Number Of Fellowship Programs Research Articles

MP25-19 TIME TREND ANALYSIS OF THE SOCIETY OF GENITOURINARY RECONSTRUCTIVE SURGEONS (GURS) FELLOWSHIP CASE LOGS: GROWTH IN TRAINING MAY REFLECT EVOLUTION OF THE DISCIPLINE

You have accessJournal of UrologyCME1 Apr 2023MP25-19 TIME TREND ANALYSIS OF THE SOCIETY OF GENITOURINARY RECONSTRUCTIVE SURGEONS (GURS) FELLOWSHIP CASE LOGS: GROWTH IN TRAINING MAY REFLECT EVOLUTION OF THE DISCIPLINE Ignacio Calvo, Jill C. Buckley, Pankaj Joshi, Drew Peterson, Hadley Wood, and Keith Rourke Ignacio CalvoIgnacio Calvo More articles by this author , Jill C. BuckleyJill C. Buckley More articles by this author , Pankaj JoshiPankaj Joshi More articles by this author , Drew PetersonDrew Peterson More articles by this author , Hadley WoodHadley Wood More articles by this author , and Keith RourkeKeith Rourke More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003253.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Society of Genitourinary Reconstructive Surgeons (GURS) began a formal fellowship match over a decade ago, growing from 14 to 23 programs over this time period. With the growth in the number of fellowship programs, some have voiced concern about possible dilution of operative experiences for fellows. The objective of this study is to examine trends in GURS fellowship case logs over time to determine if fellowship operative experienced has changed. METHODS: Year-end surgical case logs submitted by GURS fellows from 2014-2022 were collated, analyzed and grouped into 6 categories:(1) Urethral reconstruction, (2) Male incontinence, (3) Male Sexual Health, (4) Genital reconstruction, (5) Abdominal reconstruction and (6) Female urology. Programs with more than 3 years of records were included and analyzed for time trends. Centers with more than one fellow per year were averaged. Lineal regression was used to evaluate for significant change over time. RESULTS: Overall, 152 case logs from 25 different programs were reviewed. On linear regression, urethral reconstruction volumes demonstrated significant increase over time (R2=0.036, B=3.2, p=0.02) with a mean volume per program of 88.1 cases/year. On individual center-based analysis, 89.9% of programs remained stable while 11.1% showed a significant increase in urethroplasty. Genital reconstruction also demonstrated a significant increase (R2=0.095, B=2.3, p<0.01) with a mean of 16.4 cases/year and 33.3% of the centers showing significant growth while the rest remained stable. Abdominal reconstruction also showed an increase over time (R2=0.023, B=1.2, p=0.03) with a mean of 24.5 cases/year and 16.7% demonstrating a significant increase while the rest remained stable. Male incontinence cases remained stable (R2=0.01, B=1.02, p=0.21) at a mean number of 30.5 cases/year with 83.3% of centers remaining stable, 5.6% increasing and 11.1% decreasing. Male sexual health showed a significant increase (R2=0.03, B=2.4, p=0.03) at a mean of 32.7 cases/year with 66.7% of the centers showing no significant change, 5.6% a decline and 27.8% having growth. Female urologic reconstruction demonstrated a significant decline (R2=0.04, B=-3.08, p=0.01) with a mean of 23.2 cases/year. CONCLUSIONS: Despite an increase in the number of fellowship programs, the GURS fellow operative experience remains preserved with significant increases in urethral, genital and abdominal reconstruction over the match period. Possible explanations include: growth in reconstructive urology as a discipline, consolidation of cases to academic centers, and expansion of service lines offered by GURS surgeons (e.g., gender affirming surgery, adult congenital care). Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e350 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ignacio Calvo More articles by this author Jill C. Buckley More articles by this author Pankaj Joshi More articles by this author Drew Peterson More articles by this author Hadley Wood More articles by this author Keith Rourke More articles by this author Expand All Advertisement PDF downloadLoading ...

A Qualitative Study of Independent Home Visits by Hospice Fellows: Addressing Gaps in ACGME Milestones by Fostering Reflection and Self-Assessment.

