Fellowship Program Research Articles

Integrating novel interventional techniques into pediatric pulmonology training.

To review the evolution of pediatric pulmonology interventions and propose strategies for advancing training in the field. I examined the historical development of pediatric pulmonology interventions and current training practices, including hands-on courses and fellowship programs. I reviewed a survey of US pediatric pulmonology centers to assess variability in procedural expertise. Historically, foreign body removal dominated pediatric pulmonology interventions. Advancements in technology have expanded the field to include techniques such as endobronchial and transbronchial biopsies, airway lumen restoration, and cryotherapy, enabling more accurate tissue sampling with larger specimens while maintaining safety. Hands-on courses, offered globally and at major conferences, provide opportunities for skill development, self-assessment, and networking. However, limited availability leads to high demand and long waiting lists. A survey of US pediatric pulmonology centers revealed significant variability in procedural expertise, highlighting the need for uniform training across institutions. To better integrate interventional techniques, I propose that pediatric pulmonology training could benefit from a structured, tiered approach: (1) expanding hands-on workshops and incorporating them into fellowship programs, (2) facilitating collaborations between centers of excellence to allow trainees to rotate through institutions with advanced expertise, and (3) developing an additional year of training for an "Advanced Pediatric Pulmonologist" certification. This approach aims to ensure proficiency in the latest interventional techniques, standardize care, and foster advancements across the field.

Global distribution and career outcomes of international fellows trained in Canadian gynecologic oncology programs

ObjectiveWe assessed the global distribution and academic, administrative and research outcomes of international fellows (IFs) trained in Canadian gynecologic oncology (GO) programs. MethodsA web-based survey was sent to IFs who completed GO training in Canada. Using the Web of science database, we identified the publication list, citation record and H-index of IFs and classified them according to their region of practice: high-income countries (HIC), middle income countries (MIC), and low-income countries (LIC). ResultsFrom 1996 to 2020, 81 IFs from 23 countries were trained in English-speaking (62,9%) and French-speaking Canadian universities (37,1%). Most IFs came from HIC (87,6%) and none from LIC. Only 12 IFs (14,8%) are now practicing in Canada. Of the 55 IFs who completed the survey (response rate: 67,9%), the majority (58,2%) reported working in an academic hospital and 29,1% were holding an executive position in a national scholar organization. IFs participated in mentoring residents (96.4 %) and medical students (83,6%) and 36,3% initiated a GO fellowship program in their home country. 67,3% of IFs were involved in international research collaboration and 52,7% participated in international clinical trials. The mean number of publications (22,36 vs 7,75, p = 0.007), citations (369,15 vs 45,12 p = 0.0006) and H-Index (6,88 vs 2,37 p = 0.0001) were significantly higher among IFs working in HIC compared to those in MIC. Most IFs (98,2%) recommended their Canadian GO fellowship program to a colleague from their home country. ConclusionMost IFs trained in Canadian GO fellowship programs returned to their home countries and achieved important milestones in terms of academic, clinical and research accomplishments.

Training an Embedded Workforce to Realize Health System Impacts and the Promise of Learning Health Systems Comment on "Early Career Outcomes of Embedded Research Fellows: An Analysis of the Health System Impact Fellowship Program"

Learning health systems (LHSs) are designed to systematically integrate external evidence of effective practices with internal data and experience to put knowledge into practice as a part of a culture of continuous learning and improvement. Researchers embedded in health systems are an essential component of LHSs, with defined competencies. However, many of these competencies are not generated by traditional graduate/post-graduate training programs; evaluation of new LHS training programs has been limited. This commentary reviews and extends results of an evaluation of early career outcomes of fellows in one such program designed to generate impact-oriented career pathways embedded in healthcare systems. Discussion considers the need for increasingly rigorous evaluation methods to ensure production of high-quality professionals ready for system engagement, the importance of training and preparing other LHS stakeholders as effective partners and evidence users, and the promise and challenges in advancing the science and practice of embedded research in LHSs.

Perioperative Nutritional, Functional, and Bone Health Optimization in Spine Surgery: A National Investigation of Spine Surgeons' Perceptions and Practices.

