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A Survey of Critical Care Education and Training in Surgery Residents: Will They Be Ready? D
374
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
(12.1%), versus resident lifestyle as the top concern after their rotation (18.2%). The 80-hour work week was not an influence in any decision for or against surgery. Conclusions: Students planning on applying for surgery indicated procedures, diseases treated, and personality matches as important considerations. Resident role models were cited more often as positive influence on the decision to apply to a surgical residency after a student’s rotation. The lifestyles of resident and attending surgeons were of greatest concern for those not entering surgery. The 80-hour work week did not factor into the decision-making process. 52.7. Comparison of General Surgery Research Resident Absite Scores to Their Clinical Peers Reveals Need for a General Surgery Curriculum during Dedicated Research Time. A. J. Russ, R. J. McDonald, A. Munoz, V. Rajamanickam, E. F. Foley; University of Wisconsin School of Medicine and Public Health, Madison, WI Background: Approximately 40% of surgical residents pursue one to three years of dedicated research during residency. Research residents continue to participate in didactic conferences, are occasionally responsible for patient care, and continue to take the American Board of Surgery In-training Exam (ABSITE) each year. Most programs have a dedicated research curriculum for these residents; however, many do not have a formal general surgery curriculum for research residents. We sought to compare research and clinical resident performance on the ABSITE to determine if there might be a need for a formal general surgery curriculum for research residents, to keep pace with their clinical peers. Methods: We conducted a retrospective, single institution analysis of ABSITE scores from the years 1997-2008. We analyzed two cohorts of residents: PG3 clinical residents (n ¼ 57) and residents doing dedicated research (n ¼ 26); i.e., each cohort had completed two clinical years. We compared each cohort’s mean percent correct on ‘‘Basic Science’’, ‘‘Clinical Management’’ and ‘‘Total’’ ABSITE questions. Linear mixed models were compared via likelihood ratio tests. All p-values are two-sided; p < 0.05 was used as the criterion for statistical significance. Results: Research residents averaged 68.6% correct on total ABSITE compared to 70.6% for clinical PG3s (p ¼ 0.04). On the clinical management portion of the ABSITE, averages are 68.9% vs. 72.2% (p ¼ 0.01), respectively. Conclusions: Our finding that research residents perform more poorly than their clinical peers on the ABSITE exam suggests that residents might benefit from an organized, formal general surgery curriculum during their research years. 52.8. Endoscopy Education in General Surgery Residencies: Meeting the New RRC Requirements. D. M. Vo, J. M. Gauvin, S. L. Chen; University of California, Davis, Medical Center, Sacramento, CA Introduction: The Residency Review Committee for General Surgery recently increased the number of endoscopy cases required from 30 cases to 85 cases per resident. We sought to evaluate how well programs were meeting the new guidelines and what adaptations were occurring in programs to meet the new requirements. Methods: A survey was sent to the program director listed for each ACGME accredited general surgery residency. Surveys were sent both by regular mail and e-mail with data collection occurring over 3 months. Data was collated and analyzed using Excel 2003 (Microsoft, Redmond, WA) and SPSS 17.0 (SPSS, SPSS, Chicago, IL). Results: 81 surveys out of 250 surveys were returned (24%). 52% of responding programs were university based with the majority being urban programs. 100% of programs responding were compliant with the old requirement, while 90% of respondents reported being compliant with the new RRC levels. 52% of programs utilized a dedicated rotation. The most commonly used setting being in private practices (75%). Among university based programs 70% reported having endoscopy experience at their university hospital and 60% reported having residents perform endoscopy in the private
