Medicine Fellowship Program Directors Research Articles

Characteristics of Pediatric Hospital Medicine Fellowship Program Directors.

Rapid growth in pediatric hospital medicine (PHM) fellowships has occurred, yielding many new program directors (PDs). Characteristics of PDs have potential implications on the field. To describe characteristics (demographic, educational) and scholarly interests of PHM fellowship PDs. We developed and distributed a 15-question, cross-sectional national survey to the PHM PDs listserv. Questions were pilot tested. The survey was open for 4 weeks with weekly reminders. Responses were summarized using descriptive statistics. Fifty-six current fellowship leaders (40 PDs, 16 associate PDs [APDs]) responded, including at least 1 from 43 of 59 active PHM fellowship programs (73%). Most respondents identified as female (71%) and ≤50 years old (80%). Four (7%, n = 2 PD, 2 APD) leaders identified as underrepresented in medicine. About half (n = 31, 55.4%) completed a fellowship themselves (APDs > PDs; 87.5% vs 42.5%), and 53.5% (n = 30) had advanced nonmedical degrees (eg, Master of Science, Doctor of Philosophy; APDs > PDs; 62% vs 45%). Most leaders (59%, n = 33) chose multiple domains when asked to select a "primary domain of personal scholarship." Education was the most frequently selected (n = 37), followed by quality improvement (n = 29) and then clinical research (n = 19). This survey confirms a high percentage of women as PHM fellowship leaders and highlights the need to increase diversity. Less than half of senior PDs completed a fellowship in any specialty. Leaders report interest in multiple domains of scholarship; few focus solely on clinical research.

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.

The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors.

Our 2019 survey of sleep medicine fellowship program directors (PDs) indicated that fellows' contact with telemedicine was limited. Within months, the coronavirus disease 2019 (COVID-19) pandemic significantly impacted the field. This survey describes fellows' telemedicine exposure, their PDs' attitudes toward it, and their formalized telemedicine training during the pandemic's third year. A 33-item SurveyMonkey questionnaire was developed. Many quantitative (Likert scale) items were identical to items on the 2019 survey for direct comparison. An open-ended question was added for qualitative analyses. All 91 sleep medicine fellowship PDs were invited to participate. The SurveyMonkey platform provided quantitative item descriptive statistics. Qualitative data underwent thematic analyses using codebook methodology. Forty (97.5%) PDs indicated their program offers a telemedicine experience. Thirty-two (80%) PDs observed at least a 10% increase in sleep fellows' telemedicine encounters compared with prepandemic times. Although 27 (67.5%) PDs agreed that a national telemedicine curriculum could be useful, 8 (20%) of them offer a sleep telemedicine curriculum. Qualitative feedback revealed diverging attitudes toward telemedicine's place in sleep medicine practice, fellowship training, and the utility of a national curriculum. Sleep telemedicine utilization during fellowship training was markedly higher on this 2022 survey (97.5%) compared with a similar 2019 survey (33.3%), and most PDs agreed a standardized curriculum could be useful. However, relatively few programs offer formalized telemedicine training. These findings imply that, while most sleep medicine fellows participate in telemedicine, they lack the formalized training that may optimize their utilization of the medium in their postfellowship careers. Fields BG, Kaur K, Dholakia S, Ioachimescu O. The COVID-19 pandemic's impact on sleep medicine fellowship telemedicine training: a follow-up survey of program directors. J Clin Sleep Med. 2024;20(2):201-210.

Graduate medical education curriculum regarding the health and healthcare of older lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) adults experience a wide variety of unique challenges accessing healthcare. These barriers may be exacerbated among older LGBTQ+ people due to intersecting, marginalized identities. To prepare physicians to address the healthcare needs of older LGBTQ+ adults, graduate medical education (GME) must include training about the specific needs of this population. Prior studies demonstrate a lack of LGBTQ+ training in GME curricula. Here, we investigated the presence of LGBTQ+ curricula in internal medicine residencies and geriatrics fellowships through a national survey. Over 62.0% of internal medicine (n = 49) and 65.6% (n = 21) of geriatric medicine fellowship program directors, responding to the survey, reported content relevant to the health of older LGBTQ+ adults. Education about LGBTQ+ health in internal medicine residencies and geriatrics fellowships is vital for the provision of culturally-competent healthcare and to create an inclusive environment for older LGBTQ+ patients.

Pediatric Emergency Medicine Fellowship Program Directors' Viewpoint: Minimum Levels of Entrustment for Graduating Fellows and Practicing Physicians to Perform the Subspecialty's Professional Activities.

