Instability of fellowship intentions during general surgery residencies

To determine whether PGY-1 future fellowship preferences are stable during progression through residency.

Residents who took the American Board of Surgery In-Training Examination (ABSITE) were surveyed about fellowships. Three data files were created: categorical and nondesignated preliminary trainees at all postgraduate years (PGY); categorical PGY-1 and chief residents; and individual categorical residents with paired PGY-1 and PGY-5 responses. Gender was self-reported; residency characteristics were retrieved via program identifier codes. Annual frequency distributions were generated by specialty and for other, any fellowship (AF), and no fellowship (NF).

Categorical plus contains more than 80,000 responses. Undecided leads PGY-1 intentions at all times, which reached 55% by 2007 and decreased near linearly as PGY level advances. The AF rates increase by PGY level in a decelerating curve. The other rates accelerate at PGY-3 and beyond. The NF rates are low for PGY-1 and 2, nearly double from PGY-3 to 4, and double again from PGY-4 to 5. The categorical group contains more than 20,000 residents with their demographics. The undecided group predominates for both genders, but more women were undecided by 2003. Specialty distribution varies with gender; women were overrepresented in oncology, pediatric, plastic, and other. The undecided group leads choices of university and independent PGY-1 residents, with university overrepresentation in all areas except colorectal, plastic, and no fellowship. Small, medium, and large program PGY-1 residents all choose undecided first but diverge thereafter. Over 12,000 paired categorical PGY-1 and PGY-5 responses reveal that most PGY-1 residents (78%) change future specialties by PGY-5. Undecided residents most often choose no fellowship (25%), vascular (12%), or other (12%).

PGY-1 residents are increasingly unsure about future fellowships. PGY-1 preferences are unstable whether examined in groups or as individuals. Gender and residency characteristics are linked to differing selection patterns. PGY-1 residents rarely predict accurately their PGY-5 fellowship choices. Early specialization paradigms may disadvantage some residents and residency groups and risk greater attrition rates.