Instability of Fellowship Intentions During General Surgery Residencies



L. R. Vick;K. R. Borman


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PURPOSE: To determine whether PGY-1 future fellowship preferences are stable during progression through residency. METHODS: Residents who took the American Board of Surgery In-Training Examination (ABSITE) were surveyed about fellowships. Three data files were created: categorical and nondesignated preliminary trainees at all postgraduate years (PGY); categorical PGY-1 and chief residents; and individual categorical residents with paired PGY-1 and PGY-5 responses. Gender was self-reported; residency characteristics were retrieved via program identifier codes. Annual frequency distributions were generated by specialty and for other, any fellowship (AF), and no fellowship (NF). RESULTS: Categorical plus contains more than 80,000 responses. Undecided leads PGY-1 intentions at all times, which reached 55% by 2007 and decreased near linearly as PGY level advances. The AF rates increase by PGY level in a decelerating curve. The other rates accelerate at PGY-3 and beyond. The NF rates are low for PGY-1 and 2, nearly double from PGY-3 to 4, and double again from PGY-4 to 5. The categorical group contains more than 20,000 residents with their demographics. The undecided group predominates for both genders, but more women were undecided by 2003. Specialty distribution varies with gender; women were overrepresented in oncology, pediatric, plastic, and other. The undecided group leads choices of university and independent PGY-1 residents, with university overrepresentation in all areas except colorectal, plastic, and no fellowship. Small, medium, and large program PGY-1 residents all choose undecided first but diverge thereafter. Over 12,000 paired categorical PGY-1 and PGY-5 responses reveal that most PGY-1 residents (78%) change future specialties by PGY-5. Undecided residents most often choose no fellowship (25%), vascular (12%), or other (12%). CONCLUSION: PGY-1 residents are increasingly unsure about future fellowships. PGY-1 preferences are unstable whether examined in groups or as individuals. Gender and residency characteristics are linked to differing selection patterns. PGY-1 residents rarely predict accurately their PGY-5 fellowship choices. Early specialization paradigms may disadvantage some residents and residency groups and risk greater attrition rates. (J Surg 65:445-452. (c) 2008 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

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Journal of Surgical Education





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