title: The fellowship effect: how the establishment of a fellowship in female pelvic medicine and reconstructive surgery affected resident vaginal hysterectomy training.
abstract: OBJECTIVE
  We report on trends in resident-performed vaginal hysterectomies before and after the establishment of a female pelvic medicine and reconstructive surgery fellowship at Vanderbilt University Medical Center.
  
  
  METHODS
  We examined medical records and resident self-reports concerning all hysterectomies at our institution in an 8-year period: 4 years before fellowship and 4 years after. Route of hysterectomy, resident and fellow involvement, and division of attending surgeon were recorded from the electronic medical record. Resident Accreditation Council for Graduate Medical Education (ACGME) case log data were used to estimate the number of hysterectomies where residents reported themselves as the primary surgeon.
  
  
  RESULTS
  During the 8-year period of this study, 3317 hysterectomies were performed at our institution, 41% (1371) before and 59% (1946) after fellowship. Prior to fellowship, 29% (393) were vaginal, 56% (766) were abdominal, and 15% (212) were laparoscopic/robotic. After addition of fellowship, 23% (449) were vaginal, 31% (597) were abdominal, and 46% (900) were laparoscopic/robotic. Of the total vaginal hysterectomies (TVH), there was resident involvement in 98.0% (385) cases before fellowship and 98.2% (441) cases after fellowship. From the ACGME case log data, the resident identified himself/herself as the primary surgeon in 388 cases before and 393 cases after fellowship. During this time period, medical records indicate a fellow was involved in 42% (189) of TVH, with resident involvement in all but 5 of these procedures.
  
  
  CONCLUSIONS
  Frequency of resident involvement in TVH cases, either as primary surgeon or team member, remained constant after the addition of the female pelvic medicine and reconstructive surgery fellowship.
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN. Electronic address: jill.danford@vanderbilt.edu.
authors.forename: Jill McHenry
authors.initials: JM
authors.lastname: Danford
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Nicola Claire
authors.initials: NC
authors.lastname: White
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melinda
authors.initials: M
authors.lastname: New
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Sarah
authors.initials: S
authors.lastname: Fletcher
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Blume
authors.affiliation: Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Renée Melva
authors.initials: RM
authors.lastname: Ward
mesh_terms: D000046:Academic Medical Centers; D015331:Cohort Studies; D005257:Fellowships and Scholarships / Q000706:statistics & numerical data*; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007045:Hysterectomy, Vaginal / Q000193:education / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000193:education*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data
keywords: residency training; surgical fellowship; vaginal hysterectomy