Fellowship Applicants Research Articles

Normalized Competitive Index: Analyzing Trends in Surgical Fellowship Training Over the Past Decade (2009-2018)

There is a lack of literature describing how competitive surgical fellowships are, especially across specialties. Such information would be valuable to prospective candidates, especially as immediate postresidency subspecialty training becomes the norm for general surgery. Match-rates alone may be misleading indicators as programs may not fill positions with unqualified applicants. We propose a simple metric to analyze the competitiveness of various surgical subspecialties to each other and themselves over time. Retrospective cohort study. The Competitive Index is defined as the percentage of filled programs within each specialty divided by the match-rate for that specialty. For ease of comparison, a Normalized Competitive Index (NCI) was developed, normalizing the metric for all specialties in that year to a value of 1. The National Resident Matching Program, The Fellowship Council, and the San Francisco Match publicly available match data from 2009 to 2018. General Surgery Associated Fellowship Applicants (Abdominal Transplant, Colorectal, Surgical Oncology, Minimally Invasive Surgery, Pediatric, Plastic, Critical Care, Thoracic, and Vascular). The overall match rate for all specialties was 74.6% and 84.0% of all programs were filled. Over the past decade, pediatric surgery was significantly more competitive than other specialties (NCI 1.67, p < 0.0001), while surgical critical care (NCI 0.58, p < 0.0001) and vascular (NCI 0.90, p < 0.0492) were significantly less competitive. When comparing the NCI within each specialty from the first 5 years (2009-2013) to the last 5 years, (2014-2018), surgical critical care (NCI 0.54 vs. 0.62, p = 0.0462) and thoracic (NCI 0.74 vs. 1.08, p=0.0025) became significantly more competitive, while transplant (NCI 1.10 vs. 0.92, p = 0.0343) and colorectal (NCI 1.32 vs. 1.09, p = 0.0021) became significantly less competitive. The NCI is a metric which might be useful to prospective applicants and which could be provided annually by organizations sponsoring fellowship matching processes. Further research must be performed to establish what defines a qualified applicant in each specialty.

Exploring the gender gap: Letters of recommendation to pediatric surgery fellowship

BackgroundLetters of recommendation (LoR) are considered one of the most important predictors of matching into a pediatric surgery fellowship. We determined if gendered differences exist in LoR written for resident candidates. MethodsA retrospective review of blinded LoR to a fellowship program between 2015 and 2017 was performed. ResultsOf the 364 LoR reviewed for 49 female and 48 male applicants, male surgeons wrote 82.5% of letters. Male LoR contained more agentic terms (p = 0. 042), first name occurrences (p = 0.0082) and phrase “future success” (p = 0.015). Female letters included more socio-communal phrases (p = 0. 010) and 5% referenced a spouse's accomplishments vs. 0% of male letters. Male LoR contained more active possessive language (p-0. 027); ie: “he published”, “he presented”. We found no difference in an applicant's research experience (p = 0.06) or leadership qualities (p = 0. 067). ConclusionGender differences exist in LoR written for fellowship applicants applying to a highly competitive subspecialty.

Research-Track Residency Programs in Orthopaedic Surgery: A Survey of Program Directors and Recent Graduates.

The importance of research in resident education has been emphasized in the orthopaedic surgery community, and a number of residency programs have incorporated a year or more of protected research time into their training. However, limited information exists as to what programs are looking for in applicants to research-track residency programs or the perceived benefits of completing such a program. We identified orthopaedic surgery programs that have tracks involving at least 1 year of protected research time and sent surveys to their program directors and to the 2012 through 2016 research-track graduates. Twenty-three programs with research tracks were identified, and 19 program directors (83%) responded to the survey. The survey revealed that only 2 (11%) of these program directors were willing to accept lower scores and grades among applicants to their research track compared with their primary clinical (categorical) track. While most of the program directors (14 [74%]) preferred that applicants have an interest in academics, only a few (3 [16%]) considered it a failure if their research-track residents did not pursue academic careers. We obtained the e-mail addresses of 82 research-track graduates, and 66 (80%) responded to the survey. The survey revealed that those who went into academic careers were more likely than those who went into private practice to view completing a research track as beneficial for fellowship (73% versus 35%, respectively) and job (73% versus 22%, respectively) applications, believed that the income lost from the additional year of residency would be compensated for by opportunities gained from the research year (50% versus 17%, respectively), and said that they would pursue a research-track residency if they had to do it over again (81% versus 39%, respectively; all p values <0.05). The majority of program directors preferred that applicants to their research-track program have an interest in academics, although most did not consider it a failure if their research-track residents entered nonacademic careers. Graduates of research-track residency programs who entered academics more frequently viewed the completion of a research track as being beneficial compared with those who went into private practice.

