University of Maryland Medical Center, 29 South Greene Street, GS 631, Baltimore, MD, 21201, USA.
University of Maryland School of Medicine, Baltimore, MD, USA.
Surg Endosc. 2023 Jun;37(6):4623-4626. doi: 10.1007/s00464-023-09958-z. Epub 2023 Mar 2.
Minimally invasive surgery (MIS) fellowship is one of the most popular fellowship programs, but little is known about the individual fellow's clinical experience. Our goal was to determine the differences in case volume and case type in academic and community programs.
A retrospective review of advanced gastrointestinal, MIS, foregut, or bariatric fellowship cases logged into the Fellowship Council directory of fellowships during the 2020 and 2021 academic years included for analysis. The final cohort included 57,324 cases from all fellowship programs, that list data on the Fellowship Council website, including 58 academic programs and 62 community-based programs. All comparisons between groups were completed using Student's t-test.
The mean number of cases logged during a fellowship year was 477.7 ± 149.9 with similar case numbers in academic and community programs, 462.5 ± 115.0 and 491.9 ± 176.2 respectively (p = 0.28). The mean data is illustrated in Fig. 1. The most common performed cases were in the following categories: bariatric surgery (149.8 ± 86.9 cases), endoscopy (111.1 ± 86.4 cases), hernia (68.0 ± 57.7 cases) and foregut (62.8 ± 37.3 cases). In these case-type categories, no significant differences in case volume were found between academic and community-based MIS fellowship programs. However, community-based programs had significantly more case experience compared to academic programs in all of the less commonly performed case-type categories: appendix 7.8 ± 12.8 vs 4.6 ± 5.1 cases (p = 0.08), colon 16.1 ± 20.7 vs 6.8 ± 11.7 cases (p = 0.003), hepato-pancreatic-biliary 46.9 ± 50.8 vs 32.5 ± 18.5 cases (p = 0.04), peritoneum 11.7 ± 16.0 vs 7.0 ± 7.6 cases (p = 0.04), and small bowel 11.9 ± 9.6 vs 8.8 ± 5.9 cases (p = 0.03).
MIS fellowship has been a well-established fellowship program under the Fellowship Council guideline. In our study, we aimed to identify the categories of fellowship training and the perspective case volumes in academic vs community setting. We conclude that fellowship training experience is similar in case volumes of commonly performed cases when comparing academic and community programs. However, there is substantial variability in the operative experience among MIS fellowship programs. Further study is necessary to identify the quality of fellowship training experience.
微创手术（MIS） fellowship 是最受欢迎的 fellowship项目之一，但人们对住院医师的临床经验知之甚少。我们的目标是确定学术和社区项目中病例量和病例类型的差异。
对 2020 年和 2021 学年期间在 Fellowship Council 目录中记录的高级胃肠、MIS、前肠或减重外科 fellowship病例进行回顾性分析。最终队列包括 Fellowship Council 网站上列出数据的所有 fellowship 计划中的 57324 例，包括 58 个学术项目和 62 个社区项目。使用 Student's t 检验完成所有组间比较。
fellowship 年的平均病例数为 477.7±149.9，学术和社区项目的病例数相似，分别为 462.5±115.0 和 491.9±176.2（p=0.28）。平均值如图 1 所示。最常见的手术类型如下：减重手术（149.8±86.9 例）、内镜（111.1±86.4 例）、疝（68.0±57.7 例）和前肠（62.8±37.3 例）。在这些病例类型中，在学术和社区 MIS fellowship 项目之间，在病例量方面没有发现显著差异。然而，与学术项目相比，社区项目在所有不太常见的手术类型中具有显著更多的手术经验：阑尾 7.8±12.8 比 4.6±5.1 例（p=0.08），结肠 16.1±20.7 比 6.8±11.7 例（p=0.003），肝胰胆 46.9±50.8 比 32.5±18.5 例（p=0.04），腹膜 11.7±16.0 比 7.0±7.6 例（p=0.04），小肠 11.9±9.6 比 8.8±5.9 例（p=0.03）。
MIS fellowship 一直是 Fellowship Council 指南下的一个成熟的 fellowship 项目。在我们的研究中，我们旨在确定学术和社区环境中 fellowship 培训的类别和典型病例量。我们得出结论，在比较学术和社区项目时，常见手术类型的 fellowship 培训经验在病例量方面相似。然而，MIS fellowship 项目之间的手术经验存在很大差异。需要进一步研究以确定 fellowship 培训经验的质量。
