Fellowship Program Research Articles

Battling the "Imposter": Our Experience in the Development of an Advance Practice Provider Fellowship.

In the face of ever-evolving shifts in health care, the demand for advanced practice providers (APPs), including nurse practitioners and physician assistants, continues to grow as the nation faces provider shortages and increased patient complexity. Because of different educational backgrounds and previous professional experience, there is a gap in readiness for practice following completion of academic programs, leading to high rates of turnover and financial implications for health care institutions. The creation of APP fellowship programs is a strategy many health institutions implement to provide enhanced support for new graduate APPs. These programs offer fully licensed and credentialed nurse practitioners and physician assistants additional experience within medical specialty areas. The establishment and operational cost associated with an APP fellowship program is a significant barrier health systems face. This article discusses how Saint Luke's Health System developed an APP fellowship program to address these barriers. The model addresses specific fellow needs and has contributed to improved employee retention rates, increased clinical competency, and overall provider satisfaction within Saint Luke's Health System. The evolution of the model, successes, barriers, and opportunities for future program growth are discussed within this article.

Trends in Mohs surgery fellowship directors.

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.

Fellowship program teaches youths the mechanics of mental health research

For some students in California school districts, being surveyed about their mental well‐being has become much more than a passive exercise. A fellowship program implemented by a center housed at the Stanford Graduate School of Education is maximizing student input on the topics they want to know about most, with some students serving as the research investigators themselves.

The Relative Importance of Factors That Applicants Weigh When Ranking Adult Reconstruction Fellowships as Well as Their Perspectives on Robotic-Assisted Arthroplasty

BackgroundOrthopedic Surgery Fellowship programs offer highly specialized training that varies based on the training environment and surgical experience. Additionally, for Adult Reconstruction programs, robotic-assisted surgery exposure has been a widely discussed topic. The purpose of this study was to determine the relative value of various factors to Adult Hip and Knee Fellowship applicants, and their perceptions of robotic-assisted arthroplasty. MethodsWe surveyed 780 applicants who applied to our fellowship to matriculate in 2020 to 2024. We received 158 responses (20.3% response rate). We assessed factors concerning people and perceptions, logistics, salary and benefits, program reputation and curriculum, and surgical experience. Additionally, we surveyed fellows’ attitudes toward using robotic surgery and its impact on patient outcomes. ResultsThe highest-rated factors were Level of Hands-On Operative Experience (4.83), Revision Hip Volume (4.72), Revision Knee Volume (4.71), Multiple Surgical Exposures to the Hip (4.59), and Clinical Case Variety (4.59). Respondents who were postfellowship matriculation placed significantly more value on Exposure to Multiple Attendings with Surgical Diversity (P = .01), and Anterior Hip Volume (P = .04), and less value on Geographic Location (P = .04) and Patient-Specific Instrumentation (P = .02) than prematriculates. Overall, 65% of applicants plan to or currently use robotics, 7.6% do not, and 27.2% said “Maybe”. Those who plan to or currently use robotics most cited procedure fidelity, patient-preference, and marketability as reasons to use robotics. ConclusionsHands-on surgical experience and revision volume were the most important factors for fellowship applicants. Applicants placed lower importance on robotics exposure and their perspectives on robotics in their future practice were highly variable. Our results will inform fellowship programs and future applicants what previous applicants have valued in their training to help guide fellowship program structure, resource management, as well as recruitment.

A Near-Peer Interprofessional Educational Fellowship Program for Training Pre-Clinical Medical Students in the Best Practices of Teaching and Learning.

Medical school often has opportunities for students to engage in peer or near-peer teaching, however structured teacher training is rarely conducted. We present an Educational Fellowship for rising M2 students as teaching assistants for first year Physician Assistant students. In this near-peer interprofessional teaching model, the M2 students learn pedagogical theory and best practices for teaching and learning. The curriculum and experience may be used by any healthcare profession. Since many healthcare professions have classes during the summer, we present our program as a conceptual model for other institutions.

