Surgical fellowship training in Canada: What is its current status and is improvement required?

Nousiainen, Markku; Latter, David A.; Backstein, David; Webster, Fiona; Harris, Kenneth A.

doi:10.1503/cjs.043809

Cited by 16 publications

(15 citation statements)

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“…In Canada, specialty training requires a minimum of 5 years of approved training, where after 2 years, candidates sit the principles of surgery examination. Successful completion of this makes the trainee eligible for the final Royal College Certification examinations, which are taken after completion of the residency 61. In the USA, trainees applying for certification from the ABMS must be graduates of an approved medical school, must have completed an accredited residency programme (5 years) and must have completed 12 months as a chief resident with appropriate clinical responsibilities 5…”

Section: Accreditationmentioning

confidence: 99%

Training, assessment and accreditation in surgery

Aydın

Fisher

Khan

et al. 2017

Postgraduate Medical Journal

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Section: Accreditationmentioning

confidence: 99%

Training, assessment and accreditation in surgery

Aydın

Fisher

Khan

et al. 2017

Postgraduate Medical Journal

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“…For instance, international fellows may not be protected by the same local regulations for resident duty hours. 24 Therefore, this may simply shift excess workload to another group who will then battle issues of fatigue and well-being (Box 4).…”

Section: Alternative Workforce-based Solutionsmentioning

confidence: 99%

Understanding the effect of resident duty hour reform: a qualitative study

Stroud

McDonald-Blumer

et al. 2014

CMAJ Open

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Background:Concern surrounding the effect of resident fatigue on patient care recently led the National Steering Committee on Resident Duty Hours to publish Canadian recommendations suggesting that duty periods of 24 or more consecutive hours without restorative sleep should be avoided. We sought to characterize how different training programs are preparing for the effect of such changes on education, patient care and provider well-being. Methods:Using constructivist grounded theory methodology, we conducted 18 one-on-one semistructured interviews with program directors, division directors and department chiefs from 11 residency programs affiliated with one Canadian medical school. We gathered and analyzed data iteratively until we reached theoretical saturation. Results:The key theme articulated by our participants was that changes in resident duty hours would potentially lead to gaps in the provision of clinical care. These changes affect acute care specialties based primarily in the inpatient setting (e.g., medicine, surgery) more than primarily ambulatory (e.g., family medicine) or shift-model based (e.g., emergency) specialties. Potential strategies to address gaps in clinical care include resident-based solutions, faculty-based solutions and solutions based on other providers (e.g., nonacademic physicians, physician extenders). Each solution has unique advantages and disadvantages in terms of education, continuity of care, preparedness for practice and provider well-being.Interpretation: Our data-driven framework serves as a guide for programs to anticipate challenges of satisfying clinical care needs in the face of changes to resident duty hours, while balancing education, care continuity, preparedness for practice and provider wellbeing. Our findings challenge the "one-size-fits-all" approach to changes to resident duty hours and endorse flexibility in enacting duty hour regulations based on specialty-specific factors. AbstractSee CMAJ: editorial, www.cmaj.ca/lookup/doi/10.1503/cmaj140588; and analysis, www.cmaj.ca/lookup/doi/10.1503/cmaj.131053 E116 CMAJ OPEN, 2(2)Research CMAJ OPEN most of the studies used surveys to assess the perceptions of trainees and faculty; these surveys often provide insufficient detail to explore and characterize the nuanced effect of reducing resident duty hours and the interplay of the factors affected by these reductions. As a result, it is difficult to predict how all of the factors relate to one another, leaving program directors with the challenge of applying a generic understanding of the various effects of reductions of resident duty hours to their specific training contexts. To help program directors anticipate these problems and proactively identify solutions, we aimed to explore the perceived effect of changes to resident duty hours from the perspective of program directors, division directors and department chiefs, and to explore how they planned to address changes in resident duty hours. MethodsWe used constructivist grounded theory, a qualitative methodology that...

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“…Currently, fellowship participation rates vary by surgical subspeciality with approximately 70-75% of general surgery and urology residents pursuing fellowships, compared to over 90% of orthopedic residents [1,4,5]. Unfortunately, even though orthopedics is shown to have exceedingly high fellowship enrollment rates, very few studies have investigated this phenomenon [1][2][3][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

“…As residents increasingly undertake fellowships, their decisions have strong implications to future healthcare workforce planning and graduate surgical education. There are strong concerns that as more residents enroll in fellowship programs, the educational value of residency training may become undermined: Fellowships may simply represent a "de facto" extension of residency training into a 6-year undertaking, with fellows performing more resident-level duties and residents themselves being suboptimally trained with the mindset that any skill deficits can be learned later during their fellowship period [3,7]. Of course, having more fellowship-trained specialists is appealing when considering that certain surgical procedures have better productivity and clinical outcomes when performed by a fellowship-trained surgeon [6,7,9,10].…”

Section: Introductionmentioning

confidence: 99%

Increasing Trends in Orthopedic Fellowships Are Not due to Inadequate Residency Training

Almansoori

Clark

2015

Education Research International

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Orthopedic residents have one of the highest fellowship participation rates among medical specialities and there are growing concerns that inadequate residency training may be contributing to this trend. Therefore, a mixed-exploratory research survey was distributed to all 148 graduating Canadian orthopedic residents to investigate their perceptions and attitudes for pursuing fellowships. A response rate of 33% (n=49) was obtained with the majority of residents undertaking one (27%) or two (60%) fellowships. Surgical-skill development was reported as the most common motivating factor, followed by employment and marketability; malpractice protection and financial reasons were the least relevant. The overwhelming majority of residents (94%,n=46) felt adequately prepared by their residency training for independent general practice, and 84% (n=41) of respondents did not feel that current fellowship trends were due to poor residency training. Three common themes were expressed in their comments: the growing perceived expectation by healthcare professionals and employers to be fellowship-certified, the integration of fellowship training into the surgical education hierarchy, and the failure of residency training curriculums to accommodate for this trend. In conclusion, Canadian orthopedic residents are confident of their residency training and are increasingly pursuing fellowships to primarily develop their surgical skills and expertise.

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Surgical fellowship training in Canada: What is its current status and is improvement required?

Abstract: REVUEdoes not exist, we sought to summarize the current state of knowledge about fellowship training in Canada as it pertains to demographic characteristics, finances, work hours, residency training, preparation for clinical and research work, and satisfaction with training.

Cited by 16 publications

References 50 publications

Training, assessment and accreditation in surgery

Training, assessment and accreditation in surgery

Understanding the effect of resident duty hour reform: a qualitative study

Increasing Trends in Orthopedic Fellowships Are Not due to Inadequate Residency Training

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