Fellowship Positions Research Articles

Orthopedic Sub-Specialties Vary in Representation of Female Fellowship Program Directors

Background Female representation varies among subspecialities as far as existing surgeons and entry of female candidates. Mentorship has been identified as a factor affecting women’s decision to choose a sub-specialty. Orthopaedic fellowship program director gender is an important factor for female applicants in choosing a subspecialty has not been analyzed. Purpose To report on fellowship program director (PD) genders within orthopedic subspecialties and quantify the number of training positions represented by female PDs. Also, to compare the academic ranks and h-indices, of male and female PDs within each specialty. Methods Data was collected by utilizing the San Francisco Match program data, subspecialty program lists, and specific fellowship pages. For each subspecialty, we calculated the percentage of fellowship program and fellowship positions led by female program directors. We compared academic ranks and h-indices between male and female program directors. Statistical significance was defined as a P-value of <0.05. Results Female program directors led 4.7% of programs and 3.4% of fellowship positions. Female leadership varied by subspecialties, highest in orthopedic oncology (20% programs, 18.5% positions) and pediatric orthopedics (13.3% program, 9.6% positions). Lowest female representation in sports (2.2% programs, 1.2% positions) and joints (0.9% programs, 0.5% positions). Female fellowship PDs were more likely to be assistant professors than their male counterparts (39% vs. 22%), and less likely to be full professors (17% vs, 33%), but these differences were not statistically significant (P=0.13). In the 6 subspecialities for which an H-indices was calculated, 5/6 subspecialties there was not significant difference in h-indices. Conclusion Women remain underrepresented in the roles as orthopedic fellowship program directors there is significant variation amongst the subspecialities. Female program directors did not have a significantly different academic rank and H-indices did not differ significantly by program director gender in 5/6 subspecialities.

The Neuromuscular Portal and Match: Working Toward a More Fair, Equitable, and Transparent Process.

Prior to 2021, the neuromuscular medicine fellowship application process suffered from non-standardized timelines and substantial variability. To rectify this, the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) established a standardized application timeline and an online application portal in 2020-2021, followed by the introduction of a partial match process. In 2021-2022, AANEM launched a traditional, binding, two-way match system for fellowship positions allocation based on the Gale-Shapley stable matching algorithm. Surveys assessing perceptions of fairness in the application portal and match process were dispatched to applicants and program directors following the 2021 and 2022 recruitment cycles. In the 2020-21 cycle, 90% of program directors and 95% of applicants affirmed the standardized timeline benefited applicants. However, 57% of applicants deemed the process as unfair. All programs and most applicants (58%) favored a transition to a two-way match. The implementation of the two-way match in 2021-22 attracted participation from 97% of programs, with 80% of applicants and 95% of programs viewing the process as fair to applicants. A significant majority of both applicants (86%) and programs (94%) supported maintaining the standardized timeline and two-way match. We advocate for the universal adoption of the AANEM Match for neuromuscular fellowship recruitment and a standardized fellowship application timeline across all neurologic specialties to promote transparency, fairness, and equity for applicants.

Creating a sustainable rural general surgery workforce: what enables fellows to return as rural general surgeons?

In the context of shortfalls in rural general surgeon supply, this research aims to explore why rural general surgical Fellows returned and remained after fellowship at a single rural centre in Victoria, Australia. Fellowship positions post achievement of Fellowship of the Australasian College of Surgeons are traditionally not funded by government because they currently fall outside the accredited rural training post funding provided by the federal government. This article aims to explore if fellowship positions can be an important part in sustaining the rural general surgery workforce. Semi-structured interviews were conducted with nine former general surgery Fellows from a single rural Australian institution. Interviews were recorded, transcribed, coded and themed to undertake analysis according to thematic analysis. This research demonstrates that consultant rural general surgeons can be recruited from a fellowship year when emphasis is placed on: (1) creating a positive workplace culture with safe working hours, (2) ensuring diversification of the general surgical case mix, (3) facilitating opportunities for schooling and work for the surgeon's family, and (4) preferentially selecting for those who identify as rural general surgeons. Rural towns can effectively recruit general surgeons when families are supported with career and school opportunities, and the newly qualified surgeon can initially commit to a 12-month position so that opportunities can be assessed by the entire family unit. Fellowship positions (post completion of general surgical training) allow young surgeons to 'try before they buy' prior to moving to a rural area. Ensuring a sustainable general surgical workforce in a rural community requires employee and surgical leadership to ensure a collaborative and progressive culture, which offers work diversity, supports the family lifestyle and petitions for selecting those who embody the rural general surgeon identity. Post-fellowship positions can enable young general surgeons to have exposure to the realities of a rural lifestyle, which is likely to have a positive effect on recruitment. Due to the return investment of the fellowship program, we propose that the federal government should look at funding post-fellowship positions to improve rural recruitment.

