Completion Of Fellowship Research Articles

Current and Temporal Trends in Otolaryngology Department Chair Appointment.

This cross-sectional study aims to characterize current otolaryngology-head and neck surgery department chairs and division chiefs and evaluate whether there have been significant changes in the occupants of these positions over time. All permanent department chairs or division chiefs at allopathic ACGME-accredited otolaryngology residency programs (n=109) were identified and academic and professional information were collected using publicly available websites. After excluding 12 department chairs due to interim status, 97 chairs and chiefs (81 chairs and 16 chiefs) were included with mean and median current term length of 9 ± 8 and 7 ± 5 years, respectively (range=0-35 years). The most commonly completed fellowship in the group was head and neck oncologic surgery (42%). Seventy-seven percent of chairs previously held a faculty position within their institution. Seventy-one percent did not complete residency or fellowship training at their current institution. The average time between completing training and being appointed chair was 15.5 ± 7.7 years. Those appointed within the last 6 years (n=47) had more years of experience than those appointed previously (18.0 ± 7.2 vs. 13.1 ± 7.4 years, p=0.002). The number of female chairs remains low (n=9), and despite an increasing number of women being appointed in recent years, the most recent group of appointees did not demonstrate a significant increase in female appointment (4% vs. 15%, p=0.065). A very large proportion of otolaryngology-head and neck surgery department chairs are internally recruited from their home institution. Most chairs are male, and head and neck oncologic surgery is the most common subspecialty. NA Laryngoscope, 133:1356-1360, 2023.

The Status of Women in Emergency Ultrasound Fellowships: A Potential Light for the Future of Gender Inclusion in Academic Medicine.

Background: The objective of this study is to investigate gender differences in the percentage of men and women who have completed an Emergency Ultrasound (EUS) fellowship over a four-year period. Secondary objectives of this study include evaluation of the career paths and accomplishments of women who have recently completed an EUS fellowship. We will also be assessing program characteristics as reported by the program directors.Methods: This was an online survey of all EUS fellowship programs in the United States. Programs were excluded if they were not in existence before July 2020. The survey took place between September 16, 2021, and December 5, 2021. The study was approved by the appropriate institutional review board. Emergency Ultrasound fellowship programs and their respective program directors were identified from a list of participating programs created by the Society of Clinical Ultrasound Fellowships. The survey questions were divided into the following categories: program demographics, questions regarding the program's recent fellowship classes, and questions relating to the program director’s perspective on gender and fellowship.Results: This study utilized a convenience sample, from a roster of 109 programs, with a response rate of 67% by program directors. There was no significant difference in the percentage of men and women who have completed an EUS fellowship over a four-year period. No graduates who identified as transgender or non-binary/gender non-conform were reported. The majority of female fellows (65%) completed a research/scholarly project during their fellowship year (65%) and have held or currently hold a leadership position at their institution (60.3%). When program directors were asked if they felt women were equally represented in EUS fellowship programs, 24 (34.3%) respondents said yes, 18 (25.7%) said no, and 28 (40%) were not sure. When asked if they felt there were barriers that specifically prevented women from pursuing a fellowship, 28 (40%) said yes, 24 (34.3%) said no, and 18 (25.7%) were not sure.Conclusion: There does not exist a significant difference in the percentage of males and females who have completed an EUS fellowship over a four-year period. Completion of an EUS fellowship may provide women the opportunity to participate in research and receive awards for their accomplishments. It may also serve as a pipeline to academic medicine and leadership roles.

Development of a simulation technical competence curriculum for medical simulation fellows

Background and needsMedical educators with simulation fellowship training have a unique skill set. Simulation fellowship graduates have the ability to handle basic and common troubleshooting issues with simulation software, hardware, and equipment setup. Outside of formal training programs such as this, simulation skills are inconsistently taught and organically learned. This is important to address because there are high expectations of medical educators who complete simulation fellowships. To fill the gap, we offer one way of teaching and assessing simulation technical skills within a fellowship curriculum and reflect on lessons learned throughout the process. This report describes the instructional designs, implementation, and program evaluation of an educational intervention: a simulation technology curriculum for simulation fellows.Curriculum designThe current iteration of the simulation technical skill curriculum was introduced in 2018 and took approximately 8 months to develop under the guidance of expert simulation technology specialists, simulation fellowship-trained faculty, and simulation center administrators. Kern’s six steps to curriculum development was used as the guiding conceptual framework. The curriculum was categorized into four domains, which emerged from the outcome of a qualitative needs assessment. Instructional sessions occurred on 5 days spanning a 2-week block. The final session concluded with summative testing.Program evaluationFellows were administered summative objective structured exams at three stations. The performance was rated by instructors using station-specific checklists. Scores approached 100% accuracy/completion for all stations.ConclusionsThe development of an evidence-based educational intervention, a simulation technical skill curriculum, was highly regarded by participants and demonstrated effective training of the simulation fellows. This curriculum serves as a template for other simulationists to implement formal training in simulation technical skills.

