Finding the Balance: General Surgery Resident Versus Fellow Training and Exposure in Hepatobiliary and Pancreatic Surgery

Michael R. Driedger, Ryan Groeschl, Lavanya Yohanathan, Patrick Starlinger, Travis E. Grotz, Rory L. Smoot, David M. Nagorney, Sean P. Cleary, Michael L. Kendrick, Mark J. Truty

Research output: Contribution to journalArticlepeer-review


Background: Institutions training both General Surgery (GS) residents and Hepato-Pancreatico-Biliary (HPB) fellows must strive for adequate case volumes for each trainee cohort. Methods: Six academic years of graduating ACGME Residency and HPB Fellowship Council case logs (July 2011-June 2017) and institutional administrative faculty billing data were examined at a single high-volume center with a formal HPB Surgical Division with both GS Residency and HPB Surgery Fellowship trainees. Results: During the 6-year period, 7482 operations were performed by HPB faculty (5.5 total full-time equivalent (FTE)) and included 2419 major liver, 375 major biliary, and 1591 major pancreas cases. Residents/fellows performed 1102 (50%)/1101 (50%) of all major liver operations, 165 (49.7%)/163 (50.3%) major biliary operations, and 843 (59.2%)/581 (40.8%) major pancreas operations, with significantly different case mix of pancreas for resident versus fellow, p < 0.0001. The overall relative proportion of total HPB cases performed by residents versus fellows was 53%/47%, respectively, and this was stable over time, with no significant decrease in resident exposure/cases with dedicated HPB fellowship. Conclusions: Our experience in training both GS residents and HPB fellows with a formal HPB Surgical Division suggests that a high volume HPB Division allows for more than adequate exposure for both groups of trainees.

Original languageEnglish (US)
Pages (from-to)875-884
Number of pages10
JournalJournal of Surgical Education
Issue number3
StatePublished - May 1 2021


  • Hepato-Pancreatico-Biliary surgery
  • fellowship
  • general surgery residency
  • surgical education
  • trainee case volume

ASJC Scopus subject areas

  • Surgery
  • Education


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