Trends in Aesthetic Surgery Fellowship Training: An Analysis of Supply and Demand.

Aesthetic surgery fellowship applications were consolidated under the San Francisco Match in 2018. The impact of these changes on aesthetic program and applicant numbers had not yet been investigated. In this study we sought to evaluate changes in programs, positions, applications, match rates, and fill rates since aesthetic surgery joined the San Francisco Match. We also aimed to compare these trends to craniofacial surgery, microsurgery, and hand surgery fellowships over this same time period. San Francisco and National Resident Matching Program (NRMP) match data for aesthetic, craniofacial, microsurgery, and hand fellowships were obtained from 2018 to 2022, and the number of applications, positions, programs, and successful matches were evaluated. The number of aesthetic fellowship positions increased from 17 to 41 (141%) over the period studied. This resulted in increased match rates and more unfilled positions. Over the same period, fellowship positions for craniofacial, hand, and microsurgery increased by 3.4%, 6%, and 2.5% respectively. There was no increase in applications to any postgraduate subspecialty, nor was there any change in the number of residents pursuing fellowship. Similarly, there was no change in the percentage of fellowship-bound residents applying to any given discipline. The increase in aesthetic fellowship programs and positions did not generate an increase in applications. Applications to other plastic surgery subspecialties also failed to increase. Unlike aesthetic fellowships, their program numbers have remained stable. Given the limited fellowship applicant pool, our focus should be on enhancing the quality of existing aesthetic programs rather than continuing to increase the number of aesthetic positions.

GP education posts for research.

Almost every patient and every healthcare condition are seen within primary care, but research is not yet embedded in general practice in the same way it is in secondary care. There is no well-defined pathway for a career combining research delivery and active clinical general practice. In Wessex, we set out to design a career pathway for the clinically active GP that could sustain research involvement throughout their working lifetime and underpin research activity in primary care. A lead for education on research was established, in 2021, to approach relevant organisations for funding, accreditation, and design of educational posts for research delivery in primary care. Health Education England is currently looking to fund additional placements prior to completion of GP training. NIHR CRN Wessex also identified funding for posts after completion of training. The authors worked with the Southampton GP Education Unit who applied for and achieved the first national recognition of 15-month research placements to count towards completion of GP vocational training. A GP career pathway was designed starting with these posts and followed by GP Research fellow posts, which provide ongoing sessional research work at any stage of a clinical GP career. National recognition for education on research has been achieved and a career pathway for GPs to train in and then work in research has been established. This will help embed research expertise and interest within primary care. This should increase research delivery and hence a cycle of increased research funding for further similar posts.