Factors Influencing Physical Medicine and Rehabilitation Trainee Research Engagement.

Research engagement during physical medicine and rehabilitation residency and fellowship training is essential for advancing evidence-based medicine and fostering the development of clinician-scientists. Current Accreditation Council for Graduate Medical Education guidelines regarding research requirements during physical medicine and rehabilitation training are ambiguous, and it is unknown whether physical medicine and rehabilitation trainees receive adequate support to pursue research at the level they desire. This anonymous survey study aimed to identify perceived barriers and facilitators to research engagement among US physical medicine and rehabilitation residents and fellows. Our findings suggest that physical medicine and rehabilitation trainees value research engagement. However, research productivity during physical medicine and rehabilitation residency is limited, with many trainees reporting inadequate support and time to participate in research in a meaningful way. Additional support from residency and fellowship programs, including protected time for research, as well as research-specific education and mentorship should be considered to enhance physical medicine and rehabilitation trainee research engagement.

Emerging Subspecialties in Neurology: Women's Neurology.

The influence of sex and gender on neurologic disease has become increasingly recognized in science and medicine. This is evident across a woman's lifespan especially during periods of hormonal transitions. Leaders in neurology have advocated for the importance of sex and gender-enriched clinical care, education, and research. The scope of women's neurology spans across a woman's life including puberty, adolescence, peripartum care, menopause, and aging. Women's neurology is a new subspecialty that aligns with a specific patient population and intersects with established neurology subspecialties and other specialties such as obstetrics, maternal fetal medicine, endocrinology, and psychiatry. Its establishment and collaboration with existing and emerging fields enables a more comprehensive approach to neurologic illness through the lens of sex and gender. Women's neurology is rapidly evolving through increased focus at academic centers, including expanded women's neurology curricula, dedicated women's neurology fellowship programs, improved understanding of sex and gender issues in neurosciences, and expansion of therapeutic options. Herein, we describe the history of the women's neurology field, emerging need for women's neurology specialists, information about training and career opportunities, and future directions.

International postgraduate fellowships in radiology: the good, the bad, and the paperwork

Abstract Postgraduate fellowships in clinical and interventional radiology are a well-recognized path to enhancing subspecialty skills and widening professional opportunities. They involve 1-2 years of higher-level intensive training in a chosen subspecialty and can aid in the transition from registrar to consultant. International fellowships combine this professional development with a unique exposure to new concepts, healthcare systems, and communities. However, they require careful planning, with applications opening up to 2 years in advance and various processes to navigate prior to commencing the fellowship. Understanding the benefits and considerations of international fellowships, choosing the right fellowship programme, and appreciating the steps to take prior to commencement are important in making an informed decision.

Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs.

The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.

The ‘role’ of improvisational theater in learning family therapy

Mastering family therapy is a core competence in the Brown child and adolescent psychiatry fellowship program. To acuminate our skills, in addition to working doing a half day per week of family therapy for the duration of our training, we have weekly family therapy seminars led by Dr. Michelle Rickerby. Most of the time, we spend the hour discussing one or two challenging cases among our class, and if there is time, allot the last 5 to 10 minutes of class to play out a particularly arduous interaction. However, once or twice a year, Dr. Rickerby invites improvisational “improv” actors from a local theater for an extended workshop on family therapy. I was fortunate that my case was chosen as a prompt for this year's workshop.

