Yilma Mignote, Brown Audrey E, Harvey Jalen, Stahl Christopher C, Quillin Ralph C, Syed Shareef M, Cortez Alexander R
Division of Transplant Surgery, University of California San Francisco, San Francisco, California, USA.
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Clin Transplant. 2024 Jul;38(7):e15398. doi: 10.1111/ctr.15398.
Transplant surgery has historically been a less desirable fellowship among general surgery graduates. Limited work has been done to understand factors associated with residents' interest in transplantation. Using a multi-institutional cohort, we examined how the resident experience on transplant surgery may influence their decision to pursue transplant fellowship.
Individual demographics, program characteristics, and transplant-specific case logs were collected for graduates from 2010 to 2020 at 20 general surgery residency programs within the US Resident OPerative Experience (ROPE) Consortium. Residents who pursued transplant surgery fellowship were compared to those who went directly into practice or pursued a non-transplant fellowship.
Among 1342 general surgery graduates, 52 (3.9%) pursued abdominal transplant fellowship. These residents completed more transplant (22 vs. 9), liver (14 vs. 9), pancreas (15 vs. 11), and vascular access operations (38 vs. 30) compared to residents who did not pursue transplant fellowship (all p < 0.05). Multivariable logistic regression found that residents underrepresented in medicine were three times more likely (95% CI 1.54-6.58, p < 0.01) and residents at a program co-located with a transplant fellowship six times more likely (95% CI 1.95-18.18, p < 0.01) to pursue transplant fellowship. Additionally, a resident's increasing total transplant operative volume was associated with an increased likelihood of pursuing a transplant fellowship (OR = 1.12, 95% CI 1.09-1.14, p < 0.01).
The findings from this multi-institutional study demonstrate that increased exposure to transplant operations and interaction within a transplant training program is associated with a resident's pursuit of transplant surgery fellowship. Efforts to increase operative exposure, case participation, and mentorship may optimize the resident experience and promote the transplant surgery pipeline.
从历史上看，移植手术在普通外科毕业生中一直是不太受欢迎的专科 fellowship。在了解与住院医师对移植手术兴趣相关的因素方面所做的工作有限。我们利用一个多机构队列，研究了住院医师在移植手术方面的经历如何影响他们追求移植专科 fellowship 的决定。
收集了美国住院医师手术经验（ROPE）联盟内 20 个普通外科住院医师培训项目 2010 年至 2020 年毕业生的个人人口统计学资料、项目特征和特定移植病例记录。将追求移植手术专科 fellowship 的住院医师与直接进入临床实践或追求非移植专科 fellowship 的住院医师进行比较。
在 1342 名普通外科毕业生中，52 人（3.9%）追求腹部移植专科 fellowship。与未追求移植专科 fellowship 的住院医师相比，这些住院医师完成了更多的移植手术（22 例对 9 例）、肝脏手术（14 例对 9 例）、胰腺手术（15 例对 11 例）和血管通路手术（38 例对 30 例）（所有 p < 0.05）。多变量逻辑回归发现，医学领域代表性不足的住院医师追求移植专科 fellowship 的可能性高出三倍（95%置信区间 1.54 - 6.58，p < 0.01），而在与移植专科 fellowship 同地设置的项目中的住院医师追求移植专科 fellowship 的可能性高出六倍（95%置信区间 1.95 - 18.18，p < 0.01）。此外，住院医师移植手术总操作量的增加与追求移植专科 fellowship 的可能性增加相关（OR = 1.12，95%置信区间 1.09 - 1.14，p < 0.01）。
这项多机构研究的结果表明，在移植培训项目中增加对移植手术的接触和互动与住院医师追求移植手术专科 fellowship 相关。增加手术接触、病例参与和指导的努力可能会优化住院医师的经历并促进移植手术人才培养。
