Hepato-pancreato-biliary training in general surgery residency: is it enough for the real world?

BackgroundAdvanced training in hepato-pancreato-biliary (HPB) surgery is available at select centers. No approved fellowships have yet been established.ObjectiveTo determine the level of training in HPB surgery during general surgery residency and to assess the need for additional training.MethodAll general surgical residency programs in the United States were surveyed. Resident Review Committee (RRC) and International Hepato-Pancreato-Biliary Association (IHPBA) requirements were compared to Accreditation Council of Graduate Medical Education (ACGME) data.ResultsEighty of 250 general surgical residency programs (32%) responded to the survey. Eighty percent felt their graduating residents had sufficient HPB training. The average number of pancreatic cases per graduating resident was 10.2 ± 7.3. The average number of hepatic resections was 8.6 ± 5.1, and for complex biliary cases, 5.3 ± 1.3.ConclusionsA significant portion of HPB surgery is performed at transplant centers or by HPB surgeons. Guidelines must be established to assure adequate training. When HPB surgery is the main focus of the future practice, residents should seek additional training.