Residency Program Characteristics Associated with Higher Cataract Surgery Volume

ABSTRACT Purpose Prior research has shown that ophthalmology residents improve their cataract surgery competency as they perform additional surgeries beyond the 86 minimum cases mandated by the Accreditation Council for Graduate Medical Education (ACGME). Therefore, cataract surgery volume is an important benchmark for ophthalmology programs. Understanding the possible influence of residency program characteristics on resident cataract surgery volume may help educators in identifying areas for improvement and aid applicants in choosing between programs. The aim of this study was to assess residency program characteristics associated with higher mean cataract surgery volume for ophthalmology residents. Methods We conducted a retrospective, cross-sectional analysis of the San Francisco Match Program Profile Database to assess various program characteristics from the 113 listed ophthalmology residency programs. The associations between program characteristics and the mean cataract surgery volume per graduating resident (CSV/GR) over years 2018–2021 were analyzed using multiple linear regression. Results Out of 113 listed residency programs, 109 (96.5%) were included in our study. Across all programs, the mean (SD) CSV/GR was 195.9 (56.9) cases with a range of 86 to 365 cases. In multiple linear regression analysis, the presence of a Veteran Affairs (VA) training site (β = 38.8, P = .005) and the number of approved fellows per year (β = 2.9, P = .026) were positively correlated with higher mean CSV/GR. The 85 (78.0%) programs with VA training sites had a higher mean (SD) CSV/GR of 204.1 (55.7) cases compared to 166.7 (52.7) cases in the 24 (22.0%) programs without VA sites (P = .004). The mean CSV/GR increased by 2.9 cases for each additional fellow slot after adjusting for other factors. The number of approved residents per year, affiliation with a medical school, and the number of faculty were not significantly associated with CSV/GR. Conclusion All ophthalmology residency programs included in this study currently meet or exceed the ACGME requirements for cataract surgery case numbers. The presence of a VA training site and a higher number of fellowship positions were associated with higher mean resident cataract surgery volumes. Residency programs may consider further investing in these areas when seeking to improve resident surgical education. Additionally, residency applicants prioritizing cataract surgery volume may consider these factors when evaluating programs.

A 5-point framework for students evaluating plastic surgery research fellowship opportunities

An increasing number of medical students pursue research fellowships to enhance their odds of matching into an integrated plastic surgery residency program. 1 Keane C.A. Akhter M.F. Sarac B.A. Janis J.E. Characteristics of Successful Integrated Plastic Surgery Applicants from US Allopathic Medical Schools without a Home Integrated Program. J Surg Educ. 2022; 79: 551-557https://doi.org/10.1016/j.jsurg.2021.11.002 Crossref Scopus (11) Google Scholar , 2 Pathipati A.S. Taleghani N. Research in Medical School: A Survey Evaluating Why Medical Students Take Research Years. Cureus. 2016; 8e741https://doi.org/10.7759/cureus.741 Crossref Google Scholar , 3 Mehta K. Sinno S. Thanik V. Weichman K. Janis J.E. Patel A. Matching into Integrated Plastic Surgery: The Value of Research Fellowships. Plast Reconstr Surg. 2019; 143: 640-645https://doi.org/10.1097/PRS.0000000000005212 Crossref PubMed Scopus (56) Google Scholar The American Council of Academic Plastic Surgeons (ACAPS) Job Board lists research fellowship positions for the following academic year from November to March annually. 4 American Council of Academic Plastic Surgeons . Job Board. Available at 〈https://acaplasticsurgeons.org/jobs/〉. Accessed January 16, 2023 Google Scholar Zimmerman et al. also developed a database of plastic surgery research fellowships and their requirements. 5 Zimmerman C.E. Humphries L.S. Taylor J.A. Equitable Access to Research Opportunities in Plastic Surgery: Development of a Research Fellowship Database. Plast Reconstr Surg. 2021; 148: 1087e-1088ehttps://doi.org/10.1097/PRS.0000000000008535 Crossref Scopus (1) Google Scholar As students select amongst these positions it may be difficult to identify one that matches their goals and interests. The following viewpoint describes a five-part framework of important concerns research year candidates should consider when seeking placement to ensure a high-yielding experience (Figure 1). This framework includes expressing interest to a specific program, attaining funding, maximizing research productivity, creating meaningful mentorship connections and improving skills as a future resident through clinical opportunities.

