Clinical Fellowship Research Articles

The challenges and opportunities of offering and integrating training in clinical molecular genetics and clinical cytogenetics: A survey of LGG Fellowship Program Directors

PurposeThe specialty of Laboratory Genetics and Genomics (LGG) was created in 2017 in an effort to reflect the increasing convergence in technologies and approaches between clinical molecular genetics and clinical cytogenetics. However, there has not yet been any formal evaluation of the merging of these disciplines and the challenges faced by Program Directors (PDs) tasked with ensuring the successful training of laboratory geneticists under the new model. MethodsAn electronic multi-question Qualtrics survey was created and was sent to the PD for each of the Accreditation Council for Graduate Medical Education–accredited LGG fellowship programs at the time. The data were collected, and the responses were aggregated for each question. ResultsAll of the responding PDs had started training at least 1 LGG fellow. PDs noted challenges with funding, staff shortages, molecular/cytogenetics content integration, limited total training time, increased remote work, increased sendout testing, and a lack of prior cytogenetics knowledge among incoming fellows. ConclusionThis survey attempted to assess the challenges that LGG PDs have been facing in offering and integrating clinical molecular genetics and clinical cytogenetics fellowship training. Common challenges between programs were noted, and a set of 6 concluding comments are provided to facilitate future discussion.

Clinical Ethics Training in Canada: Moving Towards Standardization

This paper summarizes the presentation and stakeholder feedback gathered from the Canadian Bioethics Society Workshop and Community Forum in May 2023, in a session entitled, “Clinical Ethics Fellowship in Canada: Making the Move Towards Standardization”. This summary provides insight into the clinical ethics fellowship landscape across Canada, including current gaps in the training of Canadian healthcare ethicists and opportunities to advance the journey towards standardization.

Difficult Discharge in the Context of Suspected Malingering: Reflections on the Value of Epistemic and Professional Independence.

During a clinical ethics fellow's first week of independent supervised service, two unhoused patients on the same floor were resisting the medical team's recommendations to discharge. In the team's view, both were medically stable and no longer required hospitalization in an acute setting. The medical team suspected malingering for both. The social worker and case manager had employed their usual means of gentle persuasion and eliminating psychosocial barriers to no avail. Rather than call the police, the attending physician, social worker, and case manager decided to call ethics. These cases lead the fledgling fellow to consider the appropriate role for ethicists in difficult discharge cases. The article analyzes each case, evaluates their similarities and differences in the context of suspected malingering, and comments on ethical issues surrounding cases of suspected malingering. Finally, the authors reflect on the value and importance of developing and maintaining epistemic and professional independence.

The impact of Saudi Arabia – United States clinical pharmacy post-graduate training programs agreements on clinical pharmacy faculty in Saudi universities: A retrospective descriptive study focused on history and future recommendations

BackgroundThere has been a growing demand for clinical pharmacy services in the Kingdom of Saudi Arabia (KSA) in the past 3 decades. The Ministry of Education has established agreements with several institutions in the United States to secure clinical pharmacy residency and research fellowship programs opportunities for Saudi scholars. The aims of this study were to describe the Saudi scholars’ clinical pharmacy training pathways and their contribution to the pharmacy profession in KSA. MethodsThis is a retrospective, descriptive study conducted on clinical pharmacy faculty in governmental Saudi universities who graduated from the US until 2023. The study outcomes included the post-graduate year-1 (PGY-1) residency match rate, post-graduate year-2 (PGY-2) acceptance rate, the PGY-2 specialties of Saudi scholars, and the number of clinical pharmacy programs established in KSA. ResultsIn total, 115 Saudi scholars have pursued clinical pharmacy pathway in the US. The PGY-1 residency match rate was 80 % (92/115). In contrast, the PGY-2 acceptance rate was 60.9 % (70/115). The most common PGY-2 specialty was in infectious diseases (N = 17; 24 %). Two pharmacy colleges had established residency programs and 1 pharmacy college had established a research fellowship. ConclusionThe Ministry of Education's efforts for clinical pharmacy program agreements were fundamental for advancing clinical pharmacy in Saudi universities. A significant number of Saudi scholars returned to KSA with clinical pharmacy degrees. There are more opportunities for further development, including expanding the clinical pharmacy program collaboration in the US and increasing the number of residency and research fellowship positions in KSA.

The under-representation of racially minoritised doctors in academic general practice training: a retrospective analysis.

