Program Directors’ Perspective of Transplant Training during General Surgery Residency

Abstract

In 2011, the Accreditation Council for Graduate Medical Education (ACGME) began to mandate "a formal transplant experience" rather than a formal rotation to allow programs more flexibility. What constitutes a "transplant experience" or how to optimize such education remains unclear. The objectives of this study were to identify changes in residents' transplant exposure and determine the opinions of program directors (PDs) in response to the new requirements. A 15-item questionnaire was sent to all general surgery PDs. Demographics, resident experiences, and PDs' opinions regarding transplant rotations were collected. The response rate was 50 per cent from university and community programs at transplant and nontransplant centers. Although 55 per cent of PDs felt transplant should not be a required rotation, 92 per cent of programs reported having a formal rotation. Transplant rotations should be four months or less, according to 97 per cent of PDs. Most PDs (93%) think there should not be a minimum number of required transplant operations. Whether residencies were based at transplant centers or size of residencies did not affect PDs' responses. Transplant requirements were similar between residency programs regardless of PD opinions. Survey participants provided diverse feedback regarding this controversial topic. The new ACGME requirements have made little impact on program requirements. Most programs still mandate a formal transplant rotation. Diverse opinions exist regarding whether such a rotation should be required, highlighting the controversial nature of this issue. To facilitate education in an era of limited work hours, the ACGME changed requirements of general surgery programs to mandate "a formal transplant experience" rather than a transplant rotation. A survey of program directors revealed that although only 45 per cent of support mandatory transplant rotations, 93 per cent of programs still require transplant rotations despite the more lax ACGME requirements. This finding suggests a lack of suitable alternative to provide exposure to the concepts fundamental to transplant surgery, which are valuable in general surgery education.