With the rapid growth in the number of fellowship programs in Hospice and Palliative Medicine (HPM), many are in the process of developing ways to demonstrate that fellows are attaining educational milestones. Reflection and self-assessment are key components of 2 Accreditation Council for Graduate Medical Education (ACGME) competencies, practice-based learning and improvement, and systems-based practice, which have both been historically challenging to learn and assess. This article describes results of a content analysis of narrative data collected from HPM fellows' self-assessments as they performed hospice home visits independently in a new clinical rotation. This was a prospective qualitative study. Eight fellows completed 217 unsupervised hospice home visits from 2014 to 2016. Fellows completed weekly self-assessment forms, which captured both clinical visit information and practice data elicited from responses to open-ended reflection prompts. Analysis of 29 self-assessment forms generated 6 themes: patient- and family-centered care, self-efficacy, systems-based care, commitment to doing their best, catalyst for professional growth, and purpose and meaning in work. The fellows recognized numerous barriers distinct to providing care in homes. All fellows felt prepared to perform home visits throughout the rotation and after training. Narrative data collected during the independent home visit rotation provided evidence that HPM fellows detected gaps in their performance, planned for practice improvements in subsequent visits, and valued working within an interprofessional team. Built-in opportunities for fellows to reflect during training are critical in meeting ACGME milestones, and are integral to their professional development.

PC094 Increasing the Number of Integrated Vascular Surgery Residency Positions Is Necessary to Address the Impending Shortage of Vascular Surgeons in the United States

The demand for vascular surgeons in the next two decades is expected to far exceed the current supply. While the number of fellowship programs is stable, the numbers of vascular residency programs and positions have expanded dramatically. We sought to evaluate the qualifications and characteristics of this new workforce in terms of its ability to meet the future needs. We conducted a retrospective review of national data compiled by the Association of American Medical Colleges (AAMC) and the National Resident Matching Program (NRMP) regarding integrated vascular residency programs (2008-2015) and fellowships (2007-2016). Variables included the number of applicants, sex, United States vs foreign medical school enrollment, applications per program, and applicants per position. Additionally, we conducted a retrospective review of applicants to the University of Massachusetts Medical School integrated vascular residency program from 2008 to 2015 to examine the aforementioned variables and United States Medical Licensing Examination Step 1 and Step 2CK scores over time. The number of integrated vascular residency positions increased from four in 2008 to 56 in 2015. Concurrently, the number of integrated vascular residency applicants grew from 112 in 2008 to 434 in 2015 (Fig 1). This increase has been predominately driven by a 575% increase in U.S. graduate applicants and a 170% increase in women applicants. The percentage of foreign medical graduates has decreased by 17% over the study period. The total number of applicants per residency position increased from 5.9 to 7.8. Meanwhile, the number of vascular surgery fellowship positions remained stable with an applicant-to-position ratio near 1:1 (Fig 2). At the University of Massachusetts Medical School, the mean United States Medical Licensing Examination Step 1 and Step 2CK scores among integrated residency applicants have improved annually, and consistently exceed the national average among U.S. applicants who have matched in their preferred specialty. Since the approval of a primary certificate in vascular surgery in 2005 and the subsequent rollout of integrated vascular residency programs in 2007, the number of residency programs and the quality of residency applicants has continued to increase. Demand from highly qualified medical school applicants vastly outweighs the current supply of training positions by eightfold. In contrast, demand from fellowship applicants matches the supply of fellowship positions. With a growing public health need for more vascular surgeons, these results suggest that additional residency positions would easily be filled with talented young surgeons.Fig 2Supply and demand for traditional vascular surgery fellowships (2007-2016).View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The evolution and geographic distribution of headache medicine fellowship programs and graduates: an observational study.

