Characterizing the General Surgery Experience of Future Breast Surgeons: A Multi-institutional Study from the US ROPE...

Breast cancer care has become increasingly complex, lending itself to fellowship-based specialization. However, breast surgery expertise remains central to general surgery training. We hypothesized that residents entering breast surgical oncology (BSO) fellowship have more exposure to breast surgery and log a higher number of breast cases compared with all other graduating residents.

Demographics, program characteristics, and Accreditation Council for Graduate Medical Education (ACGME) case logs were collected for graduates from 20 general surgery residency programs in the US Resident OPerative Experience (ROPE) Consortium from 2010 to 2020. BSO fellowship matriculants (BSO group) were compared to those entering other surgical fellowships or general surgery practice (non-BSO group).

Among 1343 graduates, 45 (3.4%) matriculated into BSO fellowship. BSO matriculants were more often female (89% versus 34%, p < 0.0001). Demographic, program, and institutional variables were otherwise similar (all p > 0.05). The BSO group logged fewer total procedures (median, 976 versus 1039), consistent across Surgeon Junior and Teaching Assistant roles and multiple operative domains, including alimentary tract, pediatric, plastics, thoracic, trauma, and vascular (all p < 0.05). However, BSO group logged more breast cases (74 versus 50, p < 0.0001), despite comparable access to a breast surgery rotation (64% versus 64%) and fellowship-trained faculty (82% versus 84%; both p > 0.05).

Future BSO matriculants performed 50% more breast cases during residency but logged fewer total cases across multiple operative domains. These residents may develop early interest in breast surgery and subsequently tailor their training. Further mixed-methods studies are needed to understand these findings and their implications for trainees pursuing breast surgery.