General surgery and fellowship training: Opinions of surgical intern applicants and fellowship directors

Background. Given the pressures that exist today to modify surgical training programs, this study was undertaken to ascertain the opinions of surgical intern applicants and fellowship program directors with regard to the length of surgical training. Methods. Surveys were sent to fourth-year medical students who were applying for categorical surgical training during a 2-year period at a single university medical center and to fellowship program directors in 6 surgical subspecialties. Results. Ninety-three percent of the applicants planned to pursue fellowship training Sixty-eight percent of the applicants did not feel that 5 years of general surgery are necessary before beginning a fellowship. Seventy-one percent of the applicants indicated that they would be willing to "short track" into a subspecialty to reduce training time. Virtually all fellowship directors in pediatric surgery (94 %), transplantation surgery (94 %), and oncologic surgery (100 %)felt that 5 years of general surgery training are necessary before entering a fellowship. Significantly fewer fellowship directors in vascular surgery (53 %) cardiothoracic surgery (30 %) and plastic surgery (17 %) felt that 5 years of general surgery are essential before beginning a fellowship (P less than or equal to .001). Conclusions. For some general surgery subspecialties, a shortened, integrated training program may be desirable from the point of view of both trainees and fellowship directors. Vascular, cardiothoracic, and plastic surgery appear to be those subspecialties that are most amenable to such programs.