General practice has one of the most diverse medical training programmes in terms of sex and ethnic background. However, this diversity of race and ethnicity is not reflected in academic GP careers, with just 17% (n = 81/473) of academic GPs being from racially minoritised groups, according to the Medical Schools Council. To determine whether GP academic clinical fellow (ACF) trainees from racially minoritised backgrounds are proportionally represented, compared with the non-academic training programme, using the annual GP ACF conference as a proxy. A retrospective analysis of conference programmes from national academic GP training conferences from 2018-2023 and demographic data obtained from Health Education England (HEE). Using conference programmes and online searches, demographic information on conference speakers was obtained and a freedom of information request was made to HEE for the demographics of GP ACFs for corresponding years. This was compared with demographic data of GP trainees and academics. On average, there were 40 speakers each year at the conference. White females (average 20.2 speakers each year) were the most well represented group, followed by White males (average 12.5), Asian females (average 3.3), Asian males (average 1.8), Black males (average 0.7), and Black females (average 0.3). HEE data from 2022 revealed that 27 (71.1%) of the 38 (excluding five who did not state their ethnicity) ACFs were White British. GP academia should be more representative of the non-academic GP training scheme. Work needs to be done to understand and overcome the structural barriers to recruiting from racially minoritised groups.

Brain MRI changes in degenerative cervical myelopathy: a systematic review

Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction globally. Associated neurological symptoms and signs have historically been explained by pathobiology within the cervical spine. However, recent advances in imaging have shed light on numerous brain changes in patients with DCM, and it is hypothesised that these changes contribute to DCM pathogenesis. The aetiology, significance, and distribution of these supraspinal changes is currently unknown. The objective was therefore to synthesise all current evidence on brain changes in DCM. A systematic review was performed. Cross-sectional and longitudinal studies with magnetic resonance imaging on a cohort of patients with DCM were eligible. PRISMA guidelines were followed. MEDLINE and Embase were searched to 28th August 2023. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A qualitative synthesis of the literature is presented as per the Synthesis Without Meta-Analysis (SWiM) reporting guideline. The review was registered with PROSPERO (ID: CRD42022298538). Of the 2014 studies that were screened, 47 studies were identified that used MRI to investigate brain changes in DCM. In total, 1500 patients with DCM were included in the synthesis, with a mean age of 53 years. Brain alterations on MRI were associated with DCM both before and after surgery, particularly within the sensorimotor network, visual network, default mode network, thalamus and cerebellum. Associations were commonly reported between brain MRI alterations and clinical measures, particularly the Japanese orthopaedic association (JOA) score. Risk of bias of included studies was low to moderate. The rapidly expanding literature provides mounting evidence for brain changes in DCM. We have identified key structures and pathways that are altered, although there remains uncertainty regarding the directionality and clinical significance of these changes. Future studies with greater sample sizes, more detailed phenotyping and longer follow-up are now needed. ODM is supported by an Academic Clinical Fellowship at the University of Cambridge. BMD is supported by an NIHR Clinical Doctoral Fellowship at the University of Cambridge (NIHR300696). VFJN is supported by an NIHR Rosetrees Trust Advanced Fellowship (NIHR302544). This project was supported by an award from the Rosetrees Foundation with the Storygate Trust (A2844).

'It's a gamble': A phenomenological exploration of medical students' learning experiences as newcomers to clinical communities of practice.

Medical students become members of the clinical team through participation in their activities, as described by Lave and Wenger's situated learning theory. While there is research into how medical students cognitively engage in clinical learning, there is limited work on clinical experiences using a social theoretical lens such as situated learning theory. This study explored third year medical students' lived experience as newcomers to clinical teams using a qualitative phenomenological approach. Medical students completed in-depth, semi-structured interviews in 2021. Interpretive phenomenological analysis (IPA) using Lave and Wenger's theory of situated learning was applied to understand students' experiences. Seven students discussed their variable placement experiences. Learning related to three elements: conditions for participation, modes of participation and products of participation. When certain conditions were met relating to student, clinician and activity, students learned. This drove identity and relationship formation. The findings related and led to a self-perpetuating cycle with potential to advance student learning. When the conditions for participation were not met, the cycle stopped, leading to student disengagement. Passivity in students is a result of modifiable factors in the workplace. To encourage proactivity, clinicians must enable students to move from observation to participation as their competence increases. Participation should be supervised, challenging and should contribute to patient care. Time pressures can make this difficult; one solution is to nominate a clinician to direct students and account for this in their workload or to employ a clinical fellow to assist with student training.