While perioperative nutritional, functional, and bone health status optimization in spine surgery is supported with ample evidence, the implementation and surgeon perception regarding such efforts in clinical practice remain largely unexplored. This study sought to assess the current perception of spine surgeons and implementation regarding the nutritional, functional status, and bone health perioperative optimization. An anonymous 30-question survey was distributed to orthopaedic spine fellowship and neurosurgery program directors identified through the North American Spine Society and American Association of Neurological Surgeons contact databases. The questionnaire was completed by 51 surgeon survey respondents. Among those, 62% reported no current formal nutritional optimization protocols with 14% not recommending an optimization plan, despite only 10% doubting benefits of nutritional optimization. While 5% of respondents perceived functional status optimization as nonbeneficial, 68% of respondents reported no protocol in place and 46% noted a functional status assessment relying on patient dependency. Among the respondents, 85% routinely ordered DEXA scan if there was suspicion of osteoporosis and 85% usually rescheduled surgery if bone health optimization goals were not achieved while 6% reported being suspicious of benefit from such interventions. While most responding spine surgeons believe in the benefit of perioperative nutritional and functional optimization, logistical and patient compliance challenges were noted as critical barriers toward optimization. Understanding surgeon perception and current practices may guide future efforts toward advancement of optimization protocols.

Are paediatric cardiology textbooks obsolete in the current digital era?

With the rise of online references, podcasts, webinars, self-test tools, and social media, it is worthwhile to understand whether textbooks continue to provide value in medical education, and to assess the capacity they serve during fellowship training. A prospective mixed-methods study based on surveys that were disseminated to seven paediatric cardiology fellowship programmes around the world. Participants were asked to read an assigned chapter of Anderson's Pediatric Cardiology 4th Edition textbook, followed by the completion of the survey. Open-ended questions included theming and grouping responses as appropriate. The survey was completed by 36 participants. When asked about the content, organisation, and utility of the chapter, responses were generally positive, at greater than 89%. The chapters, overall, were rated relatively easy to read, scoring at 6.91, with standard deviations plus or minus 1.72, on a scale from 1 to 10, with higher values meaning better results. When asked to rank their preferences in where they obtain educational content, textbooks were ranked the second highest, with in-person teaching ranking first. Several themes were identified including the limitations of the use of textbook use, their value, and ways to enhance learning from their reading. There was also a near-unanimous desire for more time to self-learn and read during fellowship. Textbooks are still highly valued by trainees. Many opportunities exist, nonetheless, to improve how they can be organised to deliver information optimally. Future efforts should look towards making them more accessible, and to include more resources for asynchronous learning.

An Evaluation of the Transfer of Skills and Knowledge from Two World Federation of Societies of Anaesthesiologists Fellowship Programs.

Subspecialist training is an important part of developing human resources for health and for some learners, may require taking place in another, higher-resourced country. Despite effective learning of skills and knowledge in a different, more highly resourced context, transfer of these skills and knowledge back to a more poorly resourced context can be a challenge. We aimed to evaluate the transfer of skills and knowledge in 2 World Federation of Societies of Anaesthesiologists (WFSA) fellowship programs. This qualitative program evaluation study, guided by Guskey's evaluation framework, used in-depth interviews of both faculty and graduates of the 2 fellowship programs. Interviews were conducted remotely, transcribed verbatim, and analyzed using qualitative content and pattern analysis. We interviewed 2 administrators, 10 faculty members, 17 graduated fellows, and 3 graduated fellows now in the role of faculty member in that fellowship. Key themes were barriers and enablers to the transfer of skills, including workplace and staffing, resources, mentorship, the interprofessional team, and leadership. Graduated fellows were able to have an impact on returning home in the areas of practice and service development, research, and teaching. Our study found that the 2 fellowship programs had variable success in the transfer of learned skills and knowledge back to the fellows' "home" institutions. Contextual differences between the fellowship institution and the home institution were the main source of barriers to transfer, and fellows from different countries had diverse needs. Supporting the transfer of knowledge and skills should be an explicit goal of these fellowship programs, and as such, should be considered in the recruitment of fellows, curriculum development, and in how the success of a fellowship is evaluated. Curricula should not just focus on medical knowledge and skills, but also skills in leading change and in education.

