Fellowship Program Research Articles

Objective Structured Clinical Examination: Underused Tool in Epilepsy Fellowship Programs?

Objective Structured Clinical Examination: Underused Tool in Epilepsy Fellowship Programs?

Seeing through the myths: Practical aspects of diagnostic point-of-care ultrasound in nephrology.

Point of care ultrasonography (POCUS) is emerging as an invaluable tool for guiding patient care at the bedside, providing real-time diagnostic information to clinicians. Today, POCUS is recognized as the fifth pillar of bedside clinical examination, alongside inspection, palpation, percussion, and auscultation. In spite of growing interest, the adoption of diagnostic POCUS in nephrology remains limited, and comprehensive training beyond kidney ultrasound is offered in only a few fellowship programs. Moreover, several misconceptions and barriers surround the integration of POCUS into day-to-day nephrology practice. These include myths about its scope, utility, impact on patient outcomes and legal implications. In this minireview, we address some of these issues to encourage wider and proper utilization of POCUS.

Exploring Trends in Immediate Postresidency Career Paths: A Multi-year Analysis of Plastic Surgery Resident Graduates Across the United States.

Plastic surgery is one of the most diverse specialties in medicine. Because of the competitiveness of plastic surgery residency, applicants are entering the field with increased experience and more developed interests in specific specialties. Programs and prospective applicants may find it beneficial to know trends in the career paths of recent graduates. To identify trends in postresidency career paths for plastic surgery graduates. Data from all integrated plastic surgery residency programs were analyzed from 2013 to 2022. Eighty-eight residency programs were analyzed for review. Residency websites were the primary source of data. Postresidency career paths were categorized into subspecialty fellowships, academic practice, or private practice. Secondary data included program rank, size of the program, associated fellowship program, associated independent program, and program location. Seventy-three programs met the inclusion criteria. Private practice was the most common immediate postgraduation path. Microvascular and aesthetic fellowships demonstrated maximum growth in the last 10 years, followed by hand fellowships. Programs ranked in the top 25 by Doximity reputation were significantly associated with graduates going into craniofacial (P = .05) and microvascular fellowship (P = .021), and immediate academic practice (P = .011). Lower-ranked programs were correlated with higher levels of graduates entering directly into private/community hospital practice (ρ = 0.327). Life after residency is a necessary consideration for training physicians. Understanding trends in postresidency career paths could help programs and prospective applicants make more informed decisions on what programs may offer the best opportunities to pursue their desired career path.

Determination of Electrochemical Pretreatment Voltage Limits, Scan Rate and Cycle Number

