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Dineen SP, Behrens S, Grubbs EG, Davis JL, Farma JM. ASO Author Reflections: Surgical Oncology Fellowship Training: Is Training Hitting the Mark? Ann Surg Oncol 2024; 31:1785-1786. [PMID: 38062295 DOI: 10.1245/s10434-023-14717-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/19/2023] [Indexed: 02/08/2024]
Affiliation(s)
| | - Shay Behrens
- Surgical Oncology Program, National Cancer Institute, Bethesda, USA
| | - Elizabeth G Grubbs
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, USA
| | - Jeremy L Davis
- Surgical Oncology Program, National Cancer Institute, Bethesda, USA.
| | - Jeffrey M Farma
- Surgical Oncology, Fox Chase Cancer Center, Philadelphia, USA
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Klimberg VS, McMasters KM. Heroes and Legends in Surgical Oncology Series: Legacies and Lessons. Ann Surg Oncol 2024; 31:720-721. [PMID: 37980707 DOI: 10.1245/s10434-023-14617-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Affiliation(s)
| | - Kelly M McMasters
- The Hiram C. Polk, Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Behrens S, Lillemoe HA, Dineen SP, Russell MC, Visser B, Berman RS, Farma JM, Grubbs E, Davis JL. Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study. Ann Surg Oncol 2024; 31:31-41. [PMID: 37936022 PMCID: PMC10695882 DOI: 10.1245/s10434-023-14524-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/16/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Surgical subspecialty training aims to meet the needs of practicing surgeons and their communities. This study investigates career preparedness of Complex General Surgical Oncology (CGSO) fellowship graduates, identifies factors associated with practice readiness, and explores potential opportunities to improve the current training model. METHODS The Society of Surgical Oncology partnered with the National Cancer Institute to conduct a 36-question survey of CGSO fellowship graduates from 2012 to 2022. RESULTS The overall survey response rate was 38% (221/582) with a slight male predominance (63%). Forty-six percent of respondents completed their fellowship after 2019. Factors influencing fellowship program selection include breadth of cancer case exposure (82%), mentor influence (66%), and research opportunities (38%). Overall, graduates reported preparedness for practice; however, some reported unpreparedness in research (18%) and in specific clinical areas: thoracic (43%), hyperthermic intraperitoneal chemotherapy (HIPEC) (15%), and hepato-pancreato-biliary (15%) surgery. Regarding technical preparedness, 70% reported being "very prepared". Respondents indicated lack of preparedness in robotic (63%) and laparoscopic (33%) surgery approaches. Suggestions for training improvement included increased autonomy and case volumes, program development, and research infrastructure. Current practice patterns by graduates demonstrated discrepancies between ideal contracts and actual practice breakdowns, particularly related to the practice of general surgery. CONCLUSIONS This study of CGSO fellowship graduates demonstrates potential gaps between trainee expectations and the realities of surgical oncology practice. Although CGSO fellowship appears to prepare surgeons for careers in surgical oncology, there may be opportunities to refine the training model to better align with the needs of practicing surgical oncologists.
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Affiliation(s)
- Shay Behrens
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Heather A Lillemoe
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sean P Dineen
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Maria C Russell
- Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Brendan Visser
- Department of General Surgery, Stanford Hospital, Stanford, CA, USA
| | - Russell S Berman
- Division of Surgical Oncology, Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jeffrey M Farma
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Grubbs
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy L Davis
- Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA.
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Leiphrakpam PD, Are C. Competency-Based Medical Education (CBME): an Overview and Relevance to the Education of Future Surgical Oncologists. Indian J Surg Oncol 2023:1-11. [PMID: 37363708 PMCID: PMC9990571 DOI: 10.1007/s13193-023-01716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 06/28/2023] Open
Abstract
In the next two decades, the global cancer burden is expected to rise by 47%, and the demand for global cancer surgery will increase by 52%. At present, only 25% of the estimated 80% of patients needing surgical intervention have access to timely surgical care. The shortage of a trained workforce of surgical oncologists is one of the main barriers to providing the optimal surgical intervention needed for cancer patients. Some of the contributing factors to the shortage of trained surgical oncologists are variations in the current global educational platforms, long training programs, and physician burnout. Therefore, the availability of a credible training framework and a sustainable certification pipeline for future surgical oncologists is critical to meet the global demand for an adequate healthcare workforce. The current surgical oncology educational program is a time-based construct that trains surgeons to function seamlessly in the multidisciplinary care of cancer patients. However, there is a lack of flexibility in the training framework and timeline despite differences in trainees' abilities. Developing a globally acceptable standard curriculum for surgical oncology training based on the competency-based medical education (CBME) framework and tailoring it to local needs can increase the surgical oncology workforce ready to tackle the rising cancer burden. However, successful implementation of the global CBME-based surgical oncology training curriculum requires an innovative approach to ensure that this framework produces a competent surgical oncologist that meets the local needs.
