title: General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors.
abstract: OBJECTIVE
  To assess readiness of general surgery graduate trainees entering accredited surgical subspecialty fellowships in North America.
  
  
  METHODS
  A multidomain, global assessment survey designed by the Fellowship Council research committee was electronically sent to all subspecialty program directors. Respondents spanned minimally invasive surgery, bariatric, colorectal, hepatobiliary, and thoracic specialties. There were 46 quantitative questions distributed across 5 domains and 1 or more reflective qualitative questions/domains.
  
  
  RESULTS
  There was a 63% response rate (n = 91/145). Of respondent program directors, 21% felt that new fellows arrived unprepared for the operating room, 38% demonstrated lack of patient ownership, 30% could not independently perform a laparoscopic cholecystectomy, and 66% were deemed unable to operate for 30 unsupervised minutes of a major procedure. With regard to laparoscopic skills, 30% could not atraumatically manipulate tissue, 26% could not recognize anatomical planes, and 56% could not suture. Furthermore, 28% of fellows were not familiar with therapeutic options and 24% were unable to recognize early signs of complications. Finally, it was felt that the majority of new fellows were unable to conceive, design, and conduct research/academic projects. Thematic clustering of qualitative data revealed deficits in domains of operative autonomy, progressive responsibility, longitudinal follow-up, and scholarly focus after general surgery education.
authors.affiliation: *Indiana University School of Medicine, Indianapolis, IN †Viginia Mason Medical Center, Seattle, WA ‡Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA §Methodist Dallas Medical Center, Dallas, TX ‖Oregon Health Science University, Oregon Clinic, Portland, Oregon, OR ¶Swedish Medical Center, Seattle, WA **Cleveland Clinic Florida, Florida Atlantic University College of Medicine, Westin, Florida, FL ††University of Miami, Miami, FL ‡‡Florida Hospital, Tampa, FL §§Washington University School of Medicine, St Louis, Missouri, MO ‖‖Texas Endosurgery Institute, San Antonio, TX ¶¶St Vincent's Hospital, Indianapolis, IN ***University of Virginia, Charlottesville, VA; and †††University of Michigan, Ann Arbour, MI.
authors.forename: Samer G
authors.initials: SG
authors.lastname: Mattar
authors.forename: Adnan A
authors.initials: AA
authors.lastname: Alseidi
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.forename: D Rohan
authors.initials: DR
authors.lastname: Jeyarajah
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Aye
authors.forename: Steven D
authors.initials: SD
authors.lastname: Wexner
authors.forename: José M
authors.initials: JM
authors.lastname: Martinez
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.forename: Michael M
authors.initials: MM
authors.lastname: Awad
authors.forename: Morris E
authors.initials: ME
authors.lastname: Franklin
authors.forename: Maurice E
authors.initials: ME
authors.lastname: Arregui
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Schirmer
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Minter
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000592:standards*; D005257:Fellowships and Scholarships; D013502:General Surgery / Q000193:education* / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D013043:Specialties, Surgical / Q000193:education / Q000592:standards; D011795:Surveys and Questionnaires; D014481:United States