Evolution in Fellowship Evolution in Fellowship Selection during General Selection during General
Surgery ResidenciesSurgery Residencies
Laura R. Vick, MDLaura R. Vick, MD
Karen R. Borman, MDKaren R. Borman, MD
University of Mississippi Medical Center, Jackson, MSUniversity of Mississippi Medical Center, Jackson, MS
Increasing numbers of graduating residents Increasing numbers of graduating residents are pursuing fellowshipsare pursuing fellowships
PGY-5 choices are heterogeneousPGY-5 choices are heterogeneous– Individual variables Individual variables
(e.g. - gender)(e.g. - gender)
– Residency characteristics Residency characteristics
(e.g. - program location)(e.g. - program location)
– Over timeOver time
PGY-1 fellowship choices unreportedPGY-1 fellowship choices unreported For this studyFor this study
– PGY-1 future fellowship choices from ‘93 - ‘07PGY-1 future fellowship choices from ‘93 - ‘07– Changes in preferencesChanges in preferences
• over timeover time• as residents progress during trainingas residents progress during training
– Fellowship choices as related to demographic Fellowship choices as related to demographic variablesvariables• GenderGender• Program type, size and locationProgram type, size and location
ABSITE examination data – last 15 yearsABSITE examination data – last 15 yearsChoices for 1993-2005Choices for 1993-2005 Additional choices for 2006Additional choices for 2006
No FellowshipNo Fellowship Minimally Invasive SurgeryMinimally Invasive Surgery
Undecided Undecided Advanced GI SurgeryAdvanced GI Surgery
Colon & Rectal Colon & Rectal Hepatobiliary SurgeryHepatobiliary Surgery
SCC/Trauma/BurnSCC/Trauma/Burn Breast SurgeryBreast Surgery
OncologyOncology
Pediatric SurgeryPediatric Surgery Additional choices for 2007Additional choices for 2007
Plastic SurgeryPlastic Surgery Bariatric SurgeryBariatric Surgery
Thoracic SurgeryThoracic Surgery Endocrine SurgeryEndocrine Surgery
TransplantationTransplantation EndoscopyEndoscopy
Vascular SurgeryVascular Surgery SCC split from Trauma/BurnSCC split from Trauma/Burn
Other SpecialtyOther Specialty
= “Any Fellowship”= “Any Fellowship”
All residents All residents 1993 - 20071993 - 2007
Dataset 1Dataset 1Remove Designated Remove Designated Preliminary / HandPreliminary / Hand
Dataset 3Dataset 3Paired PGY-1 and Paired PGY-1 and PGY-5 responsesPGY-5 responses
Residents applying for ABS Residents applying for ABS Qualifying Exam by July 2007Qualifying Exam by July 2007
Dataset 2Dataset 2
PGY-5 1993 - 2005 PGY-5 1993 - 2005 PGY-1 1993 - 2003PGY-1 1993 - 2003
Dataset 1: > 80,000 responsesDataset 1: > 80,000 responses> 20,000 PGY-1 responses> 20,000 PGY-1 responses
PGY-1 responsesPGY-1 responses 19931993 20002000 20072007
UndecidedUndecided 46%46% 46%46% 55%55%
No FellowshipNo Fellowship 8%8% 11%11% 7%7%
Any FellowshipAny Fellowship 46%46% 42%42% 38%38%
Undecided Undecided Responses 1993, Responses 1993,
2000, 2007 all 2000, 2007 all PGY levelsPGY levels
0
10
20
30
40
50
60
1993 2000 2007
PGY-1
PGY-2
PGY-3
PGY-4
PGY-5
Any Fellowship for PGY-1Any Fellowship for PGY-119931993 20002000 20072007
ThoracicThoracic 10%10% 7%7% 3%3%
