title: Symbiotic or parasitic? A review of the literature on the impact of fellowships on surgical residents.
abstract: OBJECTIVE
  We conducted a systematic review of published literature to gain a better understanding of the impact of advanced fellowships on surgical resident training and education.
  
  
  BACKGROUND
  As fellowship opportunities rise, resident training may be adversely impacted.
  
  
  METHODS
  PubMed, MEDLINE, Scopus, BIOSIS, Web of Science, and a manual search of article bibliographies. Of the 139 citations identified through the initial electronic search and screened for possible inclusion, 23 articles were retained and accepted for this review. Data were extracted regarding surgical specialty, methodology, sample population, outcomes measured, and results.
  
  
  RESULTS
  Eight studies retrospectively compared the eras before and after the introduction of a fellowship or trended data over time. Approximately half used data from a single institution, whereas the other half used some form of national data or survey. Only 3 studies used national case data. Fourteen studies looked at general surgery, 6 at obstetrics-gynecology, 2 at urology, and 1 at otolaryngology. Only one study concluded that fellowships have a generally positive impact on resident education, whereas 9 others found a negative impact. The remaining 13 studies found mixed results (n = 6) or minimal to no impact (n = 7).
  
  
  CONCLUSIONS
  The overall impact of advanced surgical fellowships on surgical resident education and training remains unclear, as most studies rely on limited data of questionable generalizability. A careful study of the national database of surgery resident case logs is essential to better understand how early surgical specialization and fellowships will impact the future of general surgery education.
authors.affiliation: Department of Surgery, Inova Health System, Falls Church, VA 22042, USA. timplerhoples@gmail.com
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Plerhoples
authors.forename: Ralph S
authors.initials: RS
authors.lastname: Greco
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Krummel
authors.forename: Marc L
authors.initials: ML
authors.lastname: Melcher
mesh_terms: D005257:Fellowships and Scholarships; D007396:Internship and Residency; D013043:Specialties, Surgical / Q000193:education*