We are here to serve a need
In 1997 the MIS (Minimally Invasive Surgery) Fellowship Council was created to organize the few Fellowship programs teaching MIS1. It continued to grow and develop as the demands for Fellowship training increased. It was later renamed the Fellowship Council because it serves not only the needs of training in MIS but a greater group of gastrointestinal surgical specialties including Bariatric/Metabolic, Endoscopic, HPB, Colorectal and Thoracic surgery. The demand for post residency Fellowship training and the challenges for the FC continue to evolve.
Why did the FC start?
In 1991, there were three self proclaimed Fellowships in the United States developed to formally teach laparoscopic surgery. Two were private programs and one was a university based program. Until this time, most surgeons were learning laparoscopy by taking short courses and returning home to perform this technique. Residency programs did not teach this. These pioneering Fellowships were the first attempt to formalize the teaching of this new approach to abdominal surgery.
In 1993 there were 9 programs. Many of the program directors felt that MIS Fellowship programs would soon become obsolete once enough Surgeons were trained to go back to the residencies programs to teach. In 1997 the MIS Fellowship Council was organized by a group of these pioneering surgeons who championed the use laparoscopy and endoscopy in the realm of General Surgery. This was done to bring order to the rapidly developing Fellowships to assure that Fellows received a good experience and to provide guidance to the existing and prospective programs. By 2004 the number of programs increased to 80. Today, 2 decades after the first MIS Fellowship there are 156 programs and 210 fellowship positions in advanced GI Surgery, Endoscopy, MIS, Bariatric/Metabolic, HPB, Colorectal and Thoracic with potential for incorporating other surgical disciplines. Within some of these programs, newer techniques including SILS, NOTES, robotics surgery, intra-operative and endoscopic ultrasound, endoscopic mucosal and sub-mucosal resections, etc. are being developed and taught to future GI surgeons.
Two decades later, the need for Fellowships is increasing.
The matching process for 2012-2013 Fellowship positions under the FC included 248 enrolled applicants (178 from the United States, 29 from Canada and 41 from other countries).
There are probably many reasons for this. With restricted hours, General Surgery Residents have been estimated to get 20% less experience. Some General Surgical procedures have contracted (less gastric surgery due to less ulcer disease, less biliary surgery due to ERCP, less operative Trauma management). This is due to advances in non surgical medical care. As recently as 2002, residencies were still not providing sufficient MIS training2. There is still not enough penetration of advanced laparoscopic experiences in residencies. Flexible endoscopy for surgeons remains an issue. Up to 34% of a rural surgeons case load is flexible endoscopy3. Although the ABS has mandated colonoscopy and endoscopy in residency progams, there is little opportunity to excel in colonoscopy and much less to learn ERCP and EUS(Endoscopic Ultrasound). There are few Residencies that give adequate experience in Endoscopy and those who are interested must find this in the Fellowships. Some Residents just do not feel prepared or competitive enough to confidently seek a job. Others have limited experience in certain areas and wish to learn these areas of deficit. Others yet wish more intense experience in specialty areas.
70 to 80% of General Surgery Residents are seeking post residency Fellowships4,5.
Fellowships are here to fulfill those needs. The Fellowship Council is here to help the Fellowships handle the challenges. Funding Fellowships remains an issue and the Foundation for Surgical Fellowships is one successful answer to the contracting industry sponsorship. The FC is investigating other forms of financing fellowships through a survey of its constituent members. Accrediting Fellowships to assure a certain standard of education and experience for Fellows, monitoring Fellow satisfaction with an exit survey, improving the matching process, developing GOALS (Global Operative Assessment of Surgical Skills) to monitor Fellow progress are among some of the projects of the FC.
The FC was put together by program directors to meet the needs of the programs and Fellows. Along with our component Societies, SAGES, ASMBS, SSAT, AHPBA, ASCRS we hope to continue the process.
Maurice E. Arregui, MD FACS
Fellowship Council Board of Directors
(1). Swanstrom, LL. et. al. Bringing Order to the Chaos, Developing a Matching Process for Minimally Invasive Gastrointestinal Postgraduate Fellowships. Annals of Surgery (2006) 243:431-435
(2). Parks, A, Witzke D, Donnelly M. Ongoing Deficits in Resident Training for Minimally Invasive Surgery. J Gastrointest Surg (2002) 6:501-509
(3). Traverso, LW. Profile of the rural surgeon. Surg Endosc (2008) 22:1586-1588.
(4). Bell RH Jr, Banker MB, Rhodes RS, et. al. Graduate Medical Education in Surgery in the United States. Surg Clin North Am. 2007 Aug:87(4):811-23.
(5). Numann, PJ. Presidential Address, 97th Clinical Congress, American College of Surgeons, San Francisco Oct. 23, 2011.