Entrustable Professional Activities (EPAs) are essential tasks physicians perform within their professions. Entrustment levels that pediatric emergency medicine (PEM) fellowship program directors (FPDs) expect graduating fellows to achieve for PEM-specific and common pediatric subspecialty EPAs remain unreported. This study aims to determine minimum entrustment levels FPDs require fellows to achieve to graduate from fellowship and to compare FPD expectations for fellows versus practicing PEM physicians. Secondary analysis of PEM-specific data from a national multispecialty cross-sectional survey of pediatric subspecialty FPDs. For 6 PEM-specific and 7 common pediatric subspecialty EPAs, PEM FPDs indicated (1) minimum entrustment levels fellows should achieve by training completion, (2) whether they would allow a fellow to graduate below these minimum levels, and (3) minimum levels for safe and effective practice by PEM physicians. Minimum levels were defined as the level that more than 80% of FPDs would not drop below. Sixty of 77 PEM FPDs (78%) completed the survey. Most respondents did not require fellows to achieve the highest level (level 5-no supervision) by graduation for any PEM-specific EPAs. The median level FPDs expected for practicing PEM physicians was 5 (trusted to perform without supervision) for EPAs 1 and 4 and level 4 (indirect supervision for complex cases) for the remaining PEM-specific EPAs. Minimum levels expected by FPDs for common subspecialty pediatric EPAs were lower for both groups. Most PEM FPDs indicated that they would graduate fellows before their achievement of the highest entrustment level for all EPAs. Most also indicated that they do not expect practicing PEM physicians to perform all EPAs without supervision. These findings indicate need for stakeholders to evaluate current structure and outcomes of PEM fellowship programs and for institutions and organizations to ensure adequate support in time and resources for ongoing learning for practicing PEM physicians.

Maternal–fetal medicine fellowship program director perspective on virtual interviews following matriculation of the first virtual interview class

The first class of virtually interviewed maternal-fetal medicine fellows has matriculated into their training programs. This study aimed to evaluate the impact of virtual interviews on the outcomes of the National Resident Matching Program within our subspecialty. We assessed maternal-fetal medicine fellowship program directors' experience with their fellows who interviewed virtually as compared with experience with the previous year's fellows who interviewed in-person. In addition, we evaluated program directors' satisfaction with the virtual interview process and their preferred mode of interviewing for future cycles. A cross-sectional online survey was distributed through the Society for Maternal-Fetal Medicine to all maternal-fetal medicine fellowship program directors on October 26, 2021, approximately 4 months after the first virtually interviewed fellow matriculated into the training program. Program directors were asked to provide information about their National Resident Matching Program rank list between their final in-person and first virtual years. Program directors were asked to evaluate their experience with their fellow 4 months into the first year of fellowship compared with their expectations based on their virtual interview, and their experience at that same point in fellowship of their last fellow who interviewed in-person. For all questions, in programs with >1 fellow per year, program directors were asked to answer the questions for the fellow ranked highest on their National Resident Matching Program rank list for each year. Survey data were collected anonymously and stored securely. Descriptive statistics and bivariate analyses were performed to compare groups, all tests were 2-sided, and the significance level was set at P<.05. A total of 80 of 98 (81.6%) program directors responded. There was no difference in the position of the matched fellow on the program's National Resident Matching Program rank list between candidates interviewed in-person and candidates interviewed virtually. There was also no difference in the number of programs that took an internal or external candidate outside of the National Resident Matching Program match process or that did not fill their fellowship positions. Program directors reported no difference between fellows interviewed virtually and those interviewed in-person in meeting interview-based performance expectations with regard to clinical capabilities (P=.67), technical skills (P=.96), research potential or experience (P=.54), professionalism and ability to be a team player (P=.72), and compatibility with the division and fellowship program (P=.67). Program directors' overall experience with virtual interviews was favorable: 70 (95.8%) program directors reported that the virtual interview experience was better than expected, slightly better than expected, or as expected. In future years, most program directors favored ongoing exclusively virtual interviewing (n=41; 56.2%) or a hybrid of virtual and in-person interviews (n=27; 37.0%). Only 5 (6.9%) reported a desire to return to exclusively in-person interviewing. Maternal-fetal medicine fellowship program directors did not identify a difference in National Resident Matching Program results between fellows interviewed virtually and those interviewed in-person. Furthermore, there was no difference between these fellows in meeting interview-based expectations in the first year of the training program. Most program directors found the virtual interview process to be effective and support ongoing virtual interviews.

