Training Pathways for Minimally Invasive Gynecologic Surgery: An Analysis of Residencies and Matched FMIGS Trainees

INTRODUCTION: Residents are more likely to pursue fellowships in URPS and REI if their residency program is associated with an URPS or REI fellowship (Douglass et al 2024, Anderson et al 2024). Characteristics of FMIGS resident candidates and their background residency training are unknown. OBJECTIVE: To identify the residency training backgrounds of Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS) candidates and assess the characteristics of accredited residency programs. METHODS: This was an observational, cross-sectional study investigating characteristics of accredited OBGYN residency programs, co-location of gynecology fellowships and minimally invasive gynecologic surgery (MIGS) divisions, and background training characteristics of FMIGS matched applicants. Data were obtained from the publicly available list of ACGME obstetrics and gynecology (OBGYN) training programs and published rosters of FMIGS-matched resident candidates. RESULTS: As of 2024, there were 298 US-accredited OBGYN residencies and fellowship programs, including gynecologic oncology (n=74), urogynecology and reconstructive pelvic surgery (URPS) (n=58), reproductive endocrinology and infertility (REI) (n=51), and FMIGS (n=54). Of these gynecology subspecialties, most were co-located with a core OBGYN residency program including gynecologic oncology (70/74, 95%), URPS (55/58, 95%), REI (50/51, 98%), and FMIGS (48/54, 85%). Most residency programs did not have an affiliated fellowship including gynecologic oncology (228/298, 77%), URPS (243/298, 82%), REI (248/298, 83%), and less so FMIGS (252/298, 85%). Some residencies without an FMIGS training program had a MIGS division listed on their webpage (22/252, 9%). A total of 227 residents were identified as matched into FMIGS positions from 2022 to 2026. Of those, 140 candidates completed residency at either an institution that had an associated FMIGS program (121/227, 53%) or a MIGS division without a co-located FMIGS program (20/227, 9%). Thirty-one (14%) residents stayed at their institution for both residency and fellowship. In the last 5 years, 35% (104/298) of all US residencies have had at least one resident enter FMIGS training (range 0–8). CONCLUSIONS: Most gynecology subspecialty fellowships are co-located with core OBGYN residency programs, which facilitates integrated training and mentorship for residents. A majority of FMIGS fellows (53%) completed their residency at institutions that offered an FMIGS fellowship, suggesting that formal fellowship programs may play a crucial role in attracting candidates. The range of residents entering FMIGS training (0–8 per residency) points to variability in opportunities. Over the past 5 years, a notable percentage (35%) of all residencies had at least one resident enter FMIGS training, highlighting the growing interest and demand for this subspecialty. Unfortunately, FMIGS lags behind the ACGME-accredited fellowships in its presence among residency programs, suggesting a potential gap in advanced training opportunities and potentially impacting career trajectories for those interested in FMIGS.