Fellowship Training Research Articles (Page 1)

Fellowship Training After General Surgery Residency: Does it Pay?

Simulation-based education has become an essential component of graduate medical education as real-life clinical experiences become less frequent. Factors such as increasing trainee numbers, duty hour restrictions, and advancements in therapeutic options have contributed to reduced clinical exposure. Neonatology trainees, in particular, face challenges gaining adequate procedural experience. National data highlights gaps in procedural exposure, with graduating fellows reporting limited experience in critical procedures. Recognizing the need for structured, multi-institutional, and longitudinal education, we developed the Midwest Neonatal Simulation Boot Camp (MNSBC), a three-year simulation-based boot camp curriculum designed to enhance neonatology fellows' cognitive, technical and communication skills throughout their training. The MNSBC was developed by a multi-institutional executive committee composed of stakeholders from various Chicago-area neonatology programs. The curriculum was introduced in phases, starting with a first-year boot camp in 2019, followed by second- and third-year boot camps in subsequent years. Needs assessments informed the content and structure of each boot camp, which incorporated procedural stations, high-stakes clinical scenarios, challenging communication exercises, and point-of-care ultrasound training. Since its inception, the MNSBC curriculum has trained 152 first-year, 88 second-year, and 57 third-year fellows from 12 programs across five Midwestern states. Participants demonstrated statistically significant improvements in self-assessed proficiency following each boot camp. Anonymous evaluations collected from fellow participants consistently highlighted enhanced clinical skills, knowledge, and confidence in managing low-frequency, high-stakes procedures and clinical scenarios. The program's collaborative model has minimized costs for participating institutions, allowing funds to be redirected toward travel and accommodations. The MNSBC demonstrates that a multi-institutional, longitudinal simulation-based curriculum is both feasible and effective in improving neonatology fellows' clinical skills. As pediatric training requirements evolve, the MNSBC offers a sustainable model for enhancing procedural competency and bridging educational gaps throughout fellowship training.

Background: Sleep deprivation in medical trainees is associated with negative outcomes for both trainees and patients. Despite duty hour limitations, sleep deprivation is still common among residents and fellows. The Accreditation Council for Graduate Medical Education requires training programs to educate trainees and faculty members in recognizing fatigue and fatigue mitigation strategies, although there is no guidance on how this education should occur. Objective: To measure the impact of an asynchronous fatigue mitigation curriculum administered to trainees in graduate medical education at a large academic medical center. Methods: In the 2023-2024 academic year, all resident and fellow trainees at a large academic medical center were asked to complete an asynchronous curriculum comprising three instructional videos with teaching on sleep structure and function, recognizing and reporting fatigue, and how to improve sleep. Impact on knowledge and trainee-assessed comfort were assessed via needs assessment, pretest, and posttest surveys. An annual survey was distributed 14 weeks after the initial curriculum launch to assess decay in knowledge and comfort. Results: A total of 970 trainees participated in our asynchronous fatigue mitigation curriculum. Before curriculum launch, trainee comfort with the recognition of fatigue was low (53.5%) and baseline sleep habits were poor, with only 36% of trainees reporting at least 7 hours of sleep each night. After completion of the asynchronous curriculum, there was a significant improvement in trainee knowledge assessed via a six-question test (mean score, 2.87-3.59; P < 0.01), and this knowledge improvement was sustained over 14 weeks (P < 0.01). There were significant improvements in trainee comfort with all five fatigue-related tasks comparing pre- and posttests, with sustained improvement in four of these topics after 14 weeks. There was no significant change in trainee attitudes regarding comfort in reporting concerns about fatigue or requesting coverage when too fatigued to work. Conclusion: Our asynchronous fatigue mitigation curriculum successfully and durably improved knowledge and trainee comfort with fatigue-related tasks in its first year. The asynchronous curriculum offers a sustainable solution to ensure this education reaches medical trainees across a large population of the graduate medical education population encompassing multiple subspecialties.

