Clinical Fellowship Research Articles

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.

O.4.2-1 The within-person bidirectional association between physical activity and loneliness in the daily lives of adolescents and young adults

Abstract Purpose Adolescents and young adults are at high risk for experiencing loneliness, a well-established risk factor for mental health symptoms. Previous cross-sectional studies show an inverse association between loneliness and physical activity. The causality and directionality of this association remains unclear as longitudinal and interventional studies are currently lacking in this population. With the Experience Sampling Method, we are able to investigate fluctuations in daily life and within-person dynamics. We hypothesized a bidirectional relationship where physical activity can reduce loneliness and loneliness can reduce physical activity the subsequent moment. Methods Participants were sampled from the population-based twin registry TwinssCan. The sample consisted of 784 participants, aged 15 to 25 years. They responded to a questionnaire ten times a day for six days. Analysis was done with multilevel models. Interaction effects with affective valence (enjoyment, competence and effort), and depressive and anxiety symptoms were explored. Results We did not observe a significant association between physical activity and loneliness on the within-person level, but there was a significant interaction effect where physical activity predicts decreased subsequent loneliness, but only at moments with high affective valence where young people enjoy the activity, feel competent and requires limited effort. There was no significant interaction effect with depressive and anxiety symptoms. Conclusions The findings of this study give us a better understanding of the association between physical activity and loneliness in young people. During the presentation, we will discuss the importance of considering contextual factors when investigating psychosocial outcomes of physical activity. Support/Funding Source The TwinssCan study received funding from the European Community’s Seventh Framework Program and the Fund of Scientific Research Flanders and Twins. LJ is supported by a PhD Fellowship from Research Foundation Flanders. RvW is supported by a Senior Clinical Fellowship (FWO – 1803616N), and by the Funds Julie Renson, Queen Fabiola and King Baudouin Foundation.

Impact of Coronavirus Disease 2019 on Clinical Outcomes of Robotic Cholecystectomy.

The coronavirus disease 2019 (COVID-19) pandemic strained the health care sector, putting severe constraints on surgical departments. In this study, we evaluate the impact of the pandemic on the outcomes of patients undergoing robotic cholecystectomy (RC). Patients who underwent RC 1 year before and after March 2020 were included in this retrospective study and assigned accordingly to the pre or post-COVID group. Pre, intra, and postoperative variables were compared between groups. In total, 110 patients were assigned to the pre-COVID group versus 80 in the post-COVID group. There were no differences in the demographics, except for a higher rate of previous gallbladder disease in the pre-COVID group (35.5% vs 13.8,% P < 0.001). The post-COVID group had a higher rate of emergent RCs (62.5% vs 39.1%, P = 0.002). Operative times were greater in the post-COVID group due to the more frequent participation of clinical fellows in the cases. The median hospital length of stay for both groups was 1 day, with higher rates of same-day discharge (pre-COVID 40.9% vs post-COVID 57.5%, P = 0.028). Complications were comparable between both groups, with no recorded cases of COVID-19 contraction within the virus incubation period. The median follow-up was 10 months for the entire cohort. During the COVID-19 pandemic, an increase in emergent cases, as well as higher rates of same-day discharge, were recorded, with no impact on postoperative outcomes in patients undergoing RC.

Meeting the demand for fertility services: the present and future of reproductive endocrinology and infertility in the United States

