Pain Medicine Fellowship Programs Research Articles

The current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors.

The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences. This study aims to gather insight from pain medicine fellowship program directors across the country to assess clinical and interventional training, providing valuable perspectives on the future of pain medicine education. This study involved 56 PDs of ACGME-accredited pain fellowship programs in the United States. The recruitment process included three phases: advanced notification, invitation, and follow-up to maximize response rate. Participants completed a standard online questionnaire, covering various topics such as subcategory fields, online platforms for supplemental education, clinical experience, postgraduate practice success, and training adequacy. Surveys were completed by 39/56 (69%) standing members of the Association of Pain Program Directors (APPD). All PDs allowed fellows to participate in industry-related and professional society-related procedural workshops, with 59% encouraging these workshops. PDs emphasized the importance of integrity, professionalism, and diligence for long-term success. Fifty-four percent of PDs expressed the need for extension of fellowship training to avoid supplemental education by industry or pain/spine societies. This study highlights the challenge of providing adequate training in all Pain Medicine subtopics within a 12-month pain medicine fellowship. PDs suggest the need for additional training for fellows and discuss the importance of curriculum standardization.

Procedural education for cancer-related pain in Pain Medicine fellowships: a national program survey

IntroductionCancer-related pain is ubiquitous. Targeted procedural interventions may be an important and underutilized method for improving cancer-related pain and quality of life. The goal of this study was to determine...

Cross-sectional study on utilisation of social media by regional anaesthesia and acute pain medicine fellowship programs in the United States.

Social media provides a platform for physicians helping them change the practice in anaesthesiology as it promotes both personal and professional growth. In this cross-sectional study, we identify social media presence and engagement of Accreditation Council for Graduate Medical Education (ACGME)-accredited Regional Anesthesia and Acute Pain Medicine (RAAPM) fellowship programs, specifically on Twitter (Twitter Inc., San Francisco, CA) and Instagram (Meta Platforms Inc., Menlo Park, CA). This article presents current evidence about social media presence and engagement of ACGME-accredited RAAPM fellowship programs on Twitter and Instagram. These findings could potentially help cultivate greater social media engagement in the RAAPM community and improve recruitment of prospective applicants. The list of ACGME-accredited RAAPM fellowship programs for the academic year 2020-2021 was obtained from the ACGME website. Accounts were searched by reviewing each program's website for profile links and by querying for the name of the program directly on Twitter and Instagram. Department of Anesthesiology, Perioperative and Pain Medicine accounts were analysed for posts pertaining to RAAPM elements, and RAAPM fellowship-specific accounts were investigated. Accounts that were solely focused on an anaesthesiology residency were excluded. All posts over the academic year period of 1 July 2020 to 30 June 2021 were analyzed. While many programs had active departmental social media accounts during our study, there was a dearth of RAAPM-related output (3.4% of tweets and 2.7% Instagram posts). Furthermore, only 10% of programs had RAAPM fellowship-specific Twitter accounts, of which only 5% of programs were active. Finally, there were no RAAPM fellowship-specific Instagram accounts. While there is robust use of social media by departmental accounts, there is a paucity of RAAPM-related content and RAAPM fellowship-specific social media accounts. The current gap provides valuable opportunities for future investigations into the cyber footprint and innovative engagement strategies for the RAAPM community.

ID:16419 Neuromodulation Education During Fellowship: Potential Barriers to Independent Practice and Cases Needed for Proficiency

Despite the growing body of evidence that neuromodulation is a promising cost-effective option in the management of chronic pain, few pain medicine providers practice neuromodulation after fellowship. The Accreditation Council for Graduate Medical Education (ACGME) recommends that pain fellows complete five neuromodulation cases, although this is not a requirement.1 Exposure to neuromodulation varies greatly among pain medicine fellowship programs. It is unclear how many cases need to be completed during fellowship for a trainee to feel comfortable practicing independently.

Factors involved in applicant interview selection and ranking for chronic pain medicine fellowship

IntroductionApplicants to chronic pain medicine fellowship programs often express confusion regarding the importance of various selection criteria. This study sought to elucidate program directors’ considerations in applicant selection for fellowship...

