title: Can Rural Minimally Invasive Surgery Fellowships Provide Operative Experience Similar to Urban Programs?
abstract: OBJECTIVE
  Operative experience in rural fellowship programs is largely unknown. The 2 of the most rural minimally invasive surgery (MIS)/bariatric fellowships are located in the upper Midwest. We hypothesized that these 2 programs would offer a similar operative experience to other U.S. programs in more urban locations.
  
  
  METHODS
  The 2011 to 2012 and 2012 to 2013 fellowship case logs from 2 rural Midwest programs were compared with case logs from 23 U.S. MIS/bariatric programs. All rural Midwest fellowship graduates completed a survey describing their fellowship experience and current practice. Statistical analysis included Wilcoxon rank-sum test.
  
  
  METHODS
  Setting included the 2 rural Midwest U.S. MIS/bariatric fellowship programs.
  
  
  METHODS
  Graduates from MIS/bariatric fellowship programs participated in the study.
  
  
  RESULTS
  Mean volumes for bariatric, foregut, abdominal wall, small intestine, and hepatobiliary cases for rural Midwest fellows vs. other U.S. programs were 123.8 ± 23.7 vs. 150.2 ± 49.2 (p = 0.20); 44.3 ± 19.4 vs. 66.3 ± 35.5 (p = 0.18); 48.3 ± 28.0 vs. 57.9 ± 27.8 (p = 0.58); 11.3 ± 1.9 vs. 12.0 ± 8.7 (p = 0.58); and 55.0 ± 34.8 vs. 48.1 ± 42.6 (p = 0.63), respectively. Mean endoscopy volume was significantly higher among rural Midwest fellows (451.0 ± 395.2 vs. 99.7 ± 83.4; p = 0.05). All rural Midwest fellows reported an adequate number of cases as operating surgeon during fellowship. A total of 60% of fellows currently practice in a rural area. In all, 87% and 13% reported that their fellowship training was extremely or somewhat beneficial to their current practice, respectively.
  
  
  CONCLUSIONS
  Rural MIS fellowship programs offer a similar operative experience to other U.S. programs. A greater volume of endoscopy cases was observed in rural Midwest fellowships.
authors.affiliation: Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota.
authors.forename: James Patrick
authors.initials: JP
authors.lastname: Ryan
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Borgert
authors.affiliation: Department of Medical Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Kara J
authors.initials: KJ
authors.lastname: Kallies
authors.affiliation: Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota.
authors.forename: Lea M
authors.initials: LM
authors.lastname: Carlson
authors.affiliation: Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota.
authors.forename: Howard
authors.initials: H
authors.lastname: McCollister
authors.affiliation: Minnesota Institute for Minimally Invasive Surgery, Cuyuna Regional Medical Center, Crosby, Minnesota.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Severson
authors.affiliation: Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin. Electronic address: snkothar@gundersenhealth.org.
authors.forename: Shanu N
authors.initials: SN
authors.lastname: Kothari
mesh_terms: D050110:Bariatric Surgery / Q000193:education*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D006780:Hospitals, Rural; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D014922:Wisconsin
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; advanced laparoscopic techniques; case volume; fellowship training; minimally invasive surgery; rural surgery; surgical education