1. Gie Na Yu, MD; Stephen Helmer, PhD; Hamed Amani, MD; Anjay Khandelwal, MD Via Christi Regional Burn Center University of Kansas School of Medicine – Wichita Lehigh Valley Health Network

2.  Critical Shortage  Shortage of 1,875 general surgeons in 2020  Shortage of 6,000 general surgeons in 2050  1,522 unfilled trauma surgery positions in 2012  In a 2004 study  56 burn surgeons needed in next 5 years

3.  35 Burn Fellowships in the United States  No accreditation process through ACGME  No verification process through ABA  Only Guidelines have been published

4.  Some of the guidelines  Based in a verified ACS/ABA burn center  Expect graduates to  Lead a burn service  Teach  Develop research

5.  Assess current status of burn fellowships

6.  23 question survey sent to 36 burn fellowships  Surveys tracked with tracking number  Repeat surveys sent to non-responders  Telephone and e-mail requests to subsequent non-responders

7.  36 surveys sent  27 responses (75% response rate)  One response that burn center was closed

8.  16 centers are verified (62%)  Number of admissions 100-200: 4 programs 201-400: 13 programs 401-600: 5 programs 600+: 4 programs

9.  Age of training program < 5 years: 12% 5 – 10 years: 36% > 10 years: 52%  Number of fellows trained/year 1: 73% 2: 12% 3: 12%  Training fellows consistently for past 5 years: 69%

10.  Average number of staff: 2.6  Faculty background Majority general surgery: 58% Majority plastic surgery: 31%  Background of director General Surgery: 62%  Director fellowship trained: 62%  Director certified in critical care: 50%

11.  Design of fellowship  42% pure burns  Goals of training:  Prepare clinical burn surgeons: 72%  Incorporate burn reconstruction: 81%  Participate in out-patient care: 89%  Specific didactic training: 85%

12.  Research?  Required: 32%  Optional: 60%  Qualified to sit for critical care boards: 20%  Trainee background  General Surgery: 54%  Plastic/general surgery: 46%

13.  Percentage of graduates practicing burns: <25%: 65% 25-50%: 15% 50-75%: 8% >75%: 12%  From the 26 responding fellowship programs  29 burn surgeons will be needed within the next 5yrs

14.  There’s a wide variety in the programs

15.  An ideal fellowship program?  Burn center volume  Verification of burn center  Long standing program  >75% of graduates practicing burn  Director fellowship trained and/or certified in critical care  Goal of training to be a burn practitioner  Out-patient experience  Exposure to research  Exposure to reconstruction  Ability to sit for critical care boards?

16.  Challenges to training burn surgeons  Lack of interest among surgical residents: 69.2%  Lack of burn training in most residency programs: 26.9%  Only 60% of residency programs  Rotation in or exposure to burn care

17.  Fellowships  Ideally, need ACGME accreditation  If not, ABA needs to verify fellowships  Resident exposure to burn care  Need of techniques to increase resident interest

19.  1. Faucher LD. Are We Headed for a Shortage of Burn Surgeons? Journal of Burn Care and Rehabilitation. 2004 Nov-Dec; 25(6):464-7.  2. Brown TLH, Mills S. Where are all the burn surgeons? A survey of plastic surgical trainees in Australasia. Burns 30 (2004) 577-580.  3. Holmes JH. Critical Issues in Burn Care. Journal of Burn Care and Research 2008; 29(6), supplement 2: S180-7.  4. Demling R. Heimback D. The Burn Surgeon and the Need for Critical Care Certification. Editorial. Journal of Burn Care and Rehabilitation. 1990 Jan-Feb; 11(1): 91-92.  5. Warden GD, Heimback DM. Guidelines for Burn Fellowships. Journal of Burn Care and Rehabilitation. 2004 Nov-Dec; 25(6):469-71  6. Light TD, Latenser BA, Kealey GP, Wibbenmeyer LA, Rosenthal GE, Sarrazin MV.  The effect of burn center and brun center volume on the mortality of burned adults – an analysis of the data in the national burn repository. J Burn Care Res 2009; 30: 776-782  7. Palmieri TL, London JA, O’Mara MS, Greenhalgh. Analysis of admissions and outcomes in verified and nonverified burn centers. J Burn Care Res 2008; 29:208-212.  8. Reimel BA, Klein MB, Nathens AB, Gibran NS. Delivery of critical care in North American burn centers. J Burn Care Res 2008;29:713-717.