The fellowship effect: how the establishment of a fellowship in female pelvic medicine and reconstructive surgery affected resident vaginal hysterectomy training

Objective We report on trends in resident-performed vaginal hysterectomies before and after the establishment of a female pelvic medicine and reconstructive surgery fellowship at Vanderbilt University Medical Center. Study Design We examined medical records and resident self-reports concerning all h...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2014-11, Vol.211 (5), p.559.e1-559.e6
Main Authors: Danford, Jill McHenry, MD, White, Nicola Claire, MD, New, Melinda, MD, Fletcher, Sarah, Blume, Jeffrey D., PhD, Ward, Renée Melva, MD
Format: Article
Language:English
Subjects:
Academic Medical Centers
Cohort Studies
Fellowships and Scholarships - statistics & numerical data
Female
Gynecology - education
Humans
Hysterectomy - statistics & numerical data
Hysterectomy, Vaginal - education
Hysterectomy, Vaginal - statistics & numerical data
Internship and Residency - statistics & numerical data
Laparoscopy - statistics & numerical data
Obstetrics and Gynecology
Reconstructive Surgical Procedures - education
residency training
Retrospective Studies
Robotic Surgical Procedures - statistics & numerical data
surgical fellowship
vaginal hysterectomy
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Summary:Objective We report on trends in resident-performed vaginal hysterectomies before and after the establishment of a female pelvic medicine and reconstructive surgery fellowship at Vanderbilt University Medical Center. Study Design We examined medical records and resident self-reports concerning all hysterectomies at our institution in an 8-year period: 4 years before fellowship and 4 years after. Route of hysterectomy, resident and fellow involvement, and division of attending surgeon were recorded from the electronic medical record. Resident Accreditation Council for Graduate Medical Education (ACGME) case log data were used to estimate the number of hysterectomies where residents reported themselves as the primary surgeon. Results During the 8-year period of this study, 3317 hysterectomies were performed at our institution, 41% (1371) before and 59% (1946) after fellowship. Prior to fellowship, 29% (393) were vaginal, 56% (766) were abdominal, and 15% (212) were laparoscopic/robotic. After addition of fellowship, 23% (449) were vaginal, 31% (597) were abdominal, and 46% (900) were laparoscopic/robotic. Of the total vaginal hysterectomies (TVH), there was resident involvement in 98.0% (385) cases before fellowship and 98.2% (441) cases after fellowship. From the ACGME case log data, the resident identified himself/herself as the primary surgeon in 388 cases before and 393 cases after fellowship. During this time period, medical records indicate a fellow was involved in 42% (189) of TVH, with resident involvement in all but 5 of these procedures. Conclusion Frequency of resident involvement in TVH cases, either as primary surgeon or team member, remained constant after the addition of the female pelvic medicine and reconstructive surgery fellowship.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2014.07.017