Effectiveness and efficiency of patient care while enrolled in an orthopedic physical therapy fellowship program

Rationale: Post-professional orthopedic manual physical therapy education programs have proliferated, in part due to increasing therapist demand. Despite the time, effort, and money required to complete these programs, there is scant research addressing their impact. We investigated whether physical therapists enrolled in an accredited manual physical therapy fellowship program achieved better outcomes, determined by patient changes in function, number of physical therapy visits, and episode of care duration while enrolled in the program. We also examined whether outcomes varied by clinician demographics, clinician life circumstances, and clinic characteristics. Methods: Forty-two therapists contributed patient data addressing functional status, number of visits, and episode of care duration. We compared data from the first 30 patients with data from the last 30 patients seen by each therapist while enrolled in the program. We also surveyed therapists regarding their demographics, life circumstances, and clinic characteristics. Results: There were no clinically meaningful or statistically significant differences in change in functional status when comparing results from the first 30 patients with the last 30 patients seen by therapists. However, there was a significant reduction in the number of visits and episode of care duration. Outcomes were influenced by entry-level degree and the presence of children at home. Conclusion: In our study, enrollment in a physical therapy fellowship program did not improve patient functional status but did reduce the number of visits and episode of care duration. Outcomes were influenced by some clinician life circumstances and clinic characteristics.

Attitudes of Forensic Fellowship Psychiatry Directors towards an Applicant Match.

Forensic psychiatry fellowship programs recruit applicants through a nonstandardized process that differs by program. Although there are deadlines, informal guidance, and more recent communication guidelines, perceived differences in recruitment practices persist between geographic regions, small and large programs, and newer and more well-established programs. In the wake of a survey of fellowship applicants that found mixed opinions surrounding the application process, U.S. forensic fellowship directors undertook a mixed method quantitative-qualitative survey of their colleagues to assess interest in a match as a potential improvement and factors influencing that interest (e.g., program size, age, and unfilled positions). With responses from all 46 active U.S. programs, results indicated broad support for principles of fairness, transparency, and minimizing pressure on applicants, with an almost perfectly divided interest in a match. Respondents supported the use of a centralized database to standardize the application process and favored certain exceptions for internal applicants. Hypotheses about the reasons underlying program directors' attitudes toward a match did not yield significant results, with only the size of a program approaching significance. This novel comprehensive survey of forensic fellowship directors offers a model for assessing and monitoring the evolution of application processes for medical subspecialties interested in expanding and improving their recruitment.

Ensemble & Ensemble of Me – What I Think About When I Think About Improvisation

This exposition is a copy of Ivar Grydeland's artistic research fellowship project (2011-2015) at The Norwegian Academy of Music, financed by The Norwegian Artistic Research Fellowship Programme. The exposition was redesigned within The Research Catalogue in 2024. The content is identical to the original documentation. ________________________ Ensemble & Ensemble of Me is an artistic research fellowship project carried out at the Norwegian Academy of Music, as part of The Norwegian Artistic Research Fellowship Programme between 2011 and 2015. In this project I produced solo improvisations deriving from the music of two improvising ensembles to which I belong: Dans les arbres and Huntsville, and I produced collective improvisations with the ensembles. The project’s key questions: - What are my concepts when improvising with the ensembles and when improvising alone? - How do the ensemble improvisations inform my solo improvisations? - What do I think about when I think about our and my own improvisations? The Haruki Murakami-paraphrase in the sub-heading indicates a process of on-going reflection upon what I regard as key aspects when I improvise. More specifically, what I regard as key aspects in the music of Dans les arbres and Huntsville, as well as for my own solo improvisations. These reflections reveal key aspects and main challenges that emerged during my attempts to create solo works informed by the ensembles. The reflections are chiefly documented in the form of a personal encyclopaedia. The encyclopaedia includes audio and visual examples, both from the final artistic results and from artistic activity during the project.

