Fellowship Selection Research Articles

Is the changing landscape of fellowship recruitment during COVID-19 here to stay?

BackgroundThe 2020 Pediatric Surgery (PS) fellowship selection process was heavily impacted by the COVID-19 pandemic. A review of lessons learned can help determine best practices for the future. The purpose of the study was to analyze the virtual interview experience and assess opportunities to improve the post-pandemic fellowship recruitment process. Study DesignUsing a 28-question survey of Program Directors (PDs) of PS fellowships as well as a 44-question survey of applicants to PS fellowships in the US and Canada, we gathered information on the recruitment process during the COVID-19 pandemic (2020). Dichotomous, multiple choice and open-ended questions about the changes in process, platforms used, format, comparison to on-site interviews and overall satisfaction were used for objective and subjective feedback. ResultsA 95% participation rate was recorded for the PD survey. 24 out of 55 programs (44%) changed their on-site interviews to virtual format due to the pandemic. Most PDs described their overall impression of virtual interviews as satisfactory (66%, 16/24) and did not have an impact on the applicant's success in the match (35/54; 65%). About 50% of PDs preferred to have on-site interviews with virtual screening in the future. While the participation rate from applicants was much less (26 of 70), responses confirmed our survey results. Majority preferred on-site interviews (17/26), 6 of which preferred virtual screening followed by on-site interviews. ConclusionComponents of virtual screening and interviews were found to have benefits financially and from both time and stress perspectives, and thus might survive past the pandemic. Levels of Evidence Level IV.

While You Don't See Color, I See Bias: Identifying Barriers in Access to Graduate Medical Education Training.

There is a need to acknowledge and address issues of implicit and explicit bias within medical education. These biases can impact standardized test questions and scores, evaluations of clinical performance, and subsequent letters of recommendation, all of which can affect the selection of diverse candidates advancing through medical training. Biased behavior toward trainees can negatively impact their learning environment and career trajectory. This article outlines key definitions related to bias and discusses the ways in which bias potentially impacts selection and entry into Pulmonary and Critical Care Medicine fellowship training. Finally, we will describe some ways to mitigate bias within the fellowship selection process and training programs.

Current perspectives of gynecologic oncology fellowship training and preparedness for practice

<h3>Objectives:</h3> The field of gynecologic oncology practice has evolved over decades, yet there is little known on how current fellowships are preparing gynecologic oncologists for practice in the era of these changes. Thus, we sought to investigate gynecologic oncology fellowship graduates' training experience and preparedness for practice following fellowship. <h3>Methods:</h3> This is a cross-sectional web-based survey study using REDCap, an electronic web-based application. We surveyed members of the Society of Gynecologic Oncology (SGO) who graduated from gynecologic oncology fellowship in 2015-2020. Email invitations to participate were sent with de-identified survey links. The survey included 51 questions assessing fellowship training experiences and level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies, including chemotherapy, immunotherapy, and PARP inhibitors. Additional questions addressed factors driving participants' selection of fellowship programs, education experience, research and preparedness for independent practice. Descriptive statistics were used for analyses. <h3>Results:</h3> A total of 297 SGO members were invited to participate, one was excluded due to a non-working email. The response rate was 43.9% (n=130) and n=123 completed surveys were included for final analysis. Over half (55.2% n=68) of responders were in their first 3 years of independent practice. The highest ranked factor for fellowship selection was fit with program (36.6% n=45) followed by surgical volume (29.3% n=36). Upon completing fellowship, most were uncomfortable performing radical surgeries in ureteral conduit formation (83.8% n=103), ureteroneocystostomy (76.4% n=94), exenteration (67.5%, n=83), splenectomy (66.7% n=83) and lower anterior bowel resection (41.5%, n=51). Most were comfortable managing intraoperative complications (84.5% n=104) and obstetrical hemorrhages (88.6% n=109), as well as standard open and minimally invasive staging (range: 61%-99.2%). More than half of those who did not have off-service surgical rotations in fellowship indicated they would have wanted rotations in surgical oncology (58% n=58), urology (57% n=59) and colorectal surgery (71.5% n=73) in fellowship training. Majority of respondents (91.1% n=112) used cancer-directed therapies in their current practice and were most uncomfortable managing immunotherapy side effects (30.1% n=37). Over a third (34.1% n=42) were somewhat or not confident that their fellowship thesis project will be suitable for oral boards defense and 22.8% (n=28) were unprepared to continue research in their career. Upon completing fellowship, 77.2% (n=95) report having mentorship that met their expectations during fellowship and 94.4% (n=116) overall were prepared for independent practice as gynecologic oncologists. <h3>Conclusions:</h3> Majority of recent gynecologic oncology fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures. However, most are not comfortable with radical gynecologic oncology surgeries; for this reason mentorship in early gynecologic oncology faculty development remains important. Many graduates also desired incorporating non-gynecologic oncology surgery service experience during fellowship, which could help supplement this discrepancy for less common procedures.

Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents

Abstract Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection. Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis. Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute. Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study. Main Outcomes and Measures This study evaluated four-letter personality type from each participant. Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) (p = 0.049), thinking (T) than feeling (F) (p = 0.027), and judging (J) than perceiving (P) (p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level. Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

How to Promote Career Advancement and Gender Equity for Women in Gastroenterology: A Multifaceted Approach

How to Promote Career Advancement and Gender Equity for Women in Gastroenterology: A Multifaceted Approach

Practical guidance to advisors of residents on the fellowship selection process

ABSTRACT Inability to Match into a fellowship is usually not a reflection of some failure on the part of the resident, but rather a problem of supply and demand. Understanding how to advise residents to maximize their success in an environment with limited spots and limited fellowship faculty resources to perform holistic review remains one of the primary objectives of most residency mentors. Residents can alter the odds in their favor by engaging with local faculty and in national society mentorship programs, performing ‘enough’ research, building their ‘brand,’ and concentrating on high quality personal statements.

Analysis of Gender Diversity Within Hand Surgery Fellowship Programs

To define and compare gender diversity among faculty and trainees within hand surgery fellowship programs. We determined the gender of each program director for all orthopedic residency and fellowship programs. Specific to hand fellowship programs, we determined the gender of the fellowship director and all faculty members for all plastic surgery and orthopedic hand fellowship programs. Lists of prior hand surgery fellows from 2014 to 2019 were obtained from official program websites or program coordinators. The gender distribution of the hand fellowship program directors and faculty was compared to the prior fellows. Hand surgery fellowship programs had the second highest percentage of female fellowship directors (13%) behind orthopedic oncology (27%). Within hand surgery, 614 total faculty positions were identified, and 15% were female. Of the 89 hand surgery programs evaluated, 36 (60%) had at least 1 female faculty member. For the 849 prior fellows identified, 213 (25%) were female, and 79% of programs had at least 1 female fellow. Hand programs led by a female director did not have a higher percentage of prior female fellows compared to programs led by a male director (26% vs 25%). Programs with a female fellowship director were as likely to have had at least 1 prior female fellow compared to programs with a male fellowship director. For orthopedic subspecialties, hand surgery fellowship programs had the second highest percentage of female fellowship directors (13%). While mentorship plays an important role in surgical education, hand fellowship programs with female faculty did not appear to attract more female fellows or faculty. Hand fellowship programs should recognize that the presence of female faculty may not be a primary factor in fellowship selection for female applicants, and further study into recruiting qualified female candidates should be encouraged.

Audiovisual Content for a Radiology Fellowship Selection Process During the COVID-19 Pandemic: Pilot Web-Based Questionnaire Study.

BackgroundTraditional radiology fellowships are usually 1- or 2-year clinical training programs in a specific area after completion of a 4-year residency program.ObjectiveThis study aimed to investigate the experience of fellowship applicants in answering radiology questions in an audiovisual format using their own smartphones after answering radiology questions in a traditional printed text format as part of the application process during the COVID-19 pandemic. We hypothesized that fellowship applicants would find that recorded audiovisual radiology content adds value to the conventional selection process, may increase engagement by using their own smartphone device, and facilitate the understanding of imaging findings of radiology-based questions, while maintaining social distancing.MethodsOne senior staff radiologist of each subspecialty prepared 4 audiovisual radiology questions for each subspecialty. We conducted a survey using web-based questionnaires for 123 fellowship applications for musculoskeletal (n=39), internal medicine (n=61), and neuroradiology (n=23) programs to evaluate the experience of using audiovisual radiology content as a substitute for the conventional text evaluation.ResultsMost of the applicants (n=122, 99%) answered positively (with responses of agree or strongly agree) that images in digital forms are of superior quality to those printed on paper. In total, 101 (82%) applicants agreed with the statement that the presentation of cases in audiovisual format facilitates the understanding of the findings. Furthermore, 81 (65%) candidates agreed or strongly agreed that answering digital forms is more practical than conventional paper forms.ConclusionsThe use of audiovisual content as part of the selection process for radiology fellowships is a new approach to evaluate the potential to enhance the applicants experience during this process. This technology also allows for the evaluation of candidates without the need for in-person interaction. Further studies could streamline these methods to minimize work redundancy with traditional text assessments or even evaluate the acceptance of using only audiovisual content on smartphones.

