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Do General Surgery Residents Begin Specializing Before Fellowship? A Multi-Institutional Study from the US ROPE Consortium.

BACKGROUND
Single-center data suggest that general surgery residents perform more cases related to their future fellowship compared to their peers. This study aimed to determine if this experience was true for residents across multiple programs.


STUDY DESIGN
Data from graduates of 18 ACGME-accredited general surgery residency programs in the US Resident OPerative Experience (ROPE) Consortium were analyzed. Residents were categorized as entering one of 12 fellowships or entering directly into general surgery practice. Case log operative domains were mapped to each fellowship and analyses were performed between groups.


RESULTS
Of 1,192 graduated general surgery residents, 955 (80%) pursued fellowship training while 235 (20%) went directly into general surgery practice. The top three fellowships pursued were trauma/surgical critical care (18%), vascular surgery (13%), and minimally invasive surgery (12%). Residents entering minimally invasive surgery performed the most total cases, while residents pursuing breast performed the least (1209 [1056-1325] vs. 1091 [1006-1171], p<0.01). For each fellowship type, graduates completed more total fellowship-specific cases in their future specialty compared to their peers (all p<0.05). This association was observed for all 12 fellowships at the surgeon chief level (all p<0.05) and for 10 of 12 fellowships at the surgeon junior level (all p<0.05).


CONCLUSIONS
General surgery residents perform more cases related to their future specialty choice compared to their peers. These data suggest that the specialization process begins during residency. This tendency among residents should be considered as general surgery residency undergoes structural redesign in the future.