Advanced Gastrointestinal Surgery Fellowship Programs: Filling a Gap in Surgical Training?

Kei Nagatomo; Edward Cho; Muhammad Darwish; Terence Jackson; Houssam Osman; Steven C Stain; D Rohan Jeyarajah

doi:10.1016/j.jsurg.2021.01.012

Advanced Gastrointestinal Surgery Fellowship Programs: Filling a Gap in Surgical Training?

J Surg Educ. 2021 Sep-Oct;78(5):1593-1598. doi: 10.1016/j.jsurg.2021.01.012. Epub 2021 Jan 28.

Authors

Kei Nagatomo¹, Edward Cho², Muhammad Darwish¹, Terence Jackson¹, Houssam Osman¹, Steven C Stain³, D Rohan Jeyarajah⁴

Affiliations

¹ Department of Surgery, Methodist Richardson Medical Center, Richardson, Texas.
² Department of Surgery, Methodist Richardson Medical Center, Richardson, Texas; Department of Surgery, Albany Medical College, New York, New York.
³ Department of Surgery, Albany Medical College, New York, New York.
⁴ Department of Surgery, Methodist Richardson Medical Center, Richardson, Texas; Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, Texas. Electronic address: rohanjeyarajah@gmail.com.

PMID: 33516749
DOI: 10.1016/j.jsurg.2021.01.012

Abstract

Objective: The goal of the 1-year Advanced Gastrointestinal (AGI) surgery fellowship is to train the general surgeon to perform advanced and complex operations that they had insufficient experience with in residency training. This study examines the case logs of AGI fellows that have completed Society for Surgery of the Alimentary Tract (SSAT)-sponsored Fellowship Council (FC)-accredited AGI fellowships to determine the role of these fellowships in providing complex gastrointestinal operative experience.

Design/participants: Institutional Review Board-approved retrospective surgical case log analysis. Case logs of 60 AGI fellows in 12 different AGI fellowships from 2014 to 2019 were requested by the SSAT and provided in a de-identified format from the FC. Cases were categorized as colorectal surgery, anus, hernia-abdomen, hernia inguinal, esophagus-hiatal hernia, esophagus-Heller, pancreas, liver, bile duct, diagnostic/therapeutic esophagogastroduodenoscopy (EGD), diagnostic/therapeutic colonoscopy, thoracic esophagus, thoracic lung, spleen, thyroid, diaphragm, gastric, abdomen, adrenal/kidney, bariatric, diagnostic/therapeutic bronchoscopy, kidney/liver/pancreas transplant, and trauma.

Results: AGI fellows performed a mean of 345 cases per year (range: 184-558). Our results showed that 5 programs provided >30 colorectal cases, 6 provided >50 hernia (hernia-abdomen and hernia-inguinal) cases, 8 provided >25 hiatal hernia cases, 2 provided >100 endoscopy cases (diagnostic/therapeutic EGD and diagnostic/therapeutic colonoscopy), 6 provided >30 gastric cases, 3 provided >100 bariatric cases, 6 provided >10 pancreas cases, 3 provided >10 liver cases, and 4 provided >6 biliary cases.

Conclusion: SSAT-sponsored FC-accredited AGI fellowship programs provide a wide array of training in complex gastrointestinal surgeries. Most programs provide broad training in hiatal work, colorectal surgery, hepato-pancreato-biliary surgery, and abdominal wall reconstruction. This FC-accredited AGI training paradigm prepares trainees for broad-based complex abdominal surgery, an area that is sorely needed to augment insufficient experience in many general surgical training programs.

Keywords: Advanced gastrointestinal surgery; Complex gastrointestinal surgery; Fellowship; Fellowship Council; Society for Surgery of the Alimentary Tract.

MeSH terms

Clinical Competence
Digestive System Surgical Procedures*
Education, Medical, Graduate
Fellowships and Scholarships
General Surgery* / education
Internship and Residency*
Retrospective Studies