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Specialty Fellowships Within General Surgery How Do We Find the Right Balance?

James C. Hebert, MD1
[+] Author Affiliations
1Department of Surgery, University of Vermont College of Medicine, Burlington
JAMA Surg. 2016;151(3):211-212. doi:10.1001/jamasurg.2015.4652.
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This Viewpoint discusses specialty fellowships within general surgery and emphasizes the importance of striking a balance between specialty fellowships and residential training.

Specialization is becoming the norm, and choosing a career pathway is becoming more complex, with more graduating residents choosing additional training.1 Fellowship training has been shown to lead to better patient outcomes.2 Fellowships, both Accreditation Council for Graduate Medical Education (ACGME) accredited and nonaccredited, will continue to evolve and proliferate as advances in science and technology drive to more superspecialization. However, there is no current strategic plan for integrating fellowships and general surgical training to better meet future needs. New ACGME-accredited fellowship programs are added each year, with the only rate-limiting steps being the presence of trained faculty, adequate case volumes defined by minimal case numbers, and demonstration of compliance with ACGME requirements to the Residency Review Committee. Specialty societies usually recommend basic requirements and case volumes for non-ACGME accredited programs and provide limited accreditation function, but again, there are no limits on the number of fellowship positions. The effects of these fellowship programs on core surgery training programs and the value to the individuals undertaking additional training, as well as the value of more specialists fulfilling societal needs, is poorly understood and deserves careful study.

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