Evaluation and Analysis of Fellow Learning and Education Curriculum in a Regional Anesthesiology and Acute Pain Medicine Fellowship: A Prospective, Observational Pilot Study.

Since 2017, several regional anesthesiology and acute pain medicine fellowship programs throughout the country have developed various educational didactic curriculums to address the core medical knowledge requirements as set by the Accreditation Council for Graduate Medical Education. Given the paucity of existing literature regarding the medical knowledge acquisition of regional anesthesiology and acute pain medicine fellows, this study aimed to determine how quickly these fellows learn during their fellowship year, with a secondary aim of analyzing a new educational didactic curriculum in its goal of delivering the required medical knowledge. An 89-question, multiple-choice examination was administered to the 2020-2021 regional anesthesiology and acute pain medicine fellows at the University of Pittsburgh Medical Center during orientation and again at 4 months and 8 months into the fellowship. A secondary analysis of anonymous deidentified answers was completed. Fellows averaged 64%, 74%, and 79% correct responses on the orientation, 4-month, and 8-month exams, respectively. An analysis of the orientation exam revealed that the most commonly incorrect answers stemmed from topics including lower extremity nerve blocks, truncal blocks, and neuraxial anesthesia. The 4-month exam showed overall marked improvement; however, truncal blocks remained the most missed topic. Topics with 100% correct response rates in all examinations were local anesthetic pharmacology and systemic opioids. The results of this study indicate that a large portion of learning occurs during the first 4 months of the fellowship and slows thereafter. Using this simple form of fellowship evaluation, changes to an educational didactic curriculum can be implemented to reach medical knowledge goals more effectively and efficiently as required by the Accreditation Council for Graduate Medical Education.

An Evaluation of the Online Quality of Content of United States Accredited Pain Medicine Fellowship Training Programs.

BackgroundPain medicine fellowship applicants often seek information about programs from the Internet, which is becoming even more relevant with the transition to virtual interviews as a consequence of the global pandemic. Previous literature has revealed the significance of training program websites as part of the application process in other specialties.ObjectivesThe objective of this cross-sectional study was to evaluate the content, design, organization, and user friendliness by using a composite score to determine the quality of the pain medicine fellowship websites (PMFW).MethodsAccredited pain medicine fellowship programs was queried from three databases for pain medicine education: (1) Electronic Residency Application Service (ERAS); (2) the Fellowship and Residency Electronic Interactive Database (FREIDA); and (3) the National Resident Matching Program (NRMP). Programs that appeared within one and/or more databases were eligible for study inclusion. PMFW were evaluated for the accessibility of recruitment and education content items. The quality of PMFW was determined as multifactorial composed of four dimensions: content, design, organization, and user friendliness.ResultsFor program recruitment, PMFW contained an average of 12 ± 4.0 of 32 content items (38%) for fellowship programs: (1) 83% of fellowship programs specified the number of positions available for the 2021 Match; (2) 17% indicated alumni career placement; (3) 6.8% supplied interview dates; and (4) merely 4.9% detailed the selection process. For program education, PMFW contained an average of 7 ± 3.4 of 16 content items (44%): (1) 70% of programs provided a rotation schedule; (2) 49% detailed operative experiences; and (3) just 16% included simulation training. Regarding the quality based on content, design, organization, and user friendliness, the average PMFW was not “good” with only 1% of PMFW meeting “great” standards. A kappa value of 0.92 was calculated for inter-rater reliability.ConclusionsThe web presence of pain medicine fellowship programs falls short of providing essential accessibility, content, design, organization, and user friendliness to allow applicants to adequately access information about program characteristics. There are ample opportunities to increase the effectiveness of PMFW to benefit training programs and to inform prospective applicants, especially given the rise of virtual applications and interviews.

Pain Medicine Fellowship Program Websites in the United States of America - A Nonparametric Statistic Analysis of 14 Different Criteria.