A Lexicon of Concepts of Humanistic Medicine: Exploring Different Meanings of Caring and Compassion at One Organization.

There has been scant scholarly attention paid to characterizing how the numerous definitions of terms associated with compassion and humanism have been mobilized or what the organizational implications of pursuing different constructs might be. This study explored the uses and implications of the terminology associated with humanistic medicine in the work of the Associated Medical Services (AMS) Phoenix Project. This study involved two phases (2014-2015). First, two pilot group workshops with AMS Phoenix Project participants and stakeholders were conducted to explore ways of parsing and interpreting core concepts used in the project. The authors then assembled an archive of texts associated with the project, comprising the project website and blog posts, conference proceedings, and fellowship and grant applications. Informed by critical discourse analysis, the authors identified, described, and analyzed core terms related to the project's mission and explored the type of health care practices and reforms implied by their use. Two recurring core terms, care/caring and compassion, and eight clusters of terms related to these core terms were identified in the archive. Caring and compassion as terms were articulated in various psychological, sociological, and political configurations. This polysemy reflected a diverse array of health care reform agendas. Understanding how different interpretations of caring and compassion cluster around core topics and concerns of humanistic medicine offers scholars an entry point for comparing and appraising the quality and direction of reform agendas, including multilevel strategies that involve systems-level changes.

Training Disparities of Our Future Workforce: A Survey of Trauma Fellowship Candidates

BackgroundTraining in Acute Care Surgery (ACS) is an integral component of general surgery residency and serves as a critical base experience for the added educational qualifications of fellowship. How this training varies between programs is not well characterized. We sought to describe the variation in clinical exposure between residencies in a sample of residents applying to an ACS fellowship. We hypothesized that applicants have significant variations in clinical exposure as well as unique and specific expectations for educational experiences. Materials and methodsWe offered an anonymous 82-question survey focused on residency clinical exposure and self-perceived confidence in key areas of ACS training, as well as fellowship training and career expectations to all applicants interviewed at a single trauma, critical care, and emergency surgery fellowship program. Responses were assessed via absolute numbers and confidence via a 5-point Likert scale; data are reported using descriptive statistics and linear regression models. ResultsForty-two interviewing applicants completed the survey, for a 96% response rate. Applicants reported heterogeneous levels of comfort across most ACS domains. There was good correlation between experience and comfort in most procedural areas. During fellowship training, respondents placed highest priority on operative experience, with 43% rating this as their highest priority, followed by penetrating trauma experience (33%). ConclusionsWe found significant variations in both experience and comfort within key ACS domains among fellowship applicants. Despite training variability, there was good correlation between experience and self-reported comfort. Collaboration between residency and fellowship governing bodies may help address areas of limited exposure before entry into clinical practice.

Complex General Surgical Oncology Fellowship Applicants: Trends over Time and the Impact of Board Certification Eligibility.