We sought to assess the experiences, growth, and distribution of accredited headache medicine fellowships since accreditation began in 2007, and to examine the number and current practice locations of fellows graduated from those programs. There are no data on the distribution of headache fellowship programs and their graduates throughout the United States. We surveyed directors of Headache Medicine fellowship programs accredited by the United Council of Neurologic Subspecialties as of April 1, 2014. We recorded the geographic locations of accredited programs and fellowship graduates and determined their distribution in relation to the overall and selected minority populations of US census divisions, regions, and states. In early 2014, there were 25 accredited Headache Medicine fellowship programs in the United States. Thirty-two (63%) US states lack a headache fellowship program and 24 (47%) do not have a practicing United Council for Neurologic Subspecialties fellowship graduate. Fifty-two of 96 fellows (54%) entered practice in the same state where they did their training. The northeastern United States has the best ratio of fellowship programs and graduates to population (0.28 and 0.35 per million inhabitants) and land area (6.38 and 8 per 100,000 square miles). The Pacific Northwest has the worst (0.05 and 0.02 fellowship programs and graduates per million inhabitants and 2.3 and 1.1 per 100,000 square miles). Fifty-five percent of the US Hispanic population lives in areas of the country with only 32% of practicing certified headache specialists, 28% of accredited fellowship programs, and which have attracted only 27% of fellowship graduates. Thirty-three percent of the US black population lives in areas with just 8% of fellowship programs and 27% of fellowship graduates. Fellowship directors report that funding for fellowship positions is an important challenge. The number of fellowship programs has increased dramatically since 2007, but their geographic distribution is uneven and so are the subsequent practice locations of fellow graduates. At present, the distribution of training programs and headache specialists is not well matched to the US population as a whole or to the location of important racial and ethnic minorities. Increasing the overall supply of headache specialists is important, but geographic inequalities in specialist distribution must also be addressed or disparities will increase.

ACGME Accreditation of Orthopaedic Surgery Subspecialty Fellowship Training Programs.

Orthopaedic surgery training in the United States consists of a five-year-minimum orthopaedic surgery residency program, followed by optional subspecialty fellowship training. There is an increasing trend for trainees to complete at least one fellowship program following residency training, with approximately 90% of current trainees planning to complete a fellowship. The purpose of this investigation was to assess the overall variability of orthopaedic subspecialty fellowships in terms of characteristics, match process, and the tendency to be accredited by the Accreditation Council for Graduate Medical Education. Nine orthopaedic surgery subspecialties were assessed for their fellowship match program, their number of fellowship programs and positions in the match, and the number of programs and positions accredited by the Accreditation Council for Graduate Medical Education. Programs with a Subspecialty Certificate offered by the American Board of Orthopaedic Surgery were compared with programs without a Subspecialty Certificate. Comparative statistics utilizing an unpaired t test with a statistical cutoff of p < 0.05 were performed. Three separate matching programs are used by the nine subspecialties. Hand surgery utilizes the National Residents Matching Program, shoulder and elbow surgery utilizes the American Shoulder and Elbow Surgeons Fellowship Match, and the other seven subspecialties utilize the San Francisco Matching Program. In total, 478 fellowship programs were identified, representing 897 fellowship positions. The highest percentage of fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education was in orthopaedic sports medicine (93.1%), compared with the lowest percentage in foot and ankle orthopaedics (16.3%). A significantly higher percentage (p < 0.05) of fellowship programs accredited by the Accreditation Council for Graduate Medical Education were found for subspecialties with American Board of Orthopaedic Surgery Subspecialty Certificates (hand and sports) (87.9%) compared with subspecialties without Subspecialty Certificates (34.3%). There are more orthopaedic subspecialty fellowship positions available annually than there are graduating orthopaedic surgery residents. Three independent matching programs are currently being used by the nine orthopaedic subspecialties. Subspecialties vary in the proportion of programs with Accreditation Council for Graduate Medical Education accreditation. Subspecialties with American Board of Orthopaedic Surgery Subspecialty Certificates have a significantly greater proportion of fellowship programs accredited by the Accreditation Council for Graduate Medical Education compared with those without Subspecialty Certificates. Orthopaedic subspecialty fellowship programs are rapidly becoming a perceived necessity as part of orthopaedic surgery training. Fellowships continue to vary in matching system and their accreditation characteristics.