practice setting. While virtually every program (98%) reported use of endoscopy suites or operating rooms (85%) for at least part of their endoscopy experience, only 64% reported performing endoscopy in their ICUs. An average of 63% of endoscopies were covered by surgeons to teach their residents and 45% of programs had at least half of their endoscopic procedures covered by non-surgeons. The mean number of endoscopies performed was 160 (range 55-450) which exceeded the mean number of endoscopies (88) that program directors believed were needed to gain privileges. The most commonly identified barriers to increasing endoscopy experience were work hour restrictions (39%) and referral patterns (43%). 23% of programs also identified faculty expertise as a barrier. Discussion: Most programs responding to our survey are already compliant with the new RRC requirement to increase endoscopy exposure in general surgery residencies. Much of this teaching occurs by nonsurgeons and commonly occurs away from the dominant teaching hospital of the program. Future changes in endoscopy requirements should consider the impact of increasing non-surgical teaching time as a consideration. It seems likely that non-responding programs have even lower numbers than those responding and may have an even higher barrier to successfully increasing endoscopy education by surgeons. 52.9. A Survey of Critical Care Education and Training in Surgery Residents: Will They Be Ready? D. S. Hui,1 A. L. Eastman,1 J. L. Lang,1 H. L. Frankel,2 T. O’Keeffe3; 1 University of Texas Southwestern Medical Center, Dallas, TX; 2Penn State University, Hershey, PA; 3University of Arizona, Tucson, AZ Introduction: The introduction of the 80-hour working week in surgical residencies has had far-reaching effects, including on surgical critical care (SCC) education. Time constraints, combined with a move toward greater intensivist involvement, have reduced learning opportunities for surgical residents in the ICU. This study attempts to describe resident opinions and experiences of current SCC education. Methods: An anonymous survey was administered at the end of the academic year to categorical general surgery residents in a large university-based, ACGME-approved training program. At our institution, all dedicated SCC rotations are finished by the end of PGY 3. A Likert scale was used for self-assessment of comfort level with managing various disease processes, to rate their SCC teaching, practical experiences, and satisfaction with their SCC education. Mean Likert scores are reported with standard deviations. Data were analyzed using SPSS 15.0. Results: The survey response rate was 78% (n ¼ 52). At the time of the survey, respondents had completed 9.3 6 4.5 weeks (range 4-20) of dedicated SCC training. Senior (PGY4 and 5) residents’ comfort levels with most common ICU problems were significantly greater than junior residents, despite no formal SCC rotations in their senior years. This was also true for most common ICU procedures. Mean number of weeks on SCC rotations was significantly different between PGY3’s and PGY4/5’s; 7.8 vs. 13.2 weeks. Residents reported that attending staff did most of the didactic teaching (76%) and they felt that they were the most effective (73%). In contrast, 78% reported that senior residents did most of the procedural teaching and the majority of residents (60%) felt that they were the most effective procedural teachers. Mean satisfaction with SCC education was 3.8 6 0.9, on a scale where 5 represented extremely satisfied, and most residents did not feel that further SCC education would be beneficial. When asked which profession should primarily manage critically ill surgery patients, the majority chose Surgeons with critical care fellowship training (69.2%), followed by surgeons (32.7%). Most surgery residents did not expect critical care management to form a significant part of their future practice, with 51.9% of residents anticipating it being less than 10%. Senior residents were more likely to consider a critical care fellowship (19% vs. 0%), with the addition of an acute care surgery component to fellowship training increasing interest by 28.8%. Conclusions: Senior residents appear comfortable managing critically ill patients despite the
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS lack of formal SCC rotations in their senior years. We noted a significant decline in time spent on the critical care service, which makes the formal SCC education of surgical residents more important than ever in view of the current time constraints on surgical education. Dedicated initiatives for SCC education may be necessary to bridge the gap as the amount of time that residents spend on critical care rotations decreases. Surgery residents wish their future patients to be cared for by surgical intensivists, although few expect to pursue this as a career. This suggests an additional subspecialty facing future physician shortages. 