Twice a year, fellows are given feedback in a formal meeting. Fellows are evaluated based upon the six core competencies outlined by the ACGME (patient care, medical knowledge, interpersonal and communication skills, practice-based learning and improvement, professionalism, and systems-based practice) and through faculty estimation of acquisition of specific surgical skills. In turn, the fellow is asked to evaluate individual faculty members after each rotation and is asked for summary opinions of the program during the formal meetings with the fellowship director.