Sex diversity in spine surgery fellowship training: analysis of recent trends and program characteristics associated with increased diversity

BACKGROUND CONTEXTSex diversity in the spine surgery workforce remains limited. Accelerated efforts to recruit more female trainees into spine surgery fellowship training may help promote diversity and inclusion in the emerging spine surgery workforce. PURPOSEThis study assessed the representation of female trainees in spine surgery fellowship training and program factors associated with greater sex diversity among fellows. Study Design/SettingThis was a cross-sectional analysis of spine surgery fellows in the United States during the 2016–2017 to 2022–2023 academic years. PATIENT SAMPLEN/A. OUTCOME MEASURESRepresentation (%) and participation-to-prevalence ratios (PPRs) defined as the participation of female trainees in spine surgery fellowship training divided by the prevalence of female trainees in previous training cohorts. PPR values <0.8 indicated underrepresentation. METHODSSex diversity was assessed among spine surgery faculty, spine surgery fellows, orthopaedic surgery residents, neurosurgery residents, and allopathic medical students. Fellowship program characteristics associated with increased sex diversity were calculated with chi square tests. RESULTSThere were 693 spine surgery fellows and 41 were female (5.9%). Sex diversity in spine surgery fellowship training decreased over the study period (6.4% vs. 4.1%, p=.025). Female trainee representation in spine surgery fellowship training was less than that in orthopaedic surgery residency (14.2%, PPR=0.42), neurosurgery residency (17.1%, PPR=0.35), and allopathic medical school (47.6%, PPR=0.12) training (p<.001). There were 508 faculty at 78 spine surgery fellowships and 25 were female (4.9%). There were 3 female fellowship program directors (3.8%). Fellowship program characteristics associated with increased sex diversity included the presence of female faculty (p=.020). Additional program characteristics including geographic region, accreditation status, number of faculty and fellows were not associated with sex diversity (p>.05). CONCLUSIONSFemale representation in spine surgery fellowship training decreased over the study period and remains underrepresented relative to earlier stages of medical and surgical training. There was a positive association between female faculty and increased sex diversity among fellows. Greater efforts are needed to create training environments that promote diversity, equity, and inclusion in spine surgery fellowship training.

Outcomes of pediatric-focused advanced practice provider fellowship programs: An integrative review.

An increased demand for pediatric-focused advanced practice providers (APPs) exists to address the health care needs of children with medical complexity. Postlicensure advanced practice fellowship programs have been developed to help improve novice provider transition to practice, reducing attrition. The objectives of this integrative review are to (1) identify outcome measurements of pediatric-focused advanced practice fellowship programs and (2) evaluate the outcome measures to guide future implications for practice. A systematic integrative literature review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analyses. PubMed, CINAHL, Embase, and Google Scholar were searched in August and September 2022. Articles met inclusion criteria if they included new graduate APPs, reported the intervention of a pediatric fellowship program, and shared outcome measurements. Studies were excluded if they did not directly report on fellowship program outcome measures. Thirteen studies met inclusion criteria and were summarized and appraised for quality using the Johns Hopkins Evidence-Based Practice Model. Four themes from the literature included the favorable impact of advanced practice fellowship programs on (a) job satisfaction, (b) retention, (c) clinical and professional performance, and (d) financial outcomes. Variable strategies were used to measure outcomes across programs. Postlicensure pediatric-focused advanced practice fellowship programs seem to improve retention and job satisfaction, increase provider confidence, and bring a favorable return on investment for the organization. Future work should include investment in developing validated, standardized assessment tools to support future development of these programs in the pediatric population.

Female Orthopaedic Surgeons Are Less Represented as Head Team Physicians in Collegiate Athletic Programs

PurposeThe purpose of this study was to evaluate National Collegiate Athletic Association (NCAA) head team physicians (HTP), focusing on gender as it relates to divisional variability, medical specialty, and research productivity. MethodsIn December 2022, the NCAA member directory was utilized to obtain HTP information from the top 5 conferences within Divisions I, II, and III (DI, DII, DIII, respectively). Division I schools were selected from the previously established “Power 5” conferences. Divisions II and III used NCAA rankings. HTP data was collected from publicly available verifiable data sources. Data for gender, Scopus H-index, residency programs, and fellowship programs were collected. Mean, median, skewness, p-values, and odds ratio were calculated for analysis. ResultsOne hundred and eighty six NCAA institutions were evaluated: 69 DI (37%), 65 DII (35%), and 52 DIII (28%). DIII had the highest female representation (8; 16%). Out of the 67 orthopaedic surgery HTPs, 5 (7.5%) were female and 62 male (92.5%). There is a statistically significant difference in female orthopedic surgeon representation in the HTP field compared to males (p-value = 0.038, alpha = 0.05). Female orthopaedic surgeons have 38% lower odds of being represented as HTPs compared to males (p-value = 0.046, alpha = 0.05). Female HTPs in Divisions I and III had higher H-indexes than the overall average and median values for their respective divisons. ConclusionFemale HTPs are significantly less represented compared to males in the NCAA. Furthermore, female orthopaedic surgeons were found to have lower odds of being represented as HTPs compared to their male counterparts. For research productivity, female HTPs impacted the distribution as outliers in Divisions I and III.