Increased rate of out-of-network surgeon selection for hip arthroscopy compared to more common orthopedic sports procedures

BackgroundDemand for hip arthroscopy (HA) has increased, but shortfalls in HA training may create disparities in care access. This analysis aimed to (1) compare out-of-network (OON) surgeon utilization for HA with that of more common orthopedics sports procedures, including rotator cuff repair (RCR), partial meniscectomy (PM), and anterior cruciate ligament reconstruction (ACLR), (2) compare the HA OON surgeon rate with another less commonly performed procedure, meniscus allograft transplant (MAT), and (3) analyze trends and predictors of OON surgeon utilization. MethodsThe 2013–2017 IBM MarketScan database identified patients under 65 who underwent HA, RCR, PM, ACLR, or MAT. Demographic differences were determined using standardized differences. Cochran-Armitage tests analyzed trends in OON surgeon utilization. Multivariable logistic regression identified predictors of OON surgeon utilization. Statistical significance was set to p < 0.05 and significant standardized differences were >0.1. Results410,487 patients were identified, of which 12,636 patients underwent HA, 87,607 RCR, 233,241 PM, 76,700 ACLR, and 303 MAT. OON surgeon utilization increased for HA, rising from 7.98 % in 2013 to 9.37 % in 2017 (p = 0.026). Compared to RCR, PM, and ACLR, HA was associated with higher likelihood of OON surgeon utilization. Usage of ambulatory surgery centers (ASCs) was predictive of higher OON surgeon rates along with procedure year, insurance plan type, and geographic region. HA performed in an ASC was 13 % less likely to have an OON surgeon (p = 0.047). ConclusionOON surgeon utilization generally declined but increased for HA. HA was a predictor of OON surgeon status, possibly because HA is a technically complicated procedure with fewer trained in-network providers. Other predictors of OON surgeon status included ASC usage, PPO/EPO plan type, and Northeast geographic region. There is a need to improve access to experienced HA providers—perhaps with prioritization of HA training in residency and fellowship programs—in order to address rising OON surgeon utilization.

Pulmonary and Critical Care Fellowship Program Directors' Perspective on the Virtual Interview Process.

Since the start of the coronavirus disease (COVID-19) pandemic, the residency and fellowship recruitment process has changed significantly with the use of virtual interview (VI) platforms. Pulmonary and critical care medicine (PCCM) candidates reported in a survey that VIs hindered their ability to evaluate their fit within the program. However, the program directors' (PDs') opinion of this process remains unknown. We aim to provide insight into the PCCM fellowship PDs' perspective regarding the virtual recruitment process since the first class of fellows undergoing this process has now completed 1 year of training. An anonymous survey was sent to the PDs of PCCM programs participating in the National Resident Matching Program match process in 2020 and 2021. The survey consisted of five sections and 26 closed-ended questions and was distributed via email using the SurveyMonkey platform. The survey was conducted for a total of 6 weeks. A follow-up email to nonrespondents was sent every week. The collected responses were divided into two categories: favoring VIs versus not favoring VIs. A multivariable logistic regression analysis was performed to determine the factors associated with favoring VIs. The survey was sent to 190 email accounts from the Fellowship and Residency Electronic Interactive Database Access System website. Over the course of 6 weeks, 64 respondents participated in the survey, with a response rate of 33.68%. Of 64 respondents, 56 (87.5%) fully completed the survey and 8 (12.5%) partially completed the survey. The final sample size was 59. Thirty-six (61.02%) of the PDs favored VIs for future recruitment, and 23 (38.98%) did not (P < 0.001). Ninety-seven percent of PDs who favored VIs versus 72.73% of those who did not perceived the current fellows to fit well in the program (P = 0.007). The multivariable logistic regression analysis showed a trend toward higher odds of favoring VIs if PDs believed they were able to represent the program well virtually (adjusted odds ratio, 6.99; 95% confidence interval, 0.79 - 61.58) and if they found that the current fellows fit the program well (adjusted odds ratio, 7.15; 95% confidence interval, 0.76-66.52); however, these results were not statistically significant. In this survey research, we found that the majority of the PCCM fellowship PDs favored a virtual process for future recruitment.

Implications of a Community-Based Learning Faculty Fellows Program to Facilitate Teaching and Learning in the Jesuit Tradition

Implications of a Community-Based Learning Faculty Fellows Program to Facilitate Teaching and Learning in the Jesuit Tradition

Colon and Rectal Surgery Fellowship Applicant and Matching Trends in the United States: An Analysis of National Resident Matching Program Data.