Assessing Trends in Supply and Demand for Pediatric Surgery Training

This study assessed the supply and demand for Pediatric Surgery training in the U.S. from 2008 to 2022. We hypothesized that in the Pediatric Surgery Match: match rates would increase over time; U.S. MD Graduates would have higher match rates than non-U.S. MD Graduates; and fewer applicants would match at one of their top fellowship choices. This was a retrospective cohort study of Pediatric Surgery Match applicants (2008-2022). Cochran-Armitage tests elucidated temporal trends and chi square tests compared outcomes by applicant archetype. Accreditation Council for Graduate Medical Education (ACGME)-accredited Pediatric Surgery training programs in the United States and non-ACGME-accredited programs in Canada. A total of 1,133 applicants for Pediatric Surgery training. From 2008 to 2012, growth in the annual number of fellowship positions (34-43, 27% increase) exceeded growth in number of applicants (62-69, 11% increase) (p < 0.001). Over the study period, the applicant-to-training ratio peaked at 2.1 to 2.2 in 2017 to 2018 and decreased to 1.4 to 1.6 in 2021 to 2022. The annual match rate for U.S. MD Graduates increased from 60% to 68% (p < 0.05), but decreased from 40% to 22% (p < 0.05) for non-U.S. MD Graduates. In 2022, there was a 3.1-fold difference in match rates between U.S. MD and non-U.S. MD Graduates (68% vs 22%, p < 0.001). The percentage of applicants that matched at their first choice (25%-20%, p < 0.001), second choice (11%-4%, p < 0.001), and third choice (7%-4%, p < 0.001) fellowships decreased over the study period. The percentage of applicants that matched at their fourth choice to least desirable fellowship increased from 23% to 33% (p < 0.001). The demand for Pediatric Surgery training peaked in 2017 to 2018 and has decreased since. However, the Pediatric Surgery Match remains competitive especially for non-U.S. MD Graduates. More research is needed to understand barriers to matching into Pediatric Surgery for non-U.S. MD Graduates.

Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion

There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative. Retrospective data were analyzed using the National Resident Matching Program from 2012-2022 applicant appointment years (specialty code for vascular surgery 450). Simple linear trend analysis was performed for the number of positions available and the number of applicants, stratified by fellowship or residency. Over the 10-year study period, the total vascular surgery trainee positions expanded from 161 to 202. Integrated residency positions increased (41 positions in 2012 vs. 84 in 2022) while available fellowship positions remained stagnant (120 in 2012 vs. 118 in 2022). Total applicants rose as well, from 213 to 311. In 2022, unmatched applicants have increased for both paradigms (25 fellowship and 84 residency applicants) and 100% of programs filled. On average, the number of residency positions offered increased by 4 each year (P<0.0001) and the number of fellowship positions increased by 0.5 each year (P=0.1617). The number of integrated residency applicants increased by approximately 9 per year (P=0.001), while the number of fellowships applicants increased by approximately 1.5 per year (P=0.121). Applicants for both vascular tracks have increased since 2012 indicating successful recruitment; however, all 2022 programs filled, leaving many applicants unmatched. Residency positions have continued to expand while fellowship positions have not. With the demonstrated surge among applicants, the disproportionate lack of increasing training positions, and the existing shortage of vascular surgeons, there is an urgency to meet the increasing demand. A concerted effort should be made toward adding additional residency and fellowship positions where feasible.

Trends in ACGME Accreditation of Orthopedic Surgery Fellowship Training.

Currently, most surgeons pursue subspecialty fellowship training. This study answers the following questions: (1) How does the rate of fellowship training in orthopedic surgery compare with that in other surgical specialties? (2) To what extent did adoption of Accreditation Council for Graduate Medical Education (ACGME) accreditation change from 2013 to 2021? Orthopedic subspecialties were analyzed for total number of fellowship programs and positions in the 2013 and 2021 Match. Rates of ACGME accreditation were analyzed via chi-square tests. In 2021, orthopedic surgery had the highest rate of fellowship selection (94%) relative to general surgery (77%), ophthalmology (66%), plastic surgery (63%), and otolaryngology (55%). Across all orthopedic subspecialties, the percentage of ACGME accreditation decreased among fellowship programs (53% in 2013 to 48% in 2021, P=.166) and positions (58% in 2013 to 50% in 2021, P<.001). Orthopedic sports medicine had the highest adoption of ACGME accreditation (100%), followed by hand surgery (99%), musculoskeletal oncology (67%), and pediatric orthopedics (56%). Significant increases in the adoption of ACGME accreditation were noted for orthopedic sports medicine (93% in 2013 to 100% in 2021, P=.016) and hand surgery (81% in 2013 to 99% in 2021, P<.001). There was a significant decrease in ACGME accreditation for adult reconstructive orthopedics (40% in 2013 to 24% in 2021, P=.042), driven by the increase in unaccredited fellowship programs. Accreditation of orthopedic subspecialty fellowship training has decreased with respect to the proportion of accredited training positions. More research is needed to understand the benefits of ACGME accreditation for fellowship training in orthopedic surgery. [Orthopedics. 2024;47(1):57-63.].

