Interim Analysis of a Prospective Multi-Institutional Study of Surgery Resident Experience with Flexibility in Surgical Training - 26/03/18

Doi : 10.1016/j.jamcollsurg.2017.12.024

Darren R. Cullinan, MD ^a, Paul E. Wise, MD, FACS ^a, Keith A. Delman, MD, FACS ^b, John R. Potts, MD, FACS ^c, Michael M. Awad, MD, PhD, FACS ^a, Timothy J. Eberlein, MD, FACS ^a, Mary E. Klingensmith, MD, FACS ^a,^⁎
^a Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO
^b Department of Surgery, Emory University School of Medicine, Atlanta, GA
^c Accreditation Council for Graduate Medical Education, Chicago, IL

^∗Correspondence address: Mary E Klingensmith, MD, FACS, Department of Surgery, Washington University School of Medicine in St Louis, 660 South Euclid Ave, Campus Box 8109, St Louis, MO 63110.Department of SurgeryWashington University School of Medicine in St Louis660 South Euclid Ave, Campus Box 8109St LouisMO63110

Abstract

Background

The Flexibility in Surgical Training (FIST) consortium project was designed to evaluate the feasibility and resident outcomes of optional subspecialty-focused training within general surgery residency training.

Study Design

After approval by the American Board of Surgery, R4 and R5 residents were permitted to customize up to 12 of the final 24 months of residency for early tracking into 1 of 9 subspecialty tracks. A prospective IRB-approved study was designed across 7 institutions to evaluate the impact of this option on operative experience, in-service exam (American Board of Surgery In-Training Examination [ABSITE]) and ACGME milestone performance, and resident and program director (PD) perceptions. The FIST residents were compared with chief residents before FIST initiation (controls) as well as residents during the study period who did not participate in FIST (no specialization track, NonS).

Results

From 2013 to 2017, 122 of 214 chief residents (57%) completed a FIST subspecialty track. There were no differences in median ABSITE scores between FIST, NonS residents, and controls. The ACGME milestones at the end of the R5 year favored the FIST residents in 13 of 16 milestones compared with NonS. Case logs demonstrated an increase in track-specific cases compared with NonS residents. Resident and PD surveys reported a generally favorable experience with FIST.

Conclusions

In this prospective study, FIST is a feasible option in participating institutions. All FIST residents, regardless of track, met requirements for ABS Board eligibility, despite modifications to rotations and case experience. Future studies will assess the impact of FIST on ABS exam results and fellowship success.

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Abbreviations and Acronyms : ABS, ABSITE, ESP, FIT, FIST, NonS

Plan

Methods

Results

American Board of Surgery in-service training exam performance

Accreditation Council for Graduate Medical Education milestones

	Disclosure Information: Dr Potts is a full-time employee of the Accreditation Council for Graduate Medical Education.
	Disclosure outside the scope of this work: Dr Awad receives education research grants from Ethicon, Baxter, Bard, and Intuitive. Dr Wise receives research grants from Cancer Prevention Pharmaceuticals, Inc, and is paid for expert testimony.
	Support for this work: This work was supported by the National Institutes of Health (DRC: T32-CA009621, UL1-TR000448).
	Disclaimer: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.