Electrochemical characterisation analyses are performed to determine the electrochemical behaviour of the electrode and electrolyte of vanadium redox battery components. A 3-electrode system which consisted of counter electrode, working electrode and reference electrode is used for electrochemical testing. It is important for the consistency of the proposed idea that the results obtained from the analyses are comparable and repeatable under the same conditions. In order to prepare the working electrode surface for electrochemical reactions, an electrochemical treatment procedure is applied in addition to the polishing procedure [1,2]. In this study, it is aimed to determine the optimum pretreatment conditions of the working electrode. For this purpose, a 3-electrode system consisting of a reference electrode (Saturated KCl, ALS RE-1CP), a working electrode (ALS GCE 3 mm) and a counter electrode (platinum wire) was established. All pretreatment procedure experiments were carried out using 2 M H2SO4. After each pretreatment step, cyclic voltammetry analyses were carried out with 1.6 M VOSO4 + 2 M H2SO4 solution. CV analyses were performed in the range of 0 V - 1.2 V at a scan rate of 20 mV/s. The upper voltage was chanced between 1.5 V and 2.3 V with 0.1 V steps at the constant lower voltage limit. In contrast, the establishment of the lower voltage limit encompassed incremental increases by 0.3 V steps from -0.7 V to 1.4 V at a constant upper voltage limit. Different scan rates (10 mV/s, 20 mV/s, 50 mV/s, 100 mV/s, and 200 mV/s) were explored to identify the optimal scan rate for the pretreatment process. Additionally, experiments were performed across varying cycle numbers (1, 2, 4, 6, 8, 10) under predefined pretreatment conditions.The results of the pretreatment procedure and CV analysis are graphically presented in Figure 1. The upper voltage limit determination and CV analysis results under a lower voltage limit are displayed in Figure 1.a and 1.b. Redox reactions did not occur when the upper voltage limit was 1.5 V-1.8 V. While redox reactions started to occur after 1.9 V, the highest anodic and cathodic peaks values were obtained in the 0-2 V range. Lower limit pretreatment results and CV analysis under constant upper voltage are shown in Figures 1.c and 1.d, respectively. These experiments indicated minimal distinctions between -0.7 V and 0 V CV results, leading to the selection of 0 V as the lower limit. In cases where the lower limit is greater than 0 V, redox reactions were negatively affected by the pretreatment process. There was no significant difference was observed between the CV results of 10 mV/s and 20 mV/s. However, redox reactions were negatively affected at scanning rates of 50 mV/s and higher. The scan rate of the pretreatment process was determined as 20 mV/s. Figures 1.g and 1.h show the results of pretreatment cycle number and CV analysis results at the 0 V-2 V voltage limits and 20 mV/s scan rate. Redox reactions did not occur when pretreatment was applied in 1 and 2 cycles while 4 and higher cycle numbers were obtained. The highest anodic and cathodic peaks were obtained when the cycle numbers were 6 and 8, and these results are very close to each other. The cycle number of the pretreatment process was determined as 6 cycle.It has been shown that the conditions of the pretreatment process have a significant influence on the reaction behaviour of the working electrode. It conclusively establishes the optimum pretreatment process conditions as a voltage range 0 V-2 V, scan rate 20 mV/s and number of cycles 6. Acknowledgements This work supported by the Scientific Research Projects Unit of Erciyes University under contract no: FDK-2020-10376. The first named author MT thanks to The Scientific and Technological Research Council of Turkey (TÜBİTAK) for their scholarships under “2211-C Priority Areas PhD Scholarship Program with the grant number 1649B032000390” and “2214-A International Research Fellowship Program for PhD Students with the grant number 1059B142200567”. References J. Noack et al., J. Energy Chem., 27, 1341–1352 (2018).N. Roznyatovskaya et al., Batteries, 5, 1–16 (2019). Figure 1

Current state of musculoskeletal fellowship program directors and future directions.

To better understand the current state of musculoskeletal fellowship program directors and identify opportunities for formal training that could increase job satisfaction, provide a broader knowledge base for mentoring/advising trainees and increase diversity in musculoskeletal radiology. Eighty-one fellowship program directors who signed the Fellowship Match Memorandum of Understanding with the Society of Skeletal Radiology were sent a survey with questions about demographics, career, background, and training both for musculoskeletal radiology and for the fellowship director role. A 57/81 (70%) of program directors responded, representing 27 different states with a range of 1-9 fellowship positions. Nearly half are in their forties (48%) with most identifying as White (67%) followed by Asian (30%). The majority are male (72%) with over half (60%) remaining at the institution where they completed prior training. Over half plan to change roles within 5years and do not feel adequately compensated. Top qualities/skills identified as important for the role include effective communication, being approachable, and clinical excellence. Other than clinical excellence, most do not report formal training in skills identified as important for the role. Given the high amount of interaction with trainees, program directors play a key role in the future of our subspecialty. The low diversity among this group, the lack of formal training, and the fact that most do not feel adequately compensated could limit mentorship and recruitment. Program directors identified effective communication, organizational/planning skills, and conflict resolution as the top skills they would benefit from formal training.