Gender and Race Discrepancies in Resident Research Output at a Tertiary Care Center [ID: 1374349

INTRODUCTION: The Accreditation Council for Graduate Medical Education requires residents to complete scholarly activity prior to graduation, but this does not necessarily translate into peer-reviewed publications. However, level of scholarly activity has been directly linked to successful fellowship match, and those who identify as women, African American, Hispanic, or Native American (underrepresented in medicine [URiM]) are not well represented in fellowship positions. We therefore evaluated for race and gender-based discrepancy in scholarly activity as it relates to research involvement. METHODS: An IRB-approved (#15746) survey was sent to all residents at a tertiary hospital. This survey asked residents to share demographic information, when they got involved with research, number of first-author articles, and experience with presentations. Chi-square analysis was used. RESULTS: Analysis demonstrated that women began researching earlier than men (P=.0027). However, this did not translate to a significant increase in poster presentations (P=.270), oral presentations (P= .0522), or number of first-author publications (P=.492). When broken down by race, URiM men were exposed to research later than White men, White women, and URiM women (P&lt;.005). There was no difference in poster presentations (P=.350) or first-author publications (P=.718), but White and URiM men had more experience giving oral presentations at conferences compared to their female colleagues (P&lt;.005). CONCLUSION: The responses demonstrate that there is not a lack of involvement in research leading to less research output. In fact, despite earlier introduction to research, women have similar research outcomes as their peers. Therefore, effort needs to be placed on ensuring access to resources that assist with publishing research.

Survey on the Fellowship Application Timeline for UCNS-accredited Behavioral Neurology and Neuropsychiatry Programs (P10-2.004)

<h3>Objective:</h3> Evaluate impressions of program directors (PDs) and fellows regarding the fellowship application timelines for UCNS-accredited behavioral neurology and neuropsychiatry (BNNP) programs. Also, assess PDs’ disposition toward unified timepoints. <h3>Background:</h3> Despite 1) an AAN position statement calling for unified fellowship application timelines and 2) prior surveys documenting residents’ strong preferences for a unified timeline, BNNP programs have not yet adhered to this strategy. <h3>Design/Methods:</h3> A one-time REDCap survey was distributed to all UCNS-accredited BNNP fellowship PDs. PDs were asked to forward the survey to current and incoming fellows. <h3>Results:</h3> Surveys were completed by 22 PDs (50% response rate) and 17 fellows (11 current, 6 incoming). 71% of fellows belonged to a neurology residency and 29% psychiatry. Regarding the application process, most fellowship programs reported rolling admissions. We noted a span of 17 months between the first application opening (August PGY-3) and the last position offering (January PGY-4), with interviews occurring in the interim. 86.3% of PDs agreed (4 or 5 out of 5 on a Likert scale) that the different application timelines can negatively impact their ability to recruit applicants and 95.5% would be open to having an agreed upon date before which no offers would be made. Only 41.1% of fellows reported that different timelines prevented them from completing interviews for all their desired programs, but 82.4% agreed that the different timelines negatively impacted the ability of programs to recruit applicants; 88.3% agreed with a unified timeline. Between 50 and 60% of fellows reported anxiety or stress in trying to keep fellowship offers open while awaiting later interviews and navigating the different timelines. PDs commented on the importance of considering the typical fellowship application timelines for both neurology and psychiatry residencies. <h3>Conclusions:</h3> Most participants recognized challenges due to differing timelines. Most PDs agree in unifying the time when fellowship positions are offered. <b>Disclosure:</b> Dr. Josephy has nothing to disclose. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion Pharmaceuticals. Dr. Hamilton has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Highland Instruments. Dr. Hamilton has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology (Journal). The institution of Dr. Hamilton has received research support from NIH. The institution of Dr. Hamilton has received research support from Department of Defense.

Why do not we talk about MIS fellowship? A short review of the short literature.

