What to expect when you're expecting a hepatopancreatobiliary surgeon: self-reported experiences of HPB surgeons from different training pathways

Abstract

Fellowship training in HPB surgery varies by training pathway. Training in MIS and ultrasound is deficient in each pathway. The ultimate scope of non-transplant HPB practice appears similar across training pathways. Thus, training pathway choice is best guided by the training experience desired and non-HPB components of anticipated practice.

Perception of training in hepatopancreatobiliary surgery among general surgery residents in the Americas

“…11 These offer variable experiences in pancreas, liver and biliary cases, and each pathway offers unique training foci. 12 In this study, an AHPBA rather than a SSO fellowship was the preferred pathway for residents who seek training in HPB surgery. Our study found that the type of fellowship pathway chosen by residents for HPB training depends on who performs these cases at host institutions.…”

The influence of fellowship training on the practice of pancreatoduodenectomy

“…2 Historically, the path to a HPB-focused surgical practice involved completion of an apprentice-like model or, more recently, completion of a surgical oncology or transplant surgery fellowship. 3 A fourth pathway-completion of a HPB surgery fellowship-has been developed over the last decade, in response to increasing trends in subspecialization. 4 Among these pathways, there may be significant variation in terms of programmatic emphases and operative exposure.…”

“…Less standardized apprenticeship training models at a variety of institutions have also offered a pathway to HPB surgery for surgical trainees in years past. 3 More recently, formal HPB surgery fellowships-created and accredited through a collaboration between the Fellowship Council (FC) and Americas Hepato-Pancreato-Biliary Association (AHPBA)-now offer another pathway to specialization in HPB surgery. 4 The curricula and foci among these three training programs vary considerably within North America, and there is even further heterogeneity globally.…”

“…Two recent studies have assessed the relationship between fellowship training pathway and current operative caseload among HPB surgeons. 3,4 In order to further evaluate the influence of training pathway on HPB surgery, the present study examines practice patterns relating to a specific operationpancreatoduodenectomy (PD)-that is a cornerstone of HPB surgery and is defined by numerous intraoperative strategies and management decisions. Many of these strategies have been evaluated in randomized controlled trials (RCT), which have established Level I evidence for best clinical practices.…”

HPB fellowship training: consensus and convergence

“…For example, fellows are able to inform potential deficiencies in breadth of training. 9 Separately, there appears to remain some disparity between the perceptions of programme directors and fellows regarding operative ability to undertake certain index complex cases, with fellows reporting lower confidence. 10 Consideration of this may help inform decisions on index caseload as there are no strong data on minimum case numbers, although it has been reported that 20 pancreatectomies are required for equivalence in mortality rates and 60 for equivalence in morbidity rates.…”