Colon and Rectal Surgery fellowships are training programs that aim to train surgeons in the management of small bowel, colon, rectal, and anal pathologies. We investigated trends in Colon and Rectal Surgery fellowship match to help applicants anticipate future fellowship application cycles. This was a retrospective cohort study of applicants in the Colon and Rectal Surgery match from 2009 to 2023. Proportion of positions filled, match rates, and rank-order lists were collected. The impact of US-MD, non-US-MD, and DO status on match rate was assessed. We used the Mann Kendall trend test to obtain tau statistic and P-value for temporal trends over time, while associations between categorical variables were investigated by a chi-square test. Fellowship programs increased from 43 to 67, positions increased from 78 to 110, and number of applicants rose from 113 to 135. Nearly all positions were filled from 2009 to 2023 (range: 96.3%-100%). The overall match rate fluctuated between 67.3% and 80.7%. The match rate over the past 5years was 72.0%. The match rate for US-MDs was 80.0%, while non-US-MDs had a 56.2% match rate. The percentage matching at each rank were first choice 28.0%, second choice 10.4%, third choice 6.9%, and fourth choice or lower 23.5%. Despite an increase in Colon and Rectal Surgery fellowship positions, the overall match rate has not changed significantly over the years, mainly as a result of increased applicants.

Recent trends in hand surgery fellowship applicants and programs

BackgroundHand surgery is a competitive fellowship that draws applicants from orthopedic, plastic, and general surgery. In 2010, recommendations from the American Academy of Orthopaedic Surgeons (AAOS) Board of Specialty Societies Match Oversight Committee and the American Society of Plastic Surgeons (ASPS) Plastic Surgery Workforce Task Force led to significant reforms to their respective workforces and training. This study characterizes trends in hand fellowship applicants and programs since these recommendations (2010–2023). Materials and methodsWe queried hand fellowship applicant and program data from the American Society for Surgery of the Hand (ASSH), the National Resident Matching Program (NRMP), and the Accreditation Council for Graduate Medical Education (ACGME). Results, discussion and conclusionsFrom 2010 to 2023, the number of ACGME-accredited hand fellowship programs increased across specialties (orthopedic surgery, 58 to 74 (27.6 % increase, R = 0.97, p < 0.001); plastic surgery, 14 to 19 (35.7 % increase, R = 0.91, p < 0.001); general surgery, 1 to 2 (50 % increase, R = 0.71, p = 0.004). The number of available fellowship positions commensurately increased by 38.8 % over the same time period. The number of applicants did not significantly change between 2010 (155 applicants) and 2023 (198 applicants) (R = 0.32, p = 0.27). The ratio of applicants-to-positions significantly decreased from 2010 (1.12 applicants per position) to 2023 (1.04 applicants per position) (R = -0.74, p = 0.003). Yet, applicants ranked nearly twice as many programs in 2023 (14.9 programs per applicant) compared to in 2010 (7.5 programs per applicant) (R = 0.98, p < 0.001). In light of the American Orthopaedic Association endorsing signal preferencing in the 2022–2023 residency Match, strategies to optimize rank lists in the fellowship application process should be further explored.

Education and Experience in Intrathecal Drug Delivery Systems (IDDS) During Pain Medicine Fellowships.