Background: Fellowship training in pediatric cardiology requires complex three-dimensional visuospatial reasoning. Previous work has shown that virtual reality (VR) curricula can improve basic understanding of congenital heart disease. The efficacy of using VR to teach more complex cardiac anatomy and physiology, such as hypoplastic left heart syndrome (HLHS) and single ventricle surgical palliation, is unknown. Hypothesis: Pediatric cardiology fellows who complete a VR learning module on the various stages of HLHS surgical palliation will demonstrate superior understanding of the underlying anatomy and pathophysiology as compared to fellows who do not. Methods: Thirteen pediatric cardiology fellowship programs at major congenital heart centers were recruited to this study, with first-year fellows as the participants. Programs were assigned to the control group or intervention group. Fellows in the intervention group completed the Michigan Anatomic Congenital Heart in 3D (MACH-3) curriculum, which was not available to the control group. Both groups then completed a validated assessment tool. The total assessment score was calculated by summing the number of questions that participants answered correctly, ranging from 0 to 29. The difference in total assessment scores between the groups was examined using two-sample t-test and Cohen’s d effect size. Results: A total of 56 fellows were included in the analysis. Participants in the intervention group achieved higher total assessment scores (n=24, 23.8 ± 3.1 questions correct out of 29) than those in the control group (n=32, 21.8 ± 3.9 questions correct) (p=0.04), with a moderate effect size of 0.56. Most participants in the intervention group reported via survey that the curriculum was easy to use (96%) and enjoyable (92%), found the experience to be effective in improving their knowledge base (100%), and would recommend that this or some other VR teaching tool be incorporated into pediatric cardiology fellowship training (96%). Conclusions: In a multi-center educational study, a VR curriculum was shown to improve pediatric cardiology fellow knowledge of HLHS anatomy, pathophysiology, and palliation, while receiving nearly universally positive feedback from participants. Potential future directions for this research include expansion to include other complex congenital cardiac lesions or investigation of formalized incorporation of VR modalities into fellowship curricula.

Studies have highlighted decreasing interest in pediatric careers, including pediatric hematology oncology (PHO). This study defines the annual number of applicants, available training positions, and unfilled training positions for PHO fellowship training. From 2009 to 2025, growth in the annual number of training positions (36.6% increase) exceeded growth in the number of interested applicants (8.3% increase). Accordingly, the annual applicant-to-training position ratio decreased (from 1.01 to 0.80), while the annual rate of unfilled training positions increased over the study period (from 13.4% to 21.6%). Inadequate demand for PHO fellowship training may trigger deleterious health consequences for children with blood and cancer disorders.

PurposeArtificial intelligence (AI) has become incredibly popular over the past several years, with large language models (LLMs) offering the possibility of revolutionizing the way healthcare information is shared with patients. However, to prevent the spread of misinformation, analyzing the accuracy of answers from these LLMs is essential. This study will aim to assess the accuracy of five freely accessible chatbots by specifically evaluating their responses to questions about patellofemoral instability (PFI). The secondary objective will be to compare the different chatbots, to distinguish which LLM offers the most accurate set of responses.MethodsTen questions were selected from a previously published international Delphi Consensus study pertaining to patellar instability, and posed to ChatGPT4o, Perplexity AI, Bing CoPilot, Claude2, and Google Gemini. Responses were assessed for accuracy using the validated Mika score by eight Orthopedic surgeons who have completed fellowship training in sports-medicine. Median responses amongst the eight reviewers for each question were compared using the Kruskal-Wallis and Dunn’s post-hoc tests. Percentages of each Mika score distribution were compared using Pearson’s chi-square test. P-values less than or equal to 0.05 were considered significant. The Gwet’s AC2 coefficient was calculated to assess for inter-rater agreement, corrected for chance and employing quadratic weights.ResultsChatGPT4o and Claude2 had the highest percentage of reviews (38/80, 47.5%) considered to be an “excellent response not requiring classification”, or a Mika score of 1. Google Gemini had the highest percentage of reviews (17/80, 21.3%) considered to be “unsatisfactory requiring substantial clarification”, or a Mika score of 4 (p < 0.001). The median ± interquartile range (IQR) Mika scores was 2 (1) for ChatGPT4o and Perplexity AI, 2 (2) for Bing CoPilot and Claude2, and 3 (2) for Google Gemini. Median responses were not significantly different between ChatGPT4o, Perplexity AI, Bing CoPilot, and Claude2, however all four statistically outperformed Google Gemini (p < 0.05). Inter-rater agreement was classified as moderate (0.40 > AC2 ≥ 0.60) for ChatGPT, Perplexity AI, Bing CoPilot, and Claude2, while there was no agreement for Google Gemini (AC2 < 0).ConclusionCurrent free access LLMs (ChatGPT4o, Perplexity AI, Bing CoPilot, and Claude2) predominantly provide satisfactory responses requiring minimal clarification to standardized questions relating to patellar instability. Google Gemini statistically underperformed in accuracy relative to the other four LLMs, with most answers requiring moderate clarification. Furthermore, inter-rater agreement was moderate for all LLMs apart from Google Gemini, which had no agreement. These findings advocate for the utility of existing LLMs in serving as an adjunct to physicians and surgeons in providing patients information pertaining to patellar instability.Level of evidence: VSupplementary InformationThe online version contains supplementary material available at 10.1186/s12891-025-09227-1.