The field of reproductive endocrinology and infertility (REI) is at a crossroads; there is a mismatch between demand for reproductive endocrinology, infertility and assisted reproductive technology (ART) services, and availability of care. This document's focus is to provide data justifying the critical need for increased provision of fertility services in the United States now and into the future, offer approaches to rectify the developing physician shortage problem, and suggest a framework for the discussion on how to meet that increase in demand. The Society of REI recommend the following: 1. Our field should aggressively explore and implement courses of action to increase the number of qualified, highly trained REI physicians trained annually. We recommend efforts to increase the number of REI fellowships and the size complement of existing fellowships be prioritized where possible. These courses of action include: a. Increase the number of REI fellowship training programs. b. Increase the number of fellows trained at current REI fellowship programs. c. The pros and cons of a 2-year focused clinical fellowship track for fellows interested primarily in ART practice were extensively explored. We do not recommend shortening the REI fellowship to 2 years at this time, because efforts should be focused on increasing the number of fellowship training slots (1a and b). 2. It is recommended that the field aggressively implements courses of action to increase the number of and appropriate usage of non-REI providers to increase clinical efficiency under appropriate board-certified REI physician supervision. 3. Automating processes through technologic improvements can free providers at all levels to practice at the top of their license.

Determinants of Attitude Toward End-of-Life Care Among Junior Physicians: Findings from a Nationwide Survey in Japan.

Physicians' attitudes can be critical in quality end-of-life care. However, the determinants of the attitudes and whether the attitudes can be modified remain unclear. To investigate factors correlated with physicians' positive attitudes toward end-of-life care and whether these attitudes are modifiable through acquired factors (e.g., education or mentorship). A nationwide survey was conducted in 300 institutions and selected randomly from 1037 clinical training hospitals in Japan. From each selected institution, two resident physicians of postgraduate year (PGY) 1 or 2 and two clinical fellows from PGY 3-5 were requested to answer the survey. The primary outcome was the Frommelt Attitudes Toward the Care of the Dying (FATCOD) scale score. Factors (e.g., the respondents' age, sex, number of years of clinical experience, training environment, religion, and beliefs around death) were examined for correlation with FATCOD score. In all, 198 physicians and 134 clinical fellows responded to the survey (response rate: 33.0% and 22.3%, respectively). Factors with the strongest correlation with FATCOD scores were mostly unmodifiable factors (e.g., being female and one's beliefs around death). Modifiable factors were also identified-number of patient deaths experienced, level of interest in palliative care, availability of support from senior mentors, and frequency of consultation with nonphysician medical staff. Physicians' attitudes toward end-of-life care correlate more strongly with nonmodifiable factors, but attitudes can be meaningfully improved via mentoring by senior physicians. Future studies are warranted to determine the effective interventions to foster positive attitudes among physicians involved in end-of-life care.

218 Entrepreneurship in Plastic Surgery – a Single Departmental Experience

Abstract Aim The specialty of Plastic and reconstructive surgery has long been at the forefront of innovation. However, perceptions of individuals focusing on entrepreneurship, particularly at a junior level, remain unclear. Anecdotally, trainees can be discouraged from participating in entrepreneurial efforts for fear of seniors’ disapproval. Method A questionnaire was circulated amongst doctors at the Royal Free Plastic Surgery department aiming to establish knowledge and perceptions of entrepreneurship. It included 10 questions to be answered anonymously. Results 18 individuals responded, including Foundation doctors (n = 2), Junior clinical fellows (n = 2), Core surgical trainees (n = 3), Specialty registrars (n = 5), Senior clinical fellows (n = 2) and Consultants (n = 4). All respondents (n = 18) understood the meaning of the term “entrepreneurship” and 44.4% (n = 8) had prior entrepreneurship experience. Perceptions of the connotations of the word “entrepreneurship” in surgery varied. 33% (n = 6) reported “strongly negative” and 33% (n = 6) “strongly positive” connotations. Notably, of those reporting “strongly negative” connotations, 80% (n = 4) were junior trainees at Core surgical training or below, and 20% (n = 1) were specialty registrars. Amongst the 4 consultants, mean perception on a 5-point scale was 3.75, indicating an overall “positive” connotation. Furthermore, 83.3% (n = 15) of respondents felt their surgical career had not provided them with opportunities to develop entrepreneurship skills and 94.4% (n = 17) would like further opportunities to develop entrepreneurship skills. Conclusions Perceptions on involvement in entrepreneurship in surgery are predominantly positive. Those associating entrepreneurial efforts with negative connotations seem to be predominantly junior. This result will hopefully encourage Plastic surgeons at all levels to become involved in entrepreneurial efforts.

