SAGES Advanced GI/MIS fellowship redesign: pilot results and adoption of new standards

Introduction: SAGES is responsible for defining educational content for Advanced GI/MIS fellowships administered through the fellowship council (FC). In Fall 2016, to better define core content contained in these fellowships, SAGES proposed new case log criteria including minimum volumes within six defined categories. To test feasibility of these criteria, SAGES conducted a pilot study during the 2017–2018 academic year. Methods: Advanced GI/MIS fellowship programs directors (PD’s) who also held leadership roles in SAGES were invited to participate in the pilot. Fourteen programs including 17 fellows volunteered. To assess generalizability, 2016–2017 case log data for the volunteered pilot programs were compared to all other advanced GI/MIS programs (n = 92). To assess feasibility of the new criteria, pilot programs’ 2017–2018 case logs were compared to 3 years of historical fellows’ case logs (n = 326). Fisher’s exact test was used for comparisons with p < 0.05 considered significant. Results: Complete data were available for 16 pilot fellows (median 251.5 advanced MIS cases and 62.5 endoscopies per fellow). According to 2016–2017 data, pilot programs were not statistically different from non-pilot programs regarding achievement of any defined category minimum. Compared to historical controls, the 2017–2018 pilot fellows were significantly more likely to meet the defined category minimum for foregut cases and demonstrated a non-significant trend toward higher achievement of minimums for bariatrics, inguinal hernia, ventral hernia, and endoscopy. Pilot fellows were significantly less likely to meet the minimum for HPB/solid organ/colorectal/thoracic cases. Based on these data, SAGES eliminated the HPB/solid organ/colon/thoracic category and, in partnership with the FC, approved staged implementation of the remaining criteria over 3 years. Conclusions: The pilot study provided feasibility and generalizability evidence that allowed inclusion of appropriate defined categories for establishment of the new Advance GI/MIS fellowship criteria. We anticipate that the revised criteria will enhance the educational benefit of these fellowships.