52.10. Is Laparoscopic Colorectal Experience Increasing for General Surgery Residents?. E. S. O’Connor, R. McDonald, C. P. Heise; University of Wisconsin, Madison, WI Purpose: Laparoscopic approaches in colorectal surgery are increasingly utilized to improve patient outcomes. However, proficiency in laparoscopy has a significant learning curve and requires completion of appropriate case volume. It is unclear how adoption of laparoscopy at an academic institution might impact general surgery resident training and case volume as both the faculty teaching and resident learning curves are addressed. The goal of this study is to evaluate trends in the laparoscopic colorectal experience reported by residents at an academic general surgery training program. Methods: For the fiscal years 2003-2009, Accreditation Council for Graduate Medical Education (ACGME) operative log data was queried to determine the number of open and laparoscopic colectomy procedures, identified by Current Procedural Terminology (CPT) codes, performed by residents at an academic general surgery residency program. Eligible cases were those recorded for credit by general surgery residents in their third, fourth, or fifth clinical post-graduate year (5 residents per year). During the same time period, administrative data was used to determine the total number of open and laparoscopic colectomy procedures billed by attending surgeons at the teaching hospitals at which residents reported cases. Linear regression was used to evaluate differences in the number of colectomy cases performed by residents, compared to general surgery division totals, as well as change over time in the proportion of laparoscopic colectomy cases performed. Results: The total number of colectomy procedures performed by the general surgery division increased significantly from 291 cases (2003) to 536 cases (2009, p ¼ 0.003). However, overall colectomy volume reported by PG3-5 residents did not change in that time period (244 vs. 293 cases, p ¼ 0.295). The proportion of laparoscopic colectomies increased for both the general surgery division (23% vs. 43%, p ¼ 0.016) and its residents (12% vs. 44%, p ¼ 0.004) between 2003 and 2009, and this trend did not differ between the two groups (p ¼ 0.274). Most resident laparoscopic cases between 2003 and 2009 were recorded in the roles of Surgeon Chief, Surgeon Junior, or Teaching Assistant (562 cases), with only 13 laparoscopic colectomy cases documented in the role of First Assistant during this seven-year period. Conclusions: Adoption of laparoscopic colectomy at an academic general surgery training program translates into changes in the operative learning experience for residents. While trainees today are not necessarily reporting more colectomies overall, a greater proportion of these cases are laparoscopic. In addition, residents log these cases in advanced roles, implying active involvement in the performance of the operation. Surgery residents at this program are exposed to more advanced colorectal procedures, which may reflect a growing trend toward minimally invasive colorectal surgery, and the increasing experience with and focus on laparoscopic training. 52.11. Is Endocrine Surgery Research Dying?. J. T. Adler H. Chen; University of Wisconsin, Madison, WI Background: Surgeon-scientists are uniquely positioned to make improvements in patient care. With stagnant NIH funding coupled with an increase in grant applications, government-sponsored endocrine surgery research may be declining. Furthermore, this may compromise the training of future surgical investigators who will advance
375
the treatment of endocrine disease. Thus, we evaluated if NIH-sponsored endocrine surgery research has decreased. Methods: Grant funding of all United States active and senior members of the AAES in 1998 and 2008 was obtained from the NIH Computer Retrieval of Information on Scientific Projects (CRISP) database. The data included the time periods from 1996-1998 and 2006-2008. All R, K, and T32 grants during these time periods were abstracted, and endocrine surgery specific research excluded exocrine pancreas and breast research. Results: There were 210 and 260 active and senior members in 1998 and 2008, respectively. From 2006-2008, fewer members (8% vs. 13%, P ¼ 0.05) had NIH funding for all research compared to 1996-1998, and fewer members (3% vs. 6%, P ¼ 0.05) were funded for endocrine surgery research. However, the average number of grants per funded member did not decrease for all research (1.3 6 0.1 vs. 1.3 6 0., P ¼ 0.99) or endocrine surgery research (1.2 6 0.1 vs. 1.1 6 0.1, P ¼ 0.95). Of 22 members who had funding from 19961998, only 8 (33%) maintained funding in 2006-2008. Of the 13 members who had funding for endocrine surgery research, only 4 (33%) maintained funding. Conclusions: Overall, fewer AAES members have funding after a ten-year period. Those that formerly had funding lost funding, but it is important to note that the average number of grants per funded member is the same. This may suggest that investigators are able to obtain and maintain funding once established, but fewer investigators are able to achieve this funding. Therefore, endocrine surgery training programs must continue to emphasize the development of future surgeon-scientists. 