title: Resident Preparation for Careers in General Surgery: A Survey of Program Directors.
abstract: OBJECTIVE
  The number of general surgery (GS) residency graduates who choose GS practice has diminished as the popularity of postresidency fellowships has dramatically increased over the past several decades. This study was designed to document current methods of GS preparation during surgery residency and to determine characteristics of programs that produce more graduates who pursue GS practice.
  
  
  METHODS
  An email survey was sent by the American Board of Surgery General Surgery Advisory Committee to program directors of all GS residencies. Program demographic information was procured from the American Board of Surgery database and linked to survey results. Multiple regression was used to predict postresidency choices of graduates.
  
  
  METHODS
  Totally, 252 US allopathic surgical residencies.
  
  
  METHODS
  Totally, 171 residency program directors (68% response rate).
  
  
  RESULTS
  The proportion of programs using an emergency/acute care surgery rotation at the main teaching hospital to teach GS increased from 63% in 2003 to 83% in 2014. An autonomous GS outpatient experience was offered in 38% of programs. Practice management curricula were offered in 28% of programs. Institutions with fewer postresidency fellowships (p < 0.003) and fewer surgical specialty residencies (p < 0.036) had a greater percentage of graduates who pursued GS practice. The addition of each fellowship at an institution was associated with a 2% decrease in the number of graduates pursuing GS practice. Residency size was not associated with predilection for fellowship selection and there was no difference between university and independent residencies vis-a-vis the proportion selecting fellowship vs GS practice.
  
  
  CONCLUSIONS
  Practice management principles and autonomous GS outpatient clinic experiences are offered in a minority of programs. Graduates of programs in institutions with fewer surgery fellowships and residencies are more likely to pursue GS practice. Increased number of postresidency fellowships and specialty residencies may be associated with fewer GS rotations and fewer GS mentors. Further study of these relationships seems warranted.
authors.affiliation: Department of General and Vascular Surgery, Gundersen Health System, La Crosse, Wisconsin. Electronic address: thcogbil@gundersenhealth.org.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Cogbill
authors.affiliation: Department of Surgery, Washington University, St Louis, Missouri.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Klingensmith
authors.affiliation: American Board of Surgery, Philadelphia, Pennsylvania.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Jones
authors.affiliation: American Board of Surgery, Philadelphia, Pennsylvania.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Biester
authors.affiliation: American Board of Surgery, Philadelphia, Pennsylvania.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Malangoni
mesh_terms: D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency; D008486:Physician Executives; D011795:Surveys and Questionnaires; D014481:United States
keywords: Patient Care; Professionalism; Systems-Based Practice; general surgery careers; mentorship; practice management; surgery residency education; surgical fellowships; surgical workforce