The Washington University General Surgery Residency offers residents the opportunity to customize their training to focus on the surgical specialty of their choice through the American Board of Surgery (ABS)-approved Flexibility in Surgical Training (FIST) and Early Specialization (ESP) pathways. Since ABS approval in 2011, FIST has allowed residents to customize up to 12 of the final 24 months of residency for early tracking into subspecialty tracks. 

Possible FIST tracks include the following, although other options can be customized: 

  1. Acute Care Surgery/Surgical Critical Care 
  2. Cardiothoracic Surgery 
  3. Colorectal Surgery 
  4. Gastrointestinal Surgery 
  5. Pediatric Surgery 
  6. Plastic Surgery 
  7. Surgical Oncology 
  8. Transplantation 
  9. Vascular Surgery

The WashU general surgery residency program initiated and participated in a multi-institutional study of the resident experience with FIST in seven general surgery programs to investigate the feasibility of this training option. The study compared ACGME milestones, operative case logs, ABSITE scores and subjective attitudinal surveys of trainees in the FIST consortium to those of trainees not enrolled in a specialty track (NonS).

Residents participating in FIST scored significantly higher on 13 of 16 ACGME milestones when compared to NonS, performed significantly more cases in their respective specialties, showed no difference in ABSITE performance and responded to surveys with overall strong favorability for the FIST track options as well as improved mentorship and autonomy. 

General surgery residents who have participated in FIST have been able to focus their training in chosen specialty areas, preparing them for careers as experts in each of their surgical specialties.  WashU in StL has been one of the leaders in flexibility with almost all of our residents choosing to participate in FIST in addition to residents participating in annually in Cardiothoracic ESP (4+3 General Surgery and CT fellowship) and the first resident in the United States to fast track in Solid Organ Transplant (4+2 General Surgery and Transplant fellowship).