52.12. Does Timing of Operative Care during Fellowship Training Impact Patient Care? N. Agee, P. N. Montero, W. W. Hope, A. E. Lincourt, K. W. Kercher, D. Stefanidis, B. T. Heniford; Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, NC Introduction: It has been reported that during the weeks or months immediately following the transition of surgical residents to the next graduate level, there is significant negative impact in patient outcomes, including an increase in patient mortality. Despite the dramatic increase in popularity of post-surgical training, no previous studies have documented the safety and outcomes of patients treated by surgical fellows in their transition to fellowship from residency. The aim of this study was to examine the outcomes of patients treated by fellows who underwent laparoscopic colectomy and to determine if there is a distinction in outcomes in the beginning versus the end of the academic year. Methods: For this study, data was analyzed from a prospective IRB approved database for laparoscopic colon resections completed in a MIS program between 1999 and 2009. Patient demographics and outcome variables including operating room (OR) time, lymph nodes resected, transfusion requirements, post-operative and intra-operative complications, and hospital length of stay were reviewed. Cases performed during the first months (July through September) and last months (March through May) of the fellowship training cycle were compared. Standard statistical analysis was performed with a p value of <0.05 considered significant. Results: Our data included analysis of 232 laparoscopic colectomies (116 in early training and 116 in late training). Pre-operative parameters such as age, ASA, and BMI were statistically similar between patients undergoing surgery during the two time intervals. Operative time was similar between the early and late time intervals. Post-operative outcomes including length of stay, transfusion requirements, and complications were also similar between the early and late cohorts of patients (Table 1). No deaths occurred during the two time intervals. The number of lymph nodes harvested was similar for surgeries performed early and late in fellowship training (16.37 and 17.38, respectively. p ¼ 0.84). Conclusions: Graduated operative responsibility in laparoscopic colon resections performed during fellowship training can be effectively achieved without a compromise to the quality of operation, operative duration or adequacy of cancer staging. Despite the advanced nature of these technically demanding operations, pre-requisite training in general surgery likely minimizes the risk of error due to inexperience.
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS
(12.1%), versus resident lifestyle as the top concern after their rotation (18.2%). The 80-hour work week was not an influence in any decision for or against surgery. Conclusions: Students planning on applying for surgery indicated procedures, diseases treated, and personality matches as important considerations. Resident role models were cited more often as positive influence on the decision to apply to a surgical residency after a student’s rotation. The lifestyles of resident and attending surgeons were of greatest concern for those not entering surgery. The 80-hour work week did not factor into the decision-making process. 52.7. Comparison of General Surgery Research Resident Absite Scores to Their Clinical Peers Reveals Need for a General Surgery Curriculum during Dedicated Research Time. A. J. Russ, R. J. McDonald, A. Munoz, V. Rajamanickam, E. F. Foley; University of Wisconsin School of Medicine and Public Health, Madison, WI Background: Approximately 40% of surgical residents pursue one to three years of dedicated research during residency. Research residents continue to participate in didactic conferences, are occasionally responsible for patient care, and continue to take the American Board of Surgery In-training Exam (ABSITE) each year. Most programs have a dedicated research curriculum for these residents; however, many do not have a formal general surgery curriculum for research residents. We sought to compare research and clinical resident performance on the ABSITE to determine if there might be a need for a formal general surgery curriculum for research residents, to keep pace with their clinical peers. Methods: We conducted a retrospective, single institution analysis of ABSITE scores from the years 1997-2008. We analyzed two cohorts of residents: PG3 clinical residents (n ¼ 57) and residents doing dedicated research (n ¼ 26); i.e., each cohort had completed two clinical years. We compared each cohort’s mean percent correct on ‘‘Basic Science’’, ‘‘Clinical Management’’ and ‘‘Total’’ ABSITE questions. Linear mixed models were compared via likelihood ratio tests. All p-values are two-sided; p < 0.05 was used as the criterion for statistical significance. Results: Research residents averaged 68.6% correct on total ABSITE compared to 70.6% for clinical PG3s (p ¼ 0.04). On the clinical management portion of the ABSITE, averages are 68.9% vs. 72.2% (p ¼ 0.01), respectively. Conclusions: Our finding that research residents perform more poorly than their clinical peers on the ABSITE exam suggests that residents might benefit from an organized, formal general surgery curriculum during their research years. 