Complex general surgical oncology (CGSO) fellowships recently obtained Accreditation Council for Graduate Medical Education (ACGME) accreditation and board certification eligibility. We aimed to characterize the applicant pool and identify factors predictive of matching into our program. We conducted a retrospective review of CGSO fellowship applications to a major cancer center from 2008 to 2018. Data were analyzed for trends over time, including a comparison of pre- versus post-American Board of Surgery (ABS) certification eligibility. A total of 846 applications were reviewed. Most applicants (86.2%) trained in a US residency program; 58.4% performed ≥ 1 research year during residency; 29.6% had a dual degree. Fewer applicants (34.5%) were female, a trend which did not change over time. Post-ABS, applicants were more likely to complete ≥ 1year between residency and fellowship (20.9% versus 13.2%, p = 0.003), to be in practice at the time of application (12.2% versus 6.6%, p = 0.005), and to reapply (5.5% versus 1.0%, p < 0.001). Post-ABS applicants listed more peer-reviewed publications (8 [interquartile range (IQR) 4, 15] versus 5 [IQR 2, 10]; p < 0.001). On multivariable analysis, factors associated with matching into our program included: US allopathic medical school graduation [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.8-11.7], Alpha Omega Alpha (AOA) Honor Medical Society distinction (OR 2.7, 95% CI 1.6-4.7), dual degree (OR 2.0, 95% CI 1.1-3.4), and performance of a clinical/research rotation at our institution (OR 4.9, 95% CI 2.2-10.7). After establishment of CGSO board certification eligibility, applicants were more likely to apply while in practice and to reapply. A number of factors, including having a dual degree and rotating at our institution, were associated with matriculation.

Smartphone Application as an Education Platform in Hepato-Pancreato-Biliary Surgery.

Background. There are no data to assess the need for smartphone applications (SA) as an educational tool in hepato-pancreato-biliary (HPB) surgery. The primary objective of this study was to assess if SA can be used as an educational tool in HPB surgery. The secondary objective was to assess if SA can help as a decision-making tool for fellowship applicants in HPB surgery. Methods. A preapproved questionnaire was e-mailed by International Hepato-Pancreato-Biliary Association to all its 2350 members. Results. Two hundred seventy-one surgeons responded to the survey. Eight were excluded for incomplete data. A total of 48.7% of responders were between 28 and 43 years old (generation X) and 45.2% between 44 and 62 years old (baby boomers). A total of 37.6% of the responders considered SA as an effective method to teach future trainees, and there were slightly higher odds of choosing SA as a teaching tool if the responder considered themselves as an innovator (odds ratio: 2.24). A total of 87.8% of the responders believe that SA in HPB surgery can be directed toward surgical trainees' education, and 91.6% believed SA can be directed toward a fellow. Ninety-five percent of the responders believed that SA in HPB surgery can possibly help a future applicant to choose an HPB fellowship program. Conclusion. SA can complement other teaching techniques and educational tools in HPB surgery. In addition, it can potentially be used as a platform for HPB surgery fellowship by helping in making a decision regarding appropriate fellowship programs.

Otolaryngology Resident Well-Being and Perceptions of the Clinical Learning Environment

To measure the current state of organizational and well-being factors in otolaryngology residency programs and associate these perceptions with demographics, pursuit of subspecialty fellowships, and performance on the Otolaryngology Training Examination (OTE). Anonymous mail and online survey study of otolaryngology residents from the Southern, Mid-Atlantic, and East South-Central Regions of the United States. A total of 46 otolaryngology residents across 14 residency training programs (22% resident response rate) completed our survey. Residents who scored above the 80th percentile on the OTE perceived greater organizational support (median = 3.84) than residents who scored below the 40th percentile (median = 3.31), U = 48.00, P = .047, η2 = 0.14. Residents interested in fellowship reported less burnout (median = 2.44) compared to those who did not plan to pursue fellowship (median = 3.56), U = 105.00, P = .010, η2 = 0.05. Residents pursuing fellowship also reported less work-life strain (median = 2.56) than those forgoing fellowship (median = 2.89), U = 126.00, P = .044, η2 = 0.10. Residents with children reported greater work-life strain (median = 3.11) compared to those without (median = 2.56), U = 60.50, P = .008, η2 = 0.15. For otolaryngology residents in this survey sample, the perception of organizational support and well-being may influence resident performance (on OTE examinations) and ultimate career goals (fellowship applications). Program directors and coordinators can use this information to strengthen the perceptions of organizational support as well as improve the clinical learning environment to optimize training conditions for their residents. Residency program directors can also use the identified study measures to assess resident perceptions of the clinical learning environment and well-being for annual evaluation and improvement purposes.