Targeted drug delivery (TDD) via intrathecal drug delivery systems (IDDS) exposure and clinical adoption remains low despite multiple well-designed trials that demonstrate safety, efficacy, reliability, and cost-saving benefits. This study aims to understand the possible contributing factors starting with Pain Medicine fellowship training. An internet-based, anonymous pilot survey was distributed to pain medicine fellows enrolled in an Accreditation Council for Graduate Medical Education (ACGME) accredited pain medicine training program during the 2021-2022 academic year. Fellowship programs were identified using published online ACGME accreditation data. The survey was distributed via email to fellowship program directors and coordinators and was made available through pain medicine societies. Seventy-one of four hundred and twenty-three pain medicine fellows (17% response rate) completed the survey. Nine percent of respondents evidence-informed opinion coincided with the most recent Polyanalgesic Consensus Conference (PACC) guidelines recommendations for IDDS treatment indications. Fifty-one percent of respondents felt there was an unmet need for IDDS training. About one-third of respondents felt that lack of curriculum, faculty, and cases were barriers to IDDS use, respectively. Thirty-one percent of fellows reported sufficient training for IDDS in their fellowship programs. The majority (70%) of respondents somewhat or strongly support direct training by IDDS manufacturers. A wide variability exists surrounding IDDS training during ACGME accredited pain medicine fellowship. Insufficient case exposure and lack of a standardized curriculum may play a role in future therapy adoption. The results from this study call for a more standardized training approach with an emphasis on adequate clinical exposure, utilization of peer reviewed educational curriculum and supplemental material to aid pain medicine fellows' education.

Mentoring: Perspectives for a Diverse FCS Profession

The value of mentorship for family and consumer sciences (FCS) professionals is emphasized by inclusion in five leadership development programs offered by FCS professional organizations. The American Association of Family &amp; Consumer Sciences (AAFCS) Leadership Academy, Academy of Nutrition and Dietetics (AND) Leadership Institute, Council of Administrators of Family and Consumer Sciences (CAFCS) Emerging Leaders Workshop, Board on Health &amp; Human Sciences (BHHS) Fellows Program, and the National Extension Association of Family &amp; Consumer Sciences (NEAFCS) Extension Leadership Conference each include mentoring content and opportunities. Each organization, whether seeking to develop emerging, current, or future leaders, includes mentoring as a tool for developing FCS leaders. Components of each, including the models applied and the curriculum offered, include elements of mentoring (see Table 1). The purpose of this analysis is to examine perspectives on mentoring in FCS education and the profession, especially for women of color (WOC), as illuminated by the extant literature and the lived experiences of FCS students.

Developing a Patient and Public Voice/Involvement (PPV/I) program at the Global Brain Health Institute (GBHI) with global impact

AbstractBackgroundGBHI, a brain health leadership program for international fellows from across disciplines, undertook a 24‐month project to develop a PPV/I program aiming to: (1) provide a PPV/I perspective on GBHI activities; (2) introduce fellows to the principles and practice of PPV/I; (3) develop a ‘global PPV/I toolkit’; and (4) develop a PPV/I Special Interest Group to inform Senior Fellows around the world about PPV/I to support their local work in brain health.MethodPhase 1: Recruiting an international panel of people with lived experience of dementia to inform GBHI’s work, called ‘‘Dementia Community Research Advisory Panel’ (DC‐RAP). Phase 2: Educating: We designed and implemented a dementia‐specific PPV/I training curriculum for GBHI fellows &amp; a PPV/I awareness raising program for GBHI faculty &amp; staff; Phase 3: Creating &amp; disseminating: We developed a global resource document (‘toolkit’) to support the introduction of brain health professionals from different disciplines working around the world to PPV/I practice, fostering a global PPV/I dementia network; Phase 4: Evaluation: We tracked learning outcomes of the project at staff/faculty and Fellow level through Kirkpatrick model and overall project success through Kotter’s 7‐step organizational change model.ResultsPhase 1: DC‐RAP formed and solidified within GBHI to inform GBHI activities, provide feedback on research proposals and lay summary writing. Phase 2: We delivered a PPV/I training program for the 2020 and 2021 Fellow cohorts, which is now fully integrated into curriculum. Phase 3: The GBHI ‘Global Public Involvement in Dementia Guidelines’ were launched by a team of Senior Fellows from 10 countries, who have formed a PPV/I Special Interest Group for PPV/I practice beyond the anglosphere. Phase 4: A Kirkpatrick evaluation revealed changes in PPV/I knowledge, attitude and practices for Fellows and staff/faculty. Multiple strategic wins have enabled us to embed a culture of PPV/I at GBHI, evident in mapping against Kotter’s 7‐step organizational change model.ConclusionEmbedding dementia relevant PPV/I in GBHI provides the potential to disseminate PPV/I principles within GBHI and globally, fostering meaningful public engagement in dementia research and projects to advance dementia understanding worldwide.