52.8. Endoscopy Education in General Surgery Residencies: Meeting the New RRC Requirements. D. M. Vo, J. M. Gauvin, S. L. Chen; University of California, Davis, Medical Center, Sacramento, CA Introduction: The Residency Review Committee for General Surgery recently increased the number of endoscopy cases required from 30 cases to 85 cases per resident. We sought to evaluate how well programs were meeting the new guidelines and what adaptations were occurring in programs to meet the new requirements. Methods: A survey was sent to the program director listed for each ACGME accredited general surgery residency. Surveys were sent both by regular mail and e-mail with data collection occurring over 3 months. Data was collated and analyzed using Excel 2003 (Microsoft, Redmond, WA) and SPSS 17.0 (SPSS, SPSS, Chicago, IL). Results: 81 surveys out of 250 surveys were returned (24%). 52% of responding programs were university based with the majority being urban programs. 100% of programs responding were compliant with the old requirement, while 90% of respondents reported being compliant with the new RRC levels. 52% of programs utilized a dedicated rotation. The most commonly used setting being in private practices (75%). Among university based programs 70% reported having endoscopy experience at their university hospital and 60% reported having residents perform endoscopy in the private
practice setting. While virtually every program (98%) reported use of endoscopy suites or operating rooms (85%) for at least part of their endoscopy experience, only 64% reported performing endoscopy in their ICUs. An average of 63% of endoscopies were covered by surgeons to teach their residents and 45% of programs had at least half of their endoscopic procedures covered by non-surgeons. The mean number of endoscopies performed was 160 (range 55-450) which exceeded the mean number of endoscopies (88) that program directors believed were needed to gain privileges. The most commonly identified barriers to increasing endoscopy experience were work hour restrictions (39%) and referral patterns (43%). 23% of programs also identified faculty expertise as a barrier. Discussion: Most programs responding to our survey are already compliant with the new RRC requirement to increase endoscopy exposure in general surgery residencies. Much of this teaching occurs by nonsurgeons and commonly occurs away from the dominant teaching hospital of the program. Future changes in endoscopy requirements should consider the impact of increasing non-surgical teaching time as a consideration. It seems likely that non-responding programs have even lower numbers than those responding and may have an even higher barrier to successfully increasing endoscopy education by surgeons. 52.9. A Survey of Critical Care Education and Training in Surgery Residents: Will They Be Ready? D. S. Hui,1 A. L. Eastman,1 J. L. Lang,1 H. L. Frankel,2 T. O’Keeffe3; 1 University of Texas Southwestern Medical Center, Dallas, TX; 2Penn State University, Hershey, PA; 3University of Arizona, Tucson, AZ Introduction: The introduction of the 80-hour working week in surgical residencies has had far-reaching effects, including on surgical critical care (SCC) education. Time constraints, combined with a move toward greater intensivist involvement, have reduced learning opportunities for surgical residents in the ICU. This study attempts to describe resident opinions and experiences of current SCC education. Methods: An anonymous survey was administered at the end of the academic year to categorical general surgery residents in a large university-based, ACGME-approved training program. At our institution, all dedicated SCC rotations are finished by the end of PGY 3. A Likert scale was used for self-assessment of comfort level with managing various disease processes, to rate their SCC teaching, practical experiences, and satisfaction with their SCC education. Mean Likert scores are reported with standard deviations. Data were analyzed using SPSS 15.0. Results: The survey response rate was 78% (n ¼ 52). At the time of the survey, respondents had completed 9.3 6 4.5 weeks (range 4-20) of dedicated SCC training. Senior (PGY4 and 5) residents’ comfort levels with most common ICU problems were significantly greater than junior residents, despite no formal SCC rotations in their senior years. This was also true for most common ICU procedures. Mean number of weeks on SCC rotations was significantly different between PGY3’s and PGY4/5’s; 7.8 vs. 13.2 weeks. Residents reported that attending staff did