The minimally invasive surgery (MIS) fellowship has existed for three decades and has steadily grown in both number of positions available and variety of techniques practiced. Despite continued popularity, growth, and wide breadth of surgical techniques of the MIS fellowship, publication rates in medical journals regarding these fellowships have not been as robust as one may expect. Our goal was to review the available literature on MIS fellowship. We reviewed PubMed to search for articles pertinent for MIS fellowship. The initial search included "MIS fellowship" "minimally invasive surgery fellowship" and "laparoscopy fellowship." Articles pertaining to MIS fellowship were then reviewed by title and abstract for content. Articles were excluded from subsequent analysis if they focused on disciplines that were not direct extensions of general surgery (such as urology, gynecology, oncology). Using similar search techniques, we tabulated unfiltered publications rates specific to other major surgical fellowship disciplines. The metric articles per position was created by dividing the total number articles for each discipline by the annual fellowship positions RESULTS: An initial review of available literature produced 134 articles pertinent to MIS fellowship. Further analysis for direct relevance to MIS yielded only 58 published articles. MIS had the fewest number of publications and smallest APP, 0.7, of any of the major fellowship disciplines. There is a surprising dearth of material on MIS fellowship. While, MIS fellowship is a one-year experience, we have the opportunity to build on three decades of clinical experience to continue optimize the fellow experience and improve subspecialized surgical training and patient outcomes. This could be facilitated through broadened focus of inquiry and publication of findings.

MP25-20 TRENDS IN THE GLOBAL ENDOUROLOGY TRAINING PIPELINE: CONTEMPORARY ANALYSIS OF FELLOWSHIP MATCH OUTCOMES

You have accessJournal of UrologyCME1 Apr 2023MP25-20 TRENDS IN THE GLOBAL ENDOUROLOGY TRAINING PIPELINE: CONTEMPORARY ANALYSIS OF FELLOWSHIP MATCH OUTCOMES Garrett Ungerer, Reza Roshandel, Aaron Potretzke, and Kevin Koo Garrett UngererGarrett Ungerer More articles by this author , Reza RoshandelReza Roshandel More articles by this author , Aaron PotretzkeAaron Potretzke More articles by this author , and Kevin KooKevin Koo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The proportion of urology residents who choose to pursue fellowship training has steadily increased over the past decade. The Endourological Society fellowship match allocates fellowship positions for advanced endoscopic and minimally invasive surgical training in 83 programs across 5 continents. To understand contemporary trends in the global endourology training pipeline, we aimed to analyze results of the annual endourology fellowship match, conducted by the American Urologic Association. METHODS: We analyzed endourology fellowship match statistics from the AUA for the match years 2014-2023 to characterize trends in application volumes, vacancies, applicants, and successful matches. RESULTS: Over the past 10 years, the number of applicants entering the match increased from 54 to 86. In parallel with this increasing demand in fellowship training, the number if training opportunities has increased from 34 programs offering 36 positions in the 2014 match to 54 programs offering 59 positions in the 2023 match. Despite consistent excess of applicants relative to available positions, an average of 13 positions are unfilled each year (range 8-19) corresponding to 26% of available positions (range 18-43%). Of the potential reasons for this, applicant desirability did not appreciably change: an average of 75% of applicants (range 72%-80%) were ranked by programs each year. Increase in positions and applicants is occurring in parallel. For the prior 10 match cycles, programs received an average of 15 applications (range 14-18) and offered 7 interviews to applicants (range 6-9). Applicants consistently completed an average of 4 interviews (range 3-6). Finally, on average 75% of vacancies were filled by US graduating residents (range 55%-89%), compared to 17% by non-US-trained candidates and 8% by prior US graduates. The number of successful female candidates averaged 5 per year, increasing from 3 women in 2014 to 11 in 2023. CONCLUSIONS: Despite increasing applicant demand and global supply of endourology fellowship positions, only 3 out of 4 applicants are ranked by programs, and a relatively high proportion of vacancies go unfilled each year. Female and non-US-trained candidates remain underrepresented. Strategies to bolster the endourology training pipeline merit increased attention. Source of Funding: none to report © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e350 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Garrett Ungerer More articles by this author Reza Roshandel More articles by this author Aaron Potretzke More articles by this author Kevin Koo More articles by this author Expand All Advertisement PDF downloadLoading ...

