Clinical Fellowships in Surgical Training: Analysis of a National Pan‐specialty Workforce Survey

Abstract

BackgroundFellowship posts are increasingly common and offer targeted opportunities for training and personal development. Despite international demand, there is little objective information quantifying this effect or the motivations behind undertaking such a post. The present study investigated surgical trainees’ fellowship aims and intentions.MethodsAn electronic, 38-item, self-administered questionnaire survey was distributed in the United Kingdom via national and regional surgical mailing lists and websites via the Association of Surgeons in Training, Royal Surgical Colleges, and Specialty Associations.ResultsIn all, 1,581 fully completed surveys were received, and 1,365 were included in the analysis. These represented trainees in core or higher training programs or research from all specialties and training regions: 66 % were male; the mean age was 32 years; 77.6 % intended to or had already completed a fellowship. Plastic surgery (95.2 %) and cardiothoracic (88.6 %) trainees were most likely to undertake a fellowship, with pediatrics (51.2 %), and urology (54.3 %) the least likely. Fellowship uptake increased with seniority (p < 0.01) and was positively correlated (p = 0.016, r = 0.767) with increasing belief that fellowships are necessary to the attainment of clinical competence, agreed by 73.1 %. Fellowship aims were ranked in descending order of importance as attaining competence, increasing confidence, and attaining subspecialist skills.ConclusionsOver three-quarters of trainees have or will undertake a clinical fellowship, varying with gender, specialty, and seniority. Competence, confidence, and subspecialty skills development are the main aims. The findings will influence workforce planning, and perceptions that current training does not deliver sufficient levels of competence and confidence merit further investigation.

Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes

“…For the purposes of this review, a fellowship in surgery was defined as ‘an optional, additional period of clinical practice undertaken within a defined specialty or subspecialty area by a surgeon not in a substantive “attending” or “consultant” position, where this attachment is not a mandatory requirement of their training programme’. The terms ‘attending’ or ‘consultant’ refer to surgeons engaged in independent clinical practice.…”

Perceptions of Program Directors on the Necessity of Hepatopancreaticobiliary Fellowships in Training General Surgery Residents

“…Whether or not residents feel prepared to practice HPB surgery without further training was not reviewed in this survey. Despite the demand for the general surgeon, surgical trainees feel the need to go for further training [19]. The opinion of employers and fellowship directors on the abilities of new graduates was not within the scope of this survey.…”

Professional paradox: identity formation in qualified doctors pursuing further training

“…As medicine becomes more transdisciplinary and intersects with the humanities, arts and non‐medical sciences, further training has moved beyond clinical or research training, to include advanced degrees such as PhDs and Masters in areas such as education, philosophy, business administration and epidemiology. Motivations for pursuing additional training are many and may include a doctor's personal passion for a specialised area in their field, perceived financial gains, increasing competence prior to entering practice, a desire for dedicated research time, and increasing marketability for future job prospects …”

“…Motivations for pursuing additional training are many and may include a doctor's personal passion for a specialised area in their field, 3 perceived financial gains, increasing competence prior to entering practice, a desire for dedicated research time, and increasing marketability for future job prospects. [4][5][6] In Canada, further training has been cited to not only make one more employable, but for many doctors, is the only option at the end of their training. 5 Unemployment is a rising concern among newly graduated specialists and subspecialists; as a result, many are pursuing additional training as an alternative to unemployment.…”