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

BackgroundThe 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. MethodsA 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. ResultsTwenty-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 086, 95 per cent c.i. 084 to 088), as was the rate of complications (odds ratio 090, 078 to 102). Surgeons without fellowship training converted more laparoscopic operations to open surgery than those with fellowship training (risk ratio (RR) 104, 95 per cent c.i. 103 to 105). Comparison of outcomes for senior surgeons versus current fellows showed no differences in rates of mortality (RR 100, 100 to 101), complications (RR 103, 098 to 108) or conversion to open surgery (RR 101, 100 to 101). ConclusionFellowship training appears to have a positive impact on patient outcomes. Fellowship training improves outcomes