OBJECTIVE(S):
High surgical complexity and individual career goals has led most general surgery (GS) residents to pursue fellowship training, resulting in a shortage of surgeons who practice broad based general surgery. We hypothesize that early tracking of residents would improve operative experience of residents planning to be general surgeons, and could foster greater interest and confidence in this career path.
METHODS:
Operative data from GS and fellowship bound residents (FB) applying for the 2008 American Board of Surgery Qualifying Exam (QE) was used to construct a hypothetical training model with 6 months of early specialization (ESP) for FB residents in 4 specialties (cardiac, vascular, colorectal, pediatric); and presumed these cases would be available to GS residents within the same program.
RESULTS:
142 training programs had both FB residents (n=237) and GS residents (n=402), and represented 70% of all 2008 QE applicants. GS residents completed a mean of 1091 cases during residency and FB residents performed a mean of 252 cases in the chief year, theoretically making 126 cases available for each GS resident. GS experience and FB Chief are means case #’s; and Total # is the predicted 5 yr GS case volume if ESP was adopted in these programs.
CONCLUSIONS:
The ESP model improves operative experience of GS residents, particularly for complex gastrointestinal procedures. The expansion of subspecialty ESP should be considered.

Operation	GS Experience	1/2 FB Chief Cases	Total #	(%increase)
Mastectomy	21.7	1.4	23.1	(6.5%)
Colon resection	63.0	14.3	77.3	(22.8%)
Gastrectomy	9.4	2.2	11.6	(23.4%)
Antireflux procedure	7.7	1.8	9.5	(23.4%)
Pancreatic resection	9.1	3.4	12.5	(37.4%)
Liver resection	8.2	2.4	10.6	(29.3%)
Endocrine procedures	35.2	6.9	42.1	(19.6%)
Trauma operations	33.7	4.5	38.2	(13.4%)
GI endoscopy	66.0	4.3	71.3	(6.5%)