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Related Experiment Video

Updated: Jan 16, 2026

Model Surgical Training: Skills Acquisition in Fetoscopic Laser Photocoagulation of Monochorionic Diamniotic Twin Placenta Using Realistic Simulators
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Operating Without Direct Supervision During Pediatric Surgery Fellowship: When, How, and Why?

Gerald Gollin1, Erika A Newman2, Erin E Rowell3

  • 1Division of Pediatric Surgery, Rady Children's Hospital San Diego, University of California San Diego School of Medicine, San Diego, CA, USA.

Journal of Pediatric Surgery
|October 1, 2025
PubMed
Summary
This summary is machine-generated.

Pediatric surgical training programs show significant variation in allowing fellows operative autonomy. Few have clear protocols for unsupervised operating, impacting readiness for independent practice.

Keywords:
AutonomyPediatric surgery fellowshipSurgical education

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Area of Science:

  • Medical Education
  • Surgical Training
  • Pediatric Surgery

Background:

  • Concerns exist regarding pediatric surgical fellows' readiness for independent practice due to limited unsupervised operating experience.
  • Entrustable Professional Activities (EPAs) emphasize the need to assess policies on fellow operative autonomy.

Purpose of the Study:

  • To evaluate current practices and policies concerning pediatric surgical fellow operative autonomy in North America.
  • To understand the criteria and variability in allowing fellows to operate without direct supervision.

Main Methods:

  • A survey was sent to 59 North American pediatric surgical program directors (PDs).
  • PDs reported on program policies for fellow operative autonomy and unsupervised operating scenarios.
  • Inquiries included details on attending surgeon presence and any resulting malpractice cases.

Main Results:

  • 44 PDs (75%) responded, revealing few programs with clear protocols for indirectly supervised operating.
  • Most PDs reported fellows performing basic procedures without a scrubbed attending, but complex cases were rarely performed with only trainee supervision.
  • Parental consent for fellows acting as teaching assistants was not a standard requirement, and one malpractice suit was reported.

Conclusions:

  • Substantial variability exists in pediatric surgical training programs regarding fellow operative autonomy.
  • Few programs have established protocols to assess trainee readiness for independent operating.
  • Standardized parental consent for teaching assistant roles is not consistently obtained.