Education Research: Quality and Validity Evidence for a National In-Training Examination for Epilepsy Fellows.

Epilepsy education has been transformed over the past 2 decades, leading to a need for structured formative assessment tools. The American Epilepsy Society developed the Epilepsy Fellowship In-Training Examination (EpiFITE) to provide high-quality formative assessment for fellows, to stimulate program improvement, and to guide future learning and teaching. The aim of this study was to explore validity evidence for the EpiFITE in meeting these goals. Validity evidence was sought from multiple sources. The content of the examination was linked to the American Board of Psychiatry and Neurology blueprint for initial certification in epilepsy, and items were developed by trained experts. Internal structure was studied using internal consistency and item analysis. Surveys of fellows and fellowship directors focused on the examination experience (response process) and how results influenced fellow assessment, future learning, and program improvement (relationship to other variables and consequences). The EpiFITE was first administered in 2020, with 172 examinees from 67 programs. By 2022 (year 3), the EpiFITE was completed by 195 epilepsy fellows from 77 programs. The overall mean score of the examination was stable from year to year, and the committee predicted the difficulty of individual items with a high degree of accuracy. The examination had high internal consistency (Cronbach α 0.76-0.81). The median item discrimination index ranged from 0.17 in 2020 to 0.21 in 2022. Discrimination indices were lower (mean ≤0.10) for items that were either very easy or very difficult and significantly higher (mean >0.20) for other items. Program directors and epilepsy fellows agreed the examination questions were appropriate and agreed that the EpiFITE helped them identify areas for self-directed learning. Program directors also found the examination helpful in identifying areas of strength and areas for improvement within their programs. There are several sources of evidence of the quality and validity of the EpiFITE. By exploring this validity evidence, we have identified several best practices in the development and evaluation of a subspecialty examination, and this experience could be helpful for developers of in-training examinations in other subspecialties.

Desarrollo de una Unidad de Cirugía Hepatobiliar Compleja y Trasplante Hepático en un hospital público: a una década de su formación

Background: Centralizing hepatobiliary disease in specialized centers can reduce morbidity and mortality rates and improve long-term outcomes. Objective: The aim of the present study was to describe the clinical and pathological features and surgical outcomes of a series of patients operated on in the Hepatobiliary Surgery and Liver Transplantation Unit of Hospital El Cruce during its first 10 years, as well as the scientific and educational activity of its members. Material and methods: We conducted a descriptive and retrospective study. The information was retrieved from a prospective database. The procedures were classified according to their complexity. An analysis was conducted on liver transplantations (LTs), liver resections and complex biliary procedures, performed from 2013 to 2022. Results: Of 1449 surgical procedures, 832 were high-complexity interventions (58%). A total of 452 LTs were performed, 14 (3%) were combined liver and kidney transplantations; overall transplant survival was 83%, 77% and 75% at 1, 3 and 5 years, respectively. Primary graft dysfunction was observed in 5 cases (1.1%). There were 254 liver resections; 58 cases (23%) were related to benign liver diseases, 155 (61%) to malignancies, and 41 (16%) were associated with living donor transplants. Overall morbidity was 27% and in-hospital mortality was 2%. A total of 106 bilio-digestive bypass procedures were carried out, 53 in patients with bile duct injury. Thirty-day morbidity was 42%, and most cases were minor complications (28%). Other procedures included 17 cephalic pancreaticoduodenectomies and 3 splenectomies and distal pancreatectomies. We have published numerous papers, delivered presentations and courses, and implemented a fellowship program in the specialty since 2015. Conclusion: Centralizing hepatobiliary diseases at a high-complexity center led to comparable outcomes with those reported in international series.