Abstract
Orthopedic residents have one of the highest fellowship participation rates among medical specialities and there are growing concerns that inadequate residency training may be contributing to this trend. Therefore, a mixed-exploratory research survey was distributed to all 148 graduating Canadian orthopedic residents to investigate their perceptions and attitudes for pursuing fellowships. A response rate of 33% (n=49) was obtained with the majority of residents undertaking one (27%) or two (60%) fellowships. Surgical-skill development was reported as the most common motivating factor, followed by employment and marketability; malpractice protection and financial reasons were the least relevant. The overwhelming majority of residents (94%,n=46) felt adequately prepared by their residency training for independent general practice, and 84% (n=41) of respondents did not feel that current fellowship trends were due to poor residency training. Three common themes were expressed in their comments: the growing perceived expectation by healthcare professionals and employers to be fellowship-certified, the integration of fellowship training into the surgical education hierarchy, and the failure of residency training curriculums to accommodate for this trend. In conclusion, Canadian orthopedic residents are confident of their residency training and are increasingly pursuing fellowships to primarily develop their surgical skills and expertise.
Highlights
The current structure of residency training is based on the framework established by William Halsted in the 1800s by which a new medical-school graduate undergoes a series of apprenticeships under different surgeons to acquire the knowledge and skills necessary for independent practice [1]
Fellowship participation rates vary by surgical subspeciality with approximately 70– 75% of general surgery and urology residents pursuing fellowships, compared to over 90% of orthopedic residents
Almost half (n = 24) of the respondents claimed they had no intention of pursuing a fellowship prior to starting their orthopedic residency
Summary
The current structure of residency training is based on the framework established by William Halsted in the 1800s by which a new medical-school graduate undergoes a series of apprenticeships under different surgeons to acquire the knowledge and skills necessary for independent practice [1]. Upon graduating from a residency program, a graduate can either begin independent general practice or pursue additional 1-2 years of subspecialization training known as a fellowship. This optional training period first became popular in the 1970s and, since that time, the number of residents pursuing fellowships has dramatically increased across all medical specialities [1,2,3]. There are strong concerns that as more residents enroll in fellowship programs, the educational value of residency training may become undermined: Fellowships may represent a “de facto” extension of residency training into a 6-year undertaking, with fellows performing more resident-level duties and residents themselves being suboptimally trained with the mindset that any skill deficits can be learned later during their fellowship period [3, 7]. Having more fellowship-trained specialists is appealing when considering that certain surgical procedures have better productivity and clinical outcomes when performed by a fellowship-trained
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