Development of an EMS Curriculum

Emergency medical services (EMS) became an American Board of Medical Specialties (ABMS) approved subspecialty of emergency medicine in September 2010. Achieving specialty or subspecialty recognition in an area of medical practice requires a unique body of knowledge, a scientific basis for the practice, a significant number of physicians who dedicate a portion of their practice to the area, and a sufficient number of fellowship programs. To prepare EMS fellows for successful completion of fellowship training, a lifetime of subspecialty practice, and certification examination, a formalized structured fellowship curriculum is necessary. A functional curriculum is one that takes the entire body of knowledge necessary to appropriately practice in the identified area and codifies it into a training blueprint to ensure that all of the items are covered over the prescribed training period. A curriculum can be as detailed as desired but typically all major headings and subheadings of the core content are identified and addressed. Common curricular components, specific to each area of the core content, include goals and objectives, implementation methods, evaluation, and outcomes assessment methods. Implementation methods can include simulation, observations, didactics, and experiential elements. Evaluation and outcomes assessment methods can include direct observation of patient assessment and treatment skills, structured patient simulations, 360° feedback, written and oral testing, and retrospective chart reviews. This paper describes a curriculum that is congruent with the current EMS core content, as well as providing a 12-month format to deploy the curriculum in an EMS fellowship program. Key words: curriculum; education; emergency medical services; fellowships and scholarships

National Survey of Geriatric Psychiatry Fellowship Programs: Comparing Findings in 2006/07 and 2001/02 From the American Geriatrics Society and Association of Directors of Geriatric Academic Programs' Geriatrics Workforce Policy Studies Center

: To document the development of geriatric psychiatry (GP) fellowship training in the United States through 2008. : A cross-sectional survey of the 56 U.S. GP fellowship programs was conducted in summer 2007. Longitudinal data from the American Medical Association and the Association of American Medical Colleges' National Graduate Medical Education Census and data from the Accreditation Council for Graduate Medical Education were also analyzed. : Thirty-seven (66%) of 56 program directors responded. The number of fellowship programs has decreased over the past 7 years. During 2006/07, 72 fellows were in training, as compared with 94 fellows in 2001/02. Application rates declined significantly with a mean of 4.3 applications per program in 2006/07 as compared with the mean of 10 applications per program in 2001/02. The fill rate for first-year GP fellowship positions dropped from 61% in 2001/02 to 48% in 2006/07. During 2006/07, 67% of programs reported having two or fewer first-year fellows and 16% had no first-year fellows. Seventeen programs reported having no United States medical school graduates as first-year fellows. : The number of GP fellows in training has declined by 23% from 2001/02 to 2006/07. This decline has occurred at the same time when the number of older adults continues to expand rapidly. It is critical that an adequate number of geriatric psychiatrists be trained to support and educate general psychiatrists in the care of the elderly. Specific strategies need to be developed urgently to stimulate interest in careers in clinical and academic GP.

Recent Trends in American Board of Psychiatry and Neurology Psychiatric Subspecialties

this article reviews the current status and recent trends in the American Board of Psychiatry and Neurology (ABPN) psychiatric subspecialties and discusses the implications of those trends as well as several key questions whose answers may well determine subspecialty viability. data are presented on specialty and subspecialty programs; graduates; and ABPN certification candidates and diplomates drawn from several sources, including the records of the ABPN, the websites of the Accreditation Council for Graduate Medical Education and the American Medical Association, and the annual medical education issues of JAMA. fewer than half of psychiatry graduates pursue subspecialty training. While most recent specialty graduates attempt to become certified by the ABPN, many subspecialists elect not to do so. There have been recent decreases in the number of fellowship programs and trainees in geriatric psychiatry and addiction psychiatry. The pass rates for fellowship graduates are superior to those for the "grandfathers" in all of the newer psychiatric subspecialties. Lower percentages of subspecialists than specialists participate in maintenance of certification, and maintenance of certification pass rates are high. the initial interest in training and certification in some of the ABPN subspecialties appears to have slowed, and the long-term viability of those subspecialties may well depend on the answers to a number of complicated social, economic, and political questions in the new health care era.