Roadmap to Success: Interactive Timeline With Resources for Fellowship Scholarly Activity.

Fellowship trainees balance clinical work and scholarly activities that are necessary to graduate fellowship. Strategies for success in fellowship include (1) following a strict timeline with frequent re-evaluation of progress, and (2) participating in national groups for access to resources otherwise not provided by a home institution.1 Mentorship, resources, and support may be limited within an institution for less traditional areas of scholarship, such as medical education, global health, and quality improvement. Program leadership and fellows may need to explore external resources.The Trainees and Early Career Neonatologists (TECaN) subcommittee within the Section on Neonatal Perinatal Medicine (SONPM) developed interactive roadmaps to supplement resources provided at local institutions (Figure). The aim of the roadmaps is to provide a timeline for fellow scholarly activity synchronized with clinical requirements, conferences, and extramural grant deadlines.Roadmaps allow individuals to identify goals and follow recommendations of necessary actions. Each roadmap is divided into the 3 years of fellowship with a summary of quarterly “milestones.” Resources mapped along the roadmap include extramural grants, conferences, abstract submission deadlines, and national educational resources. Each of these resources are hyperlinked to the corresponding source.Resources highlighted in the first year provide background knowledge, training modules, mentorship, and project ideas. The second year focuses on presenting preliminary work at local or national conferences, additional training, and grant applications. Lastly, the third year focuses on the job search, provides tips on how to publish scholarly work, and guides the transition from trainee to early-career neonatologist. Each roadmap is tailored to the specific area of scholarship, but the uniform structure and design enables easy navigation.These interactive road maps were built and hosted on Google Slides (Alphabet Inc., Mountain View, California), then embedded to the TECaN website for public access. TECaN members contributed to the development of these roadmaps. Each roadmap required 3 to 5 months for completion, with input from 2 to 6 contributors per roadmap. Technical aspects were entirely drafted by TECaN volunteers at no additional cost.A survey conducted during a virtual meeting in May 2021 allowed 71 neonatal-perinatal medicine fellowship program directors (PDs) and associate program directors (APDs) to provide feedback about the roadmaps. Fifty-eight (82%) participated in the survey. Only 33% (19 of 58) of respondents were aware of the TECaN roadmaps prior to this meeting, with two-thirds of these PDs having recommended the roadmaps to their trainees. Nearly all respondents “agree” or “strongly agree” (96%, 56 of 58) that their fellowship trainees “will benefit from using the roadmaps as a template to achieve their specific scholarly goals.” Two-thirds of PDs and APDs feel that the roadmaps are equally beneficial across the 3 years of fellowship training. Notably, only 7% (4 of 58) of respondents were aware of any national-level resources similar to the TECaN roadmaps, and only 20% (12 of 58) had institution-specific guides for their trainees that covered the same material as the TECaN roadmaps.Scholarly roadmaps are useful resources to neonatal-perinatal medicine fellows, their fellowship PDs, and research mentors. They provide easy-to-understand timelines for trainees with comprehensive lists of conferences, grants, and journals within a trainee's area of interest. They are especially critical for less traditional areas of scholarship where resources and experts may be limited or scattered across institutions. This highly feasible and accessible tool has been well received by training programs and PDs and has amassed users from around the United States. The details described here provide the necessary information for other disciplines to adapt this tool, with the potential for wide-reaching impact.

Faculty Support for Advocacy Is Key to Training the Next Generation of Pediatrician-Advocates.

