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Author Notes:

Mary E Klingensmith, MD, FACS, Department of Surgery, Washington University School of Medicine in St.Louis, 660 South Euclid Ave, Campus Box 8109, St. Louis, MO 63110, klingensmithm@wustl.edu, phone: (314)362-8028.

Study conception and design: Delman, Potts, Awad, Eberlein, Klingensmith; Acquisition of data: Cullinan, Klingensmith; Analysis and interpretation of data: Cullinan, Wise, Klingensmith; Drafting of manuscript: Cullinan, Wise, Klingensmith; Critical revision: Wise, Delman, Potts, Awad, Eberlein, Klingensmith;

The authors would like to thank residency program leaders at participating programs for assisting in the design, conduct and data collection for this study, including Drs. Doug Smink;John Mullen; Karen Brasel; Karen Deveney; Pam Lipsett; Thomas Fahey; Jason Lees and Jeff Wayne.

Dr Potts is a full-time employee of the Accreditation Council for Graduate Medical Education

Dr Awad receives education research grants from Ethicon, Baxter, Bard, and Intuitive.

Dr Wise receives research grants from Cancer Prevention Pharmaceuticals, Inc, and is paid for expert testimony.


Research Funding:

This work was supported by the National Institutes of Health (DRC: T32-CA009621, UL1-TR000448).

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Surgery

Interim Analysis of a Prospective Multi-Institutional Study of Surgery Resident Experience with Flexibility in Surgical Training


Journal Title:

Journal of The American College of Surgeons


Volume 226, Number 4


, Pages 425-433

Type of Work:

Article | Post-print: After Peer Review


Background: The Flexibility in Surgical Training (FIST) consortium project was designed to evaluate the feasibility and resident outcomes of optional subspecialty-focused training within general surgery residency training. Study Design: After approval by the American Board of Surgery, R4 and R5 residents were permitted to customize up to 12 of the final 24 months of residency for early tracking into 1 of 9 subspecialty tracks. A prospective IRB-approved study was designed across 7 institutions to evaluate the impact of this option on operative experience, in-service exam (American Board of Surgery In-Training Examination [ABSITE]) and ACGME milestone performance, and resident and program director (PD) perceptions. The FIST residents were compared with chief residents before FIST initiation (controls) as well as residents during the study period who did not participate in FIST (no specialization track, NonS). Results: From 2013 to 2017, 122 of 214 chief residents (57%) completed a FIST subspecialty track. There were no differences in median ABSITE scores between FIST, NonS residents, and controls. The ACGME milestones at the end of the R5 year favored the FIST residents in 13 of 16 milestones compared with NonS. Case logs demonstrated an increase in track-specific cases compared with NonS residents. Resident and PD surveys reported a generally favorable experience with FIST. Conclusions: In this prospective study, FIST is a feasible option in participating institutions. All FIST residents, regardless of track, met requirements for ABS Board eligibility, despite modifications to rotations and case experience. Future studies will assess the impact of FIST on ABS exam results and fellowship success.

Copyright information:

© 2018 American College of Surgeons

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