Preparedness for Practice After fellowships: What are the gaps?


With recent changes in surgical training, there is significant concern about preparedness for independent practice. The majority of general surgery residents in North America are voluntarily extending their training through fellowships. A recent survey of program directors from the research committee of the Fellowship Council identified important deficiencies in the skills of incoming fellows. The purpose of this study is to evaluate the perceived preparedness for practice after completion of fellowship training in minimally invasive and bariatric surgery and identify educational gaps. 


 To describe perceived preparedness for independent practice after completion of fellowship

 To determine whether the fellowships are meeting the needs of fellows as they go into practice and define any educational gaps.


Yusuke Watanabe, MD, Liane Feldman, MD, Melina Vassiliou, MD, MEd; for the Research Committee of the Fellowship Council (this study has been approved by the Fellowship Council)


I. Study Design

There will be four phases of this study collecting cross-sectional and longitudinal data including interviews, focus groups, analysis of data collected for accreditation and a novel web-based survey. This study was approved by the Institutional Review Board of McGill University.  

Phase 1.  Analysis of data collected for accreditation purposes

As part of the current accreditation process, the current fellow and all graduated fellows since the last accreditation are required to complete a web-based survey. This survey contains items of relevance to the study question. Examples include perceptions of the balance between supervision and graduated responsibility, satisfaction with case mix and with outpatient, research and teaching experience.  Potentially identifying information will not be requested. This information may inform the development of the subsequent phases of investigation.

Phase 2.  Qualitative Interviews

We will conduct in-depth interviews longitudinally with semi-structured questions t. As a pilot, we will begin with recently graduated fellows from the McGill MIS and bariatric fellowship programs and from other fellowships identifies from the fellowship council research committee.  This will help us develop the interview structure and data collection processes.

We then will interview a sample of recently graduated fellows of MIS, MIS/bariatric, and bariatric fellowship programs, and would hope to include fellows trained in both academic and community environments. Theoretical sampling will be used to gather the most fruitful information. Participants will be invited by email through the FC. Interviews will last for about 30 minutes over Skype ( Participants will be interviewed regarding the following, developed after conferring with experts at McGill University and document analysis:

1. Why they choose to do a fellowship

2. Whether the fellowship met those expectations

3. Perceived preparation for fellowship after residency

4. Perception at the end of the fellowship of what (if anything) was missing that they think they will need in practice

5. How they think they will fill in those gaps

6. What challenges they think they will have in practice


Interviews will be audio/video recorded and transcribed for subsequent data analysis to identify emergent themes. Interviews will continue until we reach conceptual saturation (the point at which no new themes arise from the data). For graduates in their first year of practice, the interviews will be repeated after 3-4 months in practice to pursue  longitudinal changes. 

In qualitative interview, theoretical sampling is based on the premise that data collection and analysis go hand in hand. In other words, data collection never gets too far ahead of analysis because the focus of subsequent data collection; that is, the questions to be asked in the next interview are based on what was discovered during the previous analysis. We may therefore modify the interview questions depending on the previous interview and analysis.

Phase 3: Focus Group

We will conduct focus groups with a theoretical sample of recently graduated fellows from MIS, MIS/bariatric, and bariatric fellowship programs. We will send invitation letters by email through the FC and will collect 10 candidates (over-invitations will be made in anticipation of a no-show rate of 10 to 20 percent). We will develop topics for discussion from the results of the interviews. Focus groups will last about 60 minutes with free-flowing discussion. Focus groups will be audio/video recorded and transcribed for subsequent data analysis to identify emergent themes. 


Phase 4: Survey of all recently graduated fellows

The surveys will be developed by a comprehensive and multistage method based on document analysis (review of the existing research and documents), expert opinion and the themes from the interviews and focus groups.  The web-based survey will to be sent to all recently graduated fellows (MIS, MIS/bariatric and bariatric) in their first three years of practice. Distinct surveys for MIS and for bariatric will be created, with graduates of MIS/bariatric asked to complete both. In addition to demographics, practice and fellowship characteristics, the survey will collect detailed information about the cases performed in fellowship (or request permission to query their case logs) and those in practice, degree of independence during fellowship and residency, preparedness for practice, and successes and deficiencies of training.

II. Contact information
To participate in the interview or focus group, please contact me at

III. Data analysis

IV-a. Interviews and Focus groups

Grounded theory method will be used to analyze the data. This is a systematic methodology involving the discovery of theory through the analysis of data.

IV-b. Survey

Response rate will be calculated using the American Association for Public Opinion Research formula. The data per beta survey will be analyzed separately and longitudinal data will be compared. The prospective survey data will be analyzed longitudinally. Data will be analyzed using descriptive and comparative statistics including the simple/cross tabulation, chi-square analysis, factor analysis, and regression analysis. Statistical significance will be defined by p-value less than 0.05. 

V. Confidentiality

The data collected in this study are classified as confidential. Confidential data are completely anonymous. All data obtained will be coded according to position of the participant and their level of experience. We will only know the content of individual answers. All data collected from the study will be stored by the department of Minimally Invasive Surgery (MIS) at McGill University in a secure confidential database. This program is password protected and only the principal investigators will have access to this data. This data will be kept confidential and secured in a locked area in the office of the principal investigator. Once the results are submitted for publication, the data will only be made available to editors involved in the review and publication process, as well, the data will be available for open sharing between qualified investigators who are involved in a similar area of study (as enforced by the American Psychological Association guidelines). Only the non-identifiable data will be retained for at least five years after publication, abiding by the guidelines of the American Psychological Association.

IV. Anticipated Ethical Issues

This study will not involve or affect patients. All data gathered will be coded and confidential. We will safeguard responses and group them together with responses of others. Data collected will be analyzed as a group only. No information that could be used to identify individuals will be published or released to any person. Participants can chose to withdraw at any point during the study.

Oct 1, 2013, 11:06 AM