Combining disparate surgical residencies into one: lessons learned

Background: Attitudes, career goals, and educational experiences of general surgery residents are profiled during the acquisition of a community residency program by an academic residency program.

Materials and methods: The study population included all general surgery residents postgraduate years 2-5 in a tertiary academic medical center divided into community program matriculants (CPM) or academic program matriculants (APM). A survey compared perceptions before and after residency amalgamation in seven training categories as follows: relationships among residents, relationships with faculty, systems interactions, clinical training, surgical training, scholarship, and career plans. Responses were recorded on a Likert scale. Fisher exact test and one-sided t-test were applied.

Results: Thirty-five trainees (83%) participated, 23 APM (66%) and 12 CPM (34%). Neither cohort reported significant negative perceptions regarding surgical training, career planning, or scholarship (P > 0.05). There was a greater likelihood of significant negative perceptions regarding inter-resident relationships among CPM (P < 0.05). CPM perceived significantly improved opportunities for scholarship (P < 0.01) and nationwide networking through faculty (P < 0.05) after acquisition. There was a nearly significant trend toward CPM perceiving greater access to competitive specialties after acquisition. Overall, CPM perceptions were affected more often after acquisition; however, when affected, APM were less likely to be positively affected (odds ratio, 2.9).

Conclusions: Acquisition of a community surgery residency by an academic program does not seem to negatively affect trainees' perceptions regarding training. The effect of such acquisition on CPMs' decision to pursue competitive fellowships remains ill defined, but CPM perceived improved research opportunities, faculty networking, and programmatic support to pursue a career in academic surgery.