We are pleased to see a focus on advocacy in the hospital setting described by Winthrop et al in the October 2021 Hospital Pediatrics perspectives article, “Training the Next Generation of Pediatrician-Advocates: A New Focus on the Inpatient Setting.” We agree that pediatric residency training would benefit from advocacy teaching in this setting. Such training can be modeled after the advocacy curricular resources developed for pediatric hospital medicine. These resources include: (1) competency-based goals and objectives for the advocacy rotation that map to pediatric subspecialty entrustable professional activities, developed by the curriculum committee of the Pediatric Hospital Medicine Fellowship Program Directors Council; and (2) specific knowledge, skills, and attitudes in advocacy as defined by the 2020 Pediatric Hospital Medicine Core Competencies.1However, faculty development in advocacy is necessary but not sufficient to allow for advocacy training and curricular development in the inpatient setting. Inpatient faculty must also be given the time, resources, and support to perform and teach advocacy. This can only happen if advocacy scholarship is congruent to traditional scholarship, including both research and medical education. We propose the following additional faculty needs to establish integration of advocacy in the hospital practice setting: Adoption of advocacy portfolios: Clinician-researchers generate scholarship to benefit patients and populations in the form of peer-reviewed grants and publications. Clinician-educators have gained support for scholarly activities and faculty promotion in medical education through the development and application of educator portfolios. Recognition of advocacy as a scholarly pursuit can only be achieved through the dissemination and widespread adoption of advocacy portfolios (APs).2 APs supplement the curriculum vitae to highlight how advocacy can be held to the same rigorous scholarly standards as traditional scholarship. Recognition of advocacy and APs in the academic promotion process will allow those interested in pursuing an advocacy scholarship to be successful in obtaining the time and resources necessary for practice. A national group of pediatrician-advocates has developed the first standardized AP template along with the American Academy of Pediatrics Community Pediatrics Training Initiative.3Advocacy recognition within the Pediatric Hospital Medicine Board certification process: The American Board of Pediatrics (ABP) has proposed a pediatric subspecialty entrustable professional activity focused on population health. Additionally, “advocacy and leadership” is a content domain for Pediatric Hospital Medicine Board certification. Despite this, the ABP has not recognized advocacy as a form of scholarship and “work product” allowable for pediatric subspecialty fellowship completion and subsequent board certification, even it if meets the Glassick criteria for scholarship.4 Lastly, allowing physicians to submit advocacy projects for maintenance of certification credit would greatly assist in recognizing the role of physician advocacy in improving population health.Advocacy will gain congruence in academics through a simultaneous bottom-up and top-down approach: faculty use of APs as developmental and promotional tools, along with recognition and support from medical school leadership and the ABP. Only if these criteria are met will faculty be recognized for scholarly advocacy activities, thereby supporting the time, resources, and funding necessary for teaching such practice to the next generation.

Transport Medical Control Education for Pediatric Critical Care Fellows: A National Needs Assessment Study.

Characterize transport medical control education in Pediatric Critical Care Medicine fellowship. Cross-sectional survey study. Pediatric Critical Care Medicine fellowship programs in the United States. Pediatric Critical Care Medicine fellowship program directors. None. We achieved a 74% (53/72) response rate. A majority of programs (85%) require fellows to serve as transport medical control, usually while carrying out other clinical responsibilities and sometimes without supervision. Fellows at most programs (80%) also accompany the transport team on patient retrievals. Most respondents (72%) reported formalized transport medical control teaching, primarily in a didactic format (76%). Few programs (25%) use a standardized assessment tool. Transport medical control was identified as requiring all six Accreditation Council for Graduate Medical Education competencies, with emphasis on professionalism and interpersonal and communication skills. Transport medical control responsibilities are common for Pediatric Critical Care Medicine fellows, but training is inconsistent, assessment is not standardized, and supervision may be lacking. Fellow performance in transport medical control may help inform assessment in multiple domains of competencies. Further study is needed to identify effective methods for transport medical control education.

Research Productivity of Orthopaedic Sports Medicine Fellowship Programs in the United States

PurposeTo survey orthopaedic sports medicine fellowship program directors to determine the current research productivity of both fellows and faculty in Accreditation Council for Graduate Medical Education–accredited orthopaedic sports medicine fellowship programs in the United States.MethodsAn anonymous 18-question survey was distributed via e-mail to all 95 Accreditation Council for Graduate Medical Education–accredited orthopaedic sports medicine fellowship program directors in the United States. Descriptive statistics were used for data analysis. Questions included whether fellows are required to complete a certain number of projects during their fellowship year and whether fellows have protected research time.ResultsOf the programs, 31 (33%) responded to the survey. Twenty-four programs (80%) require fellows to complete 1 to 4 projects. Twenty-one programs (71%) provide 4 to 8 hours of weekly protected research time. Twenty-four programs (77%) publish 1 to 2 manuscripts per fellow during the fellowship. Twenty-two programs (71%) have fellows work on 1 to 2 projects at a time. Annually, 26 programs (84%) give 0 to 5 podium presentations, 24 (80%) present 0 to 5 posters, and 15 (48%) report 0 to 5 publications. Twenty-four programs (77%) have research fellows and/or assistants to help with research. The presence of dedicated research assistants and more than 25 annual fellowship program publications were found to be useful screening data for more than 2 and more than 4 average publications per fellow, respectively.ConclusionsThe research productivity of orthopaedic sports medicine fellowship programs may be an important consideration for applicants. Applicants who desire to be productive in research during their fellowship year should consider programs with dedicated research assistants and/or programs that publish more than 25 times annually.Clinical RelevanceThis is a descriptive epidemiologic study that helps define the research productivity landscape in orthopaedic sports medicine fellowships. A more accurate understanding of sports medicine fellowship research experience may facilitate a better match between a program’s research expectations and an applicant’s research interests.

