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J Am Coll Surg. 2014 Apr;218(4):695-703. doi: 10.1016/j.jamcollsurg.2013.12.022. Epub 2013 Dec 24.

Perceptions of graduating general surgery chief residents: are they confident in their training?

Author information

  • 1Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO. Electronic address: mark.friedell@tmcmed.org.
  • 2Guthrie Clinic, Sayre, PA.
  • 3Department of Surgery, Orlando Regional Medical Center, Orlando, FL.
  • 4Department of Surgery, Ochsner Clinic, New Orleans, LA.
  • 5Department of Surgery, University of Nebraska School of Medicine, Omaha, NE.
  • 6Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL.
  • 7Department of Surgery, University of Pennsylvania, Philadelphia, PA.



Debate exists within the surgical education community about whether 5 years is sufficient time to train a general surgeon, whether graduating chief residents are confident in their skills, why residents choose to do fellowships, and the scope of general surgery practice today.


In May 2013, a 16-question online survey was sent to every general surgery program director in the United States for dissemination to each graduating chief resident (CR).


Of the 297 surveys returned, 76% of CRs trained at university programs, 81% trained at 5-year programs, and 28% were going directly into general surgery practice. The 77% of CRs who had done >950 cases were significantly more comfortable than those who had done less (p < 0.0001). Only a few CRs were uncomfortable performing a laparoscopic colectomy (7%) or a colonoscopy (6%), and 80% were comfortable being on call at a Level I trauma center. Compared with other procedures, CRs were most uncomfortable with open common bile duct explorations (27%), pancreaticoduodenectomies (38%), hepatic lobectomies (48%), and esophagectomies (60%) (p < 0.00001). Of those going into fellowships, 67% said they truly had an interest in that specialty and only 7% said it was because they were not confident in their surgical skills.


Current graduates of general surgery residencies appear to be confident in their skills, including care of the trauma patient. Fellowships are being chosen primarily because of an interest in the subspecialty. General surgery residency no longer provides adequate training in esophageal or hepatopancreatobiliary surgery.

Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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  • Discussion. [J Am Coll Surg. 2014]
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