Competitiveness of regional labor markets as a determinant of international migration: A nexus empirical study

A large-scale migration from Ukraine caused by russian military aggression has triggered new security challenges to the national and regional economies. The paper aims to assess the competitiveness of regional labor markets and examine its nexus with international out-migration (on the example of the Carpathian region of Ukraine). The research methods include a composite approach (assessment of labor market competitiveness), the theory of sensitivity (identification of degree of sensitivity of composite and partial indices to changes in indicators), nonlinear regression (determination of dependence of the international out-migration on labor market competitiveness), and econometric nonlinear optimization (calculation of critical values of migration). The information and analytical basis comprises indicators reflecting the development of labor markets and international migrations in the oblasts of the Carpathian region in 2008–2021. The study reveals that the level of labor market competitiveness in the region mainly remained below the national average. Two groups of indicators dominated the structure of composite indices of labor market competitiveness in the region’s oblasts: institutional capacity (indicators measuring the ability of regulatory institutions and labor market entities to provide adequate support to the unemployed and promote employment) and labor motivation (wage and income indicators). Only Lviv oblast demonstrated resilience and growth of competitiveness, which was reflected in moderate out-migration. Meanwhile, the intensity of international out-migration in Zakarpattia and Chernivtsi oblasts (with worse labor market parameters) exceeded the estimated critical values. The paper confirms that low competitiveness of the labor market is a factor increasing migration losses. AcknowledgmentThis study has been conducted with the support of the Virtual Ukraine Institute for Advanced Study (VUIAS) Fellowship Programme, 2023/2024.

DEVELOPING AND IMPLEMENTING A NATIONWIDE CURRICULUM FOR AGING STUDIES. WHAT ARE THE KEY CONSIDERATIONS FOR GHANA?

Abstract In 2019, Ghana reported the implementation of a Geriatric Medicine Fellowship Program within the Faculty of Family Medicine at the Ghana College of Physicians and Surgeons (GCPS). Though this is a laudable effort to address the specialized workforce shortage the country is facing, the GCPS program is meant to provide an in-country specialization path for physicians desiring to become geriatricians. There are currently no national standardized aging studies, training programs or curricula available to other students in disciplines such as nursing, psychology, public health, and social work. Students in the public, government-owned tertiary institutions are offered isolated courses related to aging and the needs of older adults. To effectively address the workforce shortage issue and improve the overall health and wellbeing of older adults in Ghana, it is imperative to train students in diverse fields and disciplines with the needed knowledge and skills to provide the various specialized services for the aging population. This presentation highlights a proposal to the government of Ghana to consider some key issues and recommendations related to developing and implementing a nation-wide aging studies programs in the public higher institutions. Five key evidence-based areas are extensively discussed: (1) Aging studies in Ghana should be culturally relevant. (2) Aging studies in Ghana should address the needs of older Ghanaians. (3) Aging studies in Ghana should be competency-based. (4) Aging studies in Ghana should be implemented and evaluated by expert-educators. (5) Aging studies in Ghana should be attractive to potential service providers.

POLICY SERIES: HEALTH AND AGING POLICY FELLOWS: LINKING POLICY AND PRACTICE TO BENEFIT OLDER PEOPLE

Abstract The Health and Aging Policy Fellows program was founded in 2008 after its founders observed a dearth of experts with overlapping experience in policy and aging. The program is creating a growing cadre of leaders to improve the health of older adults by influencing policy at the state and national levels that is joined through an alumni network of more than 150 fellows. The fellowship’s goal is to improve the lives of older people across life domains. Past fellows serve as staff members in Congress, in State and Federal Agencies, and in the private sector. The fellowship has helped to launch many policy-focused careers. In this seminar, current and past fellows from medicine, research, social work, and law will share their experiences before, during, and after their fellowship. They will describe what they learned through the training and a placement in a full- or part-time policy role, how viewing health and aging through a policy perspective changed their understanding of systems, and how they think the fellowship will enable them to influence policy to improve the lives of older people in the future. Fellows will also highlight ongoing policy challenges that stop or slow progress toward achieving the goal.

“AH, A PROGRAM FOR FORMER CAREGIVERS. WHAT A GREAT IDEA! WHY DON’T YOU START SOMETHING?”

