Expectations of Hepato-Pancreato-Biliary Fellows; Do We Meet Them?

Preferred content, construct, and duration of a fellowship structure in HPB surgery: a cross-sectional, pan-European survey among trainees and trainers

BACKGROUND

Fellowships in HPB surgery are lacking across Europe. The aim of this survey was to investigate preferences towards an HPB-fellowship structure among trainees and trainers.

METHODS

A cross-sectional pan-European survey of trainees and consultants in HPB across Europe. Preferred content, duration and construct of a fellowship program was explored.

RESULTS

Responses from 221 eligible participants were analysed, covering all European regions (40 % trainees, of which 31 % women). Preferred duration was 2 years (53 %), international availability (71 %) and in English language (by two-thirds overall; 74 % among trainees). A majority About two-thirds (63 %) preferred an official fellowship teaching curriculum provided by the E-AHPBA. Most The vast majority of participants (n = 211; 95 %) supported accreditation of HPB-fellowships by the E-AHPBA. Trainees reported higher priorities towards technical training (i.e. time in operating room; first surgeon opportunity; minimal-invasive technique training) than consultants, while time for non-operative activities (i.e. ward rounds; responsibility for multidisciplinary team meetings etc) was valued higher by consultants.

CONCLUSIONS

We identified preferences and needs towards construct and competence in HPB fellowships with strong support for involvement of E-AHPBA in providing a involvement teaching curriculum and accreditation. A unified HPB fellowship construct and registry across Europe guided by E-AHPBA may take this into consideration.

Benefits and barriers to accreditation of HPB center and fellowship programs in Europe: a strength-weakness-opportunity-and-threats (SWOT) analysis by an E-AHPBA-ESSO-UEMS ad hoc working committee

BACKGROUND

Training in HPB surgery lacks uniformity across regions covered by the E-AHPBA. Accreditation has been in place for centers and fellowship programs, but with low uptake. The decision whether to continue, change or cease such accreditation is being discussed. Thus, a strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted.

METHODS

A mixed-methods, cross-sectional study among stakeholders in E-AHPBA, ESSO and UEMS under the E-AHPBA executive council was founded, ensuring representation by gender and geographic distribution.

RESULTS

Responses were collected from across E-AHPBA regions, with response from 15 of 24 subchapters. The most frequent and recurring themes are presented in a SWOT matrix which allows for paired evaluations of factors deemed to be helpful (Strengths and Opportunities), those that are harmful (Weaknesses and Threats).

CONCLUSION

This study identified both helpful and harmful effects to an accreditation process of HPB centers or HPB fellowship training across the E-AHPBA membership region. Formal accreditation of centers is not within the scope, nor jurisdiction nor financial capacity for E-AHPBA in the current situation. A strong interest in formal HPB training should be capitalized into E-AHPBA strategic planning towards a structured accreditation system for HPB fellowship programs or HPB training tracks.

The importance of robotic surgery training in HPB fellowship: a survey of the 2022 AHPBA fellows

BACKGROUND

The 2022 incoming fellows' expectations for their robotics training, as well as their perceptions of the utility of the surgical robot, are not well defined.

METHODS

Cross-sectional survey of 24 AHPBA fellows in 2022, analyzed with descriptive statistics and Spearman's rho.

RESULTS

Of 33 current AHPBA fellows, 22 completed the survey (66.7%). Study participants had limited-to-moderate experience with robotics prior to fellowship (mean 2.5 ± SD 1.1; range 1-4). Most participants agreed that robotics influenced their fellowship choice (mean 4.14 ± SD 0.87; range 1-5), would make then more marketable (mean 4.77 ± SD 0.52; range 1-5) and improve job prospects (mean 4.68 ± SD 0.87; range 1-5). Of the study participants, 55% responded that robotics training is "essential" in fellowship, while 64% responded that it is "essential" for their careers. Fellows were only slightly satisfied with overall robotics training within their respective programs (mean 3.44 ± SD 1.17; range 1-5) The majority (73.7%) expect that robotics will comprise <25% of their training. Notably, the majority (75%) have no formal robotics training curriculum.

DISCUSSION

This survey identifies potential gaps where robotics training could be improved for future incoming AHPBA fellows.

The job market for HPB surgeons: leadership perspectives on surgeon skillsets, training pathways, and hiring

BACKGROUND

Three tracks prepare Hepato-Pancreato-Biliary (HPB) surgeons: HPB, surgical oncology, and transplant fellowships. This study explored how surgical leaders thought about HPB surgery and evaluated potential candidates for HPB positions.

METHODS

This descriptive qualitative study utilized interviews of healthcare leaders whose responsibilities included hiring HPB surgeons. We coded inductively then used thematic network analysis to organize the data. Individual codes formed basic themes, then larger secondary themes, then finally "primary" themes.

RESULTS

Primary themes were: (1) What defines an HPB surgical practice?, (2) How do they assess candidates for HPB positions?, and (3) How will HPB practices continue to evolve? Leaders assessed applicants' training, behaviors and cultural fit, technical excellence, and more. Personal recommendations and professional networks significantly influenced the hiring process. HPB surgery needs were growing due to population changes, treatments advances, and changing market conditions.

DISCUSSION

Surgical societies should focus on facilitating networking, promoting transparency, sharing quality data, providing evidence of technical skills and teamwork, mentorship, and providing guidance to general surgery residency program directors. There is great interest in unification and cooperation across the profession, protocol standardization enhancing quality, continued workforce diversification, and evaluation of the alignment between training and practice.

Hepatopancreatobiliary Fellowship Graduates: Where do They Stand today?

BACKGROUND

The Americas Hepato-Pancreato-Biliary Association (AHPBA) Education and Training Committee standardized a Hepatopancreatobiliary (HPB) Surgery Fellowship certification process in 2010. Several classes of fellows have since graduated from HPB, combined Society of Surgical Oncology/AHPBA, and combined American Society of Transplant Surgeons/AHPBA fellowships, but there is little information on their career outcomes. We seek to offer long-term data on the careers of HPB fellowship graduates.

METHODS

A 26-question anonymous survey was distributed among graduates of accredited programs for the last 10 years. We generated descriptive statistics from the responses.

RESULTS

The respondents were evenly distributed in terms of graduation years between 2010 and 2019. Fifty-eight percent of fellows had completed a prior fellowship, 82% received 1 to 3 job offers during the fellowship, and 75% of respondents were still at their first job. The majority of graduates (>60%) were able to secure a job with a >50% HPB practice and >40 HPB cases per year within 3 years of graduation. Overall, >90% candidates rated their satisfaction with fellowship training greater than 8 out of 10.

DISCUSSION

This survey helps shed light on the early formative years in the practices of HPB fellowship graduates. These data show that HPB fellowship training is essential and effective in providing job security and helps fellowship graduates develop a gratifying practice.