What are the academic and demographic characteristics of orthopaedic spine surgery division chiefs?

BackgroundTo our knowledge no analysis of academic orthopedics division chiefs (DC) exists in the current orthopedic literature. Serving as a Division Chief may be a career milestone or an opportunity to lead and transition to additional leadership roles. Our objective is to answer the following questions (1) Are there academic characteristics common to Spine divisions chiefs? (2) Are there demographic characteristics common to Spine division chiefs? (3) Do most Spine division chiefs train at certain fellowships? MethodsAllopathic residency program websites were used to locate DC and Division Co-Chiefs (DCC). Academic characteristics evaluated included: H-index, academic rank, number of degrees, additional leadership titles, the availability of fellowship training and service as past/current society president and participation in travelling fellowships. Demographic characteristics including gender and race were collected. Years since completions of fellowship and which fellowship program the DC/DCC trained at were collected. Results102 DC/DCC were identified and had an average H-index of 22.1. The majority (48%) had an academic rank of Professor, 29% Associate Professor, 16% Assistant Professor and 8% rank could not be identified. 45% had additional leadership positions within their department and 18% had additional graduate degrees. Two institutions had designations of co-chiefs. The majority (57%) offered spine fellowships at their institution. The majority of DC were males (99%) and White (72.5%). On average the DC/DCC were 19.5 years past their fellowship completion. 19% participated in at least one travelling fellowship and 14% served as a president of a Spine or Orthopaedic Society. ConclusionsSpine surgery division chiefs are 99% male, with a rank of Professor and trained at select fellowship programs. Nearly half of spine surgery division chiefs held concurrent administrative roles in the department and 14% have served as President of a spine or Orthopaedic society. There is room to Improve on the gender and ethnic/racial diveristy of spine surgery division chief leadership.

Gaps in Practice Management Skills After Training: A Qualitative Needs Assessment of Early Career Surgeons

Shifts in American healthcare delivery mechanisms pose significant hurdles to new physicians. Surgeons are particularly susceptible to these changes, but surgical residency educational efforts primarily focus on technical and clinical training to the exclusion of business and management practices. This study conducted a needs assessment of perceived gaps in practice management skills among early career surgeons to guide future training curricula. This study was an exploratory qualitative study following the Consolidated Criteria for Reporting Qualitative Research. Purposive sampling was used to identify early career (<5 years following fellowship completion) surgeons across the United States. A semi-structured interview guide was created from interviews with surgical administrators and physician administrative curricula. Transcripts were de-identified and analyzed using a constructivist grounded theory approach. Ten surgeons from 6 specialties and 6 institutions were interviewed along with 3 surgeon administrators. Three major domains of need were identified: (1) fundamentals of procedural coding, clinical billing, & compliance, (2) finding/building a practice, and (3) navigating organizational challenges. First, surgeons thought trainees would benefit from a better understanding of reimbursement schema and the basics of health policy. They also thought that more exposure to malpractice litigation, especially for handling case review or expert witness requests, would be helpful for discerning how to handle such issues early in their career. In addition, early career surgeons expressed a desire to have dedicated mentorship time, a primer on evaluating job offers with simulated contract negotiation, and guidance regarding administrative roles. Finally, surgeons requested training in change management techniques, care pathway construction, and the basics of staffing decisions. There are significant practice management gaps in surgical training which may be amenable to targeted educational efforts during a residency or fellowship program. Future research will test the generalizability of these findings as well as build curricula that adequately meet these needs.

