Fellow or foe: the impact of fellowship training programs on the education of Canadian urology residents
Objective: Throughout North America, increasing emphasis is being placed on
surgical fellowships. Surgical educators and trainees have raised concerns that
the escalating focus on fellowships may threaten the educational mission of more
novice trainees. Our objective was to collect opinions from multiple perspectives
(faculty, fellows and residents) regarding fellowship structure, fellow selection
and the impact of clinical fellowships on urology resident training.
Methods: We anonymously surveyed 52 members of a major academic urology
training program (University of Toronto) with established fellowship training
programs for their opinions regarding fellowship structure, fellow selection,
and the impact on resident training and education.
Results: The overall response rate was 88%. We identified significant differences
of opinion among faculty, fellows and residents regarding fellowship
structure, fellow selection and the impact on resident education. Specifically,
faculty and fellows supported the addition of more fellows, felt that certain complex
cases should be designated as “fellow cases” and that residents’ research
opportunities were not restricted. Residents felt that fellows “steal” operative
cases, that performing operations with the fellow is not equivalent to performing
operations with faculty alone and that fellowship candidates should
perform an operation with division faculty as part of the application process.
There was agreement that fellowship programs add value to residents’ overall
education, that fellows should participate in the call schedule and that
fellows’ role in the operating room needs to be better defined with respect to
case volume and selection. Proficiency in technical skills, clinical knowledge,
teaching and teamwork were cited as the most attractive characteristics
of an effective clinical fellow.
Conclusion: Residency and fellowship program directors must clearly define
the role of the fellow and outline the limits of surgical practice, establish clear
and consistent guidelines outlining responsibilities (operative, clinical and
on-call), and open lines of communication to ensure that all opinions are
recognized and addressed. Finally, they must select fellows with proficient technical
skills, clinical knowledge, teaching ability and work ethic to ensure that
they focus on “specialized” training.
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