Trends in Racial, Ethnic, and Gender Diversity in Orthopaedic Surgery Spine Fellowships from 2007-2021.

Descriptive. To analyze trends in racial, ethnic, and gender diversity in orthopaedic spine surgery fellowship trainees. Orthopaedic surgery has consistently been labeled as one of the least diverse fields in Medicine. While some effort has been made to combat this in recent years at the residency level, it is uncertain if spine fellowships have had any changes in fellow demographics. Fellowship demographic data was collected through the Accreditation Council for Graduate Medical Education (ACGME). Data collected included gender (Male, Female, Not reported), and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007-2008 to 2020-2021. A χ2 test for trend (Cochran-Armitage test) was done to determine if there was a significant change in percentages of each race and gender during the study period. Results were considered statistically significant at P<0.05. White, Non-Hispanic males represent the largest proportion of orthopaedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in representation of any race or gender of orthopaedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be underrepresented in orthopaedic spine fellowship. Orthopaedics spine surgery fellowship programs have not made substantial progress in diversifying its population. To see progression of diversity, more attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field. 1.

Direct anterior versus direct lateral hip approach in total hip arthroplasty with the same perioperative protocols one year post fellowship training

BackgroundVariable results have been reported regarding the clinical outcomes in Total hip arthroplasty (THA) based on the surgical approach. The aim of this study is to compare the clinical outcomes between Direct anterior (DA) and direct lateral (DL) approaches in THA when performed immediately after fellowship training.MethodsDuring the 1st year of practice, all consecutive patients who underwent THA via DA and DL hip approaches were retrospectively investigated. Patients’demographics, diagnosis, American society of Anesthesiology (ASA) score, route of anesthesia, length of hospital stay (LOS), leg length discrepancy (LLD), radiographic parameters, operative time, number of opioids refills postoperatively, and complications were collected and compared between the two groups. The short form of Hip Disability and Osteoarthritis Outcome score, Joint Replacement (HOOS, JR) was prospectively collected pre and postoperatively. The minimum follow-up period was 2 years.ResultsForty patients in DA group and 38 patients in DL group were included. No statistically significant difference was found between the two groups in terms of demographics, diagnosis, ASA scores, route of anesthesia at the time of THA, postoperative radiographic parameters, LOS, LLD, opioid refills and HOOS scores (p > 0.05). Patients in the DA group had shorter operative time (83 ± 17 min) when compared to the DL group (93 ± 24 min) (p = 0.03). No major complications were found except for one early deep infection patient in DL group.ConclusionBoth DA and DL approaches resulted in satisfactory outcomes in THA when performed by a fellowship trained surgeon.

The mismatch in supply and demand: reproductive endocrinology and infertility workforce challenges and controversies

Infertility affects a significant proportion of the population. When including people interested in fertility preservation or family building services as part of the LGBTQ+ community, the number needing fertility care far exceeds the current supply of providers and clinics. The field of reproductive endocrinology and infertlity needs to comprehensively address this mismatch in supply and demand with both short and long term solutions. In the short term, networking with primary Ob/Gyns to provide initial fertility care and integrating advanced practice providers into our practice can help to reduce some of the current needs. Ultimately, making meaninful changes to the current REI fellowship training program is critical to improving the number of trained reproductive endocrinologists available. Expanding fellowship positions may necessitate building a closer relationship with private practices and potentially private equity funded practices. Ensuring that these relationships would train independent REIs is of the utmost importance and could potentially be addressed through a comprehensive national curriculm as well as some protections on post-training obligations. Furthermore, although some have proposed the utilization of primary gynecologists for ART counseling or procedures, also known as "upskilling," such quick solutions may not provide the depth and breadth of care that many infertile patients require. The field of REI is at a criticial juncture. With many competing interests to address this mismatch, as REIs, now is the time to develop solutions that will maintain the integrity and quality of our field.

Trends in the Sports Medicine Match: An Analysis of the National Resident Matching Program Data from 2010 to 2021.