most of the didactic teaching (76%) and they felt that they were the most effective (73%). In contrast, 78% reported that senior residents did most of the procedural teaching and the majority of residents (60%) felt that they were the most effective procedural teachers. Mean satisfaction with SCC education was 3.8 6 0.9, on a scale where 5 represented extremely satisfied, and most residents did not feel that further SCC education would be beneficial. When asked which profession should primarily manage critically ill surgery patients, the majority chose Surgeons with critical care fellowship training (69.2%), followed by surgeons (32.7%). Most surgery residents did not expect critical care management to form a significant part of their future practice, with 51.9% of residents anticipating it being less than 10%. Senior residents were more likely to consider a critical care fellowship (19% vs. 0%), with the addition of an acute care surgery component to fellowship training increasing interest by 28.8%. Conclusions: Senior residents appear comfortable managing critically ill patients despite the
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS lack of formal SCC rotations in their senior years. We noted a significant decline in time spent on the critical care service, which makes the formal SCC education of surgical residents more important than ever in view of the current time constraints on surgical education. Dedicated initiatives for SCC education may be necessary to bridge the gap as the amount of time that residents spend on critical care rotations decreases. Surgery residents wish their future patients to be cared for by surgical intensivists, although few expect to pursue this as a career. This suggests an additional subspecialty facing future physician shortages. 52.10. Is Laparoscopic Colorectal Experience Increasing for General Surgery Residents?. E. S. O’Connor, R. McDonald, C. P. Heise; University of Wisconsin, Madison, WI Purpose: Laparoscopic approaches in colorectal surgery are increasingly utilized to improve patient outcomes. However, proficiency in laparoscopy has a significant learning curve and requires completion of appropriate case volume. It is unclear how adoption of laparoscopy at an academic institution might impact general surgery resident training and case volume as both the faculty teaching and resident learning curves are addressed. The goal of this study is to evaluate trends in the laparoscopic colorectal experience reported by residents at an academic general surgery training program. Methods: For the fiscal years 2003-2009, Accreditation Council for Graduate Medical Education (ACGME) operative log data was queried to determine the number of open and laparoscopic colectomy procedures, identified by Current Procedural Terminology (CPT) codes, performed by residents at an academic general surgery residency program. Eligible cases were those recorded for credit by general surgery residents in their third, fourth, or fifth clinical post-graduate year (5 residents per year). During the same time period, administrative data was used to determine the total number of open and laparoscopic colectomy procedures billed by attending surgeons at the teaching hospitals at which residents reported cases. Linear regression was used to evaluate differences in the number of colectomy cases performed by residents, compared to general surgery division totals, as well as change over time in the proportion of laparoscopic colectomy cases performed. Results: The total number of colectomy procedures performed by the general surgery division increased significantly from 291 cases (2003) to 536 cases (2009, p ¼ 0.003). However, overall colectomy volume reported by PG3-5 residents did not change in that time period (244 vs. 293 cases, p ¼ 0.295). The proportion of laparoscopic colectomies increased for both the general surgery division (23% vs. 43%, p ¼ 0.016) and its residents (12% vs. 44%, p ¼ 0.004) between 2003 and 2009, and this trend did not differ between the two groups (p ¼ 0.274). Most resident laparoscopic cases between 2003 and 2009 were recorded in the roles of Surgeon Chief, Surgeon Junior, or Teaching Assistant (562 cases), with only 13 laparoscopic colectomy cases documented in the role of First Assistant during this seven-year period. Conclusions: Adoption of laparoscopic colectomy at an academic general surgery training program translates into changes in the operative learning experience for residents. While trainees today are not necessarily reporting more colectomies overall, a greater proportion of these cases are laparoscopic. In addition, residents log these cases in advanced roles, implying active involvement in the performance of the operation. Surgery residents at this program are exposed to more advanced colorectal procedures, which may reflect a growing trend toward minimally invasive colorectal surgery, and the increasing experience with and focus on laparoscopic training. 52.11. Is Endocrine Surgery Research Dying?. J. T. Adler H. Chen; University of Wisconsin, Madison, WI Background: Surgeon-scientists are uniquely positioned to make improvements in patient care. With stagnant NIH funding coupled with an increase in grant applications, government-sponsored endocrine surgery research may be declining. Furthermore, this may compromise the training of future surgical investigators who will advance