A multi-institutional study from the United States Resident OPerative Experience (ROPE) Consortium examining factors influencing vascular surgery specialization among general surgery residents

ObjectiveThere remains a progressive projected deficit in the vascular surgery (VS) workforce for decades. Despite the expanding integrated VS residency pathway, the fellowship training model remains critical in supporting our future workforce. Therefore, it is imperative to understand the resident and program-specific factors that influence VS specialization among general surgery (GS) residents. MethodsData from the United States Resident OPerative Experience (ROPE) Consortium, which comprises 20 Accreditation Council for Graduate Medical Education-accredited GS residency programs across the United States, were queried for resident demographics and residency program-related details. Logistic regression analysis was used to identify factors associated with VS specialization. ResultsFrom 2010 to 2020, a total of 1343 graduating GS residents were included in the study. Of these, 135 (10.1%) pursued VS fellowship training. Residents pursuing VS were more frequently male (80.7% vs 62.8%; P < .0001) and younger (median age, 32 vs 33 years; P = .03) compared with other GS residents. Racial and ethnic group, underrepresented in medicine status, and international medical graduate status were similar between the VS and non-VS groups. Residency program-level details were also similar between groups, including program type (university vs community-based), region, size, resident volume, dedicated research experience, and National Institutes of Health funding. Dedicated vascular rotations were common among all GS programs (95.4%), and total months spent on a VS rotation (median, 4 vs 4.5 months; P = .11) did not differ among residents pursuing VS and all other residents. The presence of a collocated traditional (5 + 2) VS fellowship (91.1% vs 90.4%; P = .79) or integrated (0 + 5) VS residency (56.3% vs 55.0%; P = .77) were also similar between groups. On multivariate analysis, only male sex (odds ratio, 2.34; 95% confidence interval, 1.50-3.81; P < .001) was associated with pursuing VS fellowship. Factors that did not impact VS specialization included resident age, underrepresented in medicine status, international medical graduate status, program volume, dedicated research experience, or total months spent on a VS rotation. ConclusionsIn this multi-institutional study, we did not find any program-specific factors that influence VS specialization among GS residents. Notably, the presence of a collocated 0 + 5 residency or 5 + 2 fellowship program did not appear to deter GS residents from pursuing a VS fellowship. These data suggest that individual factors, such as mentorship, may be more impactful in recruiting GS residents to the VS specialty.

Examining Transitions in Risk for Depression Among African Americans

ABSTRACT The Council on Social Work Education Minority Fellowship Program (MFP) (2015–2017) contributed to the development of my research agenda. This article is a product of the support I received as a minority fellow and illuminates heterogeneity in depression burden among African Americans. This study sought to identify distinct constellations of risk and protection for depression and investigate individual stability, or transitions, between risk types over time. Latent transition analysis was conducted using longitudinal data from a nationally representative sample of African Americans. Results suggest that there are two risk types, and eight distinct risk paths. Transition between risk types was associated with higher depressive symptoms. The results of this study can help social work educators understand variations in the experience of depression among African Americans to inform nuanced and antiracist clinical curricula. Ultimately, this study supports the need to develop depression interventions that are aimed at a moving target and tailored to the unique needs of subpopulations of African Americans likely to experience poor depression outcomes.

