Creating a Bright Future for Fellowship Training
Over its 21 year history, the Fellowship Council (FC) has evolved considerably and continues to serve a vital purpose of providing oversight to non-ACGME gastrointestinal and related surgical fellowships. The FC maintains a robust infrastructure, including an accreditation process with site visits, a matching process, a caselog database, and an evaluation system. The FC offers fellowships in Advanced GI, Advanced GI/MIS, Bariatric, non-ACGME Colorectal, Flexible Endoscopy, Hepatopancreatobiliary,
and non-ACGME Thoracic surgery. Accreditation criteria and curricula are developed in collaboration with FC sponsoring societies, including AHPBA, AHS, ASCRS, ASMBS, SAGES, and SSAT. Over the past eight years, the FC has benefited greatly from the generous support provided by the Foundation for Surgical Fellowships (FSF) and its sponsors. Many FC programs rely on these funds to offset the cost of fellowship training; in 2018, the FSF provided grants for 128 fellowship positions, representing 66% of all FC positions. These partnerships have been instrumental in allowing the FC to flourish.
The number of and demand for FC fellowships has grown considerably. In 2004 (the first match year), there were 80 programs offering 113 positions to 130 applicants; in 2018, there were 172 programs offering 211 positions to 360 applicants. Indeed, the FC has experienced a 115% growth in its number of programs and a 176% growth in the number of applicants over this period of time, with the match rate going from 87% to 58% for certified applicants. These statistics validate the perceptions that applicants hold regarding the high quality and value of these training experiences. Data also support the benefits of FC fellowship training from the fellows’ perspective. According to exit surveys administered over an 11-year period, fellowship graduates indicated that they were highly satisfied with their training, had adequate case volumes and types, were given sufficient autonomy in the operating room, had ample opportunities for research, and were entering the type of practice that they desired.
Recognizing the changing landscape of surgical education, the FC has remained nimble and creative. For many years the FC has had a representative on the Gastrointestinal Advisory Committee (GISAC) of the American Board of Surgery (ABS) and has been an active participant in discussions regarding new frameworks for competency assessment. While the ABS has launched a pilot for Entrustable Professional Activities (EPA’s) for surgery residents, the FC has launched a parallel effort, creating EPA’s for its fellowships. It is envisioned that these disease-specific modules will allow the FC to further unify its standards for core content across multiple fellowship types. Several FC sponsoring societies have also embarked on significant curricular revisions, developing new criteria for HPB, Bariatric, MIS, and Flexible Endoscopy fellowships. Most recently, the Americas Hernia Society has joined the FC as a sponsoring society and is helping to develop materials for accrediting fellowships focusing on complex hernia surgery. Within the FC, leadership has undertaken a major IT overhaul, such that processes for applications, accreditation, caselog mapping, technical and clinical assessments, autonomy metrics, and program benchmarking will be further refined and automated. At its recent annual retreat, the FC board agreed to pursue additional efforts regarding faculty development, specifically designed to share best practices amongst program directors. Needless to say, there is a great deal of excitement about these undertakings and the future of FC fellowship training is brighter than ever!
Daniel Scott, MD
Past President, The Fellowship Council
October 2, 2018