Education Research: Competency-Based EEG Education: An Online Routine EEG Examination for Adult and Child Neurology Residents.

We recently published expert consensus-based curricular objectives for routine EEG (rEEG) interpretation for adult and child neurology residents. In this study, we used this curriculum framework to develop and validate an online, competency-based, formative and summative rEEG examination for neurology residents. We developed an online rEEG examination consisting of a brief survey and 30 multiple-choice questions covering EEG learning objectives for neurology residents in 4 domains: normal, abnormal, normal variants, and artifacts. Each question contained a deidentified EEG image, displayed in 2 montages (bipolar and average), reviewed and optimized by the authors to address the learning objectives. Respondents reported their level of confidence (LOC, 5-point Likert scale) with identifying 4 categories of EEG findings independently: states of wakefulness/sleep, sleep structures, normal variants, and artifacts. Accuracy and item discrimination were calculated for each question and LOC for each category. The test was disseminated by the International League Against Epilepsy and shared on social media. Of 2,080 responses, 922 were complete. Respondents comprised clinical neurophysiologists/experts (n = 41), EEG/epilepsy clinical fellows (n = 211), EEG technologists (n = 128), attending neurologists (n = 111), adult neurology residents (n = 227), child neurology residents (n = 108), medical students (n = 24), attending non-neurologists (n = 18), and others (n = 54). Mean overall scores (95% CI) were 82% (77-86) (clinical neurophysiologists), 81% (79-83) (clinical fellows), and 72% (70-73) (adult and child neurology residents). Experts were more confident than clinical fellows in all categories but sleep structures. Experts and clinical fellows were more confident than residents in all 4 categories. Among residents, accuracy and LOC increased as a function of prior EEG weeks of training. Accuracy improved from 67% (baseline/no prior EEG training) to 77% (>12 prior EEG weeks). More than 8 weeks of EEG training was needed to reach accuracy comparable with clinical neurophysiologists on this rEEG examination. Increase in LOC was slower and less robust than increase in accuracy. All but 3 questions had a high discrimination index (>0.25). This online, competency-based rEEG examination, mapped to a published EEG curriculum, has excellent psychometrics and differentiates experienced EEG readers from adult and child neurology residents. This online tool has the potential to improve resident EEG education worldwide.

764. Return to the Roundtable: A Clinical Case Discussion Curriculum for Infectious Diseases Fellows

Abstract Background The Accreditation Council for Graduate Medical Education (ACGME) and the Infectious Diseases Society of America (IDSA) require infectious diseases fellowship programs to include a core curriculum as part of their requirements for clinical training, though recommendations regarding content and structure are limited. Despite advances in online tools available for asynchronous learning in medical education, there remains a scarcity of published ready-to-teach content. We hypothesized that case-based clinical reasoning sessions covering core clinical topics would improve the attitudes and confidence of infectious diseases fellows. Methods We conducted an informal needs assessment of current fellows, reviewed published recommendations and other fellowship curricula. Then, we developed a series of case-based clinical reasoning sessions for clinical and research fellows based on constructivist theory and emphasizing adult learning principles. Topics were rooted in published guidelines and evidence-based practice, prioritizing complex and high-yield clinical topics. Content was peer-reviewed by faculty and sessions were facilitated by senior fellows. Facilitation guides were created to allow for dissemination in the future. Faculty and pharmacists attended the sessions as expert discussants. Fellows completed anonymous surveys assessing attitudes and confidence after each session. Results Three sessions covering Endemic Mycoses, Non-tuberculous Mycobacteria, and Toxoplasmosis were completed with 6-8 fellows in attendance at each. Surveyed fellows felt that the sessions were valuable and improved their confidence in clinical management of the topics presented (Figure 1). Participants also provided narrative feedback (Table 1). Post-session Survey ResultsFigure 1.Post-session survey results from Likert-scale questions assessing attitudes and confidence, n=11 surveys completed by infectious diseases fellows. Post-session Narrative FeedbackTable 1.Narrative feedback from fellows who completed the post-session surveys. Conclusion This curriculum represents a novel initiative by trainee physicians to create a series of peer-facilitated, discussion-based sessions for learners at the level of subspecialty fellowship. We demonstrated that these sessions improve the attitudes and confidence of fellows in a single-program pilot. Future directions will include studying the intervention in other fellowship programs and sharing this program broadly within the infectious diseases education community. Disclosures Eileen K. Maziarz, MD, Karius, Inc: Advisor/Consultant