Assessment of Resident Opinions and Knowledge of Neurology Subspecialty Fellowship Application (P2.9-025)

Assessment of Resident Opinions and Knowledge of Neurology Subspecialty Fellowship Application (P2.9-025)

Critical Analysis of Hematology and Oncology Fellowship Web Sites in the United States.

Prospective hematology-oncology fellowship applicants use program Web sites as a critical source of information. The purpose of this study was to evaluate the current content and comprehensiveness of hematology-oncology fellowship Web sites and to identify specific areas for improvement. This study assessed the presence of 27 commonly evaluated program and application and curriculum and training informational items for Web sites of all accredited hematology-oncology fellowship programs in 2018. The comprehensiveness score was calculated as the number of items present on a fellowship Web site out of 27 and was compared by program region and size using analysis of variance and two-tailed t tests. Of the 143 fellowship Web sites evaluated, the mean comprehensiveness score was 39.3% (10.6 ± 3.8 out of 27). Programs contained a mean of 42.1% (5.9 ± 2.3 out of 14) of program and application and 36.2% (4.7 ± 2.1 out of 13) of curriculum and training items. The program and application items most common among Web sites were program coordinator contact and faculty listing (83.2% and 74.1% of Web sites, respectively), whereas social events and salary and benefits were less common (31.5% and 20.3% of Web sites, respectively). Prevalent curriculum and training items were research publications and activity and rotation scheduling (86.0% and 81.1% of Web sites, respectively), whereas board examination pass rates and fellow call duties were uncommon (4.2% and 15.4% of Web sites, respectively). Large programs were associated with greater overall Web site items compared with small programs (43.0% [11.6 ± 4.1 out of 27] v 35.9% [9.7 ± 3.3 out of 27]; P = .003). Hematology-oncology fellowship Web sites vary considerably in the level and nature of content they contain. Because applicants rely on online information for decision making, more comprehensive online content may promote a better fit between program and applicant. There is room for improvement in hematology-oncology fellowship Web sites, and programs may consider directing resources toward enhancing these Web sites.

Has Rheumatology Become a More Attractive Career Choice? Comparison of Trends in the Rheumatology Fellowship Match From 2008 to 2013 With Those From 2014 to 2017.

Rheumatology has previously been a less attractive career choice than other internal medicine (IM) subspecialties. Recent fellowship data from the National Resident Matching Program (NRMP) has suggested that this may have changed. Therefore, we evaluated the current attractiveness of rheumatology as a career choice and compared it with other medical subspecialties. Data from the NRMP from 2008 to 2017, the 2015 American College of Rheumatology workforce study, and Medscape physician salaries from 2010 to 2017 were used to determine annual numbers of fellowship applicants, availability of positions, and post-fellowship salary trends. Data from 2008 to 2013 were compared with those from 2014 to 2017, and rheumatology was compared with other IM subspecialties. The total number of annual fellowship applicants to rheumatology for 2008-2013 decreased by 3% (average annual mean ± SEM percentage change of -1.9 ± 2.6%), from 251 to 244 applicants. However, for 2014-2017, annual rheumatology applications increased by 44% (average annual mean ± SEM percentage change of 20.7 ± 10.5% [P = 0.03]), from 230 to 332 applicants. Other nonprocedural and procedural IM subspecialties did not exhibit a similar increase. For rheumatology, the increases in the ratio of annual applicants to positions (P = 0.02) and in the percentage of US medical graduates applying (P = 0.03) were statistically significant, and mean post-fellowship salary also rose. The aforementioned observations suggest that rheumatology has become a more attractive career choice since 2014. We speculate that the increasing popularity of the field is multifactorial, likely reflecting lifestyle, job satisfaction and availability, influence of mentors, and other elements. This salutary and exciting potential opportunity for rheumatology should be exploited.