Characterizing Leadership Trends in Hand Surgery Fellowship Programs

PurposeThe purpose of this study was to characterize academic and demographic factors most associated with fellowship director (FD) roles in hand surgery programs. A secondary aim was to characterize educational and employment trends. The final aim was to compare these findings with those in other orthopedic subspecialties.MethodsDomestic programs were identified using the American Society for Surgery of the Hand fellowship directory. Data were collected via internet searches of publicly available information and direct contact with programs. Variables included demographic characteristics (age, sex, and race/ethnicity), education and employment history, Hirsch index (H-index) research productivity, and membership of select hand surgery societies.ResultsInformation about 86 FDs was collected from a total of 88 identified hand surgery fellowships. Seventy-six (88.4%) FDs were men, whereas 10 (11.6%) were women. The mean age was 53.3 years. Most FDs (n = 68, 79.1%) completed their residency in orthopedic surgery. The average Scopus H-index was 16.3. Most FDs were White (n = 64, 74%) followed by Asian (n = 14, 16%). The mean duration from fellowship completion to FD appointment was 12.6 years, whereas the mean duration of employment at an institution before FD appointment was 17.9 years. The mean duration of tenure as an FD was 9.8 years. Twenty-eight (32.94%) individuals served as an FD at their residency institution and 20 (23.5%) led at their fellowship institution. The most frequently attended residency institution by FDs was University of Pennsylvania, whereas Mayo Clinic was the most frequently attended fellowship program. Six FDs have served as the presidents of a hand surgery society.ConclusionsFellowship directors are largely White and men. They are distinguished by their research productivity. A few select programs contribute an outsized proportion of individuals to FD positions. This may be due to a pipeline effect or because applicants with ambition to become FDs pursue specific programs for training.Clinical relevanceThis study characterizes the academic/demographic factors of hand surgery FDs.

Mentoring for diversity and inclusion in pediatric radiology: nurturing the next generation of physicians from underrepresented minorities.

The increasing recognition of the need for a diverse workforce as a tool for excellence in medicine has fortified the efforts toward recruitment, retention and development of faculty from racial and ethnic minorities. Despite these efforts, individuals of Black, Hispanic, American Indian and Alaska Native, Native Hawaiian and other Pacific Islander backgrounds remain vastly underrepresented in the radiology workforce. The main impediments to increasing their representation are an insufficient pipeline and the long time required to train a pediatric radiologist. A greater representation of minorities can only be achieved through the enduring nurturing of future pediatric radiologists along every step in the professional life cycle of a physician, from high school through fellowship completion. Restructuring of faculty recruitment and faculty development policies is also required. A key component of faculty development and overall wellness is mentorship. Junior faculty, particularly those from racial and ethnic minorities, benefit from the experience, advice and support of more experienced radiologists. Successful mentorship is key to ensuring that staff from underrepresented backgrounds thrive within their institutions and in turn become successful mentors to younger individuals, thus completing a virtuous cycle of minority mentorship.

Orthopedic Surgery Fellowship Directors: Trends in Demographics, Education, Employment, and Institutional Familiarity.

Background: Fellowship directors are assumed to be distinguished in orthopedics, but the traits and training that have enabled them to achieve their leadership positions have not been assessed. Purpose: We sought to identify common demographics, research output, and educational trends of fellowship directors in orthopedics, with an emphasis on racial, ethnic, and gender diversity. Methods: We conducted a literature review to identify published studies on fellowship directors in orthopedic surgery and found 4 cross-sectional studies of fellowship directors in spine, arthroplasty, pediatrics, and sports medicine subspecialties. Another 4 accredited orthopedic subspecialties and their fellowship directors were identified using the American College of Graduate Medical Education Public Accreditation Data System for 2020-2021 and national fellowship directories. Data endpoints included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at current institution, year of fellowship directors appointment, and h-index. The demographics and educational backgrounds for listed fellowship directors were collected from curricula vitae (CVs). Results: Of the 537 fellowship directors identified among 8 orthopedic subspecialties, the average age was 52.9 ± 2.2 years, 5.6% (N = 30) were women, 79.1% (N = 406) were white, 12.5% (N = 64) were Asian American, 3.7% (N = 19) were African American, 2.9% (N = 15) were Middle Eastern, and 1.7% (N = 9) were Hispanic/Latino. Oncology 20% (N = 4) had the highest percentage of female fellowship directors; 37.6% (N = 202) of fellowship directors were at the same institution they trained at for residency or fellowship. Their average h-index was 18.6 ± 3.7. Conclusion: This study of fellowship directors in orthopedics found that they have a high research output and a high level of institutional familiarity. We identified a need for greater diversity in these leadership positions in both gender and race/ethnicity.

Faculty Support for Advocacy Is Key to Training the Next Generation of Pediatrician-Advocates.

