• M J Johnston, P Singh, P H Pucher, J E F Fitzgerald, R Aggarwal, S Arora, and A Darzi.
• Patient Safety Translational Research Centre, Department of Surgery and Cancer, London, UK.
• Br J Surg. 2015 Sep 1;102(10):1156-66.

BackgroundThe number of surgeons entering fellowship training before independent practice is increasing. This may have a negative impact on surgeons in training. The impact of fellowship training on patient outcomes is not yet known. This review aimed to investigate the impact of fellowship training in surgery on patient outcomes.MethodsA systematic review of the literature was conducted to identify studies exploring the structural and surgeon-specific characteristics of fellowship training on patient outcomes. Data from these studies were extracted, synthesized and reported qualitatively, or quantitatively through meta-analysis.ResultsTwenty-three studies were included. The mortality rate for patients in centres with an affiliated fellowship programme was lower than that for centres without (odds ratio 0.86, 95 per cent c.i. 0.84 to 0.88), as was the rate of complications (odds ratio 0.90, 0.78 to 1.02). Surgeons without fellowship training converted more laparoscopic operations to open surgery than those with fellowship training (risk ratio (RR) 1.04, 95 per cent c.i. 1.03 to 1.05). Comparison of outcomes for senior surgeons versus current fellows showed no differences in rates of mortality (RR 1.00, 1.00 to 1.01), complications (RR 1.03, 0.98 to 1.08) or conversion to open surgery (RR 1.01, 1.00 to 1.01).ConclusionFellowship training appears to have a positive impact on patient outcomes.© 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

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