Different rotations: does it have an impact on confidence of future HBP surgeons to perform complicated procedures

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Presenter: Salah Abdel Jalil MD | Grand Strand Regional Medical Center Background: The pursuit of a fellowship has become increasingly popular over the past several years with >90% of graduating general surgical residents continuing their education in further subspecialties (1). The goal of the HPB fellowship is to provide the fellow with the necessary skills and expertise to be able to perform complicated procedures, which is variable between programs. Our goal of the survey is to investigate the strength and weakness areas upon participating in different rotations including Surgical Oncology, Hepatobiliary Surgery and Transplant Surgery rotation. Methods: This is a retrospective survey using an anonymous online survey of hepato-pancreato-biliary fellowship (HPB) program fellows and physicians. Statistical analysis was performed to calculate how many respondents were needed to achieve a 95% confidence level for p <0.05, as there is 220 HBP graduates since 2012. Thirty percent was the response rate needed to achieve the that power. The survey underwent face validation process with expert physicians. Also, cognitive interview was done by fellows outside of the HBP field. Respondents were asked to answer 18 questions to judge the effect of different rotations on the HBP physician’s confidence in doing complicated HBP procedures. No incentives were offered to the fellows at any stage in the study in exchange for survey completion other than the satisfaction of participating in the acquisition of knowledge and benefits of future HBP fellow’s education. The survey was posted online using Monkey survey software that allows fellow to access through the link that was distributed. Results: eight fellows responded, Our survey showed that half of the fellows completed both Transplant and HBP rotations during their fellowship, while only 25% completed surgical oncology rotations, also about 42% found that surgical oncology and Transplant rotation’s duration was about the right length, and non-thought it’s too long for both rotations, while for HBP rotation slightly more than half the reposnders found it’s about the right length while 42% responds as its too short. Slightly more than half of the fellows were comfortable performing complex bile duct excision and reconstruction, and 42% were comfortable performing hemi-hepatectomy, and complex bile duct excision and reconstruction on the other side more than 80% did not feel comfortable performing HPB-related vascular reconstruction. Conclusion: Our survey shows that most of the recently graduated fellows in HBP surgeons were not comfortable in performing HPB-related vascular reconstruction after graduation. We believe increasing the length of transplant and HBP rotations should have a positive impact on the surgeon’s ability and self-confidence to perform such procedures.