Clinician accuracy in identifying essential laryngeal landmarks on swallowing fluoroscopy.

Identification of anatomical landmarks is essential for interpretation of video fluoroscopic swallow studies (VFSS). This investigation sought to confirm the location of essential laryngeal landmarks and determine clinician accuracy in structure identification on VFSS. A single human cadaver was used to generate unmarked standard lateral and anterior-posterior (AP) fluoroscopic images. Essential laryngeal structures (e.g., true vocal fold, arytenoid) were directly identified using a guidewire placed through an endoscope while obtaining corresponding marked fluoroscopic images. Licensed clinicians (speech-language pathologists [SLP], laryngologists) and trainees (otolaryngology residents, SLP clinical fellows [CF]) identified 18 structures (9 lateral, 9 AP) on unmarked images. Answers were compared to corresponding marked images. The percentage of accurate identification was calculated for each clinician and then compared between groups using t-tests. Twenty-four individuals (10 SLPs, 1 CF, 9 residents, 4 laryngologists) from six institutions completed structure identification. Mean overall accuracy was 41.7 ± 13.0% (range 18.8-68.8%). There were no significant differences in mean overall accuracy between trainees (41.9 ± 12.9%) and clinicians (42.0 ± 13.1%), p = .97, or between SLPs (45.5 ± 12.8%) and physicians (38.9 ± 12.3%), p = .22. On average, participants were significantly more accurate identifying structures on lateral view (53.1 ± 16.1%) than AP (27.3 ± 22.8%), p < .001. Less than half of participants accurately identified the laryngeal ventricle, cricoid, epiglottic petiole, and the anterior commissure on lateral view. The ability of certified clinicians and trainees to correctly identify essential anatomic landmarks on swallowing fluoroscopy may be poor. Future work is needed to identify how we can train clinicians on more accurate identification of essential anatomic structures on swallowing fluoroscopy.Level of Evidence: NA.

See-saws: the delicate balance of burden of treatment in chronic heart failure

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This work was supported as a part of a fully funded Clinical Academic Doctoral Fellowship at the University of Southampton, Portsmouth Hospitals University NHS Trust, and the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) Wessex. This article is independent research supported in part by the NIHR ARC Wessex. Carl May’s contribution was supported by NIHR ARC North Thames and Alison Richardson’s by NIHR ARC Wessex. Rosalynn Austin is funded by an NIHR ARC Wessex Internship. Background Burden of Treatment (BoT) is often described as a delicate balance between a patient’s capacity (capabilities and resources) to do the work of illness management and the workload (self-care, treatment and illness burden). Chronic heart failure (CHF) is regarded as a burdensome disease for both patients and healthcare services with the burden expected to rise. While research in BoT in CHF is increasing, the factors influencing the balance between capacity and workload has yet to be fully elucidated. Purpose To identify factors which may influence BoT in CHF. Methods Secondary analysis of 32 semi-structured interviews of participants with CHF who participated in the SYMPACT trial. All participants were asked to describe the balance between capabilities and workload of manging CHF using the metaphor of a see-saw. Responses to that question were examined for factors patients reported as altering the balance between capacity and workload. Results Most participants (n=31) described the seesaw as dynamic, where capacity and workload were balanced or unbalanced. If capacity &amp;gt; workload this was viewed as positive, "I would stay down because the things that you mentioned are very easy" (T137). When instead the balance reversed and capacity &amp;lt; workload it was viewed as negative, "The heavier you know with the work and the abilities less, you kind of think […] I’m good for nothing" (B001). Factors reported by patients, to alter their capacity included: ability to self-care, support from social networks, symptoms, illness identity, and quality of life. Workload was reported to be altered by nature of healthcare interactions, effectiveness of treatments, comorbidities and the feeling of overwhelming treatment burden (Figure 1). One participant described overwhelming burden with a different metaphor: "A huge weight around my neck. Pulling me down into a pit of despair" (S110), was reported as more accurate than a seesaw when thinking about treatment burden. Conclusions BoT is an important factor to consider in the clinical management of CHF. Modifiable factors such as symptoms, quality of life, and the nature of healthcare interactions are reported as altering the balance between a patient’s capacity and the workload associated with self-care.Factors balancing burden of treatment

External Validation of a Five-Tiered CT Algorithm for the Diagnosis of Clear Cell Renal Cell Carcinoma: A Retrospective Five-Reader Study.