Investigating Factors at Play in Hepatopancreatobiliary Fellowship Selection: Beliefs versus Reality.

Selection biases affecting candidate matches to fellowship programs directly influence diversity within the surgical community. The review of selection bias has never been distinctively investigated in the Hepatopancreatobiliary (HPB) surgery community. This study seeks to (i) evaluate factors affecting selection of candidates to HPB fellowships, (ii) examine explicit biases among program directors and faculty of HPB programs in North America, and (iii) compare the demography of the HPB faculty and recently graduated fellows to general surgery residents. An anonymous, self-reported survey consisting of 10 sets of fictional applications was distributed to 52 faculty members, including program directors, of AHPBA-affiliated HPB fellowships in North America. The respondents had to pick a preferred candidate between two abridged, fictional HPB fellow applications and give an open-ended response as to why they picked that candidate. The applications were nearly identical with one notable characteristic of interest. Demographic information of both faculty and their recent fellows was also collected. This survey was administered and collected between February and April, 2020. A total of 29 fully completed responses were received, comprising a 55.7% response rate. Respondents were 72.4% male, 69.0% Caucasian, and 79.3% held US medical degrees (MD). 50.0% of respondents preferred an MD candidate to a DO candidate, and 37% preferred US graduates to foreign-trained candidates. The respondents were unanimous in stating that gender, race, and family status were not a factor in their selection process. 5.0% said they would support an LGBTQ candidate when faced with otherwise similar applicants. Seventy-six HPB fellows from the past 5years were 76.3% male, 56.6% Caucasian, and 51.3% US graduated Doctor of Medicine (US MD). This is the first study explicitly exploring the impact of demographic factors in the HPB fellowship selection process. The respondents unanimously and explicitly stated that race and gender do not play any role in their selection process. Yet, there is stark discordance between general surgery resident demographics and HPB fellow demographics. A greater effort to promote a more diverse HPB surgery community may be needed.

Race and Gender Bias in Internal Medicine Program Director Letters of Recommendation.

While program director (PD) letters of recommendation (LOR) are subject to bias, especially against those underrepresented in medicine, these letters are one of the most important factors in fellowship selection. Bias manifests in LOR in a number of ways, including biased use of agentic and communal terms, doubt raising language, and description of career trajectory. To reduce bias, specialty organizations have recommended standardized PD LOR. This study examined PD LOR for applicants to a cardiology fellowship program to determine the mechanism of how bias is expressed and whether the 2017 Alliance for Academic Internal Medicine (AAIM) guidelines reduce bias. Fifty-six LOR from applicants selected to interview at a cardiology fellowship during the 2019 and 2020 application cycles were selected using convenience sampling. LOR for underrepresented (Black, Latinx, women) and non-underrepresented applicants were analyzed using directed qualitative content analysis. Two coders used an iteratively refined codebook to code the transcripts. Data were analyzed using outputs from these codes, analytical memos were maintained, and themes summarized. With AAIM guidelines, there appeared to be reduced use of communal language for underrepresented applicants, which may represent less bias. However, in both LOR adherent and not adherent to the guidelines, underrepresented applicants were still more likely to be described using communal language, doubt raising language, and career trajectory bias. PDs used language in a biased way to describe underrepresented applicants in LOR. The AAIM guidelines reduced but did not eliminate this bias. We provide recommendations to PDs and the AAIM on how to continue to work to reduce this bias.

Assessing Trends in Fellowship Training Among Otolaryngology Residents: A National Survey Study.

