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