Electing to speak: professional dialogue in the context of Fellowship of the Higher Education Academy

ABSTRACTWritten submissions are traditionally used in the assessment of applications for Fellowship of the Higher Education Academy, with dialogue offering an alternative approach. Quite why individuals elect for dialogue has received little attention. Using a mixed methods approach, data were gathered from two Universities offering dialogic and written routes in their Fellowship schemes. Most individuals elected for dialogue, although this decision varied between Fellowship categories. Reasons for the choice were highly individual. This study demonstrates that dialogic approaches are popular with staff. However, we argue the importance of choice in Fellowship assessment options and recommend this to other academic developers.

Challenges and Perspectives to the Fall in Psychiatry Fellowship Applications.

Challenges and Perspectives to the Fall in Psychiatry Fellowship Applications.

US government shutdown by the numbers: NSF grant proposals and fellowship applications

US government shutdown by the numbers: NSF grant proposals and fellowship applications

How to Succeed in Fellowship Acquisition: A Survey of Pathology Residents

Medical school curricula limit students’ exposure to pathology practice while pathology subspecialty training programs require residents to apply for fellowships as early as the end of their first year of training. Thus, limited exposure to pathology practice creates significant confusion and anxiety, often making the fellowship application process premature. Additionally, early focus on subspecialty training in order to acquire a fellowship adds to the initial lack of emphasis on general pathology training. We prepared a voluntary online survey with questions developed through focus groups and advice from an expert in survey design to determine which fellowships are desired and how successful residents are in their pursuit of these fellowships. The survey was distributed through the Pathology Residency Program Directors' (PRODS) listserv. Answers were solicited from pathology trainees throughout the entire training cycle. There were 141 (4.6% response rate) total respondents with each postgraduate year represented. One hundred twenty-two (95%) of 129 residents plan on completing 1 or 2 fellowships after residency training. Encouragingly, 94 (75%) of 126 pathology residents attained their desired specialty fellowship. However, 32 (32%) of 99 residents who acquired at least one fellowship chose a general surgical pathology fellowship. Furthermore, 33 (24%) respondents had already decided to pursue a specific specialty while still in medical school. An additional 32 (23%) came to their decision during postgraduate year 1. Therefore, although most residents are successful in attaining their desired fellowship, further research is needed to understand the effect of early commitment to a subspecialty and its impact on pathology education.

Analysis of Abdominal Radiology fellowship website content and comprehensiveness.

Fellowship programs' online content plays a key role in prospective Abdominal Radiology applicants' evaluation of programs. The purpose of this study is to examine the online accessibility of Abdominal Radiology fellowships, the comprehensiveness of the program websites' content, and evaluate whether specific program characteristics are associated with differentiated website comprehensiveness. A list of 67 Abdominal Radiology fellowship programs was obtained from the Society of Abdominal Radiology (SAR) website. Each of the 65 publicly-available fellowship websites was scored for the presence of 19 binary variables related to the program's attributes and curriculum to assess informational comprehensiveness. Comprehensiveness scores were compared by program characteristics (accreditation status, region, and size) using Kruskal-Wallis and two-tailed t tests. Mean comprehensiveness score of Abdominal Radiology fellowship websites as measured by online criteria met was 52.6% (10.0 ± 3.0/19). Application requirements and information, rotation scheduling, and program director contact were found on more than 87.5% of the 65 websites, whereas salary and benefits, social information, and alumni were listed on fewer than 33.8% (22/65) of websites. Program accreditation status, region, and size were not associated with difference in mean comprehensiveness scores. There is a discrepancy between information commonly sought by prospective Abdominal Radiology fellowship applicants and what is available on fellowship program websites. Programs and applicants alike may benefit from programs strengthening their online material.

Preparing for a Fellowship in Adult Cardiothoracic Anesthesiology: Resources and Approaches for the Anesthesiology Trainee

Adult cardiothoracic anesthesiology (ACTA) is a competitive fellowship. Despite increases in both the number of programs offering cardiothoracic fellowships and the number of residents applying each year, there is little direction or advice for prospective candidates. This review aims to educate anesthesiology residents who are hoping to pursue cardiothoracic anesthesiology, by examining a brief history of the advanced perioperative echocardiography qualification, the credentialing goals of ACTA fellowships, and the current status of ACTA fellowships. The second part of the review covers the ACTA fellowship application and aims to assist the candidate in navigating this process. The review examines the qualifications that fellowship programs look for in a candidate, including a discussion on professional behavior, and what an applicant can look for in a program. Finally, there is a brief discussion on post-match preparation.

