Evaluate operative exposure

Separate the volume of cases from your share of them

A centre may perform many hundreds of operations a year, yet a fellow may assist at only some of them. Ask how many fellows share the caseload, how cases are assigned, and what share are suitable for fellow participation. Total unit volume is not evidence of the number you will perform.

Use clear participation categories

• Observed: present without taking part in the procedure.
• Assisted: took part as an assistant under supervision.
• Performed with supervision: carried out key steps with a supervising surgeon present.
• Performed independently: carried out the operation with remote or no supervision, where the programme and regulation allow it.

Programmes use different terms. Ask how they define each one and which categories your registration allows. Hands-on participation is often tied to registration and host credentialing, so an offer that does not address them is incomplete.

Questions to ask

1. Which operations in this subspecialty will I be expected to perform, and which will I only assist with or watch?
2. What were the numbers for the most recent fellow, by procedure type?
3. How are cases allocated among fellows, residents and consultants?
4. Who supervises me in theatre, and how is feedback given?
5. Do I have access to the outpatient clinic, multidisciplinary meetings and the intensive care unit for these patients?
6. Is there simulation, wet-lab or proctoring time built in?
7. What does the programme record or certify about my participation at the end?

Read the answers carefully

Numbers that come with a role, a time period and a procedure group are more reliable than general statements. Be cautious about promises that depend on factors the programme does not control, such as local credentialing or other fellows' choices. When you hear different answers from different people, ask for a written summary and keep it.

Check for fit with your own plans

Match the exposure to what you need to be able to do afterwards. If you plan to introduce a technique at home, ask about the whole pathway: case selection, equipment, teamwork and follow-up, not only operating steps. A shorter placement with a defined set of procedures can be more useful than a longer one with general exposure.

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