Prevalence of chronic pain or analgesic use in children and young people and its long-term impact on substance misuse, mental illness, and prescription opioid use: a retrospective longitudinal cohort study

Epidemiological studies suggest chronic and recurrent pain affects around a quarter of children, while 8% report intense and frequent pain. The long-term implications of chronic pain in childhood are uncertain. Using electronic health records (EHRs) we used both disease codes and medicines prescription records to investigate the scale of chronic pain and long-term analgesic use in children and young people (CYP), and if chronic pain and/or use of analgesic medicines at an early age is associated with substance misuse, use of prescription opioids, and poor mental health in adulthood. We conducted a cohort study using data from IQVIA Medical Research Data UK. We identified individuals aged 2-24 with exposure to either a diagnostic code indicating chronic pain (diagnosis-exposed), repeat prescription for medicines commonly used to treat pain (prescription-exposed), or both. Follow-up began at 25, and the unexposed population acted as comparators. We calculated hazard ratios (HR) for mental health and substance misuse outcomes, and rate ratios (RR) for opioid prescriptions in adulthood. Additionally, we investigated which diagnoses, if any, were over-represented in the prescription-exposed subgroup. The cohort constituted 853,625 individuals; 146,431 had one or more of the exposures of interest (diagnosis-exposed=115,101, prescription-exposed=20,298, both-exposed=11,032), leaving 707,194 as comparators. Median age at index exposure was 18.7 years (IQR 14.7-22.3). On average during follow-up, the pooled exposed group had, respectively, a 31% and 17% higher risk of adverse mental health and substance misuse outcomes (adjusted HR [95% CI] of 1.31 [1.29-1.32] and 1.17 [1.11-1.24]). Exposed individuals also received prescription opioids at double the rate of unexposed individuals on average during follow-up (adjusted RR 2.01 [95% CI 1.95-2.10]). Outcomes varied between exposure subgroups, with prescription- and both-exposure tending to have worse outcomes. Unlike these two subgroups, in the diagnosis-exposed subgroup we did not detect a greater risk of substance misuse. Chronic pain in CYP is associated with increased prescription opioid use and adverse mental health outcomes in adulthood, as is repeat prescription for analgesic medicines, but only the latter is also associated with substance misuse in adulthood. It is essential to avoid the harms of under-treating pain in CYP while giving due consideration to the risks posed by analgesic medicines. Early recognition of chronic pain in CYP and utilising non-pharmacological management options may help minimise overprescribing, and long-term reliance on dependence-forming-drugs. AL is an NIHR funded academic clinical fellow, and was supported by funding from UCLH Charities while carrying out this work. RS and DS are part of the Advanced Pain Discovery Platform and were supported by a UKRI and Versus Arthritis grant (MR/W002566/1) as part of the Consortium Against Pain Inequality. AW was supported by the Wellcome Trust (220558/Z/20/Z).

Experience of an NIHR Clinical Lectureship (medical/dental) and the determining factors for a clinical academic career post lectureship: a mixed-method evaluation

ObjectivesThe objective of this study is to investigate early-to-late postdoctoral clinical academic progression and the experiences of NIHR Clinical Lectureship (CL) fellows, considering enablers and barriers to success, and identifying...

Piloting a New Subspecialty: A Novel, Cross-Disciplinary Clinical Fellowship to Care for Children with Medical Complexity.

Piloting a New Subspecialty: A Novel, Cross-Disciplinary Clinical Fellowship to Care for Children with Medical Complexity.

Improving patient-centered care for HIV and mental illness: exploring hospital and community integration through education

ABSTRACT Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020–March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.

Taking a Break? The Growing Trend of FY3: Why More Junior Doctors are Taking Time Out after the Foundation Programme and What They Elect to Do?

There is a growing trend of UK doctors taking time out of clinical training following completion of the Foundation Programme. At a time when NHS services are facing unparalleled demand, considering the reasons why early career clinicians are deciding to delay entry into specialist training is paramount. Here, we describe some of the push and pull factors contributing to the “FY3” year phenomenon as well as the avenues doctors explore. Within the NHS, clinical fellowships can offer more flexibility in terms of rota and location compared to specialty training posts whilst also providing clinical experience and the chance to develop highly sought-after skills in teaching, research, and leadership. Similarly, locum rotas can be negotiated and usually offer significantly enhanced pay. Outside of the NHS, healthcare systems in Australia, New Zealand, and Canada actively seek out UK doctors, incentivising them with better work–life balance, increased pay, and improved working conditions, leading many doctors who had intended to return to the NHS to stay abroad. Doctors are also becoming increasingly aware of their transferable skills and the value they can bring to non-clinical roles in the pharmaceutical industry, management consulting, and medical law. Although the FP was originally introduced to address issues surrounding career progression and poor training experiences, current push factors for taking an “FY3” including increasing competition for specialty training posts, an imbalance towards service provision versus training, and high workload suggest systemic issues within the UK health service are undermining this aim and ultimately leading doctors to take time out of training.