We are pleased to see a focus on advocacy in the hospital setting described by Winthrop et al in the October 2021 Hospital Pediatrics perspectives article, “Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.” We agree that pediatric residency training would benefit from advocacy teaching in this setting. Such training can be modeled after the advocacy curricular resources developed for pediatric hospital medicine. These resources include: (1) competency-based goals and objectives for the advocacy rotation that map to pediatric subspecialty entrustable professional activities, developed by the curriculum committee of the Pediatric Hospital Medicine Fellowship Program Directors Council; and (2) specific knowledge, skills, and attitudes in advocacy as defined by the 2020 Pediatric Hospital Medicine Core Competencies.1However, faculty development in advocacy is necessary but not sufficient to allow for advocacy training and curricular development in the inpatient setting. Inpatient faculty must also be given the time, resources, and support to perform and teach advocacy. This can only happen if advocacy scholarship is congruent to traditional scholarship, including both research and medical education. We propose the following additional faculty needs to establish integration of advocacy in the hospital practice setting: Adoption of advocacy portfolios: Clinician-researchers generate scholarship to benefit patients and populations in the form of peer-reviewed grants and publications. Clinician-educators have gained support for scholarly activities and faculty promotion in medical education through the development and application of educator portfolios. Recognition of advocacy as a scholarly pursuit can only be achieved through the dissemination and widespread adoption of advocacy portfolios (APs).2 APs supplement the curriculum vitae to highlight how advocacy can be held to the same rigorous scholarly standards as traditional scholarship. Recognition of advocacy and APs in the academic promotion process will allow those interested in pursuing an advocacy scholarship to be successful in obtaining the time and resources necessary for practice. A national group of pediatrician-advocates has developed the first standardized AP template along with the American Academy of Pediatrics Community Pediatrics Training Initiative.3Advocacy recognition within the Pediatric Hospital Medicine Board certification process: The American Board of Pediatrics (ABP) has proposed a pediatric subspecialty entrustable professional activity focused on population health. Additionally, “advocacy and leadership” is a content domain for Pediatric Hospital Medicine Board certification. Despite this, the ABP has not recognized advocacy as a form of scholarship and “work product” allowable for pediatric subspecialty fellowship completion and subsequent board certification, even it if meets the Glassick criteria for scholarship.4 Lastly, allowing physicians to submit advocacy projects for maintenance of certification credit would greatly assist in recognizing the role of physician advocacy in improving population health.Advocacy will gain congruence in academics through a simultaneous bottom-up and top-down approach: faculty use of APs as developmental and promotional tools, along with recognition and support from medical school leadership and the ABP. Only if these criteria are met will faculty be recognized for scholarly advocacy activities, thereby supporting the time, resources, and funding necessary for teaching such practice to the next generation.

Disparities in Research during Plastic Surgery Training: How Can We Level the Playing Field?

Background:Lack of female and ethnically underrepresented in medicine (UIM) surgeons remains concerning in academic plastic surgery. One barrier to inclusion may be unequal opportunity to publish research. This study evaluates the extent of this challenge for plastic surgery trainees and identifies potential solutions.Methods:Data were collected on academic plastic surgeons' research productivity during training. Bivariate analysis compared publication measures between genders and race/ethnicities at different training stages (pre-residency/residency/clinical fellowship). Multivariate analysis determined training experiences independently associated with increased research productivity.Results:Overall, women had fewer total publications than men during training (8.89 versus 12.46, P = 0.0394). Total publications were similar between genders before and during residency (P > 0.05 for both) but lower for women during fellowship (1.32 versus 2.48, P = 0.0042). Women had a similar number of first-author publications during training (3.97 versus 5.24, P = 0.1030) but fewer middle-author publications (4.70 versus 6.81, P = 0.0405). UIM and non-UIM individuals had similar productivity at all training stages and authorship positions (P > 0.05 for all). Research fellowship completion was associated with increased total, first-, and middle-author training publications (P < 0.001 for all).Conclusions:Less research productivity for female plastic surgery trainees may reflect a disparity in opportunity to publish. Fewer middle-author publications could indicate challenges with network-building in a predominately male field. Despite comparable research productivity during training relative to non- UIM individuals, UIM individuals remain underrepresented in academic plastic surgery. Creating research fellowships for targeting underrepresented groups could help overcome these challenges.