Abstract Sheryl Fairbanks and Warren Wolfe had insight into the experiences of bereaved dementia caregivers, having cared for four parents, two of whom had dementia, who all died within 14 months of each other after 12 years of care. After taking some time to grieve and settling an entire generation’s estates, Ms. Fairbanks and Mr. Wolfe sought resources to help them re-engage in life following caregiving. Here they were uniquely qualified to find what resources might exist. Mr. Wolfe had been a newspaper reporter and editor for four decades. Two of these decades were spent covering aging and in 2010 he was a member of the GSA Journalists in Aging Fellows Program. Likewise, Ms. Fairbanks attended GSA in 2015 as a journalist and editor as they contacted experts across the country seeking resources for bereaved dementia caregivers. While many sympathized with the need for such resources, few could be found, and it was suggested that maybe Mr. Wolfe and Ms. Fairbanks ought to create a group to help bereaved dementia caregivers figure out what was next after caregiving. In 2016 they created the Former Dementia Caregiver Re-Entry Initiative, which has helped more than 60 members figure out the next steps for themselves, re-engaging with life after caregiving. They have talked about hundreds of topics, laughed a lot, cried at times, disclosed deep fears, shared small and big discoveries about themselves, and generally have found a firmer footing as they have embarked on this new journey.

INSIGHTS FROM A HAPF ALUMNUS ON AGING POLICY ADVOCACY IN SOCIAL WORK

Abstract “Once a fellow, always a fellow” and “Networks get things done”. The Health and Aging Policy Fellows Program has brought together experts in aging for more than ten years for policy education and fellowships, assembling an alumni network of more than one hundred and fifty fellows. Fellow alumni are social work scholars, physicians, nurses, gerontologists, sociologists, and many more. Each of these alumni completed one or more placements in policy making in congress, federal agencies, and advocacy organizations. Some have remained in those spaces while others are academics, state and local officials, and corporate leaders. They continue to advocate for and shape policy in aging in those positions. Told from the perspective of a non-residential program alumnus who is a mid-career faculty member in social work, this presentation will discuss the lessons learned during the fellowship, how the fellowship shaped future policy work, and present insights on how social workers can engage in policy advocacy in aging through the fellowship.

Virtual Interviews Are Not Adequate Replacements for In-Person Interviews for Orthopaedic Sports Medicine Fellowship Program Directors and Applicants

To understand the opinions of both orthopaedic sports medicine fellowship program directors (PDs) and applicants regarding the utility of virtual interviews in comparison to in-person interviews following the 2022-2023 application cycle. An anonymous online survey was distributed through the American Orthopaedic Society for Sports Medicine to applicants and PDs of orthopaedic sports medicine fellowship programs. Questions in the survey included how the virtual format affected the applicants' personal connection to the program, the interview day structure, and costs associated with the interview process. Responses were received from 69 of 93 PDs (74%) and 97 of 266 applicants (36%). Ninety-five percent of PDs (59 of 62) preferred in-person interviews, compared to 79% of applicants (70 of 89). Ninety-eight percent of PDs (60 of 61) and 82% of applicants (72 of 88) thought it was important/very important to interview in-person. Sixty-one percent of PDs (35 of 57) and 49% of applicants agreed/strongly agreed that conducting virtual interviews negatively affected their personal connection with the fellowship interviewee/program. The presence of virtual interviews allowed 50% (43 of 86) of applicants to go on more interviews. Thirty-two percent (18 of 57) of fellowship programs saved up to $5,000 conducting virtual interviews, and 85% (69 of 81) of applicants saved up to $5,000 on travel expenses by attending virtual interviews. Virtual interviews allow fellowship applicants to complete more interviews and presented financial savings for both programs and applicants. However, both PDs and applicants stated that interviewing in-person is essential for applicants to meet faculty and tour the facilities. This study may be valuable to fellowship programs considering continued use of virtual interviews.

A Fish Out of Water?