To summarize trends in otolaryngology fellowship applications, fellowships selected, and reasons for pursuing a fellowship. One-page anonymous questionnaire. A survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. Data included age, gender, fellowship type, reasons for doing a fellowship, and type of practice that examinees will enter. Spearman correlation and Pearson chi-square tests were completed. Over the 8-year study, 58% of the 2243 responding examinees did fellowships. The most frequently chosen fellowship was facial plastic surgery (25%), followed by pediatric otolaryngology (21%), head and neck surgery (19%), rhinology (13%), laryngology (9%), and neurotology (8%). The 2 most common reasons for doing a fellowship were desire for additional expertise beyond residency training (35%) and intellectual appeal (30%). Over the study period, the number of residents choosing to do a fellowship increased from 45.6% in 2011 to 61.5% in 2019, with a positive correlation between year and number of residents (r = 0.73, P = .036). When the data were stratified by gender, there were statistically significant differences in fellowship selection (P < .001), notably with women selecting pediatric otolaryngology at a higher frequency than men (30.9% vs 15.8%). There is a statistically significant increasing trend of otolaryngology residents who choose to undergo further training in fellowship. These data from a large, long-term study will be valuable in planning for training and workforce needs in the future.

Gender Differences in Peer Recognition by Economists

We study the selection of Fellows of the Econometric Society, using a new data set of publications and citations for over 40,000 actively publishing economists since the early 1900s. Conditional on achievement, we document a large negative gap in the probability that women were selected as Fellows in the 1933-1979 period. This gap became positive (though not statistically significant) from 1980 to 2010, and in the past decade has become large and highly significant, with over a 100% increase in the probability of selection for female authors relative to males with similar publications and citations. The positive boost affects highly qualified female candidates (in the top 10% of authors) with no effect for the bottom 90%. Using nomination data for the past 30 years, we find a key proximate role for the Society's Nominating Committee in this shift. Since 2012 the Committee has had an explicit mandate to nominate highly qualified women, and its nominees enjoy above-average election success (controlling for achievement). Looking beyond gender, we document similar shifts in the premium for geographic diversity: in the mid-2000s, both the Fellows and the Nominating Committee became significantly more likely to nominate and elect candidates from outside the US. Finally, we examine gender gaps in several other major awards for US economists. We show that the gaps in the probability of selection of new fellows of the American Academy of Arts and Sciences and the National Academy of Sciences closely parallel those of the Econometric Society, with historically negative penalties for women turning to positive premiums in recent years.

Gender Differences in Peer Recognition by Economists

We study the selection of Fellows of the Econometric Society, using a new data set of publications and citations for over 40,000 actively publishing economists since the early 1900s. Conditional on achievement, we document a large negative gap in the probability that women were selected as Fellows in the 1933-1979 period. This gap became positive (though not statistically significant) from 1980 to 2010, and in the past decade has become large and highly significant, with over a 100% increase in the probability of selection for female authors relative to males with similar publications and citations. The positive boost affects highly qualified female candidates (in the top 10% of authors) with no effect for the bottom 90%. Using nomination data for the past 30 years, we find a key proximate role for the Society's Nominating Committee in this shift. Since 2012 the Committee has had an explicit mandate to nominate highly qualified women, and its nominees enjoy above-average election success (controlling for achievement). Looking beyond gender, we document similar shifts in the premium for geographic diversity: in the mid-2000s, both the Fellows and the Nominating Committee became significantly more likely to nominate and elect candidates from outside the US. Finally, we examine gender gaps in several other major awards for US economists. We show that the gaps in the probability of selection of new fellows of the American Academy of Arts and Sciences and the National Academy of Sciences closely parallel those of the Econometric Society, with historically negative penalties for women turning to positive premiums in recent years.

DPM Foot and Ankle Fellowship Selection Criteria: Survey of Fellowship Directors.