Subspecialty and Training Preferences for U.S. Neurosurgery Faculty with International Training

Academic neurosurgeons with international medical training play a large role in the U.S. neurosurgical workforce. We aimed to compare U.S.-trained neurosurgeons with internationally trained neurosurgeons to reveal differences in subspecialty preferences and training opportunities abroad. We identified 1671 neurosurgeons from 115 Accreditation Council for Graduate Medical Education (ACGME)-accredited neurosurgical residency programs. Data on demographics, institution characteristics, and chosen subspecialty were collected, and faculty were divided based on location of training. Univariate analysis and multivariable logistic regression compared faculty characteristics between training locations. Compared with the U.S. medical school+ U.S. residency group, the international medical graduate+ U.S. residency group was more likely to subspecialize in oncology/skull base and vascular neurosurgery and complete a fellowship in the United States or internationally (P < 0.05). The international medical graduate+ international residency group was more likely to subspecialize in oncology/skull base neurosurgery, more likely to complete an international fellowship, and less likely to practice general neurosurgery (P < 0.05). Neurosurgeons in pediatrics, radiosurgery, and vascular subspecialties were more likely to receive fellowship training in any location (P<0.05). Additionally, functional neurosurgeons were more likely to complete fellowships internationally, spinal neurosurgeons were less likely to pursue international fellowships, and peripheral nerve neurosurgeons were more likely to have dual fellowship training in both the United States and abroad (P < 0.05). International medical training affected subspecialty choice and fellowship training. Internationally trained neurosurgeons more often specialized in oncology and vascular neurosurgery. Functional neurosurgeons were more likely to complete international fellowships, spine neurosurgeons were less likely to complete international fellowships, and peripheral nerve neurosurgeons more often had both U.S. and international fellowships.

Physician Preferences on Surgical Technique and Graft Type for Anterior Cruciate Ligament (ACL) Reconstructions for Pediatric Patients with ACL Injuries

Introduction:The frequency of anterior cruciate ligament (ACL) injuries is increasing in pediatric and adolescent patients. Most surgeons elect to reconstruct the ACL in young, active patients to facilitate the resumption of sports and restore stability to the knee. Surgical technique and graft type preferences depend on the surgeon and skeletal maturity of the patient, but there is no clear standard based on age.Hypothesis/Purpose:This study aims to evaluate physicians’ preferences for choosing a surgical plan for pediatric and adolescent patients with an ACL injury.Methods:A voluntary survey link was sent to members of Pediatric Research in Sports Medicine (PRiSM). Consent was obtained by the participants taking part in the survey.Results:Forty-five (n=45) physician responses were included in this analysis. Seven were female, thirty-six male, and one preferred not to answer. Twenty completed pediatric orthopaedic fellowships, six completed sports medicine fellowships, and nineteen completed both pediatric orthopaedic and sports medicine fellowships. Thirty-five respondents reported that greater than 75% of their patients were 18 years old or younger. The majority prefer the over the top technique for 8 to 10-year-old males over the all epiphyseal, partial transphyseal, and transphyseal techniques. The technique preference is split for 11, 12, and 13-year-old males. Twenty-five respondents prefer the partial transphyseal technique for 14-year-old male patients. A majority (n=42, n=43) prefer the transphyseal technique for 16 year old males and skeletally mature males. The technique preferences for female patients 9 years or less is the over the top technique. The technique preference is split for 10, 11, 12, and 13-year-old females. The majority (n=37, n=44, n=44) prefer the transphyseal technique for 14-year-old, 16-year-old, and skeletally mature female patients. The graft preference for males 11 years old or younger is the iliotibial band (ITB). The graft preference for males 12-year-old and older was split among the hamstring, ITB, bone-tendon-bone (BTB) and quadriceps grafts. When looking at the preferred graft for female patients, a majority prefer ITB for patients 10-years-old and younger. The participants’ graft preferences for female patients 11-years-old and older is split.Conclusion:Results of this survey suggest that graft type and surgical technique preferences for pediatric and adolescent patients with ACL tears change based on the patient’s age, with more agreement among surgeons at the extremes of patient ages. Further research is needed to track the impact of each surgical technique and graft choice on pediatric and adolescent patients.Table 1.Surgical Technique and Graft Preferences for Pediatric and Adolescent Patients with ACL Injuries

Leadership Trends in Shoulder and Elbow Surgery Fellowship Directors: A Cross-sectional Study.

Introduction:We aimed to describe the demographic and professional backgrounds of current shoulder and elbow fellowship directors.Methods:The American Shoulder and Elbow Surgeons (ASES) 2021 to 2022 Fellowship Directory was reviewed to identify the 31 ASES-recognized US fellowship programs. Demographic and other data were obtained through an electronic survey and publicly available online resources from February 28, 2021, to March 5, 2021.Results:Of the 31 fellowship directors, 97% (30) identified as male and 74% (23) as White, the mean age was 53 ± 7 years, and the mean Scopus h-index was 24.2 ± 13. Almost all (95%) held ASES committee leadership appointments in at least one committee. The mean time from completion of most recent fellowship to fellowship director appointment was 7.3 ± 6 years. About two-thirds of fellowship directors trained at one of five fellowship programs: Columbia University (n = 7), California Pacific Orthopaedics (n = 4), Washington University in St. Louis (n = 3), Mayo Clinic (n = 3), and Hospital for Special Surgery (n = 2).Discussion:ASES fellowship directors share similar demographic and professional characteristics with high levels of research productivity and involvement in orthopaedic societies. There is a lack of diversity in shoulder and elbow fellowship directors, highlighting a need for priority consideration of this disparity by leaders in the field.