Sports medicine (SM) fellowship training has become popular among residents. Thus, an analysis was undertaken to assess data on matching rates from 2010 to 2021. The purpose of this study is to analyze trends in SM fellowship applications using National Resident Matching Program data. Retrospective study with analysis of applicants applying into accredited SM fellowships between 2010 and 2021. The number of accredited programs and fellowship positions have more than doubled from 2010 to 2021. There was a significant increase in match rates over time (P < 0.001); match rates were at 70% or below prior to 2015 and above 70% after 2015. The average number of applicants per position stayed consistent. The number of Doctor of Osteopathic Medicine applicants increased 110% whereas the number of U.S. born foreign and non-U.S. citizen applicants decreased 20.8%. SM fellowship training has increased since 2010. Acceptance rates and number of applicants have increased over time because of the growth in fellowship programs and accredited positions.

Assessing the pediatric subspecialty pipeline: it is all about the data source.

National Resident Match Program (NRMP) data are often used to identify the pediatric subspecialty pipeline. Other data sources may provide greater accuracy. Analysis of data from the NRMP and the American Board of Pediatrics (ABP) for 14 pediatric subspecialties from 2008 to 2020. We calculated, within each subspecialty, the annual number of first-year fellowship positions offered, the NRMP match rate, the actual number of fellows entering training (ABP data) relative to the number of positions in the match (fill rate), and the actual number of matriculating first-year fellows each year. For all subspecialties and years, the fill rate was greater than the match rate. All subspecialties had an increase in the relative and absolute number of first-year fellows, with the largest increases seen in emergency medicine (73.3%) and critical care (68.9%). Except for adolescent medicine, all subspecialties had an absolute increase in the number of positions offered, with the largest increase in pulmonology (32.1%). NRMP data underestimate the actual number of first-year fellows entering subspecialty training. For all subspecialties, the number of first-year fellows has increased over time, indicating continued expansion in the pipeline for most. However, there remains great variation across subspecialties. Perceptions of the pipeline for the pediatric subspecialty workforce vary depending on the data source. The use of NMRP match data alone underestimates the number of matriculating trainees. The number of unmatched fellowship positions has created a perception of a diminishing number of pediatric subspecialty fellows. This study uses multiple data sources to better understand the actual number of fellows entering pediatric subspecialty training and demonstrates that the NRMP match rate alone underestimates the pipeline of the pediatric subspecialty workforce.

Education Research: Evaluation of Epilepsy Surgery Education in Epilepsy and Clinical Neurophysiology Fellowship Programs

Background and Objectives To assess the scope of surgical epilepsy exposure and training among fellows in Epilepsy and Clinical Neurophysiology (CNP) fellowship programs in the United States. Characteristics associated with increased fellow involvement in epilepsy surgery were evaluated. Methods A 10-question multiple-choice survey was designed to characterize individual fellowship programs, epilepsy surgery programs, trainee involvement, and assessment of trainee performance. The survey was distributed to program directors of adult Epilepsy and CNP-EEG track fellowships between November 2021 and April 2022. Epilepsy surgery procedures included resective approaches, neurostimulation modalities, and palliative interventions approved for drug-resistant epilepsy. Associations between categorical variables were evaluated using the Fisher exact test. Results There were 37 responses from a total of 72 survey recipients (51% response rate). The majority (68%) of surgical programs performed &gt;30 surgical procedures per year. The range of procedures was overall similar across programs. At most programs, fellows were personally involved in 1–10 (49%) or 11–30 (46%) surgical procedures per year. Institutions with &gt;50 surgical cases/year were more likely to expose fellows to &gt;10 cases/y compared with institutions with volumes ≤50 per year (77% vs 33%, p = 0.017). Fellows had the greatest involvement in presurgical planning with more variable involvement in perioperative and postoperative activities. Competency in surgical management was primarily investigated through faculty assessments (97%), whereas oral (46%) and written (30%) assessments were less frequently used. Discussion High-volume epilepsy surgery centers provide trainees with increased exposure despite also having more fellowship positions. There is variability in surgical epilepsy exposure, trainee involvement, and performance evaluation metrics between institutions. We identify specific areas that programs may focus on to improve fellow competency in the surgical management of epilepsy.