ACGME Accreditation of Orthopaedic Surgery Subspecialty Fellowship Training Programs.

BACKGROUND: Orthopaedic surgery training in the United States consists of a five-year-minimum orthopaedic surgery residency program, followed by optional subspecialty fellowship training. There is an increasing trend for trainees to complete at least one fellowship program following residency training, with approximately 90% of current trainees planning to complete a fellowship. The purpose of this investigation was to assess the overall variability of orthopaedic subspecialty fellowships in terms of characteristics, match process, and the tendency to be accredited by the Accreditation Council for Graduate Medical Education.

METHODS: Nine orthopaedic surgery subspecialties were assessed for their fellowship match program, their number of fellowship programs and positions in the match, and the number of programs and positions accredited by the Accreditation Council for Graduate Medical Education. Programs with a Subspecialty Certificate offered by the American Board of Orthopaedic Surgery were compared with programs without a Subspecialty Certificate. Comparative statistics utilizing an unpaired t test with a statistical cutoff of p < 0.05 were performed.

RESULTS: Three separate matching programs are used by the nine subspecialties. Hand surgery utilizes the National Residents Matching Program, shoulder and elbow surgery utilizes the American Shoulder and Elbow Surgeons Fellowship Match, and the other seven subspecialties utilize the San Francisco Matching Program. In total, 478 fellowship programs were identified, representing 897 fellowship positions. The highest percentage of fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education was in orthopaedic sports medicine (93.1%), compared with the lowest percentage in foot and ankle orthopaedics (16.3%). A significantly higher percentage (p < 0.05) of fellowship programs accredited by the Accreditation Council for Graduate Medical Education were found for subspecialties with American Board of Orthopaedic Surgery Subspecialty Certificates (hand and sports) (87.9%) compared with subspecialties without Subspecialty Certificates (34.3%).

CONCLUSIONS: There are more orthopaedic subspecialty fellowship positions available annually than there are graduating orthopaedic surgery residents. Three independent matching programs are currently being used by the nine orthopaedic subspecialties. Subspecialties vary in the proportion of programs with Accreditation Council for Graduate Medical Education accreditation. Subspecialties with American Board of Orthopaedic Surgery Subspecialty Certificates have a significantly greater proportion of fellowship programs accredited by the Accreditation Council for Graduate Medical Education compared with those without Subspecialty Certificates.

CLINICAL RELEVANCE: Orthopaedic subspecialty fellowship programs are rapidly becoming a perceived necessity as part of orthopaedic surgery training. Fellowships continue to vary in matching system and their accreditation characteristics.