Characterization of Educational and Executive Leadership in University-Based General Surgery Programs: Demographics, Training Backgrounds, and Institutional Ties.

Examining Variation in Prostate Biopsy Practices in the United States: An Analysis of American Urological Association Census Data.

Making an impact: Reflections from the American Association of Endocrine Surgeons presidential address.

Fellowship Training and Expanded Scope as a Practice Model.

Vascular Surgery Residents and Fellows Graduate at Higher Levels of Proficiency in Endovascular as Compared to Open Aortic Operations.

This cross-sectional survey study evaluated the current treatment preferences of US glaucoma specialists for open angle glaucoma, finding that most preferred selective laser trabeculoplasty over topical medications for treatment-naive patients with ocular hypertension and open angle glaucoma. To describe US glaucoma specialists' preferences regarding the use of selective laser trabeculoplasty (SLT) versus topical glaucoma medications for the treatment of open angle glaucoma. Actively practicing glaucoma specialists from the American Glaucoma Society were invited to participate in a survey assessing treatment preferences and influencing factors. Multivariable logistic regressions were performed to determine predictors of preference for SLT. Of 136 eligible respondents, 65%-71% preferred SLT for treatment-naive patients with ocular hypertension, mild-to-moderate primary open angle glaucoma (POAG), pseudoexfoliation glaucoma, or pigmentary glaucoma. For mild-to-moderate POAG on one medication, 75% of respondents favored SLT. For advanced POAG on maximum medical therapy, 57% of respondents favored surgery and 38% preferred SLT. Respondents indicated that reducing medication nonadherence (93%), suitable glaucoma type or stage (88%), and experience performing SLT (83%) were key facilitators in recommending SLT to their patients. In contrast, patients' inability to position for the procedure (78%), unsuitable glaucoma type or stage (67%), and comorbidities or contraindications to SLT (55%) were primary reasons to not recommend SLT. Physicians in private practice, those who completed fellowship training more recently, and those who see more treatment-naive glaucoma patients were significantly more likely to prefer SLT over medication. The majority of US glaucoma specialists report a preference for SLT over medication for open angle glaucoma treatment, demonstrating that acceptance of SLT has increased over the past several years, especially for treatment-naïve patients. Statistically significant predictors of SLT preference were practice setting, practice duration, and patient volume.

Evolving Industry Fellowship Training to Prepare PharmDs for Pharmaceutical Careers of the Future

The Current State of the Board-Certified Adult Congenital Heart Disease Workforce 10 Years After Initial Certification.

Feasibility of an international multicentric HPB fellowship training program in Latin America.

In 2020, the scientific council of the Israeli Medical Association approved a National Simulation Program (NSP) for Pediatric Emergency Medicine (PEM) fellows as a mandatory component of their training curriculum. The study aimed to outline the NSP's development, its components, and assess PEM fellows' self-reported perception of knowledge and confidence acquisition following participation. The NSP comprised 9 simulation days over 2.5 years, covering various PEM emergencies with 34 novel scenarios and 4 technical skill stations. After each session, PEM fellows completed a self-assessment using a 5-point Likert scale to evaluate the NSP's impact on their knowledge and confidence in managing complex PEM scenarios. From July 2020 to February 2023, 197 participants attended 9 simulation days, representing 59 PEM fellows from all 14 different PEM departments across Israel offering PEM fellowship programs. PEM fellows rated the NSP's contribution to improving abilities and confidence in leading resuscitation teams according to Crisis Resource Management (CRM) principles with an average of 4.7/5 (±0.7) and 3.9/5 (±0.6), respectively, on a 5-point Likert scale. They also rated NSP's contribution to improving clinical knowledge and scenario management abilities with averages of 4.8/5 (±0.5) and 4.7/5 (±0.6), respectively. We demonstrated that it is possible to successfully establish and implement an NSP in Israel. Our findings indicate that the NSP enhances PEM fellow's perception of knowledge and confidence in managing complex PEM conditions. The NSP is deemed valuable for training PEM fellows in Israel.

