Table 3A.

Open-ended responses to the question “describe the strengths/deficits of residency training for fellowship” (48 comments).

Impact of obstetrics training (8.3%)

“Too much obstetrics”

“High volume of ob made it difficult to focus more on subspecialties”

“I felt like I was in a very obstetrics-heavy program, which I would have preferred to have more time in gyn-related rotations.”

“Difficult high risk OB service helped train me to be calm in bad situations.”

Not enough exposure to research (8.3%)

“Exposure to basic and translational research techniques is limited during residency as it is very difficult to structure adequate time to complete wet lab experiments. Most of these skills were acquired in fellowship.”

“However, the down side of residency without associated fellowships is that my basic science research background was lacking.”

“…I felt less well prepared from academic standpoint regarding research and scientific writing.”

Not enough mentoring (6.2%)

“Deficits: no fellowships at our program and minimal guidance in pursuing a fellowship, met the minimum requirements for research exposure, which is not enough for a desire to pursue fellowship”

“I had no fellows in my residency program, which was detrimental when applying to fellowship because my program was not in tune with the application process/didn't realize how important they were in the match process by making phone calls etc. I felt there was little guidance and little mentorship in what academic gyn oncology could be.”

“Deficits: I came into residency already wanting to do gynecologic oncology, but I still feel my mentorship during residency could have been more fostering.”

Deficient in GO knowledge/clinical management (12.5%)

“Content of gyn onc on my rotations were lacking but surgical skills/experience were above average”

“I was unprepared in my understanding of gynecologic oncology literature and management.”

“We didn't have a gyn/oncologist until I was a 3rd year, very slow service. So… no tumor board/evidence based discussion of guidelines, etc.”

“We did not do any chemotherapy or chemotherapy-related side effect management during residency since our Gyn Oncologists did not administer chemotherapy.”

Not enough surgery (22.9%)

“Due in part to low operative volume and sharing cases with fellows, I had limited opportunities for autonomous decision making in the OR, and with taking a junior trainee through the case.”

“Not enough surgical cases, attendings constantly took away cases from the resident and did them themselves or called for help.”

“My attendings on gyn and gyn onc in residency seemed unsure of themselves and this often trickled down to the residents. Because they were unsure of themselves they often called in for help which meant less operative time for me.”

“Robotic and laparoscopic surgical training could have been stronger prior to fellowship.”

“Deficits: I did not get enough robotics training in residency to be ready for robotic oncology cases.”

“Minimal robot experience and laparoscopic experience”

“low surgical volume, minimal robotic training. Almost no minimally invasive vaginal cuff closure or laparoscopic suturing.”

“Limited surgical training - > feeling like I had to ‘start over’ in fellowship (at a different institution)”

“There are currently very few opportunities for residents to actively make intraoperative decisions especially regarding complications. Residents are most often being led through the steps of the operation by fellows or faculty. Increased simulation would provide the opportunity to increase these opportunities without compromising patient safety, but the realities of the burden of the electronic medical record and time required to provide patient care, limit the time residents can spend doing activities like simulation.”

“I wish we had more one-on-one time in the OR with our onc attendings during residency”

Not enough exposure to feel prepared to care for large service (6.2%)

“The expectation for fellowship is very clinically competent with little instruction given. Fellows who did not have much clinical experience really struggle to manage fellow responsibilities.”

“We didn't have a gyn/oncologist until I was a 3rd year, very slow service… just didn't have the exposure to be ready for a very busy clinical service with multiple complicated/sick patients.”

“The patient load was much smaller in residency- so very quickly had to develop the skills/organization to care for 25–30 patients compared to the 8–12 patient services I was used to in residency”

Impact of fellows (16.7%)

“My residency did not have any fellowships associated with it which was great for developing surgical skills. I was able to actively develop surgical skills instead of observe/retracting for a fellow.”

“We did, however have high surgical volume and no fellows, so lots of experience as first assist on big cases.”

“Helpful that I trained at a residency where there was a very strong fellowship program, but residents were still given a lot of autonomy both on and off onc rotations regarding patient care management”

“When I started my residency, we did not have a fellowship, and I think this is why I was so prepared for fellowship. The fellowship started in my chief year, and it was immediately apparent that a surgical fellowship takes cases from residents. it's a self perpetuating cycle - residents who train at programs with fellowships are more likely to match, but they are less likely to be able to do a hyst, so as a fellow they end up doing resident level cases in order to ‘catch up’”

“The strengths of a residency without fellows was that I was performing high level complexity cases as a resident that would normally be reserved for a fellow. I was managing the intra-, post-operative complications as a resident, which very much prepared me for handling these situations as a fellow.”

“I had no fellows in my residency program, which was detrimental when applying to fellowship because my program was not in tune with the application process/didn't realize how important they were in the match process by making phone calls etc. I felt there was little guidance and little mentorship in what academic gyn oncology could be. The residents in my fellowship program had a completely different experience and were mentored and supported from a very early stage. Surgically there are some downsides in being at a program with a fellowship - as the fellow I was assisting the attending in the nodes/debulkings and leaving the hysterectomies to the residents. This was helpful to me (the fellow) later on in learning how to teach as an attending, but as a resident, comparatively, I did gain a lot more experience surgically than my residents.:

“Residency training: fellows took priority over residents in surgical education. Did not have many opportunities to operate more independently with just fellow or attending.”