-volume clinical training programme would not detract from residents' HPB experience.
  
  
  METHODS
  Resident operative case logs and HPB fellow case logs were reviewed. Resident exposure to complex HPB procedures for 3 years prior to and 3 years after fellowship incorporation were compared.
  
  
  RESULTS
  No significant changes in surgical resident exposure to liver and pancreatic resection were seen between the two time periods. Surgical resident exposure to complex biliary procedures decreased in the 3 years after HPB fellowship incorporation (P= 0.003); however, exceeded the national average in each year except 2006. Graduating residents' overall HPB experience was unchanged in the 3 years prior to and after incorporating an HPB fellow. Expansion of HPB volume was a critical part of successful HPB fellowship implementation.
  
  
  CONCLUSIONS
  An HPB fellowship programme can be incorporated into a high-volume clinical training programme without detracting from resident HPB experience. Individual training programmes should carefully assess their capability to provide an adequate clinical experience for fellows without diminishing resident exposure to complex HPB procedures.
authors.affiliation: Department of Surgery, Indiana University School of Medicine Indianapolis, IN 46202, USA. nzyromsk@iupui.edu
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.forename: Laura
authors.initials: L
authors.lastname: Torbeck
authors.forename: David F
authors.initials: DF
authors.lastname: Canal
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
mesh_terms: D001662:Biliary Tract Surgical Procedures / Q000193:education; D002983:Clinical Competence; D003479:Curriculum; D013505:Digestive System Surgical Procedures / Q000193:education*; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D006498:Hepatectomy / Q000193:education; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007196:Indiana; D007396:Internship and Residency; D010180:Pancreatectomy / Q000193:education; D016730:Program Development; D015397:Program Evaluation; D013997:Time Factors