A recent increase in podiatric medicine fellowships has occurred as the field continues to progress. Research regarding selection criteria from a fellowship director's perspective for potential fellows is lacking. This study aimed to examine objective and subjective selection criteria that directors consider when selecting applicants for the interview and when ranking prospective fellows after the interview. We electronically surveyed American College of Foot and Ankle Surgeons fellowship directors with preselected criteria for granting applicants an interview and for compiling their ranking list after the interview. A Likert scale from 1 (most important) to 5 (least important) was used to prioritize each criterion, an average rating was calculated, and the results were placed in order of importance. The most important selection criteria for granting an interview were quality of residency program (1.985), a written personal statement of reasons for attending that fellowship (2.063), and publications/presentations produced as a resident (2.267). The most important criteria in completing the ranking order after the interview were assessment of applicant's personality (1.111), interview performance (1.173), and expressed interest in program (1.563). Knowledge of the selection criteria that fellowship directors seek in applicants can assist those who desire to further their training. The selection criteria that program directors seek differed between being selected for the interview, which combined both objective and subjective criteria, and when compiling their rankings after the interview, which included only subjective criteria. Results show more emphasis on subjective selection criteria when directors select applicants for an interview and when ranking applicants after the interview.

Disrupting the Fellowship Match: COVID-19 and the Applicant Arms Race

Resident and fellow selection carried out via "the Match" has historically relied upon in-person interviews to evaluate and rank candidates. However, the COVID-19 pandemic has required fellowship matches and the upcoming Main Residency Match® to become wholly virtual. The 2020 pediatric surgery match offers a unique case study in the benefits and shortcomings of a virtual process and begins a much-needed conversation regarding opportunities for innovation in candidate selection. For many candidates, the application cycle imposes considerable costs - financial, professional, and personal - which have only escalated over time. We draw on our experience from the most recent match cycle to discuss limitations of the traditional Match® and suggest potential solutions to improve the subspecialty interview process moving forward.

Far-flung female (and fossil bone hunting) Fellows: an autoethnographical approach

Abstract Geologists roam worldwide; no less for women who took up fellowship of the ‘Geol. Soc.’. Since 1919, women Fellows of the Geological Society have lived and worked across the globe conducting fieldwork and research. Based on the author's interests and in part considering her 50 years an FGS, a selection of women Fellows is considered, many of whom affected her geological life, such as Phoebe Walder and Peigi Wallace. This autoethnographical approach encompasses women from the colonies who joined as soon as they were able; the legendary Dorothy Hill of Queensland was one of the first, with other notable Australians being Nell Ludbrook and June Phillips Ross. Others worked across the former Gondwana, such as Pamela Robinson, who pioneered much research in vertebrate palaeontology on the Indian subcontinent. Important British geologists and vertebrate palaeontologists include Dorothea Bate, Sonia Cole, Elinor Gardner and Eileen Hendriks, who wrote key geological texts in the earlier twentieth century. More contemporary women did work for UNESCO, the International Union of Geological Sciences and in the oil industry. During the later twentieth and early twenty-first centuries, female Fellows have worked across the world in greater numbers in all aspects of geoscience, from the Arctic to the Antarctic.

Interviewer bias in selection of anaesthesia Fellows: A single-institution quality assessment study.

Fellowships are competitive training posts, often in a subspecialty area. We performed a quality assessment of potential interviewer bias on anaesthesia Fellow selection. After research locality approval, we analysed interview scores for all Fellowship applications to our department over sixyears. Panel interviewers participated in a structured interview process, asking a series of standardised questions to rate applicants. A mixed model analysis of total applicant rating with crossed effects of applicants and interviewers was used. A total of 94 applicants were interviewed by 27 panel members, with between two and four panel members per interview, giving a total of 329 applicant ratings. The random effect of applicants accounted for 45.8% of total variance in ratings (95% confidence intervals (CI) for intraclass correlation (ICC) 35.8%-57.2%) while interviewer effects accounted for 13.4% of total variance (95% CI for ICC 5.3%-30.0%). We found no evidence of bias for most potential sources after analysing multiple applicant and interviewer factors. After adjusting for interviewer training programme, applicants from other training programmes were rated a mean of 1.87 points lower than Australian and New Zealand College of Anaesthetists (ANZCA) applicants (95% CI 0.62-3.12, P = 0.003) and 1.84 points lower than Royal College of Anaesthetists (RCoA) applicants (95% CI 0.37-3.32, P = 0.014). After adjusting for applicant gender, female clinicians rated applicants 1.12 points higher (95% CI 0.19-2.06, P = 0.019) on average than male clinicians. The observed differences in interview scores amongst male and female clinicians and lower scores in applicants from programmes other than ANZCA/RCoA were small, and require confirmation in independent studies.