Value Based Care: An Opportunity for Geriatric Psychiatrists to Become Healthcare System Leaders

The American population is rapidly aging. As of 2021, there are approximately 46 million adults over the age of 65 and it is projected that by 2050 the number will nearly double to 90 million. According to the WHO, rates of mental illness are also increasing: At present, about 20% of adults over 60 suffer from psychiatric or neurological disorders. According to the Alzheimer's Association, in 2021 there are about 6.2 million Americans 65 and older living with AD by 2050 that number will expand to about 12.7 million. The population of older adult Americans who currently need and will need access to high quality psychiatric care is astounding. The 50 or so new geriatric psychiatrists who complete fellowship training annually are unable to manage the rapidly aging population in a fee-for-service environment given the sheer scale of the patient population. The Alzheimer's Association data points out that the disparities are much deeper than just a deficit of geriatric psychiatrists. About one-third of Black Americans one-fifth of Hispanic and Asian Americans believe they would be discriminated against while attempting to access Alzheimer's care. Hispanic, Black and Native Americans are twice as likely as Whites to say they would not see a doctor if experiencing thinking or memory problems. One in five Black and Hispanic Americans say they would feel insulted if a doctor suggested a cognitive assessment. Value based care (VBC), the idea that healthcare delivery should be reimbursed based on quality of care and outcomes, rather than encounters, offers a future where geriatric psychiatrists can play a prominent role in determining how psychiatrist disease is managed across large populations. Novel care delivery models that increase access to high quality care for the entire population have the potential to transcend health disparities and bring geriatric psychiatry to the forefront. In this symposium, we will learn about the concept of VBC, the interface of geriatric psychiatry with VBC, the roles that some geriatric psychiatrists are already taking in VBC healthcare delivery, and how VBC programs are implemented and assessed.

Leadership Roles, Academic Appointments, and Scholarly Activity-Does a Fellowship after Plastic Surgery Training Make a Difference?

Background Fellowship training is becoming more popular in plastic surgery, with over half of residents pursuing advanced training. Here, we investigate how clinical and research fellowship training impacts career trajectory and scholastic achievement in academic plastic surgery. Methods Plastic surgery faculty members, from programs recognized by the American Council of Academic Plastic Surgeons, were identified using institutional Web sites. Data extracted included faculty demographics, training history, academic positions, and research productivity. Continuous and categorical variables were compared using t -tests and chi-square, respectively. Results In total, 949 faculty members were included, with 657 (69%) having completed fellowship training. Integrated program residents were more likely to complete a fellowship when compared with independent residents ( p < 0.0001). Fellowship trained faculty were more likely to have graduated from a higher ranked residency program, in terms of both overall and research reputation ( p = 0.005 and p = 0.016, respectively). When controlling for years in practice, there was no difference found in number of publications, Hirsch index (h-index), or National Institutes of Health funding between faculty between the two cohorts ( p > 0.05). In a subanalysis comparing hand, craniofacial, microsurgery, and research fellowships, those who completed a research fellowship had higher h-indices and were more likely to reach full professor status ( p < 0.001 and p = 0.001, respectively). Fellowship training had no effect on being promoted to Chief/Chair of departments ( p = 0.16). Conclusion Fellowship training is common among academic plastic surgeons. In this study, both clinical and research fellowships were associated with various aspects of academic success. However, fellowship training alone did not affect attainment of leadership positions.

Current status and trends in subspecialty certification in physical medicine and rehabilitation.