Maternal-fetal medicine program director experience of exclusive virtual interviewing during the coronavirus disease 2019 pandemic

The coronavirus disease 2019 pandemic necessitated an abrupt transition to exclusive virtual interviewing for maternal-fetal medicine fellowship programs. This study aimed to assess the maternal-fetal medicine fellowship program directors' approaches to exclusive virtual interviews and to obtain program director feedback on the virtual interview experience to guide future interview cycles. A novel cross-sectional online survey was distributed through the Society for Maternal-Fetal Medicine to program directors after the completion of the interview season, but before the results of the National Resident Matching Program on October 14, 2020. Survey data were collected anonymously and managed using secure Research Electronic Data Capture electronic data capture tools. Overall 71 of 89 program directors (80%) responded. All respondents completed their 2020 interviews 100% virtually. Nearly half of program directors (33 of 68, 49%) interviewed more candidates in 2020 than in 2019. Of those who interviewed more candidates in 2020, the mean number of additional candidates per fellowship position was 5.8 (standard deviation, ±3.8). Almost all program directors reported no (35 of 71, 49%) or minimal (34 of 71, 48%) negative impact of technical difficulties on their virtual interview processes. Most programs structured their interview to a half day (4 hours) or less for the candidates. Many programs were able to adapt their supplemental interview materials and events for the candidates into a virtual format, including a virtual social event hosted by 31 of 71 programs (44%). The virtual social event was most commonly casual and led by current fellows. Ultimately, all program directors reported that the virtual interview experience was as expected or better than expected. However, most program directors felt less able to provide candidates with a comprehensive and accurate representation of their program on a virtual platform compared with their previous in-person experiences (46 of 71 [65%] reported minimally, moderately, or significantly less than in-person). In addition, most program directors felt their ability to get to know candidates and assess their "fit" with the program was less than previous in-person years (44 of 71 [62%] reported minimally, moderately, or significantly less than in-person). In a hypothetical future year without any public health concerns, there were 23 of 71 respondents (32%) who prefer exclusive in-person interviews, 24 of 71 (34%) who prefer exclusive virtual interviews, and 24 of 71 (34%) who prefer a hybrid of virtual and in-person interviews. The virtual interview experience was better than expected for most program directors. However, most program directors felt less able to present their programs and assess the candidates on a virtual platform compared with previous in-person experiences. Despite this, most program directors are interested in at least a component of virtual interviewing in future years. Future efforts are needed to refine the virtual interview process to optimize the experience for program directors and candidates.

Current State of Nutrition Education in Pediatric Critical Care Medicine Fellowship Programs in the United States and Canada.

To assess the current state of nutrition education provided during pediatric critical care medicine fellowship. Cross-sectional survey. Program directors and fellows from pediatric critical care medicine fellowship programs in America and Canada. Seventy current pediatric critical care medicine fellows and twenty-five pediatric critical care medicine fellowship program directors were invited to participate. Participants were asked demographic questions related to their fellowship programs, currently utilized teaching methods, perceptions regarding adequacy and effectiveness of current nutrition education, and levels of fellow independence, comfort, confidence, and expectations in caring for the nutritional needs of patients. Surveys were sent to randomly selected program directors and fellows enrolled in pediatric critical care medicine fellowship programs in America and Canada. Twenty program directors (80%) and 60 fellows (86%) responded. Ninety-five percent of programs (19/20) delivered a formal nutrition curriculum; no curriculum was longer than 5 hours per academic year. Self-reported fellow comfort with nutrition topics did not improve over the course of fellowship (p = 0.03), with the exception of nutritional aspects of special diets. Sixty-five percent of programs did not hold fellows responsible for writing daily parenteral nutrition prescriptions. There was an inverse relationship between total number of fellows in a pediatric critical care medicine program and levels of comfort in ability to provide parenteral nutrition support (p = 0.01). Program directors perceived their nutritional curriculum to be more effective than did their fellows (p ≤ 0.001). Nutrition education was reported as highly underrepresented in pediatric critical care medicine fellowship curricula. The majority of programs rely on allied health care professionals to prescribe parenteral nutrition, which may influence trainee independence in the provision of nutritional therapies. Improving the format of current nutrition curriculums, by relying on more active teaching methods, may improve the delivery and efficacy of nutrition education. The impact of novel training interventions on improving the competency and safety of enteral and parenteral nutrition delivery in the PICU must be further examined.

