General Surgery Residency Inadequately Prepares Trainees
General Surgery Residency Inadequately Prepares Trainees
The global assessment survey was completed by 91 of 145 fellowship directors (63% response rate) over a 6-week period. In addition to the quantitative responses (Table 2, Table 3, Table 4, Table 5, Table 6), each of the 5 domains queried returned 15 to 25 free text reflective qualitative responses in response to a request for comments, specifying the strengths and deficits on recent incoming fellows within each domain.
Within the domain of professionalism, fellowship directors reported that overall incoming fellows demonstrated effective communication strategies and were respectful of patients and colleagues, with a response of agree or strongly agree provided 79% to 92% of the time for all attributes queried within this domain (Table 2). Within the qualitative comments for this domain, however, the predominant theme emerging from the open-ended responses was a lack of patient ownership, with illustrative comments highlighting this concern in 8 of 21 (38%) of the comments provided (Table 7).
Within the domain of level of independence/graduated responsibility, there was a shift toward utilization of the entire breadth of the scale as demonstrated by the modal responses shown in italic in Table 3. The greatest area of deficiency seemed to reside with the ability of an incoming fellow to perform 30 minutes of a major procedure independently on arrival to fellowship, with 42.7% of fellowship directors providing a response of disagree or strongly disagree with this statement. Despite this deficiency on entry to fellowship, 82% of fellowship directors agreed that fellows were able to perform advanced cases independently by the completion of fellowship, and 89% agreed that fellows were able to practice independently by the completion of fellowship training (Table 3). Themes that emerged from the open-ended responses in this domain reflected a generalized lack of autonomy and independence during residency that delayed progress, or at least required a "catching-up" phase at the beginning of the fellowship. Limited experience during residency with advanced procedures was also highlighted (Table 7).
The psychomotor ability domain was evaluated with only a 4-point scale, with vivid descriptors provided for each response of strongly disagree, disagree, agree, and strongly agree to improve the consistency of responses for a given level of performance. Although the modal response as shown in italic was "agree" for most skills queried, almost one third of responders provided an answer of disagree or strongly disagree for statements relating to an incoming fellow's proficiency in recognizing and dissecting tissue planes, and 56% disagreed that incoming fellows were proficient in laparoscopic suturing (Table 4). These same areas of concern were reflected in the open-ended responses. However, fellowship directors also reported that fellows typically progressed toward independence over the course of the fellowship (Table 7).
With respect to incoming fellows' skills within the domain of clinical evaluation and management, there was an overall agreement that fellows demonstrated the ability to evaluate patients, develop and deliver appropriate recommendations, and initiate appropriate interventions (Table 5). One concern raised in the open-ended responses was associated with an observed tendency of incoming fellows to order excessive tests or overutilize hospital resources such as an intermediate or intensive care unit level of care to be certain that the patient was "okay" (Table 7).
The greatest concerns raised by fellowship directors in this survey were within the domain of academia and scholarship (Table 6). Although the modal response shown in italic was agree or neutral for all attributes queried, the percentage of fellowship directors responding within the agree or strongly agree response options ranged from only 32% to 76% (Table 6). The open-ended responses also reflected this concern, with 69% of the comments received relating to a general lack of interest among fellows in academic pursuits or scholarship activities (Table 7).
Results
The global assessment survey was completed by 91 of 145 fellowship directors (63% response rate) over a 6-week period. In addition to the quantitative responses (Table 2, Table 3, Table 4, Table 5, Table 6), each of the 5 domains queried returned 15 to 25 free text reflective qualitative responses in response to a request for comments, specifying the strengths and deficits on recent incoming fellows within each domain.
Within the domain of professionalism, fellowship directors reported that overall incoming fellows demonstrated effective communication strategies and were respectful of patients and colleagues, with a response of agree or strongly agree provided 79% to 92% of the time for all attributes queried within this domain (Table 2). Within the qualitative comments for this domain, however, the predominant theme emerging from the open-ended responses was a lack of patient ownership, with illustrative comments highlighting this concern in 8 of 21 (38%) of the comments provided (Table 7).
Within the domain of level of independence/graduated responsibility, there was a shift toward utilization of the entire breadth of the scale as demonstrated by the modal responses shown in italic in Table 3. The greatest area of deficiency seemed to reside with the ability of an incoming fellow to perform 30 minutes of a major procedure independently on arrival to fellowship, with 42.7% of fellowship directors providing a response of disagree or strongly disagree with this statement. Despite this deficiency on entry to fellowship, 82% of fellowship directors agreed that fellows were able to perform advanced cases independently by the completion of fellowship, and 89% agreed that fellows were able to practice independently by the completion of fellowship training (Table 3). Themes that emerged from the open-ended responses in this domain reflected a generalized lack of autonomy and independence during residency that delayed progress, or at least required a "catching-up" phase at the beginning of the fellowship. Limited experience during residency with advanced procedures was also highlighted (Table 7).
The psychomotor ability domain was evaluated with only a 4-point scale, with vivid descriptors provided for each response of strongly disagree, disagree, agree, and strongly agree to improve the consistency of responses for a given level of performance. Although the modal response as shown in italic was "agree" for most skills queried, almost one third of responders provided an answer of disagree or strongly disagree for statements relating to an incoming fellow's proficiency in recognizing and dissecting tissue planes, and 56% disagreed that incoming fellows were proficient in laparoscopic suturing (Table 4). These same areas of concern were reflected in the open-ended responses. However, fellowship directors also reported that fellows typically progressed toward independence over the course of the fellowship (Table 7).
With respect to incoming fellows' skills within the domain of clinical evaluation and management, there was an overall agreement that fellows demonstrated the ability to evaluate patients, develop and deliver appropriate recommendations, and initiate appropriate interventions (Table 5). One concern raised in the open-ended responses was associated with an observed tendency of incoming fellows to order excessive tests or overutilize hospital resources such as an intermediate or intensive care unit level of care to be certain that the patient was "okay" (Table 7).
The greatest concerns raised by fellowship directors in this survey were within the domain of academia and scholarship (Table 6). Although the modal response shown in italic was agree or neutral for all attributes queried, the percentage of fellowship directors responding within the agree or strongly agree response options ranged from only 32% to 76% (Table 6). The open-ended responses also reflected this concern, with 69% of the comments received relating to a general lack of interest among fellows in academic pursuits or scholarship activities (Table 7).