PlasticPlastic 10%10% 11%11% 9%9%
VascularVascular 5%5% 3%3% 3%3%
SCC/Trauma/ SCC/Trauma/ BurnBurn
4%4% 4%4% 5%5%
PediatricPediatric 4%4% 3%3% 3%3%
OncologyOncology 4%4% 4%4% 4%4%
OtherOther 3%3% 5%5% 8%8%
CRSCRS 2%2% 2%2% 2%2%
TransplantTransplant 2%2% 2%2% 1%1%
PGY-1 PGY-1 responsesresponses
19931993 20002000 20072007
UndecidedUndecided 46%46% 46%46% 55%55%
No FellowshipNo Fellowship 8%8% 11%11% 7%7%
Any FellowshipAny Fellowship 46%46% 42%42% 38%38%
Any Fellowship for all PGY yearsAny Fellowship for all PGY years
0
10
20
30
40
50
60
70
80
90
100
1993 2000 2007
PGY-1PGY-1
PGY-2PGY-2
PGY-3PGY-3PGY-4PGY-4PGY-5PGY-5
0
5
10
15
20
25
30
35
40
45
50
1993 2000 2007
No Fellowship for all PGY yearsNo Fellowship for all PGY years
PGY-1PGY-1
PGY-2/3PGY-2/3
PGY-4PGY-4
PGY-5PGY-5
PGY-1 PGY-1 responsesresponses
19931993 20002000 20072007
UndecidedUndecided 46%46% 46%46% 55%55%
No FellowshipNo Fellowship 8%8% 11%11% 7%7%
Any FellowshipAny Fellowship 46%46% 42%42% 38%38%
Dataset 2: > 19,000 responsesDataset 2: > 19,000 responses 9,000 PGY-1 responses9,000 PGY-1 responses
0% 20% 40% 60% 80% 100%
Male%
Female%
Undecided
Thoracic
None
Oncology
Plastic
SCC
Vascular
Pediatric
CRS
Other
Transplant
Responses by Responses by Gender for Gender for all years all years
1993 - 20031993 - 2003
Female %Female %
Male %Male %
FemaleFemale MaleMale
19931993 19981998 20032003 19931993 19981998 20032003
No FellowshipNo Fellowship 7%7% 4%4% 5%5% 5%5% 5%5% 5%5%
UndecidedUndecided 55%55% 57%57% 57%57% 46%46% 56%56% 51%51%
Colon & RectalColon & Rectal 4%4% 1%1% 2%2% 3%3% 2%2% 5%5%
SCC/Trauma/BurnSCC/Trauma/Burn 3%3% 5%5% 2%2% 6%6% 6%6% 4%4%
OncologyOncology 8%8% 12%12% 6%6% 4%4% 5%5% 4%4%
Pediatric SurgeryPediatric Surgery 9%9% 8%8% 4%4% 5%5% 3%3% 3%3%
Plastic SurgeryPlastic Surgery 8%8% 3%3% 15%15% 6%6% 3%3% 10%10%
Thoracic SurgeryThoracic Surgery 2%2% 3%3% 4%4% 16%16% 10%10% 11%11%
TransplantationTransplantation 2%2% 1%1% 1%1% 2%2% 4%4% 2%2%
Vascular SurgeryVascular Surgery 1%1% 3%3% 2%2% 7%7% 5%5% 4%4%
Other SpecialtyOther Specialty 2%2% 4%4% 4%4% 1%1% 1%1% 2%2%
Program TypeProgram TypeUniversityUniversity IndependentIndependent
19931993 19981998 20032003 19931993 19981998 20032003
No FellowshipNo Fellowship 4%4% 4%4% 5%5% 8%8% 6%6% 5%5%
UndecidedUndecided 49%49% 54%54% 47%47% 47%47% 61%61% 60%60%
Colon & RectalColon & Rectal 2%2% 2%2% 4%4% 4%4% 1%1% 4%4%
SCC/Trauma/BurnSCC/Trauma/Burn 2%2% 5%5% 4%4% 8%8% 6%6% 3%3%
OncologyOncology 6%6% 7%7% 6%6% 3%3% 6%6% 2%2%
Pediatric SurgeryPediatric Surgery 7%7% 5%5% 5%5% 3%3% 2%2% 1%1%
Plastic SurgeryPlastic Surgery 5%5% 3%3% 10%10% 8%8% 3%3% 11%11%
Thoracic SurgeryThoracic Surgery 16%16% 10%10% 10%10% 10%10% 6%6% 9%9%
TransplantationTransplantation 2%2% 3%3% 2%2% 2%2% 3%3% 1%1%
Vascular SurgeryVascular Surgery 5%5% 4%4% 4%4% 7%7% 4%4% 2%2%
Other SpecialtyOther Specialty 1%1% 2%2% 3%3% 1%1% 2%2% 2%2%
Program SizeProgram SizeSmall Small MediumMedium LargeLarge
19931993 19981998 20032003 19931993 19981998 20032003 19931993 19981998 20032003
No FellowshipNo Fellowship 10%10% 10%10% 7%7% 5%5% 3%3% 5%5% 7%7% 20%20% 3%3%
UndecidedUndecided 42%42% 58%58% 59%59% 50%50% 57%57% 49%49% 59%59% 46%46% 52%52%