Geriatrics in Brazil: A Big Country with Big Opportunities

Brazil has approximately 180 million inhabitants, of whom 15.2 million are aged 60 and older and 1.9 million are aged 80 and older. By 2025, the Brazilian elderly population is expected to grow to more than 32 million. Brazil has many problems related to its geographic and population size. Great distances between major cities, marked cultural and racial heterogeneity between the various geographic regions, high poverty levels, and decreasing family size all combine to put pressure on the medical and social services that can be made available to the elder population. Less than 500 Brazilian physicians are certified as geriatricians, translating into one geriatrician for every 37,000 elderly Brazilians. Beside 15 geriatric medicine residencies a larger number of fellowship programs exist, and these programs are in high demand, with more than 20 candidates per position, indicating new opportunities for growth in elder care. In addition, geriatric initiatives such as the annual elder vaccination program and the elder statute, recently approved by the Brazilian Congress, indicate that geriatric care in Brazil is entering a new era of growth and development. Although the challenges remain great, there are opportunities for Brazilian geriatrics and gerontology.

Physician Recruitment into Geriatrics—Further Insight into the Black Box

Physician Recruitment into Geriatrics—Further Insight into the Black Box

Geriatric medicine fellowship programs: a national study from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice in Geriatric Medicine.

This report documents the development and growth of geriatric medicine fellowship training in the United States through 2002. A cross-sectional survey of geriatric medicine fellowship programs was conducted in the fall 2001. All allopathic (119) and osteopathic (7) accredited geriatric medicine fellowship-training programs in the United States were involved. Data were collected using self-administered mailed and Web-based survey instruments. Longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, the Accreditation Council for Graduate Medical Education (ACGME), and the American Osteopathic Association (AOA) were also analyzed. The survey instrument was designed to gather data about faculty, fellows, program curricula, and program directors (PDs). In addition, annual AMA/AAMC data from 1991 to the present was compiled to examine trends in the number of fellowship programs and the number of fellows. The overall survey response rate was 76% (96 of 126 PDs). Most (54%) of the PDs had been in their current position 4 or more years (range: <1-20 years), and 59% of PDs reported that they had completed formal geriatric medicine fellowship training. The number of fellowship programs and the number of fellows entering programs has slowly increased over the past decade. During 2001-02, 338 fellows were training in allopathic programs and seven in osteopathic programs (all years of training). Forty-six percent (n = 44) of responding programs offered only 1-year fellowship-training experiences. PDs reported that application rates for fellowship positions were stable during the academic years (AYs) 1999-2002, with the median number of applications per first year position available in AY 2000-01 being 10 (range: 1-77). In 2001-02, data from the AMA/AAMC National GME Census indicated a fill rate for first-year geriatric medicine fellowship positions of 69% (259 first-year fellows for 373 positions). During 2001-02, more than half of programs (53%) reported having two or fewer first-year fellows, whereas 31% had three or four first-year fellows. Thirty-three programs (36%) reported having no U.S. medical school graduate first-year fellows, and another 25 (28%) reported having only one. Of the 51 programs offering second-year fellowship training, PDs reported 61 post-first-year fellows (median 1, range: 0-7). During the past 10 years, 27 new allopathic geriatric medicine fellowship programs opened; there are now 119 programs. There are also seven osteopathic programs. The recruitment of high-quality U.S. medical school graduates into these programs remains a challenge for the discipline. Furthermore, the retention of first-year fellows for additional years of academic training has been difficult. Incentives will be needed to attract the best graduates of U.S. family practice and internal medicine training programs into academic careers in geriatric medicine.

Geriatric Psychiatry Fellowship Programs in the United States: Findings from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice

Objective The authors document the development and growth of geriatric psychiatry fellowship training in the United States (U.S.) through 2002. Methods A cross-sectional survey of the 62 U.S. geriatric psychiatry fellowship programs was conducted in Fall 2001. They also analyzed longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, along with data from the Accreditation Council for Graduate Medical Education (ACGME). Results Forty-six (74%) of 62 training directors (TDs) responded. The number of fellowship programs has slowly increased over the past 7 years. During 2001–2002, a total of 94 fellows were in training (all years of training). Seventy-eight percent (N=36) of responding programs offered only 1-year fellowship training experiences. TDs reported that application rates for fellowship positions were stable during the academic years 1999–2002, with a median number of eight applications per program for first-year positions in 2001–2002. The fill-rate for first-year geriatric psychiatry fellowship positions dropped from 84% in 1999–2000 to 61% in 2001–2002. During 2001–2002, 73% of programs reported having two or fewer first-year fellows, and 16% had no first-year fellows. Seventeen programs reported having no U.S. medical school graduates (USMGs) as first-year fellows. Conclusion Recruiting high-quality USMGs into geriatric psychiatry fellowship programs remains a challenge. Furthermore, retaining first-year fellows for additional years of academic training has been difficult. Findings indicate that specific strategies need to be developed to stimulate undergraduate and graduate interest in careers in clinical and academic geriatric psychiatry. The authors document the development and growth of geriatric psychiatry fellowship training in the United States (U.S.) through 2002. A cross-sectional survey of the 62 U.S. geriatric psychiatry fellowship programs was conducted in Fall 2001. They also analyzed longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, along with data from the Accreditation Council for Graduate Medical Education (ACGME). Forty-six (74%) of 62 training directors (TDs) responded. The number of fellowship programs has slowly increased over the past 7 years. During 2001–2002, a total of 94 fellows were in training (all years of training). Seventy-eight percent (N=36) of responding programs offered only 1-year fellowship training experiences. TDs reported that application rates for fellowship positions were stable during the academic years 1999–2002, with a median number of eight applications per program for first-year positions in 2001–2002. The fill-rate for first-year geriatric psychiatry fellowship positions dropped from 84% in 1999–2000 to 61% in 2001–2002. During 2001–2002, 73% of programs reported having two or fewer first-year fellows, and 16% had no first-year fellows. Seventeen programs reported having no U.S. medical school graduates (USMGs) as first-year fellows. Recruiting high-quality USMGs into geriatric psychiatry fellowship programs remains a challenge. Furthermore, retaining first-year fellows for additional years of academic training has been difficult. Findings indicate that specific strategies need to be developed to stimulate undergraduate and graduate interest in careers in clinical and academic geriatric psychiatry.

Geriatric Psychiatry Fellowship Programs in the United States: Findings from the Association of Directors of Geriatric Academic Programs' Longitudinal Study of Training and Practice

The authors document the development and growth of geriatric psychiatry fellowship training in the United States (U.S.) through 2002. A cross-sectional survey of the 62 U.S. geriatric psychiatry fellowship programs was conducted in Fall 2001. They also analyzed longitudinal data from the American Medical Association (AMA) and the Association of American Medical Colleges' (AAMC) National Graduate Medical Education (GME) Census, along with data from the Accreditation Council for Graduate Medical Education (ACGME). Forty-six (74%) of 62 training directors (TDs) responded. The number of fellowship programs has slowly increased over the past 7 years. During 2001-2002, a total of 94 fellows were in training (all years of training). Seventy-eight percent (N=36) of responding programs offered only 1-year fellowship training experiences. TDs reported that application rates for fellowship positions were stable during the academic years 1999-2002, with a median number of eight applications per program for first-year positions in 2001-2002. The fill-rate for first-year geriatric psychiatry fellowship positions dropped from 84% in 1999-2000 to 61% in 2001-2002. During 2001-2002, 73% of programs reported having two or fewer first-year fellows, and 16% had no first-year fellows. Seventeen programs reported having no U.S. medical school graduates (USMGs) as first-year fellows. Recruiting high-quality USMGs into geriatric psychiatry fellowship programs remains a challenge. Furthermore, retaining first-year fellows for additional years of academic training has been difficult. Findings indicate that specific strategies need to be developed to stimulate undergraduate and graduate interest in careers in clinical and academic geriatric psychiatry.

A study of geriatric training programs in the United States.

Training physicians in geriatrics is essential to improving health care for the elderly. The study reported here provides a detailed analysis of geriatric education at the undergraduate, graduate, and fellowship levels. The number of programs for medical students and residents has increased but is still relatively few; most are elective, and they are of variable quality. Both the number of fellowship programs (36) and positions (87) and the current number of yearly graduates (40) are quite small. Few of these programs have been thoroughly evaluated. Data are presented on the type of training sites, educational activities, and clinical interaction at different levels of training. Overall, the nursing home is most frequently used as a training site, and trainees have contact with many care providers. Information of this kind may be of value to those planning or conducting geriatric programs. The results suggest that there is a persistent need for high quality programs at all levels of educational continuum and that such efforts should be evaluated to ensure and improve quality.