Emory General Surgery Residency to Assess Innovative New Training Paradigm

April 2013

As a member of a 10-institution consortium that includes Brigham and Women's Hospital, Cornell University, Johns Hopkins, Massachusetts General Hospital, Northwestern University, Oregon Health and Science University, University of Oklahoma, University of Southern California, and Washington University in Saint Louis, the general surgery residency program of the Emory University School of Medicine will role out a pilot program entitled Flexibility in Surgical Training (FIST) in July 2013. By reviewing and collating their collective experiences with FIST, the consortium will evaluate the impact of enacting the American Board of Surgery's 2011-approved policy that allows up to 12 months of flexible rotations in the last 36 months of general surgery training. In deviation from the focus of traditional residencies, this type of specialty training gives program directors the opportunity to tailor training to residents' future career interests.

"Up until this pilot, the early specialization training allowed by this flexibility rule only comprised vascular or cardiothoracic surgery," says Dr. Keith Delman, program director of Emory's general surgery residency. "Each of the FIST centers will offer additional early specialization experiences, such as advanced GI, acute care surgery, surgical oncology, endocrine and breast at MGH, or transplant, breast, advanced GI, hepatobiliary, CRS, surgical critical care, and pediatric surgery at Johns Hopkins. Emory will have residents pursuing flexibility training in plastics, transplant, surgical oncology, endocrine, advanced GI, comprehensive general surgery, and the early specialization versions of vascular surgery and cardiothoracic surgery."

FIST trainees will be monitored and followed from training through certification in their intended specialty. Outcomes criteria to be examined will include case numbers; formative and summative assessments from components of the particular training programs, such as operative performance rating systems; annual ABSITE results for both participants and non-participants; completion of specified core and specialty specific SCORE modules; and several other measures. The pilot is expected to last a minimum of five years. "As we collect, analyze, and report the data, we plan on sharing it with the RRC, ACGME, and ABS to help formulate best practices in applying the flexibility rule," says Dr. Delman.

One of the consortium's primary concerns is observing that the quality of non-participants' training experience is unaffected by the presence of various focused tracks. To qualify for the pilot, the host institutions had to have sufficient clinical material to support the training of both participants and non-participants, and those measures that encompass traditional general surgery residents and those in specialized tracks—such as examination of case logs—will be inspected closely to insure that nonparticipants are not adversely affected. In fact, supporters of the flexibility ruling believe that the incorporation of focused training into general surgery residencies will also benefit those pursuing general surgery, which is in fact its own specialty, and improve their overall training experience.

"We anticipate that the multi-institutional foundation of the pilot will let us document the impact and outcome of the flexibility rule faster and more fully than a single institution could," says Dr. Delman. "We also suspect that the pilot will vindicate the concept that graduates with additional clinical experience in their area of eventual practice will be more comfortable with independent practice immediately following training, and that these graduates will be better prepared to provide quality surgical care to their patients with improved outcomes."

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