Learning to acknowledge water as the interconnecting element of a dense ecosystem such as Venice and its lagoon marked an epistemological turn for the Author. Which language is being used – or silenced – to describe the rapidly shifting climatic conditions of the Mediterranean basin? In this article, Casavecchia retraces her steps as curator of the 2021‑23 fellowship programme The Current III, titled Thus Waves Come in Pairs (after Etel Adnan), promoted by TBA21-Academy. ‘Thinking with waves’ means questioning our apparatuses of knowledge, and activating transdisciplinary processes of exchange, choral mappings and pedagogies of relation.

Minimum Supervision Levels Required for Pediatric Cardiology Fellowship Graduation by Pediatric Cardiology Fellowship Program Directors.

Entrustable professional activities (EPAs) are "observable essential tasks expected to be performed by a physician for safe patient care in practice." Six PediatricCardiology (PC) EPAs and their level of supervision (LOS) scales were developed by medical educators in PC using a modified Delphi process and reviewed by the Subspecialty Pediatrics Investigator Network (SPIN). However, their general use in assessment for PC fellows for graduation requirements has yet to be studied. The objective of this study was to determine the minimum LOS required for PC fellows to graduate and compare it with the minimum LOS expected for safe and effective practice for the six PC EPAs, from the perspective of the PC Fellowship Program Directors(FPD). All FellowshipProgramDirectors(FPD) of ACGME-accredited PC fellowships were surveyed through SPIN between April 2017 and August 2017. For each of the PC EPAs, the FPDs were asked to indicate the minimum LOS expected for graduation and whether they would allow a fellow to graduate if this level was not achievedand the minimum LOS expected for a practicing pediatric cardiologist to provide safe and effective patient care. The minimum LOS was defined as the LOS for which no more than 20% of FPDs would want a lower level. The survey response rate was 80% (47/59). The majority of the FPDs did not require a minimum LOS of five corresponding to unsupervised practice in any of the six PC EPAs at graduation. For EPAs related to imaging, arrhythmia management, and management of cardiac problems, the minimum LOS for graduation was 3, corresponding to being "trusted to perform a task with indirect supervision for most simple and a few complex cases." For the EPAs related to interventional cardiology, heart failure pulmonary hypertension, and cardiac intensive care, the minimum LOS for graduation was 2, corresponding to being "trusted to perform a task only with direct supervision and coaching." The minimum LOS considered necessary for safe and effective practice for all but one EPA was 3. For the EPA related to the management of cardiac problems, the minimum LOS for safe practice was 4, corresponding to being "trusted to execute tasks independently except for few complex and critical cases." Most PC FPDs reported they would not require fellows to achieve the highest entrustment level for any of the six PC EPAs for graduation. It is crucial that educational programs evolve to address these essential activities during training better and that stakeholders ensure that graduating PC fellows have adequate resources and infrastructure to continue professional development as early career pediatric cardiologists.

Perspectives of gynecologic oncology fellowship training and preparedness for practice

We aimed to examine the preparedness of recent gynecologic oncology fellowship graduates for independent practice.We conducted a web-based survey study using REDCap targeting Society of Gynecologic Oncology (SGO) members who graduated gynecologic oncology fellowship within the last six years. The survey included 52 items assessing fellowship training experiences, level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies. Questions also addressed factors driving participants’ selection of fellowship programs, educational experience, research and preparedness for independent practice. A total of 296 participants were invited to complete the survey. Response rate was 42% with n = 124 completed surveys included for analysis. The highest ranked factor for fellowship selection was fit with program 36% (n = 45). Upon completing fellowship, most were uncomfortable performing ureteral conduit formation 84% (n = 103), ureteroneocystostomy 77% (n = 94), exenteration 68% (n = 83), splenectomy 67% (n = 83) and lower anterior resection 41% (n = 51). Most were comfortable managing intraoperative complications 85% (n = 104) and standard cancer staging procedures (range: 61%–99%). Majority were comfortable providing cancer directed therapies with chemotherapy 99% (n = 123), immunotherapy 84% (n = 104), and poly ADP-ribose polymerase (PARP) inhibitors 97% (n = 120). Upon completing fellowship, 77% (n = 95) report having mentorship that met their expectations during fellowship and 94% (n = 116) felt they were ready for independent practice. Majority of fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures and cancer directed treatment. However, most are not comfortable with ultra-radical gynecologic oncology procedures. Maximizing surgical opportunities during fellowship training and acquiring early career mentorship may help.