Precision in Endometrioma Surgery: Fellowship Training Predicts Ovarian Preservation and Guideline Adherence

A call to action: Physician grief and the importance of affective debriefing in the intensive care unit.

BackgroundChatbots powered by large language models have shown promising results when addressing medical queries, thus transforming access to medical information. Although these chatbots produce detailed and accurate responses, it is unclear how they perform when handling real, unedited patient questions, particularly in non-English languages. This study aimed to assess the readability, accuracy, and comprehensiveness of responses to retinal disease queries provided by four chatbots (ChatGPT 4.0, ConsensusGPT, Gemini, and Claude 3) compared to responses from retina specialists.MethodsIn this cross-sectional, comparative, and blinded study, twenty unedited questions about retinal diseases were randomly selected from a popular online video channel in Portuguese. The questions were submitted to the four selected chatbots and retina specialists with fellowship training. Two independent retinal experts evaluated the responses using standardized Likert scales for accuracy and completeness. Readability was assessed using the Flesch Reading Ease Score and the Flesch-Kincaid Grade Level tests. Additional metrics, including word count and response generation time, were analyzed. Data were compared among groups using non-parametric statistical tests, including the Kruskal-Wallis test with Dunn’s pairwise comparisons and chi-squared tests, with a two-sided p-value threshold of 0.05 for statistical significance.ResultsRetinal specialists and the Gemini chatbot produced responses with higher readability, indicating lower educational levels were needed for comprehension. In contrast, ChatGPT 4.0, ConsensusGPT, and Claude 3 delivered more detailed and accurate answers but required a higher reading level. ChatGPT 4.0 and ConsensusGPT achieved superior quality and comprehensiveness ratings compared to human experts and the other chatbots. Additionally, all AI systems generated responses significantly faster than the human specialists. Evaluators could correctly distinguish between human-generated and AI-generated responses in most cases.ConclusionsArtificial intelligence chatbots demonstrate considerable promise for rapidly disseminating accurate medical information directly to the end-user, not only in English. However, optimizing the simplicity of their language is essential to ensure that detailed responses remain accessible to a broad audience. Future research should aim to replicate our findings with larger datasets of questions with the goal of refining these systems to balance comprehensive content with user-friendly language.Supplementary InformationThe online version contains supplementary material available at 10.1186/s40942-025-00737-7.

Postgraduate education for advanced practice team members has emerged as a viable way of gaining critical experience needed for specialty practice. Residency and fellowship training programs have been part of the landscape for medical education for decades but have only recently become available to advanced practice team members. Most programs provide a year of structured learning, but there are few published reports of their value. We provide a description and outcome data of our specialty practice fellowship at an academic medical center over a 5-year period. A fellowship advisory board with representation from numerous specialties defined entry criteria, curriculum, and clinical site placement. Participant and preceptor experience was measured monthly to optimize rapid acquisition of skills. The curriculum was modified through rapid cycle quality improvement in response to scores lower than 70%. In total, 30 fellows have participated in the advanced practice nurse practitioner and physician assistant fellowship program between 2019 and 2023, among 8 specialty tracks. Of the participants from 2019 to 2023, 28 fellows graduated with successful program completion. Ninety-six percent were employed in specialty care settings at the time of graduation or within six months post program completion. The overall postfellowship retention rate at the training site was 79%. This outcome data supported the return on investment. This article provides data and insight into postgraduate fellowship programs with 5 years of cohort data, long-term outcomes, retention rates, and return on investment. In addition, it informs educators and employers with insight into programmatic design, evaluation, and outcomes in transition to practice programs.