Factors Important in the Selection of a Rhinology/Skull Base Surgery Fellow: A National Survey of Fellowship Directors.

The numbers of Rhinology/Skull Base Surgery fellowship programs and applicants have been increasing in recent years. However, little information is currently available with regards to the most important aspects of the application process. The goal of this study was to determine the factors that Rhinology/Skull Base Surgery fellowship directors consider most important when selecting a fellow. An anonymous, online survey was distributed to current Rhinology/Skull Base Surgery fellowship directors. 28 of 31 fellowship directors (90%) completed the survey. Respondents were asked to provide basic information regarding the program and to rank various selection factors they deem most important. For assessing the quality of an application, fellowship directors placed the highest value on LORs. Research experience and publications were also important considerations. The traditional strength of an applicant's residency program was a factor, while medical school performance, USMLE scores, and OTE score did not play a significant role in the selection process. For subjective assessment of applicants, the most value was placed on faculty assessment of the applicant during their interview. Attention was also given to personality fit with the program and the perceived maturity and initiative of the applicant. Numerous academic achievements and personal characteristics are given consideration in the Rhinology/Skull Base Surgery fellowship selection process, but recommendation from a trusted colleague and performance on interviews were viewed to be the most critical factors for fellowship programs in selecting applicants. This is consistent with studies that have explored the selection process for other otolaryngology fellowship programs.

How and Why Trainees Choose a Career in Pediatric Pulmonology. A Qualitative Study.

Background: There is concern that inadequate recruitment of new subspecialty trainees to replace the aging physician population will lead to significant workforce issues in pediatric pulmonology. The factors leading trainees to pursue a fellowship in pediatric pulmonology are unclear.Objective: To gain a better understanding of the decision-making process surrounding the choice to pursue a pediatric pulmonary fellowship and to provide informed recommendations to increase recruitment of new trainees.Methods: Informed by the Social Cognitive Career Theory, eight focus groups were held with pediatric residents and fellows attending the 2019 American Thoracic Society International Conference. Questions focused on personal background, learning experiences, self-efficacy and outcome expectations, interests, and goals. Transcripts were analyzed by conventional content analysis.Results: Fifty-six residents and fellows representing 42 different institutions participated. Responses resulted in seven major themes: 1) attractive aspects of pediatric pulmonology draw trainees to the field, 2) exposure to the breadth and scope of the field is limited, 3) mentorship is key, 4) decisions surrounding fellowship selection occur early in the second year, 5) trainees want flexibility in length and structure of fellowship, 6) financial considerations are not the driving factor in decision-making, and 7) there are inherent aspects of pulmonology that trainees may not enjoy.Conclusion: A lack of broad exposure to pediatric pulmonology during residency results in false perceptions of the field and is a deterrent to recruitment. Improving faculty engagement, guaranteeing broad and early exposure to the field, and creating learning experiences aimed at raising self-efficacy may improve recruitment and ultimately improve the pediatric pulmonary workforce.

Fellow selection protocols in sleep surgery: a national survey of sleep surgery program directors.

To determine the factors that sleep medicine/surgery fellowship program directors look for in applicants. Program directors from 9 sleep medicine/surgery fellowship programs in the USA were sent an anonymous online survey. They were asked to select the five most important academic factors (of a list of 17) when evaluating potential fellowship candidates, then rank those five in order of importance. They were then asked to do the same for the most important subjective criteria (of a list of 12). Eight of 10 survey responses met inclusion criteria. Of the academic factors, strength of letters of recommendation, reputation of letter writer, and letters from sleep surgeons ranked highest. As for the subjective criteria, faculty assessment of the applicant on interview was ranked highest, followed by initiative and personality "fit" with the program. The reputation of an applicant's residency was ranked as more important than the reputation of their medical school. An applicant's performance in residency was assessed as more predictive of their performance in fellowship than performance during the interview process or position on the rank order list for the match. Only one program has a United States Medical Licensing Examination (USMLE) Step, and a different program has an Otolaryngology Training Examination (OTE) score cutoff. Letters of recommendation and interview are the most important factors in the selection process for hybrid sleep medicine and surgery fellowship programs, followed by research and residency program reputation. Sleep surgery-specific experience is helpful.