Factors Used by Program Directors in the Orthopedic Sports Medicine Fellowship Match

Background: Obtaining an orthopedic sports medicine fellowship position is becoming more difficult, as the number of residents seeking post-graduate training continues to increase. Objective: To identify factors that orthopedic surgery sports medicine fellowship program directors deem valuable in selecting applicants. Methods: A web-based questionnaire was sent to all ACGME accredited sports medicine fellowship program directors in the United States in 2016. The questionnaire was designed to identify the most important criteria in selecting applicants for an interview, and ranking candidates to match into their program. Results: Thirty-five of ninety-one program directors responded. The criteria for offering an applicant an interview were quality of recommendation letter, technical competence, and residency program reputation. Letters of recommendation that held the highest value were from the chief of sports medicine and another sports medicine surgeon in the department. The most important features of the interview were the applicant’s ability to articulate thoughts, the maturity of the applicant, and the ability of the applicant to listen well. The attributes deemed most important in high ranking a candidate included the applicant’s commitment to hard work, quality of the interview, and quality of letters of recommendation. Conclusion: There are identifiable factors considered important by sports medicine fellowship directors when selecting candidates for an interview and ranking them in the match process. With increasing costs of the application process and competition among applicants, this information can be valuable to medical students and residents considering a career in orthopedic sports medicine.

Do Pain Medicine Fellowships Provide Adequate Education in Head and Facial Pain? A Survey of Pain Medicine Fellowship Program Directors

Background: Fellows with insufficient education in head and facial pain may feel ill equipped to treat patients suffering from these disabling disorders. We hypothesized that there is variation in the scope and extent of headache and facial pain education that pain fellows receive during their pain fellowship. Study Design: A survey Setting: Accreditation Council for Graduate Medical Education (ACGME) Accredited pain medicine fellowship programs. Methods: After an exemption was obtained from the University of Virginia Institutional Review Board (IRB), an email with a link to the survey was sent to members of the Association of Pain Program Directors (APPD). The survey was also distributed to Association of Pain Program Director members at the annual 2019 APPD meetings during the Annual Society of Associations of Academic Anesthesiologists and Perioperative Medicine (SAAAPM) and the American Society of Regional Anesthesia and Pain Medicine (ASRA) meetings. The survey contained 16 questions. (questions are shown in Appendix 1). Results: Forty-seven of 108 program directors responded to the survey. Some program directors did not respond to every question. Limitations: The response rate is a limitation, but it is comparable to similar studies. Conclusions: The majority of pain fellows receive some education in head and facial pain. However; there were variations among fellowship programs in the extent and scope of education provided. Recognizing these gaps and variations in education, may lead to a better understanding of how to enhance and provide head and facial pain education during pain fellowship.

Sleep telemedicine training in fellowship programs: a survey of program directors.

Telemedicine is a novel modality of health care delivery that can improve patients' access to sleep medicine services, but little is known about telemedicine training during sleep medicine fellowship. We studied telemedicine training prevalence, use, and attitudes of program directors (PDs) and other faculty members, PDs' receptiveness to a standardized telemedicine curriculum, and whether PDs have reviewed existing American Academy of Sleep Medicine (AASM) sleep telemedicine reference materials. This was an anonymous online survey of all 86 PDs of accredited sleep medicine fellowships in the United States. Response rate was 45%. Thirteen (33.3%) of the PDs already offer telemedicine experience to their trainees, although none use a standard telemedicine curriculum. Among the 26 (66.7%) PDs not offering telemedicine experience, 38.5% plan to do so and 53.9% agree that it would benefit fellows. Most PDs (57.9%) report faculty using telemedicine now or within the next 3 years. Many PDs agree that telemedicine is technically feasible, but relatively few agree it is financially feasible (82.1% and 38%, respectively). Few PDs have reviewed both primary AASM telemedicine reference materials. Overall, 64.1% of PDs agree that a national sleep telemedicine curriculum could be useful. Although only a minority of current sleep medicine fellows are exposed to telemedicine, it is likely that most will get some exposure in the next 3 years. PDs' attitudes toward telemedicine vary significantly with respect to feasibility and importance to their programs. Nevertheless, most PDs believe a standardized sleep telemedicine training curriculum could be useful.

Procedural Training and Assessment for Pediatric Emergency Medicine Physicians Within the United States and Canada: A Survey Study.

