Perceptions of Program Directors on the Necessity of Hepatopancreaticobiliary Fellowships in Training General Surgery Residents

Objective: To determine the perceptions of general surgery PDs (program directors) concerning the necessity for HPB (hepatopancreatobiliary) fellowships to practicing HPB surgery. Methods: A 22-question electronic survey was sent to 250 general surgery PDs recognized by the American Association of Medical Colleges in the United States regarding the experience and competency of graduating general surgery residents. Survey included qualitative and quantitative responses in multiple choice and write-in format. Results: Eighty-one PDs responded (32%): 74% from university affiliated programs and 26% from community programs. 80% did not have an HPB fellowship. 66% had no HPB service for general surgery residents.40% of PDs felt that residents performed 11-25 hepatic, pancreatic and biliary cases, and some were performing > 40 complex hepatic, pancreatic and biliary cases. Two-thirds of PDs were confident that graduating residents could perform pancreaticoduodenectomies and liver resections independently;100% believed that residents could perform distal pancreatectomies. A majority of PDs felt that residents could be certified to perform HPB surgery without fellowship training. Conclusions: Current opinion amongst general surgery PDs suggests that general surgery residents perform more than the ACGME (Accreditation Council for Graduate Medical Education) required number of complex HPB cases and should be individually assessed for competence in HPB without the need for further training.