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

Johnston, Maximilian J.; Singh, Pritam; Pucher, Philip H.; Fitzgerald, J Edward; Aggarwal, Rajesh; Arora, Sonal; Darzi, Ara

doi:10.1002/bjs.9860

Cited by 54 publications

(42 citation statements)

References 50 publications

(110 reference statements)

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“…In the subset of patients who had a converted procedure with an incision shorter than the shortest open incision, the median postoperative stay was the same as for patients undergoing completed laparoscopic surgery, suggesting they gained benefit from laparoscopy. The study reinforces the considerable evidence that supervised trainees can provide safe and competent colorectal cancer surgery. Notably, it appears to extend this argument for laparoscopic rectal cancer resection, with a highly structured approach to training.…”

Section: Discussionsupporting

confidence: 78%

Outcomes following laparoscopic rectal cancer resection by supervised trainees

Currie

White

Malietzis

et al. 2016

British Journal of Surgery

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Section: Discussionsupporting

confidence: 78%

Outcomes following laparoscopic rectal cancer resection by supervised trainees

Currie

White

Malietzis

et al. 2016

British Journal of Surgery

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“…The quality of postgraduate training can have a persistent effect on subsequent health outcomes. 56,57 While current patient care is of paramount importance, ensuring that reflection and feedback are encouraged and trainee learning and assessment are maximized would better serve the health of future patients. Achieving a high-quality training system requires re-defining our working conditions to embed learning and assessment in our work practices and create time and intellectual space for training.…”

Section: Mini-cex = Mini-clinical Evaluation Exercisementioning

confidence: 99%

Perceptions of purpose, value, and process of the mini-Clinical Evaluation Exercise in anesthesia training

Castanelli

Jowsey

Chen

et al. 2016

Can J Anesth/J Can Anesth

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“…In the general surgery literature, a review of 23 studies demonstrated a positive impact of fellowship training on patient outcomes across several surgical subspecialties. 17 This meta-analysis showed a lower conversion of laparoscopic to open procedures for fellowship-trained minimally invasive surgeons. Of the 11 studies comparing fellowship-trained surgeons to those without fellowship training, one study showed increased survival, another showed decreased length of stay, and the remainder showed no difference in patient outcomes.…”

Section: Discussionmentioning

confidence: 84%

Impact of a Fellowship-Trained Minimally Invasive Gynecologic Surgeon on Patient Outcomes

Clark

Gujral

Wright

2017

JSLS

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Background and Objectives:As the performance of minimally invasive hysterectomy has increased in the United States, the need to apply outcomes measures has also increased. This study was conducted to determine the impact of a fellowship-trained minimally invasive gynecologic surgery (MIGS) specialist on patient outcomes after laparoscopic hysterectomy (LH) in a gynecology department.Methods:This is a retrospective review of 218 patients who underwent a laparoscopic hysterectomy for benign indications at a suburban academic-affiliated tertiary care hospital with a broad patient base from 2010 to 2014.Results:A total of 218 women underwent conventional laparoscopic hysterectomy by 10 members of a gynecology department: 96 women (44%) by a MIGS specialist and 122 women (56%) by a group of general gynecologists. Operative time was less (119 vs 148 min; P < .001), and patients were more likely to be discharged on the same day (90.6% vs 66.4%; P < .001) for the MIGS specialist compared to other surgeons. More patients of the MIGS specialist had undergone prior laparotomies (42.7% vs 17.2%; P = < .001) and had a greater uterine weight (392 vs 224 g; P < .001). Although the difference was not statistically significant, conversion to laparotomy (0 vs 2 cases; P = .505) and postoperative infection (6 vs 16 cases; P = .095) were lower for the MIGS specialist. Total billing charges were also lower for the MIGS specialist ($9,920 vs $11,406; P < .001).Conclusion:A fellowship-trained MIGS specialist performed laparoscopic hysterectomy in less time on more difficult surgical patients, with a shorter length of stay and lower costs, and no difference in complications compared to other providers in a gynecology department.

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

Abstract: Fellowship training appears to have a positive impact on patient outcomes.

Cited by 54 publications

References 50 publications

Outcomes following laparoscopic rectal cancer resection by supervised trainees

Outcomes following laparoscopic rectal cancer resection by supervised trainees

Perceptions of purpose, value, and process of the mini-Clinical Evaluation Exercise in anesthesia training

Impact of a Fellowship-Trained Minimally Invasive Gynecologic Surgeon on Patient Outcomes

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