The aims of this study were to determine current practices in procedural training and skill assessment for attending physicians working in pediatric emergency departments within the United States and Canada and identify barriers to providing training and assessment. This was a cross-sectional survey study. Members of the pediatric emergency medicine fellowship program directors and associate program directors Listserv were invited to participate in an anonymous survey about attending physician training and assessment practices for 9 specific procedures and barriers to training and assessment. Eighty-two (56.2%) of 146 recipients responded, with 79 surveys fully completed; 58.5% of responders report that their division offers procedural training, whereas 14.6% report assessment of procedural skills. The most common procedure for which participants report training and assessment is orotracheal intubation (53.1% and 7.5%, respectively), with training rates for other procedures ranging from 2.5% to 43.0%. Most sites that report training use simulation in some form for education. For assessment, simulation is used almost exclusively. Cost (50.6%), lack of faculty interest (36.7%), and lack of standardized guidelines (36.7%) are the most common barriers to training. Lack of standardized guidelines (51.9%), cost (43.0%), and lack of faculty interest (38.0%) are the most common barriers for assessment. Although pediatric emergency medicine physicians may be required to perform emergent procedures, opportunities to receive training and assessment in these procedures are limited. Simulation and other educational modalities are being used to provide skill training and assessment, but cost and lack of resources, standardized protocols, and faculty interest are barriers to the implementation of training and assessment programs.

Establishing the Knowledge and Skills Necessary in Pediatric Critical Care Medicine: A Systematic Approach to Practice Analysis.

To describe the practice analysis undertaken by a task force convened by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to create a comprehensive document to guide learning and assessment within Pediatric Critical Care Medicine. An in-depth practice analysis with a mixed-methods design involving a descriptive review of practice, a modified Delphi process, and a survey. Not applicable. Seventy-five Pediatric Critical Care Medicine program directors and 2,535 American Board of Pediatrics Pediatric Critical Care Medicine diplomates. A practice analysis document, which identifies the full breadth of knowledge and skill required for the practice of Pediatric Critical Care Medicine, was developed by a task force made up of seven pediatric intensivists and a psychometrician. The document was circulated to all 75 Pediatric Critical Care Medicine fellowship program directors for review and comment and their feedback informed modifications to the draft document. Concurrently, data from creation of the practice analysis draft document were also used to update the Pediatric Critical Care Medicine, was developed by a task force made up of seven pediatric intensivists and a psychometrician. The document was circulated to all 75 Pediatrics Pediatric Critical Care Medicine fellowship program directors for review and comment and their feedback informed modifications to the draft document. Concurrently, data from creation of the practice analysis draft document were also used to update the Pediatric Critical Care Medicine content outline, which was sent to all 2,535 American Board of Pediatrics Pediatric Critical Care Medicine diplomates for review during an open-comment period between January 2019 and February 2019, and diplomate feedback was used to make updates to both the content outline and the practice analysis document. After review and comment by 25 Pediatric Critical Care Medicine program directors (33.3%) and 619 board-certified diplomates (24.4%), a comprehensive practice analysis document was created through a two-stage process. The final practice analysis includes 10 performance domains which parallel previously published Entrustable Professional Activities in Pediatric Critical Care Medicine. These performance domains are made up of between three and eight specific tasks, with each task including the critical knowledge and skills that are necessary for successful completion. The final practice analysis document was also used by the American Board of Pediatrics Pediatric Critical Care Medicine Sub-board to update the Pediatric Critical Care Medicine content outline. A systematic approach to practice analysis, with stakeholder engagement, is essential for an accurate definition of Pediatric Critical Care Medicine practice in its totality. This collaborative process resulted in a dynamic document useful in guiding curriculum development for training programs, maintenance of certification, and lifetime professional development to enable safe and efficient patient care.

A Needs Assessment of Brain Death Education in Pediatric Critical Care Medicine Fellowships.

To assess the current training in brain death examination provided during pediatric critical care medicine fellowship. Internet-based survey. United States pediatric critical care medicine fellowship programs. Sixty-four pediatric critical care medicine fellowship program directors and 230 current pediatric critical care medicine fellows/recent graduates were invited to participate. Participants were asked demographic questions related to their fellowship programs, training currently provided at their fellowship programs, previous experience with brain death examinations (fellows/graduates), and perceptions regarding the adequacy of current training. Twenty-nine program directors (45%) and 91 current fellows/graduates (40%) responded. Third-year fellows reported having performed a median of five examinations (interquartile range, 3-6). On a five-point Likert scale, 93% of program directors responded they "agree" or "strongly agree" that their fellows receive enough instruction on performing brain death examinations compared with 67% of fellows and graduates (p = 0.007). The responses were similar when asked about opportunity to practice brain death examinations (90% vs 54%; p < 0.001). In a regression tree analysis, number of brain death examinations performed was the strongest predictor of trainee satisfaction. Both fellows and program directors preferred bedside demonstration or simulation as educational modalities to add to the fellowship curriculum. Pediatric critical care medicine fellows overall perform relatively few brain death examinations during their training. Pediatric critical care medicine fellows and program directors disagree in their perceptions of the current training in brain death examination, with fellows perceiving a need for increased training. Both program directors and fellows prefer additional training using bedside demonstration or simulation. Since clinical exposure to brain death examinations is variable, adding simulated brain death examinations to the pediatric critical care medicine fellowship curriculum could help standardize the experience.