There is a need to better understand the overall state of sub-specialization in physical medicine and rehabilitation (PM&R). To examine the status and trends in subspecialty certification for each of the seven subspecialties approved for American Board of Physical Medicine and Rehabilitation (ABPMR) diplomates. Retrospective analysis of deidentified information from the ABPMR database. Physicians certified by ABPMR through 2019. Not applicable. For each subspecialty, we examined: (1) the number of certificates issued to ABPMR diplomates; (2) the recertification rate; (3) the yearly trends for total active, new, and expired certificates; and (4) for ABPMR-administered subspecialties, recertification rates for those entering the subspecialty through fellowship completion versus a "grandfathered" practice pathway. Of 11,421 ABPMR diplomates in the United States in 2019, a total of 3560 (31.2%) had 3985 active subspecialty certificates. Pain Medicine (PM) was the most common subspecialty certification (15.5% of all ABPMR diplomates) followed by Sports Medicine (SM, 6.6%), Brain Injury Medicine (BIM, 4.8%), Spinal Cord Injury Medicine (SCIM, 4.2%), Pediatric Rehabilitation Medicine (PRM, 2.5%), Neuromuscular Medicine (NMM, 0.7%), and Hospice and Palliative Medicine (HPM, 0.5%). For diplomates with more than one subspecialty certification, PM and SM was the most frequent combination. Both the recertification rate and the end of practice track eligibility influenced certification trends differently for individual subspecialties. The average number of new certificates added annually for every subspecialty was higher before than after the temporary practice track-based eligibility ended; the difference was statistically significant (p < .05) for SCIM, PM, SM, and NMM. The recertification rate for all subspecialties combined was 73.4%. For the subspecialties (SCIM, PRM) for which these data were available, fellowship candidates had higher recertification rates than those grandfathered through a practice track. This report informs stakeholders about the state and evolution of subspecialty certification in PM&R over time.

Micrographic dermatologic surgery (MDS) diplomates: a demographic evaluation and comparison of Medicare case volume.

Micrographic dermatologic surgery (MDS) recently became a board-certified field within dermatology with the first board examination administered in October 2021. To be eligible,dermatologists must have completed a fellowship through the Accreditation Council for Graduate Medical Education (ACGME) or attest to active practice of Mohs micrographic surgery. Attestation of active practice is available from 2021-2025, after which, those sitting for the certifying examination must demonstrate completion of an ACGME-accredited fellowship. This study aimedto compile demographic information on physicians who passed the MDS board certification examination. Medicare Mohs micrographic surgery case volume was compared between fellowship-trained and non-fellowship-trained physicians as well as between members and non-members of Mohs organizations. Names of physicians who passed the examination were accessed on the publicly available American Board of Dermatology website. The Medicare database was used to screen for Mohs surgery case numbers from 2019, and the American College of Mohs Surgery (ACMS) and American Society for Mohs Surgery (ASMS) physician finder tools were used to determine active membership.Physicians not in the Medicare database and those who completed an ACGME-accredited fellowship within the past three years were excluded from case volume analysis. 1673 dermatologists passed the first certifying examination. Medicare Mohscase volumes were compared for1310 of these physicians. The median number (interquartile range (IQR)) of Mohs surgery cases was significantly higher for physicians who were ACMS/ACGME-fellowship-trained compared to those who were not (370 cases (IQR: 211-560) vs 138 cases (IQR: 37-284), p < 0.001). Members of ACMS and/or ASMS also performed a higher median number of cases compared tonon-members (334 cases (IQR: 160-526) vs 95 cases (IQR: 6-246), p < 0.001). Given the 5-year window to take the MDS examination without having completed an ACMS/ACGME-accredited fellowship, more physicians without formal training may choose to become board certified. In addition, less dermatologists may choose to complete an ACMS/ACGME-accredited fellowship since it is not required for board certification. As more dermatologists become board certified in MDS, it may become important to assess for active practice of Mohs surgery and define proficiencymetrics.

How Knowledgeable Are Spine Surgeons Regarding EMG-NCS for Cervical Spine Conditions? An International Aospine Survey.

Cross-sectional, international survey. To evaluate the knowledge of spine surgeons regarding the use of electromyography (EMG) and nerve conduction studies (NCS) for degenerative cervical spine conditions (DCC). All members of AO Spine International were emailed an anonymous survey to evaluate their clinical knowledge about the use of EMG and nerve conduction studies for DCC. Descriptive statistics were used to analyze the results, as well as to compare the answers among different groups of surgeons and assess demographic characteristics. A total of 402 participants answered the survey, 91.79% were men from the 5 continents. There were 221 orthopedic surgeons (55.39%) and 171 neurosurgeons (42.86%), more than a half of them with a complete spinal fellowship (56.44%). The most common reasons that surgeons obtain the test is to differentiate a radiculopathy from a peripheral nerve compression (88.06%). As a group, the responding surgeons' knowledge regarding EMG-NCS was poor. Only 53.46% of surgeons correctly answered that EMG-NCS is unable to differentiate a C5 from a C6 radiculopathy. Only 23.47% of the surgeons knew that EMG-NCS are not able to diagnose a pre vs a post-fixed brachial plexus. Only 25% of the surgeons correctly answered a question regarding the test's ability to diagnose other neurological diseases. We found that our respondents' knowledge regarding EMG-NCS for DCC was poor. Identifying the weak points of knowledge about EMG-NCS may help to educate surgeons on the indications for the test and the proper way to interpret the results.

