S. A. Moore1, R. Maduka3, P. M. Reilly2, J. C. Morris2, M. J. Seamon2, D. N. Holena2, L. J. Kaplan2, N. D. Martin2 3Yale University School Of Medicine,New Haven, CT, USA 1University Of New Mexico HSC,Albuquerque, NM, USA 2Hospital Of The University Of Pennsylvania,Philadelphia, PA, USA
Introduction:
Fundamental training in Acute Care Surgery (ACS) is an integral component of general surgery residency and serves as a critical base experience for the added educational qualifications of fellowship. How this training varies between programs is not well-characterized. We sought to describe the variation in clinical exposure between residencies and characterize the educational expectations (clinical and non-clinical) in a sample of residents applying to an ACS fellowship. We also sought to characterize the expectations of applicants for fellowship and future career plans. We hypothesized that applicants to an academic trauma, surgical critical care, and emergency surgery training program have significant variations in clinical exposure as well as unique and specific expectations for educational experiences.
Methods:
We offered an anonymous 70-question survey focused on residency clinical exposure and self-perceived confidence in key areas of ACS training, as well as fellowship training and career expectations to all applicants interviewed at a large, urban, academic, level one trauma, critical care, & emergency surgery fellowship program. Responses were assessed via absolute numbers and confidence via a 5-point Likert scale; data is reported using descriptive statistics and linear regression models.
Results:
Forty-two out of 44 interviewing applicants completed the survey, for a response rate of 96%. Applicants reported heterogeneous levels of comfort across most ACS domains. There was poor correlation between experience and comfort in several key areas where despite little experience respondents reported high levels of comfort (FIGURE 1). During fellowship training, respondents placed the highest priority on operative experience, with 43% rating this as their highest priority, followed by penetrating trauma experience (33%), a heavy clinical ICU exposure (17%) and leadership training (12%).The majority of respondents (58%) envisioned a career that was comprised of 50% trauma, 25% emergency general surgery, and 25% critical care.
Conclusion:
We found significant variations in both experience and comfort within key ACS domains amongst fellowship applicants. Applicants with little experience still reported high level of comfort with fundamental ACS skills. Collaboration between general surgery residency and ACS fellowship governing bodies may help address areas of limited exposure prior to entry into clinical practice. Understanding the expectations of fellowship applicants is essential in demonstrating the elements of a program that resonate with applicants to aid rendering an informed program selection. ACS fellowship programs must balance these expectations with realistic experiences during training and in the job market.