375
the treatment of endocrine disease. Thus, we evaluated if NIH-sponsored endocrine surgery research has decreased. Methods: Grant funding of all United States active and senior members of the AAES in 1998 and 2008 was obtained from the NIH Computer Retrieval of Information on Scientific Projects (CRISP) database. The data included the time periods from 1996-1998 and 2006-2008. All R, K, and T32 grants during these time periods were abstracted, and endocrine surgery specific research excluded exocrine pancreas and breast research. Results: There were 210 and 260 active and senior members in 1998 and 2008, respectively. From 2006-2008, fewer members (8% vs. 13%, P ¼ 0.05) had NIH funding for all research compared to 1996-1998, and fewer members (3% vs. 6%, P ¼ 0.05) were funded for endocrine surgery research. However, the average number of grants per funded member did not decrease for all research (1.3 6 0.1 vs. 1.3 6 0., P ¼ 0.99) or endocrine surgery research (1.2 6 0.1 vs. 1.1 6 0.1, P ¼ 0.95). Of 22 members who had funding from 19961998, only 8 (33%) maintained funding in 2006-2008. Of the 13 members who had funding for endocrine surgery research, only 4 (33%) maintained funding. Conclusions: Overall, fewer AAES members have funding after a ten-year period. Those that formerly had funding lost funding, but it is important to note that the average number of grants per funded member is the same. This may suggest that investigators are able to obtain and maintain funding once established, but fewer investigators are able to achieve this funding. Therefore, endocrine surgery training programs must continue to emphasize the development of future surgeon-scientists. 52.12. Does Timing of Operative Care during Fellowship Training Impact Patient Care? N. Agee, P. N. Montero, W. W. Hope, A. E. Lincourt, K. W. Kercher, D. Stefanidis, B. T. Heniford; Carolinas Laparoscopic and Advanced Surgery Program, Charlotte, NC Introduction: It has been reported that during the weeks or months immediately following the transition of surgical residents to the next graduate level, there is significant negative impact in patient outcomes, including an increase in patient mortality. Despite the dramatic increase in popularity of post-surgical training, no previous studies have documented the safety and outcomes of patients treated by surgical fellows in their transition to fellowship from residency. The aim of this study was to examine the outcomes of patients treated by fellows who underwent laparoscopic colectomy and to determine if there is a distinction in outcomes in the beginning versus the end of the academic year. Methods: For this study, data was analyzed from a prospective IRB approved database for laparoscopic colon resections completed in a MIS program between 1999 and 2009. Patient demographics and outcome variables including operating room (OR) time, lymph nodes resected, transfusion requirements, post-operative and intra-operative complications, and hospital length of stay were reviewed. Cases performed during the first months (July through September) and last months (March through May) of the fellowship training cycle were compared. Standard statistical analysis was performed with a p value of <0.05 considered significant. Results: Our data included analysis of 232 laparoscopic colectomies (116 in early training and 116 in late training). Pre-operative parameters such as age, ASA, and BMI were statistically similar between patients undergoing surgery during the two time intervals. Operative time was similar between the early and late time intervals. Post-operative outcomes including length of stay, transfusion requirements, and complications were also similar between the early and late cohorts of patients (Table 1). No deaths occurred during the two time intervals. The number of lymph nodes harvested was similar for surgeries performed early and late in fellowship training (16.37 and 17.38, respectively. p ¼ 0.84). Conclusions: Graduated operative responsibility in laparoscopic colon resections performed during fellowship training can be effectively achieved without a compromise to the quality of operation, operative duration or adequacy of cancer staging. Despite the advanced nature of these technically demanding operations, pre-requisite training in general surgery likely minimizes the risk of error due to inexperience.