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Affiliation(s)
- Premila D. Leiphrakpam
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5524 USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-6880 USA
| | - Chandrakanth Are
- Graduate Medical Education, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5524 USA
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198-6880 USA
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Blazer DG. Supply and Demand: Is the Surgical Oncology Match in a Bear Market? Ann Surg Oncol 2022; 29:7947-7949. [PMID: 36103015 PMCID: PMC9472720 DOI: 10.1245/s10434-022-12544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
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Tyler D. 2022 SSO Presidential Address: What is a Surgical Oncologist? Evolution of Surgical Oncology and the Society of Surgical Oncology in an Era of Hyperspecialization. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11770-3. [PMID: 35430661 PMCID: PMC9013271 DOI: 10.1245/s10434-022-11770-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Douglas Tyler
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
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Training Paradigms in Hepato-Pancreatico-Biliary Surgery: an Overview of the Different Fellowship Pathways. J Gastrointest Surg 2021; 25:2119-2128. [PMID: 33948865 PMCID: PMC9350681 DOI: 10.1007/s11605-021-05019-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023]
Abstract
Hepato-pancreatico-biliary (HPB) surgery, and the training of HPB surgeons, has evolved significantly over the last several decades. The current state of training in HPB surgery in North America is defined through three main pathways: the Complex General Surgical Oncology (CGSO) ACGME fellowship, the American Society of Transplant Surgeons (ASTS) fellowship, and the Americas Hepatopancreaticobiliary Association (AHPBA) fellowship. These fellowships offer variable experiences in pancreas, liver, and biliary cases, and each pathway offers a unique perspective on HPB surgery. The CGSO ACGME, ASTS, and AHPBA fellowships represent decades of work by the three major surgical leadership stakeholders to improve and ensure quality training of future HPB surgeons. The best care is provided by the HPB surgeon who has been trained to understand the importance of all available treatment options within the context of a multidisciplinary setting. The three fellowship pathways are outlined in this paper with the nuances and variations characteristic of the different training programs highlighted.
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Coit DG. Society of Surgical Oncology Presidential Address: Seattle, WA, USA, March 17, 2017 : The Future Ain't What it Used to Be. Ann Surg Oncol 2017; 24:2055-2064. [PMID: 28547564 DOI: 10.1245/s10434-017-5892-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel G Coit
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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The influence of fellowship training on the practice of pancreatoduodenectomy. HPB (Oxford) 2016; 18:965-978. [PMID: 28029534 PMCID: PMC5144550 DOI: 10.1016/j.hpb.2016.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/13/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND There has been a proliferation of gastrointestinal surgical fellowships; however, little is known regarding their association with surgical volume and management approaches. METHODS Surveys were distributed to members of GI surgical societies. Responses were evaluated to define relationships between fellowship training and surgical practice with pancreatoduodenectomy (PD). RESULTS Surveys were completed by 889 surgeons, 84.1% of whom had completed fellowship training. Fellowship completion was associated with a primarily HPB or surgical oncology-focused practice (p < 0.001), and greater median annual PD volume (p = 0.030). Transplant and HPB fellowship-trained respondents were more likely to have high-volume (≥20) annual practice (p = 0.005 and 0.029, respectively). Regarding putative fistula mitigation strategies, HPB-trained surgeons were more likely to use stents, biologic sealants, and autologous tissue patches (p = 0.007, <0.001 and 0.001, respectively). Surgical oncology trainees reported greater autologous patch use (p = 0.003). HPB fellowship-trained surgeons were less likely to routinely use intraperitoneal drainage (p = 0.036) but more likely to utilize early (POD ≤ 3) drain amylase values to guide removal (p < 0.001). Finally, HPB fellowship-trained surgeons were more likely to use the Fistula Risk Score in their practice (29 vs. 21%, p = 0.008). CONCLUSION Fellowship training correlated with significant differences in surgeon experience, operative approach, and use of available fistula mitigation strategies for PD.
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Balch CM, Coit DG, Berman RS. 2015 James Ewing Lecture: 75-Year History of the Society of Surgical Oncology-Part III: The Transformative Years (1991-2015). Ann Surg Oncol 2016; 23:1409-17. [PMID: 26822879 DOI: 10.1245/s10434-015-5011-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Charles M Balch
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Daniel G Coit
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, New York University School of Medicine, New York, NY, USA
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Balch CM, Coit DG, Berman RS. 2015 James Ewing Lecture: The 75-Year History of the Society of Surgical Oncology-Part I: The Traditional Years (1940-1965). Ann Surg Oncol 2015; 23:16-22. [PMID: 26340862 DOI: 10.1245/s10434-015-4837-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Charles M Balch
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Daniel G Coit
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Russell S Berman
- Department of Surgery, New York University School of Medicine, New York, NY, USA
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