Can Rural Minimally Invasive Surgery Fellowships Provide Operative Experience Similar to Urban Programs?

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Bariatric Surgery

Background:

• Operative experience in rural minimally invasive surgery (MIS)/bariatric fellowship programs is not well-documented.
• Two prominent rural MIS/bariatric fellowships are situated in the upper Midwest.
• The study aimed to compare the operative experience offered by these rural programs with more urban U.S. programs.

Purpose of the Study:

• To evaluate and compare the operative case volumes of rural Midwest MIS/bariatric fellowship programs with those in urban U.S. programs.
• To assess the fellowship experience and current practice of graduates from rural MIS/bariatric fellowship programs.
• To determine the perceived benefit of fellowship training for current practice among rural program graduates.

Main Methods:

• Comparative analysis of fellowship case logs from 2011-2013 between 2 rural Midwest MIS/bariatric programs and 23 other U.S. programs.
• Surveys administered to rural Midwest fellowship graduates regarding their training and current practice.
• Statistical analysis using the Wilcoxon rank-sum test to compare case volumes.

Main Results:

• No significant differences were observed in the mean volumes of bariatric, foregut, abdominal wall, small intestine, and hepatobiliary cases between rural Midwest fellows and other U.S. programs.
• Rural Midwest fellows demonstrated a significantly higher mean volume of endoscopy cases (p = 0.05).
• All rural fellows reported sufficient cases as operating surgeon, and 60% currently practice rurally, with 87% finding their training extremely beneficial.

Conclusions:

• Rural MIS fellowship programs deliver an operative experience comparable to their urban counterparts.
• A notable finding is the higher volume of endoscopy cases experienced by fellows in rural Midwest programs.
• Fellowship training in rural settings is perceived as highly beneficial for subsequent practice, with a significant portion of graduates continuing rural practice.