Oversight Organizations in Complex General Surgical Oncology - Potential Impact on Competency Based Education

Postgraduate training to become a surgical oncologist involves a general surgery residency and a Complex General Surgical Oncology (CGSO) Fellowship, with most graduates spending approximately 9 years in training. This paradigm remains dependent on devoting a specific, fixed amount of time to training. A competency-based medical education (CBME) approach acknowledges that learners progress through different milestones at variable paces. Currently, several oversight organizations are involved in training surgical oncologists, which are still dependent on time-based training.

A narrative review was conducted reviewing literature and current guidelines on CGSO training. The interplay between the various organizations was outlined in hypothetical models.

Many organizations are involved in the ultimate oversight of surgical oncology training, including at the residency, fellowship, match, and board certification level. These organizations still rely on time spent in training for the ultimate approval of a trainee through each step of training. New initiatives are slowly introducing CBME, notably the Entrustable Professional Activity initiative through the American Board of Surgery.

Our current training environment faces many challenges, including duty hours, increasing use of technology, and employment models that are quite different from those present at the outset of CGSO as a specialty. To improve our approach to training surgical oncologists, it is necessary to understand the current framework for oversight. We have reviewed the most relevant oversight bodies to allow for a better understanding of the machinery involved in any attempt to modify CGSO Fellowship towards a CBME model.