Academic, Leadership, and Demographic Characteristics of Orthopaedic Sports Medicine Division Chiefs in the United States.

Introduction:Division chiefs (DCs) play an integral role within the department, making critical decisions and helping shape the future of both the division and the department. This study aimed to investigate the demographic characteristics and scholarly work of DCs in academic orthopaedic sports medicine division in the United States.Methods:Orthopaedic residency programs at academic centers were identified using the Association of American Medical Colleges' Electronic Residency Application Service. DCs were identified using the program's respective websites where data points such as sex, race/ethnicity, fellowship training institution, time since graduating fellowship, academic rank, number of degrees, and additional leadership titles were collected. Scopus database was used to determine h-indices.Results:From the 191 programs identified, 100 had a DC for the sports medicine subspecialty division, and 66 programs offered a sports medicine fellowship. Most DCs (96%) were men. The racial/ethnic demographics of the DCs were mostly White (86%), followed by Asian (11%), African American (1%), Hispanic/Latino (1%), and mixed ethnicity (1%). On average, the DCs were 19.6 years past their fellowship completion. The average h-index was 21.2. Many (48%) had an academic rank of professor, 28% associate professor, and 12% assistant professor. Four held additional graduate degrees. The fellowship programs that trained the most DCs were Hospital for Special Surgery (11), Kerlan Jobe Orthopaedic Clinic (8), University of Pittsburgh (7), American Sports Medicine Institution (5), Cleveland Clinic (5), Cincinnati Sports Medicine (4), Massachusetts General Hospital (4), and Steadman Hawkins Clinic (4).Discussion:DCs in academic orthopaedic surgery plays a crucial role in the department and is a topic that is understudied. A lack of diversity exists among DCs in academic Sports Medicine in orthopaedics. The position is held predominately by White men with a rank of either full or associate professor and extensive leadership experience. More efforts are needed to increase the diversity of sports medicine leadership within academic orthopaedic programs in the United States.

Gender and Geographic Trends Amongst Foot &amp; Ankle Surgeons: Where Are We and Where Do We Need to Improve?

Category:OtherIntroduction/Purpose:Clinical and elective experiences as well as the guidance of mentors are all critical factors in the pursuance of orthopedic residencies and fellowships. Women have historically been underrepresented in orthopedics. Some propose that the root cause lies in the lack of availability in the aforementioned factors. Previous studies demonstrated geographic differences in sex representation in orthopedic residency programs. Studies over geographic distributions of orthopedic foot and ankle (OFA) surgeons showed high variation in geographic density of OFA surgeons throughout the U.S. This study seeks to determine both the gender and geographic distributions of OFA surgeons as well as to determine geographic patterns between their training locations and current practices.Methods:AOFAS data regarding fellowship completion from 1988 through 2021 was analyzed with regards to gender and fellowship location. Internet searches were performed for all those identified within the database for their medical school, residency, and current practice location. This biographical data was obtained from their front-facing biographical webpage or hospital affiliation. States were placed into regions and subsequent divisions as defined according to the US Census Bureau definition: Northeast (New England and Middle Atlantic), Midwest (East North Central and West North Central), South (South Atlantic, East South Central, and West South Central) and West (Mountain and Pacific).Results:1,088 OFA surgeons were analyzed. 168 (15.3%) were female and 922 (84.7%) were male. Female-held OFA fellowship positions increased over time, currently sitting at 13 (22% of all fellowship positions), with a maximum of 15 (25%) in 2017. Geographically, the Pacific had most females (n=26, 15.6% of females), while East South Central had least (n=10, 6.0%). The South Atlantic had most males (n=193, 20.9% of males) while East South Central had least (n=59, 5.3%). The region with the most OFA surgeons in total was the South Atlantic (n=218, 20.0% of the total) whereas the regions with the least were East South Central and New England (n=59, 5.4% in each).Conclusion:Although the amount of female OFA surgeons has increased, the numbers are still low. Geographically, the East South Central division of the U.S consistently had the least number of OFA surgeons whereas the South Atlantic division had the highest.