BACKGROUND. In 2022, a five-tiered CT algorithm was proposed for predicting whether a small (cT1a) solid renal mass represents clear cell renal cell carcinoma (ccRCC). OBJECTIVE. The purpose of this external validation study was to evaluate the proposed CT algorithm for diagnosis of ccRCC among small solid renal masses. METHODS. This retrospective study included 93 patients (median age, 62 years; 42 women, 51 men) with 97 small solid renal masses that were seen on corticomedullary phase contrast-enhanced CT performed between January 2012 and July 2022 and subsequently underwent surgical resection. Five readers (three attending radiologists, two clinical fellows) independently evaluated masses for the mass-to-cortex corticomedullary attenuation ratio and heterogeneity score; these scores were used to derive the CT score by use of the previously proposed CT algorithm. The CT score's sensitivity, specificity, and PPV for ccRCC were calculated at threshold of 4 or greater, and the NPV for ccRCC was calculated at a threshold of 3 or greater (consistent with thresholds in studies of the MRI-based clear cell likelihood score and the CT algorithm's initial study). The CT score's sensitivity and specificity for papillary RCC were calculated at a threshold of 2 or less. Interreader agreement was assessed using the Gwet agreement coefficient (AC1). RESULTS. Overall, 61 of 97 masses (63%) were malignant and 43 of 97 (44%) were ccRCC. Across readers, CT score had sensitivity ranging from 47% to 95% (pooled sensitivity, 74% [95% CI, 68-80%]), specificity ranging from 19% to 83% (pooled specificity, 59% [95% CI, 52-67%]), PPV ranging from 48% to 76% (pooled PPV, 59% [95% CI, 49-71%]), and NPV ranging from 83% to 100% (pooled NPV, 90% [95% CI, 84-95%]), for ccRCC. A CT score of 2 or less had sensitivity ranging from 44% to 100% and specificity ranging from 77% to 98% for papillary RCC (representing nine of 97 masses). Interreader agreement was substantial for attenuation score (AC1 = 0.70), poor for heterogeneity score (AC1 = 0.17), fair for five-tiered CT score (AC1 = 0.32), and fair for dichotomous CT score at a threshold of 4 or greater (AC1 = 0.24 [95% CI, 0.14-0.33]). CONCLUSION. The five-tiered CT algorithm for evaluation of small solid renal masses was tested in an external sample and showed high NPV for ccRCC. CLINICAL IMPACT. The CT algorithm may be used for risk stratification and patient selection for active surveillance by identifying patients unlikely to have ccRCC.

Using a Mediator's Toolbox: Reducing Clinical Conflict by Learning to Reconceive the "Difficult" Patient or Family.

Given the prevalence of conflict between physicians and patients and families, it is crucial that trainees build the skills to manage clinical conflict. Mediators employ an approach that can be applied to clinical encounters to prevent conflicts from escalating. This workshop introduced trainees to techniques commonly used by mediators to manage disputes. Medical students in a virtual workshop (cohort A) and clinical fellows in an in-person workshop (cohort B) were presented with a mediator's approach to interpreting patient and family behavior viewed as challenging. Trainees were introduced to two specific techniques designed to facilitate the resolution of clinical conflict. After an interactive large-group discussion of each method, small groups practiced applying the technique to a sample clinical case. Finally, participants completed an assessment of their perception of the workshop's effectiveness. In early 2022, 15 medical students (cohort A) participated in a virtual workshop and 10 clinical fellows (cohort B) participated in an in-person workshop on clinical conflict management. Eight medical students from cohort A completed the postworkshop assessment (response rate: 53%); six clinical fellows from cohort B completed the assessment (response rate: 60%). Cohort A gave the workshop an overall evaluation of 4.6 out of 5.0; cohort B gave the workshop an overall score of 4.7 out of 5.0. In both the virtual platform and the traditional in-person format, this workshop introduces a set of tools for navigating bedside conflicts with patients and their families that participants believed would better prepare them for such challenging interactions.

To What Extent Are Programs Recruiting Their Own Graduates as Faculty? A CERA Study.

Most family medicine (FM) residency programs continuously recruit faculty, though little is known about their recruitment practices. In this study, we sought to define to what extent FM residency programs are relying on recruitment of program graduates, regional programs, or programs outside their region for filling faculty roles and to compare these data across program characteristics. As part of a large 2022 omnibus survey of FM residency program directors, we asked specific questions regarding the percentage of FM faculty who were graduates of that program, a program in the region, or a distant program. We aimed to determine to what extent respondents attempted to recruit their own residents to faculty positions and to identify additional program offerings and characteristics. The response rate was 41.4% (298/719). Programs reported hiring more of their own graduates compared to regional or distant graduates, and 40% prioritized recruiting their own graduates for open positions. Those who prioritized recruiting their own graduates were significantly more likely to have a higher percentage of their graduates on faculty as were larger, older, more urban programs and those offering clinical fellowships. The existence of a faculty development fellowship was significantly associated with having more faculty from regional programs. Programs that aim to improve faculty recruitment from their own graduates should consider prioritizing internal recruitment. They also may consider the development of both clinical and faculty development fellowships for local and regional hires.

Harnessing the force of post-F2 doctors – a medical clinical fellow post that transformed locally employed doctor recruitment

In 2018, North Bristol Trust (NBT) faced difficulties recruiting clinical fellows. In response, a new programme was introduced that includes opportunities for non-clinical time, supervision, and a study budget, as well as flexibility of contract duration and on-call commitment. This has significantly improved the application ratios, with a 94% fill rate in August 2021 and competition ratios of 2.5:1. Not only has it been successful for staffing medical rotas, but clinical fellows also report positive experiences, have gained opportunities that would not be available in a training role and feel the role will benefit their future job applications. This report outlines the new programme and analyses it from the clinical fellow and Trust perspective. We hope that by sharing this successful new programme, other organisations can take inspiration to harness the potential of the high proportion of doctors taking a break from training post-foundation programme.

The under-representation of minority ethnic groups in academic general practice.

General practice has a diverse training programme. It is majority female (57%) and more than half of all trainees are from an ethnic minority, according to the GMC workforce report 2022. However, we are not seeing the same representation of ethnic minorities in academic general practice, with 85.1% of GP professors being White. To determine if ethnic minorities are fairly represented in general practice academia, using the National Academic GP Training Conferences as a proxy. The programmes of the last five National Academic GP Training Conferences were searched and demographic information about the speakers was sought through online sources. Data were compared to demographic data available of non-academic GPs. A freedom of information request was made to Health Education England (HEE) to determine the demographic data of GP academic clinical fellows (ACF). Between the years of 2018 and 2022 there was an average of 40 speakers at the conference. The majority of speakers were White females, appearing an average of 20.2 times. Black females were the least represented, appearing an average of 0.4 times. Data available from HEE on the demographics of new ACFs for 2022 revealed that 27 (71%) of the 38 (excluding 5 who did not state their ethnicity) were White. With such a diverse training scheme, we need to have a better representation of ethnic minorities in GP academia. There is a clear problem recruiting or attracting people from ethnic minorities to an academic career and work needs to be done to understand and overcome those barriers.

Awareness and Referral Attitudes of Diabetic Retinopathy among Surgeons at a Tertiary Care Hospital in Pakistan

Purpose: To assess the awareness of diabetic retinopathy (DR) in surgeons and compare their referral practices from different specialities at a tertiary care center. Study Design: Cross sectional survey. Place and Duration of Study: Department of Surgery, Agha Khan University Hospital, Karachi. Methods: A survey was created using Google Forms and the link to the survey was shared to 99 surgery faculty members on official university email addresses. We employed non-probability, convenience sampling technique and the total population of faculty under the Department of Surgery was sampled, including clinical fellows. Residents, research associates, and ophthalmology faculty were subsequently excluded. The survey contained questions in 4 categories; consent, relevant practices of DM, knowledge regarding DR and referral practices to an ophthalmologist. Scoring was based on a 5-point Likert scale with 5 being the most rigorous practice. Data was entered into SPSS v.23. Qualitative data was reported as frequencies with percentages, and quantitative data was reported as mean with standard deviation. Results: Out of 40 participants, 87.5% had excellent practices of diabetes mellitus and 77.5% had excellent knowledge of diabetic retinopathy. Referral practices to an ophthalmologist were graded fair in 75% and poor in 15% whereas, referral practices were fair or poor across all surgical specialties. Conclusion: Our study indicates a gap between knowledge and practices of surgeons regarding DM. Hence, there is a strong need to enhance awareness about timely referrals to an ophthalmologist to prevent complications of diabetes related blindness.

Survey of clinical informatics fellows graduating 2016-2024: experiences before and during fellowship.

To describe experiences and activities of Clinical Informatics (CI) fellows since the first fellowships were accredited in 2014. We performed a voluntary and anonymous survey of 394 alumni and current clinical informatics fellows from the graduating classes of 2016-2024 in the summer of 2022. We received 198 responses; 2% declined to participate. Most were male (62%), White (39%), 31-40 years old (72%), from primary care specialties (54%) and nonprocedural specialties (95%), and without prior informatics experience or any careers before medicine. Most fellows (87-94%) participated significantly in operations, research, coursework, quality improvement, and clinical care activities during fellowship. Women, underrepresented racial and ethnic minorities, and procedural physicians were underrepresented. Many incoming CI fellows did not have an informatics background. During CI fellowship, trainees earned Master's degrees and certificates, were exposed to many different types of CI activities, and were able to spend most of their time pursuing projects that supported their personal career goals. These findings represent the most comprehensive report to date of CI fellows and alumni. Physicians without prior informatics experience who are interested in CI should be encouraged to apply because CI fellowship provides a strong foundation of informatics knowledge while supporting fellows' personal career goals. There remains a lack of women and underrepresented minorities in CI fellowship programs; efforts to expand the pipeline are needed.

The journey of becoming a congenital heart surgeon: Too long, too costly, too unpredictable

ObjectiveThe pathway to become a congenital heart surgeon (CHS) is challenging and unpredictable. Previous voluntary manpower surveys have shed partial light on this problem but have not included all trainees. We believe that this arduous journey merits more attention. MethodsTo examine the real-life challenges of recent participants in Accreditation Council for Graduate Medical Education–accredited CHS training programs, we conducted phone interviews with all graduates of approved programs from 2021 to 2022. This institutional review board approved survey focused on issues including preparation, length of training, debt burden, and employment. ResultsAll 22 (100%) graduates during the study period were interviewed. Age at fellowship completion was a median 37 years (range, 33-45 years). Pathways to fellowship included traditional general surgery with adult cardiac (43%), abbreviated general surgery (“4 + 3,” 19%) and integrated-6 (38%). Time spent on any pediatric related rotation before CHS fellowship was a median 4 months (range, 1-10 months). During CHS fellowship, graduates reported medians of 100 (range, 75-170) total cases and 8 (range, 0-25) neonatal cases as the primary surgeon. Debt burden at completion was a median of $179,000 (range, $0-$550,000). Maximal financial compensation during training before and during CHS fellowship were medians of $65,000 (range, $50,000-$100,000) and $80,000 (range, $65,000-$165,000), respectively. Six (27.3%) are currently in roles in which they cannot practice independently (5 [22.7%] faculty instructors, 1 [4.5%] CHS clinical fellowship). Median salary in first job is $450,000 (range, $80,000-$700,000). ConclusionsGraduates of CHS fellowships are old, and training is highly variable. Aptitude screening and pediatric-focused preparation are minimal. Debt burden is onerous. Further attention to refining training paradigms and compensation are justified.