Racial differences in cardiothoracic surgery letters of recommendation

ObjectiveCardiothoracic surgery lacks racial diversity. Attracting the best candidates requires valuing diversity and advancing a recruitment process that minimizes racial bias. Implicit bias in recommendation letters has been identified as an influential mechanism for lack of diversity in cardiothoracic surgery. We aim to investigate how applicant race impacts language used in cardiothoracic surgery fellowship recommendation letters. MethodsWe examined applications to an accredited cardiothoracic surgery fellowship program between 2017 and 2021. Recommendation letter authors were categorized as cardiothoracic and noncardiothoracic surgeons. Applicant self-reported race was dichotomized as White and non-White. Applicant characteristics were described using standard descriptive statistics and compared between applicant race. Recommendation letters were examined with linguistic analysis software and higher-level analysis to assess language associations between applicant race and author specialty. ResultsA total of 597 recommendation letters were analyzed from 158 individual applications. Cardiothoracic surgeons composed 334 (55.9%) recommendation letters. A total of 95 applicants (60.1%) were categorized as White. White applicants were described as more driven (P = .03), whereas letters for non-White applicants were more authentic (P = .02) and highlighted past experiences (P = .05). Cardiothoracic surgeons wrote longer letters (P = .04) with standout adjectives (P = .03) more frequently for White applicants and emphasized perceptiveness (P = .02) more often when writing for non-White applicants. ConclusionsWe demonstrate that authors' recommendation letters are influenced by applicant race. Letters written for White candidates are significantly longer and more descriptive of drive and outstanding characteristics than letters written for non-White candidates, particularly when written by cardiothoracic surgeons. Addressing this bias is crucial for recruiting the best candidates for cardiothoracic surgery.

Centering Asian Americans in Social Work Education, Research, and Policy

ABSTRACT The Asian American population is incredibly diverse in terms of ethnicity, culture, language, religion, class, and histories of war shaped by U.S. imperialism. Understanding this immense diversity is crucial for engaging with communities while recognizing the diversity–convergence paradox - the idea that Asian Americans share common experiences of discrimination and racialization despite their varied backgrounds and social locations. This paradox offers a critical lens to address health and social challenges for Asian Americans and other minoritized populations. Drawing on insights that account for this paradox, this article reflects on the authors’ experiences as Asian American social work scholars and alumni of the Council on Social Work Education’s Minority Fellowship Program. We discuss contemporary and historical issues facing Asian American communities as well as offer recommendations for advancing antiracism, diversity, equity, and inclusion within social work and beyond.

Postdoctoral Fellowship Program (DOD)

Postdoctoral Fellowship Program (DOD)

The lasting impact of virtual interviews on surgical fellowship applicants

PurposeSurgical fellowship interviews shifted to a virtual platform in 2020 due to the COVID-19 pandemic. While virtual interviews provide convenience, they also pose difficulties for programs and raise potential barriers for applicants. This study compares in-person to virtual interviews and characterizes the impact on programs and applicants.MethodsIn-person (2007–2019) and virtual (2020–2022) fellowship application data were extracted from publicly available NRMP Specialties Matching Service data. Fellowship programs included surgical critical care, surgical oncology, colorectal, pediatric, thoracic, and vascular surgery. Competitiveness was assessed using a validated normalized competitiveness index (NCI).ResultsSince virtual interviews, rankings per applicant, a surrogate for program interview workload, increased for all fellowships except pediatric surgery. The most competitive subspecialties now include colorectal, pediatric, and thoracic surgery. For non-US MDs in these subspecialties, applicants per position decreased (pediatric), match rate decreased (thoracic), and NCI increased (thoracic) under virtual interviewing. However, for the least competitive subspecialties, non-US MDs had increased rankings per applicant (critical care and vascular), increased match rate (critical care and surgical oncology), and decreased NCI (surgical oncology) with virtual interviewing.ConclusionsSince the virtual platform was implemented, applicants have interviewed at and ranked more programs, subsequently increasing program workload. While this is positive for many applicants, a differential pattern of securing a fellowship emerged for non-US MD applicants. This finding is important for fellowship program directors to consider and ensure non-US MD applicants are not marginalized with the virtual platform.Level of EvidenceIII

The Development and Execution of An Orthopaedic Sports Medicine Fellowship Surgical Skills Assessment

Background: Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency. Purpose: To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows. Study Design: Case series; Level of evidence, 4. Methods: A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions. Results: Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement (P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement (P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship (P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship (P < .001). Conclusion: This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.

Quartertone marimba

A PhD-level project in the Fellowship program for artistic research and development ("Stipendprogrammet for kunstnerisk utviklingsarbeid") at the Norwegian Academy of Music in Oslo, by Kjell Tore Innervik.