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August 2003

The arguments against fellowship training and early specialization in general surgery

Arch Surg. 2003;138(8):915-916. doi:10.1001/archsurg.138.8.915

HOw could anyone not be in favor of fellowship training and further subspecialization in surgery? residents certainly want it, as evidenced by the response to a question included on the 2001 american board of surgery in-training examination: 76% of residents stated that they planned to continue with further training in a fellowship. in our program, 87% of residents finishing in 2001 underwent further training, a percentage that has been stable for the past 10 years. residents believe that fellowship training will provide them with expertise in a specific area, which will increase their marketability. Educators certainly want fellowships, as evidenced by the rapid proliferation of fellowships in surgical oncology, breast surgery, laparoscopy, advanced gastrointestinal surgery, and other areas. a large body of data suggest that increased volume decreases morbidity and mortality rates, although even the strongest proponents of specialization concede that it is unclear whether surgeon volume or hospital volume makes the difference. many educators agree with the opinion expressed by lawrence way, md, in his presidential address to the society for surgery of the alimentary tract in may 1995: