Abstract
Background
There is concern regarding the competency of today’s general surgery graduates as
a large proportion defer independent practice in favor of additional fellowship training.
Little is known about the graduates who directly enter general surgery practice and
if their operative experiences during residency differ from graduates who pursue fellowship.
Methods
Nineteen Accreditation Council for Graduate Medical Education–accredited general surgery
programs from the US Resident OPerative Experience Consortium were included. Demographics,
career choice, and case logs from graduates between 2010 to 2020 were analyzed.
Results
There were 1,264 general surgery residents who graduated over the 11-year period.
A total of 248 (19.6%) went directly into practice and 1,016 (80.4%) pursued fellowship.
Graduates directly entering practice were more likely to be a high-volume resident
(43.1% vs 30.5%, P < .01) and graduate from a high-volume program (49.2% vs 33.0%, P < .01). Direct-to-practice graduates performed 53 more cases compared with fellowship-bound
graduates (1,203 vs 1,150, P < .01). On multivariable analysis, entering directly into practice was positively
associated with total surgeon chief case volume (odds ratio = 1.47, 95% confidence
interval 1.18–1.84, P < .01) and graduating from a US medical school (odds ratio = 2.54, 95% confidence
interval 1.45–4.44, P < .01) while negatively associated with completing a dedicated research experience
(odds ratio = 0.31, 95% confidence interval 0.22–0.45, P < .01).
Conclusion
This is the first multi-institutional study exploring resident operative experience
and career choice. These data suggest residents who desire immediate practice can
tailor their experience with less research time and increased operative volume. These
data may be helpful for programs when designing their experience for residents with
different career goals.
Graphical abstract
Graphical Abstract
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Article info
Publication history
Published online: July 01, 2022
Accepted:
May 30,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
