AHPBA senior leaders’ assessments of strengths, weaknesses, opportunities, and threats facing fellowship training in HPB surgery: “We need to standardize our training experiences”

Published:September 30, 2022DOI:



      Multiple fellowship programs in North America prepare surgeons for a career in Hepato-Pancreatico-Biliary (HPB) surgery. Inconsistent operative experiences and disease process exposures across programs and pathways produces variability in training product and therefore, lack of clarity around what trained HPB surgeons are prepared to do in early practice. Thus, a strengths, weaknesses, opportunities, and threats (SWOT) analysis of AHPBA fellowship training was conducted.


      This was a mixed-methods, cross-sectional study. Eleven AHPBA-Founding Members (FM) and 24 current or former Program Directors (PD) of programs eligible for AHPBA certificates were surveyed and interviewed. Grounded theory principles and thematic network analysis were used to analyze interview transcripts. Descriptive statistics were used to analyze survey data.


      Three main themes were identified: (i) Concern for training rigor and consistency (ii) Desire to standardize curricula and broaden training requirements and, (iii) Need to validate both the value of training and job marketability via certification.


      Based on the themes identified, the strengths of AHPBA-certified HPB programs include superior technical training and case volumes. Areas of improvement included elevating baseline competencies by increasing required case volume and breadth to ensure minimally invasive experience, operative autonomy, and multidisciplinary care coordination.
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        • Jeyarajah D.R.
        • Abouljoud M.
        • Alseidi A.A.
        • Russell B.
        • D'Angelica M.
        • Hagopian E.
        • et al.
        Training paradigms in hepato-pancreatico-biliary surgery: an overview of the different fellowship pathways.
        J Gastrointest Surg. 2021; 25: 2119-2128
        • Warner S.G.
        • Alseidi A.A.
        • Hong J.
        • Pawlik T.M.
        • Minter R.M.
        What to expect when you’re expecting a hepatopancreatobiliary surgeon: self-reported experiences of HPB surgeons from different training pathways.
        HPB. 2015; 17: 785-790
        • Chapman A.L.
        • Hadfield M.
        • Chapman C.J.
        Qualitative research in healthcare: an introduction to grounded theory using thematic analysis.
        J R Coll Physicians Edinb. 2015; 45: 201-205
        • Berthelsen C.B.
        • Grimshaw-Aagaard S.
        • Hansen C.
        Developing a guideline for reporting and evaluating grounded theory research studies (GUREGT).
        Int J Health Sci. 2018; 6: 13
        • Jackson T.
        • Lim J.S.
        • Nagatomo K.
        • Darwish M.
        • Cho E.E.
        • Osman H.
        • et al.
        Investigating factors at play in hepatopancreatobiliary fellowship selection: beliefs versus reality.
        World J Surg. 2021; 45: 2556-2566
        • Day A.L.
        • Siddiqui A.H.
        • Meyers P.M.
        • Jovin T.G.
        • Derdeyn C.P.
        • Hoh B.L.
        • et al.
        Training standards in neuroendovascular surgery: program accreditation and practitioner certification.
        Stroke. 2017; 48: 2318-2325
        • Silvestre J.
        • Serletti J.M.
        • Chang B.
        Trends in accreditation Council for graduate medical education accreditation for subspecialty fellowship training in plastic surgery.
        Plast Reconstr Surg. 2018; 141: 768e-774e
        • Bilgic E.
        • Valanci-Aroesty S.
        • Fried G.M.
        Video assessment of surgeons and surgery.
        Adv Surg. 2020; 54: 205-214
        • Sell N.M.
        • Cassidy D.J.
        • McKinley S.K.
        • Petrusa E.
        • Gee D.W.
        • Antonoff M.B.
        • et al.
        A needs assessment of video-based education resources among general surgery residents.
        J Surg Res. 2021; 263: 116-123
        • Matsuda T.
        • Kanayama H.
        • Ono Y.
        • Kawauchi A.
        • Mizoguchi H.
        • Nakagawa K.
        • et al.
        Reliability of laparoscopic skills assessment on video: 8-year results of the endoscopic surgical skill qualification system in Japan.
        J Endourol. 2014; 28: 1374-1378
        • Kogon B.
        • Karamlou T.
        • Baumgartner W.
        • Merrill W.
        • Backer C.
        Congenital cardiac surgery fellowship training: a status update.
        J Thorac Cardiovasc Surg. 2016; 151: 1488-1495