Research Assessment Exercise 2023: A Report

In 2023, the University of Jyväskylä conducted a comprehensive assessment of its research activities over the period from 2018 to 2022, with the faculties acting as the units of assessment. Independent institutes were included as a part of a faculty according to their discipline. The subjects of the assessment were the research environment, doctoral training and the societal impact of research conducted at the University of Jyväskylä. The primary goal of the assessment was to facilitate the development of the key preconditions for high-quality, high-impact research and doctoral training. One way to achieve this goal is to use the outcome of the assessment for the planning and strategy work of the units as well as that of the University. The assessment consisted of a self-assessment as well as an external assessment by an 11-person international multidisciplinary panel. To support the assessment, the units of assessment and the assessment panel were provided with background material that consisted of statistics on funding, research personnel, mobility, doctoral training, and publishing. In addition to statistical data on the units, the panel received the units’ self-assessment reports and research development plans. Development plans describe the actions each unit is taking to develop the areas for improvement they have identified. In May 2023, the assessment panel visited the University, where it met members of the units of assessment, the rector and the vice rectors, interviewed the research personnel and leadership of each unit, and visited research facilities. After the visit, the panel authored a joint report on each unit of assessment, where it gave constructive feedback on the units’ research development plans and assessed the units without giving a numerical rating or ranking them. The units received recommendations and ideas on how to further strengthen the quality of their research environments and doctoral training, as well as the societal impact of their research. The units used the feedback to finalize their research development plans. In addition to the unit-level recommendations, the panel pointed out overall challenges the University should address and provided suggestions for overcoming them. It suggested, among other measures, that the University review its tenure track system, reconsider moving some key administrative services back to the faculties, strengthen post-award support, develop a research leave scheme, and continue the JYU Visiting Fellow Programme. The panel also identified challenges the University should address to develop its well-functioning doctoral training. These challenges included the structure of the Graduate School, the number of doctoral students, and the sense of isolation experienced by some doctoral students. The panel saw that the potential for societal impact of research conducted at JYU could be boosted through, for example, training, support, and encouragement. For detailed feedback and recommendations, see Section 4 of the panel report. The final report presents the principles, process, and results of the assessment. The report contains summaries of the research development plans but not the complete plans and the self-assessment reports, as these are intended for internal use only.showless

Inventing for Tomorrow: The State of the National Academy of Inventors

The National Academy of Inventors (NAI) held the Eleventh Annual Meeting of the NAI in Phoenix, AZ, in June 2022. The event, whose theme was "Defining the Future: Inventing for Tomorrow," consisted of keynotes, panel discussions, induction ceremonies for Senior Members and new Fellows, and a student showcase, all of which honored and empowered the world's brightest innovators and professionals by creating powerful connections between them and by generating the momentum that will enhance and transform our innovation ecosystem. In his State of the Academy address, Paul R. Sanberg, president of the NAI, discussed the year's advances, including a new diversity initiative undertaken in partnership with the United States Patent and Trademark Office. He also provided updates on existing programs, such as the NAI Fellows program and the Chapter program, as well as exciting new ventures like the new Sentinel Award.

Women in Microsurgery Fellowships: Trends and Impact on Future Practice Patterns.

