Fellow or foe: the impact of fellowship training programs on the education of Canadian urology residents

Abstract

Objective: Throughout North America, increasing emphasis is being placed onsurgical fellowships. Surgical educators and trainees have raised concerns thatthe escalating focus on fellowships may threaten the educational mission of morenovice trainees. Our objective was to collect opinions from multiple perspectives(faculty, fellows and residents) regarding fellowship structure, fellow selectionand the impact of clinical fellowships on urology resident training.Methods: We anonymously surveyed 52 members of a major academic urologytraining program (University of Toronto) with established fellowship trainingprograms 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 differencesof opinion among faculty, fellows and residents regarding fellowshipstructure, fellow selection and the impact on resident education. Specifically,faculty and fellows supported the addition of more fellows, felt that certain complexcases should be designated as “fellow cases” and that residents’ researchopportunities were not restricted. Residents felt that fellows “steal” operativecases, that performing operations with the fellow is not equivalent to performingoperations with faculty alone and that fellowship candidates shouldperform an operation with division faculty as part of the application process.There was agreement that fellowship programs add value to residents’ overalleducation, that fellows should participate in the call schedule and thatfellows’ role in the operating room needs to be better defined with respect tocase volume and selection. Proficiency in technical skills, clinical knowledge,teaching and teamwork were cited as the most attractive characteristicsof an effective clinical fellow.Conclusion: Residency and fellowship program directors must clearly definethe role of the fellow and outline the limits of surgical practice, establish clearand consistent guidelines outlining responsibilities (operative, clinical andon-call), and open lines of communication to ensure that all opinions arerecognized and addressed. Finally, they must select fellows with proficient technicalskills, clinical knowledge, teaching ability and work ethic to ensure thatthey focus on “specialized” training.