Neurology residency training in 2017: A survey of preparation, perspectives, and plans.

To survey graduating US neurology residents on the topics of debt, fellowship interview process, future plans, and their readiness for practice and business management tasks. An electronic survey was sent to all US American Academy of Neurology member adult and child neurology residents graduating in June 2017. The response rate was 23.4% (n = 159). Of the 143 residents who provided information about student loans, 57% reported having debt (median $180,000). Ninety percent of respondents reported plans to pursue a fellowship after residency; 57% intended to stay at their home institution for additional training. Among respondents from adult neurology programs, 87% preferred to begin the fellowship application process after the first 6 months of the third postgraduate year. Almost half (46%) of adult neurology program residents felt they did not have enough outpatient exposure prior to making fellowship decisions compared to 14% of child neurology trainees. Although reported readiness to perform specific tasks (coding and office management) increased since 2007 (p < 0.05), only 36% of all respondents reported receiving business management training during residency. Trainees completing residency report considerable educational debt. A large majority of residents feel the fellowship application process occurs too early. Despite improvements over recent years, the majority of residents continue to feel ill-prepared for specific practice management tasks. These results suggest a need to better understand the effect of educational debt on career choices, an examination of the timing of the fellowship application process, and the incorporation of additional business management training during residency.

What Does a Successful Postdoctoral Fellowship Publication Record Look Like?

Obtaining a prize postdoctoral fellowship in astronomy and astrophysics involves a number of factors, many of which cannot be quantified. One criterion that can be measured is the publication record of an applicant. The publication records of past fellowship recipients may, therefore, provide some quantitative guidance for future prospective applicants. We investigated the publication patterns of recipients of the NASA prize postdoctoral fellowships in the Hubble, Einstein, and Sagan programs from 2014 through 2017, using the NASA ADS reference system. We tabulated their publications at the point where fellowship applications were submitted, and we find that the 133 fellowship recipients in that time frame had a median of 6 ± 2 first-author publications, and 14 ± 6 co-authored publications. The full range of first-author papers is one to 15, and for all papers ranges from two to 76, indicating very diverse publication patterns. Thus, while fellowship recipients generally have strong publication records, the distribution of both first-author and co-authored papers is quite broad; there is no apparent threshold of publications necessary to obtain these fellowships. We also examined the post-PhD publication rates for each of the three fellowship programs, between male and female recipients, across the four years of the analysis and find no consistent trends. We hope that these findings will prove a useful reference to future junior scientists.

1322. Impact of Hospital Medicine on Trends in Infectious Diseases and Other Subspecialty Fellowship Applications

BackgroundOver the last decade, the rapid growth of hospital medicine has raised concerns that fewer graduating internal medicine (IM) residents might be pursuing fellowship,1 including in ID.2 We analyzed national trends in applications to subspecialty fellowships over the last 10 years to examine the potential impact of hospital medicine on resident career choice.MethodsWe examined 2009–2018 data from the National Resident Matching Program Specialties Matching Service3 for applicants to eight IM subspecialties. The number of third year residents (R3s) was obtained from the American Board of Internal Medicine Resident Workforce Data.4ResultsThe number of matched applicants increased significantly over the last 10 years from 2,889 to 3,640 (P < 0.0001) and was highly correlated with the increase in number of R3s (r2 = 0.93, P < 0.001). All subspecialties saw a significant increase in matched applicants over time except ID and nephrology, which both saw initial decreases that reversed after converting to an “all-in” match. In 2018, ID had its highest number of matched applicants in the last 10 years.ConclusionDespite concerns that the growth in hospital medicine would lead to fewer IM residents pursuing subspecialty fellowship, the number of matched applicants to subspecialty fellowships has actually increased over the last 10 years, and has kept pace with the growth in R3s over this time. Initial decreases in the number of matched applicants in ID have now reversed after conversion to the “all-in” match, and the next few years will be critical to determine whether this trend continues.