While the number of female plastic surgeons has continued to increase over time, plastic surgery has historically been a male-dominated profession with only 15% of practicing plastic surgeons being female. Microsurgery, as a subspecialty, has been long perceived as an even more male-centric career path. The objective of this study was to determine the representation of females in the subspecialty field of microsurgery and the impact of microsurgical fellowship training. A review of all microsurgery fellowship programs participating in the microsurgery fellowship match from 2010 to 2019 were analyzed. Fellows were identified through fellowship Web site pages or direct contact with fellowship program coordinators and directors. The current type of practice and performance of microsurgery were also identified through a Web search and direct contact with fellowship program coordinators and directors. A total of 21 programs and 317 fellows over a 10-year period were analyzed. Over this 10-year period, there was a total of 100 (31.5%) female microsurgery fellows and 217 (68.5%) male microsurgery fellows. There was a small, statistically insignificant increase in the yearly percentage of female microsurgery fellows over this 10-year period with an average yearly increase of 2.7% (p = 0.60; 95% confidence interval: -6.9 to 13.2%). There were significantly fewer females who continued to practice microsurgery compared to males (75 [75.0%] vs. 186 [85.7%], p = 0.02). There was no significant difference in the current practice types (academic, private, and nonacademic hospital) between females and males (p = 0.29). Women are underrepresented in the field of microsurgery to a similar extent as they are underrepresented in overall plastic surgery. While there is a small insignificant increase in the number of female microsurgery fellows every year, a significantly smaller proportion of females continue to practice microsurgery compared to males.

Academic and Demographic Characteristics of Pediatric Orthopaedic Division Chiefs in the United States.

Division Chiefs (DCs) and department leadership play an integral role within the service. The goal of this study is to assess the demographics and scholarly work of the leadership in pediatric orthopaedics services across the United States and comment on the role of diversity within leadership positions. Academic medical centers and pediatric hospitals were identified using the Electronic Residency Application Service website, the Pediatric Orthopaedic Society of North America website, and the Children's Hospital Association website. Leadership was identified using the hospitals' respective websites where data such as sex, race/ethnicity, fellowship institution, time since graduating fellowship, and academic rank were collected. Scopus database was used to determine h-indices and PubMed was used to determine the number of publications. Of 196 academic centers and 223 pediatric hospitals identified, 98 had a designated DC of the pediatric orthopaedics division. The majority of the DCs were male (85.7%), and leadership positions at hospitals with academic affiliations had a higher proportion of female DCs than nonacademic centers ( P =0.0317). DCs were mostly white (83.7%), followed by Asian (12.2%), and African American (2.0%). The average time since fellowship was 21.1 years and the average h-index was 15.7. The average age of the DCs was 56.8 years old. Of those in academic settings, 48.5% held the rank of professor. The fellowship programs that trained the most DCs were Boston Children's Hospital (16.3%) and Texas Scottish Rite for Children (14.3%). There is a paucity of available research on leadership characteristics in pediatric orthopaedic surgery. While progress has been made, there is still a lack of diversity that exists among leadership in pediatric orthopaedics, both within the academic setting as well as the private sector. The position of DC is held predominately by white males with a rank of either professor or no academic association. Intentional efforts are needed to continue to increase diversity in leadership positions within pediatric orthopaedic programs in the United States. IV.

Battling the "Imposter": Our Experience in the Development of an Advance Practice Provider Fellowship.

In the face of ever-evolving shifts in health care, the demand for advanced practice providers (APPs), including nurse practitioners and physician assistants, continues to grow as the nation faces provider shortages and increased patient complexity. Because of different educational backgrounds and previous professional experience, there is a gap in readiness for practice following completion of academic programs, leading to high rates of turnover and financial implications for health care institutions. The creation of APP fellowship programs is a strategy many health institutions implement to provide enhanced support for new graduate APPs. These programs offer fully licensed and credentialed nurse practitioners and physician assistants additional experience within medical specialty areas. The establishment and operational cost associated with an APP fellowship program is a significant barrier health systems face. This article discusses how Saint Luke's Health System developed an APP fellowship program to address these barriers. The model addresses specific fellow needs and has contributed to improved employee retention rates, increased clinical competency, and overall provider satisfaction within Saint Luke's Health System. The evolution of the model, successes, barriers, and opportunities for future program growth are discussed within this article.

Trends in Mohs surgery fellowship directors.

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.