- 作者：Peter T. Hallowell ; M.D. ; pth2f@virginia.edu ; Mohamed I. Dahman ; M.D. ; Jayme B. Stokes ; M.D. ; Damien J. LaPar ; M.D. ; M.Sc. ; Bruce D. Schirmer ; M.D.
- 关键词：Residents ; Fellows ; Fellowship ; General surgery ; MIS fellowship ; Laparoscopic fellowship
- 刊名：The American Journal of Surgery
- 出版年：2013
- 出版时间：March, 2013
- 年：2013
- 卷：205
- 期：3
- 页码：307-311
- 全文大小：109 K
Background
With the advent of clinical fellowships in general surgery, there has been a continual debate over the effect on general surgical resident training. Will a fellowship interfere with a chief resident's experience or case volume? The aim of this study was to test the hypothesis that the presence of an advanced laparoscopic fellow in a tertiary care hospital and residency has had no deleterious effect on chief resident laparoscopic case volume.Methods
The operative case logs of graduating residents and fellows from 2001 to 2011 were reviewed, focusing on laparoscopic basic and complex cases and comparing between those 2 groups and comparing residents' case numbers with the national average published by the Accreditation Council for Graduate Medical Education.
Results
Residents graduating from 2001 to 2011 (4-6 chief residents per year) performed an average of 989 ¡À 76.2 laparoscopic cases per graduating chief class, with each chief averaging 207.7 ¡À 10.7. The average number of laparoscopic basic cases per graduating chief year was 555.3 ¡À 42.1, with each chief averaging 116.2 ¡À 4.9. The average number of laparoscopic complex cases per graduating chief year was 434.4 ¡À 39.2, with each chief averaging 91.5 ¡À 7.2. Over the same period of time (1 or 2 fellows per year), fellows performed an average of 336 ¡À 23.3 cases per year. When comparing residents' total average cases with the national data, the residents performed a similar number of cases (209.9 ¡À 11.9 vs 195.0 ¡À 19.5, P = .53). When comparing years when there were 2 clinical fellows vs years with 1 fellow, there was no change in the total number of laparoscopic cases per chief (224.2 vs 195.6, P = .26) and no change in the number of complex laparoscopic cases (97.1 vs 88.7, P = .63). There was a significant difference for basic laparoscopic cases, with a slight decrease when there were 2?fellows (127.8 vs 106.9, P = .04).
Conclusions
A laparoscopic fellowship has not had an adverse impact on the complex or basic laparoscopic case experience of surgical residents. In a busy academic practice, laparoscopic fellowships and general surgical residency can coexist.