Awareness and Perceptions of Flexibility in Surgical Training: Insights From a National Survey of Surgical Fellowship...

The American Board of Surgery (ABS) permits flexibility in surgical training (FIST) by allowing general surgery (GS) residents to spend up to 12 of their final 36 months completing optional subspecialty-focused flexible rotations. Prior research has shown that incorporating FIST is feasible, with participating GS residents performing similarly or superiorly to their peers across several metrics. However, the impact of FIST on postgraduate outcomes remains unclear. This study examined the awareness and perceptions of FIST among surgical fellowship program directors (PDs).

A cross-sectional, electronic survey was distributed to all PDs of accredited fellowships in colorectal, hepatobiliary, minimally invasive/gastrointestinal, pediatric, and oncologic surgery. The 21-item, multidomain survey focused on understanding PD attitudes and opinions on FIST. Univariate logistic regression was used to assess associations between predictor variables and two key outcomes: awareness of the FIST initiative and perceptions of its educational value.

In total, 146 PDs completed the survey (response rate: 34.8%). Overall, 68 (46.6%) and 93 (63.7%) PDs were unaware of the ABS policy permitting flexible rotations and the published literature on FIST, respectively. Only 14 (9.6%) PDs believed that resident participation in FIST was an important consideration when evaluating fellowship applicants, while most (n = 102; 69.9%) felt that incorporating FIST could enhance the preparation of residents for fellowship. Only 14 (9.6%) PDs were aware of a fellow they trained having participated in FIST during residency. Of these PDs, 57.1% (n = 8/14) and 71.4% (n = 10/14) felt that participating fellows had greater technical skills and subspecialty-specific medical knowledge, respectively, compared to other fellows at the start of fellowship. Most PDs (n = 13/14; 92.9%) felt that fellows who participated in FIST performed similarly or superiorly to their peers at the completion of fellowship in technical skills, patient care, subspecialty-specific knowledge, professionalism, autonomy, and research proficiency.

Most fellowship PDs favorably perceive incorporating greater flexibility into the structure of GS residency training but lack awareness of the FIST paradigm. While participation in FIST is not prioritized in evaluating fellowship applicants, participating trainees may be viewed by PDs as having greater subspecialty-specific knowledge and skills upon entering fellowship.