An evaluation of clinical fellow programmes in an acute teaching hospital trust.

Clinical fellows support the hospital workforce while gaining experience in different specialities, research, leadership and teaching. The authors aimed to assess the impact of clinical fellow programmes in an acute teaching hospital trust. An anonymous electronic service evaluation was sent to clinical fellows to investigate their views on whether the programme had improved patient safety, doctors' clinical performance, training and wellbeing. Thematic analysis was used to analyse the free-text responses. A total of 95 out of 144 clinical fellows responded to the evaluation survey. The clinical fellows believed that the programme had improved patient safety, clinical performance (time to manage acute patients), foundation and internal medicine training, undergraduate teaching and junior doctors' wellbeing. Four similar themes emerged from the free-text responses: career development, patient safety, training and doctors' wellbeing. Clinical fellow programmes may improve patient safety, clinical performance, training, undergraduate education and doctors' wellbeing.

Online Patient Education Resources for Anterior Cruciate Ligament Reconstruction: An Assessment of the Accuracy and Reliability of Information on the Internet Over the Past Decade.

The purpose of this study is to evaluate the quality of patient education materials accessible through popular online search engines regarding anteriorcruciateligament (ACL) injuries and anteriorcruciateligament reconstruction (ACLR). Methods: Two search terms ("ACL surgery" and "ACL reconstruction") were entered into three search engines (Google, Yahoo, and Bing). The quality of information was scored using a novel scoring system developed and overseen by sports medicine orthopedic clinical research fellows and fellowship-trained orthopedic surgeons. Website quality, credibility, and readability were further assessed by the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria, and Flesch-Kincaid Reading Grade Level (FKRGL), respectively. The Health On the Net Code of Conduct (HONcode) certification was also utilized to assess the transparency of health information for each website. We evaluated 39 websites. The average score for all websites was 11.2±5.6 out of 28 total points. Six out of the 39 websites (41%) were HONcodecertified. The websites that contained HONcode certification had a higher average JAMA benchmark score (3.5±0.7) and DISCERN score (44.6±14.7) when compared to the websites without the certification, 2.2±1.2and 37.6 ± 15.9for JAMA and DISCERN, respectively. The mean JAMA benchmark score was 2.7±1.2 (67.5%) for all websites out of a possible four points. The average FKRGL for all 39 websites was 10.0±2.0 (range: 5.4-13). The quality of patient education materials accessible on the internet regarding ACL injuries and ACLR can be misleading and directly impact the patient's decision-making process essential to the patient-physician relationship over the past decade. The internet can be a helpful online resource, however, surgeon clarification and consultation with qualified healthcare professionals are strongly recommended prior to clinical decision-making regarding potential treatment options.

Counseling practices of speech-language pathologists working with aphasia: “I did not have adequate training in actual counseling strategies.”

ABSTRACT Background Counseling is a part of the scope of practice for speech-language pathologists (SLPs), however training has been inconsistent across programs. Students, clinical fellows, and practicing SLPs alike report feeling under-prepared to address the counseling needs of clients and their families. Research evidence about counseling training and practices specific to addressing the psychological well-being of individuals with aphasia and their families is even more limited. While practicing SLPs feel confident and prepared to address communication-specific interventions for aphasia, they feel ill prepared to address the counseling needs that arise on a regular basis. Aims The present investigation was part of a two-part investigation that included an online survey to practicing SLPs throughout the United States (US) and follow-up interviews with a subgroup of those participants. This paper addresses the counseling practice interview portion and addresses two research questions: How confident do SLPs feel using counseling with individuals with aphasia? To what extent are SLPs implementing counseling in practice with individuals with aphasia and their family members? Methods & Procedures Eight practicing SLPs who participated in the part 1 counseling practices survey agreed to participate in the part 2 counseling practices intervention. They varied by years of practice, region of practice, and practice setting (acute, subacute, and chronic). Participants engaged in the Counseling Practices Interview (CPI) via the BlueJeans video conferencing application. Interviews were transcribed and coded qualitatively using open and axial coding methods. Multiple rounds of iterative coding were conducted to ensure rigor and coding stability. Outcomes & Results Multiple rounds of coding resulted in the following overarching themes: confidence in aphasia-specific skills/techniques, SLPs encounter emotional and psychosocial discussions regularly, confidence with educational counseling, not prepared for psychosocial adjustment counseling, taking the perspective of individuals with aphasia and their family, referrals/interprofessional practices and scope of practice issues, and SLP self-care. SLPs reported a clear difference between knowledge and skills for which they feel prepared and confident, versus addressing psychological well-being of individuals with aphasia and understanding practice boundaries. Conclusions SLPs recognize the importance of counseling skills for working with individuals with aphasia because counseling moments arise regularly. They use a variety of techniques but lack intentionality and specialised training. Academic training was deemed to be inadequate in scope and instructional methods. Post-academic training was identified as hard to access but useful. SLPs reported a lack of clarify on scope of practice, practice boundaries, and referrals.