Orthopaedic Sports Medicine Fellowship Interviews: Structure and Organization of the Interview Day.

Background:Over the past few decades, there has been a trend toward an increasing subspecialization in orthopaedic surgery, with orthopaedic sports medicine being one of the most competitive subspecialties. Information regarding the application and interview process for sports medicine fellowships is currently lacking.Purpose:To survey orthopaedic sports medicine fellowship program directors (PDs) to better define the structure of the sports medicine fellowship interview and to highlight important factors that PDs consider in selecting fellows.Study Design:Cross-sectional study.Methods:A complete list of accredited programs was obtained from the American Orthopaedic Society for Sports Medicine (AOSSM) website. An anonymous survey was distributed to fellowship PDs of all Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic sports medicine fellowships in the United States. The survey included 12 questions about the fellowship interview and selection process.Results:Of the 95 orthopaedic sports medicine fellowship PDs surveyed, 38 (40%) responded. Of these, 16 (42.1%) indicated that they interview between 21 and 30 applicants per year. Eleven of the 38 fellowship programs (28.9%) have only 1 fellow per year at their respective program. Most programs (27/37, 73%) reported that between 0 and 5 faculty members interview applicants, and 29 of the 38 programs (76.3%) arrange for applicants to have ≥4 interviews during their interview day. Large group interviews are conducted at 36 of 38 (94.7%) sports medicine fellowship programs, and most programs (24/38, 63.2%) hold individual interviews that last between 5 and 15 minutes. The most important applicant criterion taken into account by PDs was the quality of the interview, with an average score of 8.68 of 10.Conclusion:The most significant factor taken into account by PDs when deciding how to rank applicants was the quality of the interview. Many orthopaedic sports medicine fellowship programs interview between 21 and 30 applicants per year, with each applicant participating in an average of 2 to 4 individual interviews per interview day and interviews commonly lasting between 5 and 15 minutes.

Determining the Most Important Factors Involved in Ranking Orthopaedic Sports Medicine Fellowship Applicants.

Background:Orthopaedic surgery residencies and certain fellowships are becoming increasingly competitive. Several studies have identified important factors to be taken into account when selecting medical students for residency interviews. Similar information for selecting orthopaedic sports medicine fellows does not exist.Purpose:To determine the most important factors that orthopaedic sports medicine fellowship program directors (PDs) take into account when ranking applicants.Study Design:Cross-sectional study.Methods:A brief survey was distributed electronically to PDs of the 92 orthopaedic sports medicine fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). Each PD was asked to rank, in order, the 5 most important factors taken into account when ranking applicants based on a total list of 13 factors: the interview, the applicant’s residency program, letters of recommendation (LORs), personal connections made through the applicant, research experience, an applicant’s geographical ties to the city/town of the fellowship program, United States Medical Licensing Examination (USMLE) scores, Orthopaedic In-Training Examination (OITE) scores, history of being a competitive athlete in college, extracurricular activities/hobbies, volunteer experience, interest in a career in academics, and publications/research/posters. Factors were scored from 1 to 5, with a score of 5 representing the most important factor and 1 representing the fifth-most important factor.Results:Of the 92 PDs contacted, 57 (62%) responded. Thirty-four PDs (37%) listed the interview as the most important factor in ranking fellowship applicants (overall score, 233). LORs (overall score, 196), an applicant’s residency program (overall score, 133), publications/research/posters (overall score, 115), and personal connections (overall score, 90) were reported as the second- through fifth-most important factors, respectively.Conclusion:According to orthopaedic sports medicine fellowship PDs, the fellowship interview is the most important factor in determining how an applicant will be ranked. Other factors, including LORs, the applicant’s residency program, research production, and personal connections, were also considered to be important. This information provides orthopaedic sports medicine fellowship applicants with a better understanding of which areas to focus on when preparing for the fellowship interview and matching process.