The Fellowship Effect: Does Surgical Subspecialty Training Affect Pediatric Surgery Case Volume?

Area of Science:

• Medical Education
• Surgical Training
• Pediatric Surgery

Background:

• The Accreditation Council for Graduate Medical Education (ACGME) monitors fellow case numbers.
• Previous studies indicate that new fellowships can negatively impact general surgery residency case numbers.
• The rise of subspecialty fellowships raises concerns about case volume distribution in pediatric surgery.

Purpose of the Study:

• To investigate the impact of increased pediatric otolaryngology and pediatric urology fellowships on overlapping pediatric surgery fellowship case numbers.
• To test the hypothesis that more fellowships in these subspecialties would decrease shared case volumes.

Main Methods:

• Reviewed fellowship match data and public pediatric surgery case logs (2003-2018).
• Focused on overlapping cases: thyroidectomy, parathyroidectomy, branchial cleft cyst excision, thyroglossal duct cyst excision, major neck tumor excision, nephrectomy, orchidopexy, inguinal hernia, and testicular torsion.
• Utilized linear regression analysis to assess trends in case numbers and fellow numbers.

Main Results:

• A significant increase in fellowship graduates was observed from 2003 to 2018.
• Despite the increase in fellows, overall pediatric surgery case volumes showed minimal fluctuation.
• A slight decrease in tumor-related nephrectomies and orchidopexies was noted, alongside a small increase in thyroidectomies.

Conclusions:

• The expansion of pediatric subspecialty fellowships has had a limited effect on pediatric surgery case volumes.
• Ongoing surveillance of these trends is crucial for maintaining sufficient training opportunities in pediatric surgical subspecialties.