Colon & RectalColon & Rectal 5%5% 1%1% 3%3% 2%2% 2%2% 4%4% 3%3% 2%2% 4%4%
SCC/Trauma/SCC/Trauma/BurnBurn 8%8% 8%8% 3%3% 5%5% 6%6% 4%4% 3%3% 3%3% 2%2%
OncologyOncology 1%1% 4%4% 3%3% 6%6% 7%7% 3%3% 3%3% 7%7% 8%8%
Pediatric SurgeryPediatric Surgery 3%3% 2%2% 0%0% 6%6% 4%4% 5%5% 0%0% 6%6% 3%3%
Plastic SurgeryPlastic Surgery 10%10% 4%4% 13%13% 6%6% 3%3% 8%8% 13%13% 3%3% 13%13%
Thoracic SurgeryThoracic Surgery 12%12% 8%8% 5%5% 12%12% 10%10% 12%12% 5%5% 6%6% 9%9%
TransplantationTransplantation 2%2% 1%1% 1%1% 2%2% 3%3% 2%2% 1%1% 4%4% 1%1%
Vascular SurgeryVascular Surgery 6%6% 4%4% 2%2% 6%6% 5%5% 4%4% 2%2% 3%3% 2%2%
Other SpecialtyOther Specialty 1%1% 3%3% 3%3% 1%1% 1%1% 3%3% 3%3% 2%2% 2%2%
Program Location over all yearsProgram Location over all years
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
NE SE MW SW W
Transplant
Other
CRS
Pediatric
Vascular
SCC
Plastic
Oncology
None
Thoracic
Undecided
Dataset 3: 12,259 paired responsesDataset 3: 12,259 paired responses 6,111 PGY-1 chose Undecided (50%)6,111 PGY-1 chose Undecided (50%) Of the UndecidedOf the Undecided
No Fellowship (24%)No Fellowship (24%)
Vascular Surgery (12%)Vascular Surgery (12%)
Other Fellowship (12%)Other Fellowship (12%)
Only 22% of all PGY-1 residents Only 22% of all PGY-1 residents
accurately identified their final accurately identified their final
post-residency planspost-residency plans
Majority of incoming residents are UndecidedMajority of incoming residents are Undecided
Fellowship choices evolve as PGY level Fellowship choices evolve as PGY level advancesadvances
Evolution occurs at variable ratesEvolution occurs at variable rates
Uncertainty for PGY-1 residents is desirable, Uncertainty for PGY-1 residents is desirable, reflecting open-mindednessreflecting open-mindedness
Junior residents should experience the full Junior residents should experience the full spectrum of potential fellowship areasspectrum of potential fellowship areas
The number of residents choosing fellowships The number of residents choosing fellowships are increasingare increasing
Fellowships chosen have changed over timeFellowships chosen have changed over time
PGY-1 residents unsure whether to pursue PGY-1 residents unsure whether to pursue fellowship fellowship
Alternative educational pathways are being Alternative educational pathways are being evaluated and implemented evaluated and implemented
Educational models featuring early specialty tracking Educational models featuring early specialty tracking continue to proliferatecontinue to proliferate
These models should include exposure to all areas These models should include exposure to all areas of specialization of specialization
Examination of PGY-1 fellowship training choices Examination of PGY-1 fellowship training choices could contribute to the ongoing process of residency could contribute to the ongoing process of residency redesignredesign
Further studies underway to determine the final Further studies underway to determine the final plans of the 78% percent of residents who plans of the 78% percent of residents who change their mindchange their mind