Current perspectives of gynecologic oncology fellowship training and preparedness for practice

Objectives: The field of gynecologic oncology practice has evolved over decades, yet there is little known on how current fellowships are preparing gynecologic oncologists for practice in the era of these changes. Thus, we sought to investigate gynecologic oncology fellowship graduates’ training experience and preparedness for practice following fellowship. Methods: This is a cross-sectional web-based survey study using REDCap, an electronic web-based application. We surveyed members of the Society of Gynecologic Oncology (SGO) who graduated from gynecologic oncology fellowship in 2015-2020. Email invitations to participate were sent with de-identified survey links. The survey included 51 questions assessing fellowship training experiences and level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies, including chemotherapy, immunotherapy, and PARP inhibitors. Additional questions addressed factors driving participants’ selection of fellowship programs, education experience, research and preparedness for independent practice. Descriptive statistics were used for analyses. Results: A total of 297 SGO members were invited to participate, one was excluded due to a non-working email. The response rate was 43.9% (n=130) and n=123 completed surveys were included for final analysis. Over half (55.2% n=68) of responders were in their first 3 years of independent practice. The highest ranked factor for fellowship selection was fit with program (36.6% n=45) followed by surgical volume (29.3% n=36). Upon completing fellowship, most were uncomfortable performing radical surgeries in ureteral conduit formation (83.8% n=103), ureteroneocystostomy (76.4% n=94), exenteration (67.5%, n=83), splenectomy (66.7% n=83) and lower anterior bowel resection (41.5%, n=51). Most were comfortable managing intraoperative complications (84.5% n=104) and obstetrical hemorrhages (88.6% n=109), as well as standard open and minimally invasive staging (range: 61%-99.2%). More than half of those who did not have off-service surgical rotations in fellowship indicated they would have wanted rotations in surgical oncology (58% n=58), urology (57% n=59) and colorectal surgery (71.5% n=73) in fellowship training. Majority of respondents (91.1% n=112) used cancer-directed therapies in their current practice and were most uncomfortable managing immunotherapy side effects (30.1% n=37). Over a third (34.1% n=42) were somewhat or not confident that their fellowship thesis project will be suitable for oral boards defense and 22.8% (n=28) were unprepared to continue research in their career. Upon completing fellowship, 77.2% (n=95) report having mentorship that met their expectations during fellowship and 94.4% (n=116) overall were prepared for independent practice as gynecologic oncologists. Conclusions: Majority of recent gynecologic oncology fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures. However, most are not comfortable with radical gynecologic oncology surgeries; for this reason mentorship in early gynecologic oncology faculty development remains important. Many graduates also desired incorporating non-gynecologic oncology surgery service experience during fellowship, which could help supplement this discrepancy for less common procedures.