SURGICAL FELLOWSHIP PER ORAL ENDOSCOPIC MYOTOMY EXPERIENCE: A RETROSPECTIVE REVIEW OF FELLOW CASE LOGS
David Morrell*, Eric Pauli
Penn State Health Milton S. Hershey Medical Center, Hershey, PA
Introduction
Since it was first introduced, per oral endoscopic myotomy (POEM) has been increasingly used in the management of achalasia. In 2013, POEM was added as a category to The Fellowship Council fellow case log reflecting the importance of fellow exposure to the procedure. This study reports surgical fellow experience with POEM following the addition of this category to track fellow experience in this relatively new procedure.
Methods
A retrospective analysis was performed on case logs of 1,117 surgery fellows who began fellowship training between 2013-2016. All fellows were enrolled in an accredited surgery fellowship program by The Fellowship Council. Fellows were grouped by year of fellowship matriculation and further subcategorized by type of fellowship program. Number of POEM procedures per fellow was calculated by year and further subcategorized by fellow role in the procedure.
Results
A total of 590 POEM procedures were logged by 57 unique fellows over the 4 years studied. Of the 57 fellows, 24 were enrolled in Advanced Gastrointestinal (Adv GI) Minimally Invasive (MIS), 15 in Adv GI MIS/Bariatric, 4 in Thoracic, 3 in Adv GI MIS/Flexible Endoscopy (Flex Endo), 3 in Flex Endo, 3 in Adv GI, 2 in Adv GI MIS/Foregut, 2 in Bariatric, and 1 in Hepatobiliary Surgical Oncology fellowships. 25 fellows logged cases as both primary surgeon and first assistant, 12 logged as only primary surgeon, and 20 logged as only first assistant. Of the 590 POEM procedures, fellows logged 369 as primary surgeon and 221 as first assistant. Median total procedures per fellow was 9 (range 1-65, interquartile range [IQR] 13) with 6 (range 1-64, IQR 12) as primary and 3 (range 1-19, IQR 5) as first assistant. In 2013, 2 fellows logged a total of 5 procedures with 184 cases logged the following year by 16 fellows which remained stable to 2016 with 17 fellows logging 190 procedures. Of cases logged in 2014, 59.2% were logged as primary surgeon compared to 69.5% in 2016.
Conclusions
Since its introduction, the POEM procedure has been rapidly adapted by a stable number of fellows doing a consistent number of annual procedures. Fellow independence, however, has been increasing as demonstrated by the increasing percentage of fellows logging this case as primary surgeon.
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