Practical Considerations for Instrumental Acoustic and Aerodynamic Assessment of Voice: Discussion Points From an Open Forum of Clinicians

Purpose: The purpose of this clinical focus article is to summarize a community discussion about the practical implementation of recommended vocal function measures by practicing speech-language pathologists specializing in the treatment of voice and upper airway disorders, review common barriers and challenges to implementation, and suggest opportunities for further education and discussion. Method: An online discussion was held with members of American Speech-Language-Hearing Association Special Interest Group (SIG) 3 to facilitate discussion regarding participants' experiences implementing vocal function assessment (acoustic and aerodynamic assessment) in their practice settings. The discussion was based on the expert panel consensus paper by Patel et al. (2018), which provided recommendations for a minimum core set of vocal function measures. Results: Discussion topics included standardization methods, environmental factors, preferred hardware and software, tasks and measures, interpretation, and infection control. Participants reported that the recommendations of the consensus paper provide a useful guideline for obtaining a core set of reliable and valid measures. They also reported facing barriers in meeting these recommendations due to varying practice settings and resources. Conclusions: Variations in instrumental assessment may arise due to differences in clinic models, testing environments, accessible equipment, allotted time, and clinician opinion. During the discussion, participants emphasized the need for further education and discussion on the implementation of vocal function assessment, particularly regarding adaptations for different clinical models, low-cost and low-tech alternatives, synthesis of findings, and the relevance of additional or omitted measures in specific situations. To address these concerns, it is recommended that the SIG 3 community delve deeper into this topic, open additional discussion about various topics cited as barriers to vocal function assessment implementation, and create ongoing educational opportunities for clinicians, especially for those who lack access to a voice-specialized clinical fellowship program or mentorship by a specialized clinical expert.

Addicted to Life

David Newman lives and works on the lands of the Gadigal people, also known as Sydney, Australia. He is a faculty member of Dulwich Centre and an honorary clinical fellow at The University of Melbourne’s Department of Social Work. Through his independent therapy practice, Sydney Narrative Therapy, he meets with individuals, couples and families. He delights in this work and narrative practices have offered invigorating company

The clinical anatomy fellowship: A participants' perspective.

Kansas City University offers a Clinical Anatomy Fellowship which enrolls nine medical students during each academic year and provides training in research, teaching, and advanced anatomical topics. The Fellows practice as novice educators, working alongside Anatomy faculty to teach medical students in the Gross Anatomy laboratory. However, little has been reported related to Fellowship participation and success outcomes. This survey-based study was designed to explore (1) student motivation(s) for pursuing the Fellowship, (2) benefits of participation, and (3) the perceived impact on residency applications and career success. Three unique populations were surveyed. The most important factors driving application to the Fellowship were a desire to increase competitiveness in the residency application process (Likert mean score 4.7-5.0) and a passion for Anatomy (Likert mean score 4.3-4.7). Taking a year away from the College of Osteopathic Medicine curriculum (Likert mean score 4.4) and delaying clinical exposure (Likert mean score 4.2) were the most important deterrents to application. The most reported benefits after program completion included opportunities to build a strong residency application (44% and 50% of Fellows), conduct research (44% and 45% of Fellows), and participate in teaching (11% and 50% of Fellows). 73% of past Fellows matched into their top specialty of choice. Flexibility in the program allows participants to individualize their Fellowship experience to address their personal goals related to residency applications and careers as future physicians. As the results suggest, the Clinical Anatomy Fellowship benefits Fellows, signaling other medical institutions to consider adopting a similar program.