Early subspecialization and perceived competence in surgical training: are residents ready?

Background: In order to understand how current surgical residents feel about their training, a survey focused on perceptions regarding early entry into a subspecialty and the adequacy of training was sent to selected residency programs in general surgery (GS).

Study design: A 36-item online anonymous survey was sent to the program directors of 55 GS programs. The national sample consisted of 1,515 PGY 1 to PGY 5 categorical residents.

Results: The response rate was 45%. Overall, 80% were planning on pursuing a fellowship. The majority (63%) believed that the Residency Review Committee for Surgery and the American Board of Surgery should consider the shift to early subspecialty training. Almost 70% of respondents preferred a 3-year basic track followed by a 3-year subspecialty track. In response to the survey item, "Do you think a 5-year GS residency fully prepares you to practice GS?", 38% of residents overall responded "no" or "unsure." This figure decreased with each increasing year of residency training, from PGY 1 (53.3%) to PGY 5 (23%). Finally, 71% of residents who answered "no" or "unsure" to the above question believe there should be a change to a track system.

Conclusions: The choice of fellowship training for 80% of trainees partially reflects that 38% are not confident about their skills with 5 years of training in GS, including 23% of graduating chief residents. Training and certifying groups should update and strengthen the current curriculum for categorical residents in GS and continue their efforts to offer shortened independent or integrated residency training for those who will enter surgical specialties. Innovative solutions are needed to solve the logistic and financial problems involved.