News from the European Journal of Therapeutics: A new issue and a new editorial board

News from the European Journal of Therapeutics: A new issue and a new editorial board

Defining the Duty Hour for Surgical Trainees

Being mindful of duty hours has become an integral part of surgical training. Violations can lead to disciplinary action by the American Council for Graduate Medical Education (ACGME), including probation or even withdrawal of accreditation. It is therefore crucial to ensure these hours are accurately reported. However, as these are often self-reported by the resident, what counts as a duty hour is at the discretion of the reporter. The goal of this study is to identify what trainees and faculty include in their definitions of a duty hour. We hypothesized that there would be discrepancies in faculty versus trainee definitions of the duty hour, and that there remains an unclear understanding of which nonclinical activities contribute to surgical trainee duty hours. An anonymous, voluntary survey was conducted at a single institution. The survey contained 14 scenarios, and participants answered either "yes" or "no" as to if they believed the scenario should be counted within duty hour reporting. Analysis of the results included evaluating overall responses to determine which scenarios were more controversial, as well as chi square analysis comparing trainee (residents and fellows) versus faculty responses to each scenario. This survey was performed within the Department of Surgery at the University of Texas Southwestern Medical Center, a large academic institution in Dallas, TX. There were 91 total faculty and trainee responses to the voluntary survey within the General Surgery Department and associated subspecialties, including 50 residents (54.9%), 4 clinical fellows (4.4%) and 37 faculty (40.7%). When analyzing total responses, the most controversial scenarios were taking a short period of home call (50.6% of all respondents included this as a duty hour), making a presentation for resident education (48.4%), making a presentation related to patient care (57.1%), and making a monthly call schedule (44.0%). The least controversial topic was transit to and from work (91.2% of all respondents did not include this as a duty hour). Additionally, there were statistically significant differences between trainee and faculty perceptions when it came to attending departmental curricula (96.2% trainees included as a duty hour v 81.6% faculty, p =0.02), participating in nonmandatory journal club (5.7% trainees v 23.7% faculty, p =0.01), and attending mentorship meetings (30.2% trainees v 52.6% faculty, p =0.03). There is no consensus as to what nonclinical activities formally count towards a duty hour. There are also significant differences identified between faculty and trainee definitions, which could have implications for duty hour reporting and ACGME violations. Further research is required to obtain a clearer picture of the surgical opinion on defining the duty hour, and hopefully this will reduce duty hour violations and better optimize surgical trainee education.

Developing an application for the UK Pre-Doctoral Clinical and Practitioner Academic Fellowship (PCAF): the collective experience of a community of physiotherapists

For physiotherapists and other healthcare professionals, developing capability and expertise in research can be challenging. However, involvement in research is beneficial at organisational and individual levels, both for clinicians and patients. One way to embark on research is to apply for a personal fellowship such as the National Institute for Health and Care Research (NIHR) Pre-Doctoral Clinical Academic Fellowship (PCAF). While the NIHR has guidance on how to complete the application form, it can be difficult to implement this guidance and understand what a competitive application looks like. As a group of physiotherapists and academic supervisors, who have applied for NIHR PCAFs, what follows is a supportive resource, to inform others who might be thinking of applying. Contribution of paper•This is the first paper to report a collective reflection on the experience of a community of physiotherapists and their academic supervisors of applying for NIHR PCAFs•A description of the process is provided which will be beneficial to other physiotherapists aspiring to develop their application for an NIHR PCAF