1244 Neurosurgery Fellowships and the Residencies that Enfold Them: A Nationwide Correlational Analysis

INTRODUCTION: Accredited neurosurgery fellowship training is available in 10 subspecialties, and fellowships can sometimes be completed during the PGY7 residency year. However, residency curriculum structure to support this activity is highly variable across training programs. METHODS: Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from ACGME and CAST, respectively. Information about residency curricula was obtained electronically from each training program and used for correlational analysis of residency and fellowship training characteristics at each program. RESULTS: The total number of neurosurgery fellowship positions available per year (352) is higher than the total number of residency positions (240). Eighty-three of the 117 institutions with a neurosurgery residency offer at least one fellowship, and 37 of these have more fellowships than graduating residents. Thirty-eight residencies include a formal option for fellowship completion during the PGY7 year, but six of these do not offer any local fellowships. Programs with a PGY7 fellowship option have significantly more fellowship programs than those using a traditional PGY7 chief model (2.4 vs 1.6, p<0.05). The resident complement at each program correlates with number of fellowships offered (r^2=.56, p<0.05) but not the option for PGY7 fellowship training. There is substantial regional variation in ratio of fellowships to residency programs, highest in the west (2.3:1) and lowest in the south (1:1). CONCLUSIONS: The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training.