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Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes

Title: Systematic review with meta-analysis of the impact of surgical fellowship training on patient outcomes
Authors: Johnston, MJ
Singh, P
Pucher, PH
Fitzgerald, JEF
Aggarwal, R
Arora, S
Darzi, A
Item Type: Journal Article
Abstract: Background The number of surgeons entering fellowship training before independent practice is increasing. This may have a negative impact on surgeons in training. The impact of fellowship training on patient outcomes is not yet known. This review aimed to investigate the impact of fellowship training in surgery on patient outcomes. Methods A systematic review of the literature was conducted to identify studies exploring the structural and surgeon‐specific characteristics of fellowship training on patient outcomes. Data from these studies were extracted, synthesized and reported qualitatively, or quantitatively through meta‐analysis. Results Twenty‐three studies were included. The mortality rate for patients in centres with an affiliated fellowship programme was lower than that for centres without (odds ratio 0·86, 95 per cent c.i. 0·84 to 0·88), as was the rate of complications (odds ratio 0·90, 0·78 to 1·02). Surgeons without fellowship training converted more laparoscopic operations to open surgery than those with fellowship training (risk ratio (RR) 1·04, 95 per cent c.i. 1·03 to 1·05). Comparison of outcomes for senior surgeons versus current fellows showed no differences in rates of mortality (RR 1·00, 1·00 to 1·01), complications (RR 1·03, 0·98 to 1·08) or conversion to open surgery (RR 1·01, 1·00 to 1·01). Conclusion Fellowship training appears to have a positive impact on patient outcomes.
Issue Date: 30-Jun-2015
Date of Acceptance: 20-Apr-2015
URI: http://hdl.handle.net/10044/1/58773
DOI: https://dx.doi.org/10.1002/bjs.9860
ISSN: 0007-1323
Publisher: WILEY
Start Page: 1156
End Page: 1166
Journal / Book Title: BRITISH JOURNAL OF SURGERY
Volume: 102
Issue: 10
Copyright Statement: © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd. This is the accepted version of the following article: Johnston, M. J., Singh, P. , Pucher, P. H., Fitzgerald, J. E., Aggarwal, R. , Arora, S. and Darzi, A. (2015), Systematic review with meta‐analysis of the impact of surgical fellowship training on patient outcomes. Br J Surg, 102: 1156-1166, which has been published in final form at https://dx.doi.org/10.1002/bjs.9860
Sponsor/Funder: National Institute for Health Research
Imperial College Healthcare NHS Trust
National Institute for Health Research (NIHR)
Funder's Grant Number: NF-SI-0510-10186
RDPSC 79560
RDPSC 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
ABDOMINAL AORTIC-ANEURYSM
Y GASTRIC BYPASS
2 DECADES LATER
LEARNING-CURVE
RESIDENT SUPERVISION
OPERATING-ROOM
SURGERY
PROGRAMS
APPENDECTOMY
CONVERSION
Clinical Competence
Education, Medical, Continuing
General Surgery
Humans
Internship and Residency
Patient Outcome Assessment
Surgical Procedures, Operative
11 Medical And Health Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine



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