ObjectiveTo evaluate the content of Pain Medicine Fellowship Program websites in the United States of America.MethodsWe obtained a list of accredited 104 Pain Medicine Fellowship Program websites from the Accreditation Council for Graduate Medical Education and the Electronic Residency Application Service. Individual Pain Medicine Fellowship Program websites were then evaluated on 14 different criteria. We grouped fellowship programs based on census region and Electronic Residency Application Service participation status, and analyzed the differences using nonparametric statistics.ResultsA total of 104 accredited Pain Medicine Fellowship Program websites were evaluated for a total of 14 different criteria. Of the 14 different criteria, an average of 3.94 were described in each website. Number of Fellowship positions per year (71.8%), clinical rotations during the program (65.1%), and faculty background (62.2%) were the most frequently described features on the websites. Night call responsibilities (3.9%), meal allowance (7.8%) and parking availability (10.7%) were the least described features in the websites. There were no significant differences between program websites when grouped by census regions or the participation status in the Electronic Residency Applications Service.ConclusionThe content of Pain Medicine Fellowship Program websites is extremely variable across the United States of America. This study indicates that there is room for improvement and enhancement of the comprehensiveness of website content for the majority of the programs analyzed. Additionally, this study also emphasizes the importance of having accurate and easily available online information in a post-pandemic era, when prospective fellows evaluate programs online through their websites.

Gender Representation in Fellowship Program Director Positions in ACGME-Accredited Chronic Pain and Acute Pain Fellowship Programs.

We quantified the representation of female program directors (PDs) and assessed their respective demographics, academic metrics, and program-related characteristics in chronic pain and acute pain medicine fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). We identified chronic and acute pain PDs on the ACGME website on November 15, 2020. We abstracted data from public databases and performed comparisons of demographics, academic metrics, and program-related characteristics between female and male PDs. We identified 111 chronic pain programs and 35 acute pain programs. Overall, there were 35 (31.5%) chronic pain programs with a female PD and 76 (68.5%) chronic pain programs with a male PD. Female chronic pain PDs published fewer peer-reviewed articles (4.0 publications, interquartile range [IQR] = 2.0-12.0) compared with male chronic pain PDs (9.0 publications, IQR = 4.0-27.0; P = 0.050), although there was no difference in the H-index score (3.0 vs 4.0 publications, respectively; P = 0.062) or senior academic rank status (57.1% vs 50.0%, respectively; P = 0.543). There were 10 (28.6%) acute pain programs with a female PD and 25 (71.4%) acute pain programs with a male PD. Similar to the chronic pain cohort, there was no difference in senior academic rank status based on gender in acute pain PDs (50.0% vs 24.0%, respectively; P = 0.227). Our study highlights gender differences in the PD role in ACGME-accredited chronic and acute pain fellowships. Female PDs remain underrepresented and have fewer peer-reviewed publications. Senior academic rank status was similar across genders, contradicting the current evidence in academic medicine.

Why Do Physicians Choose Pain as a Specialty?

Numerous forces shape the practice of pain management: scientific advances, technical advances, societal expectations, public health crises, reimbursement factors, and the parameters of who gets trained and what motivates the trainees. In this observational study, we sought to determine expressed motivations for entering the subspecialty of pain management, and in particular whether applicants were more interested in procedural skills (our hypothesis) or rehabilitative and cognitive practices. We analyzed the personal statements of 142 applicants to the University of Minnesota's pain medicine fellowship program. In addition to those themes, the personal statements were scrutinized for other themes such as interest in teaching and research. Comprehensive vs interventional/procedural interests were coded by a group of four research assistants who were trained using practice essays until they achieved high interrater reliability (alpha > 0.8). Two of the researchers coded for additional themes on a two-point scale indicating presence or absence of a particular theme. When they did not agree, a third researcher broke the tie. Theme prevalence was compared by specialty and gender. Residents expressed interest in interventional and comprehensive pain practice without significant differences; however, there were specialty and gender differences in other themes such as teaching, research, and leadership in program development. If pain specialty training is going to meet the needs of prospective residents, patients, and society, we should do more to attract women and neurology and psychiatry residents. We should include more opportunities for research and the flexibility to educate trainees who may not pursue a procedural practice.

Factors associated with academic rank among chronic pain medicine faculty in the USA

BackgroundNumerous factors are considered in the academic promotion of pain medicine physicians. In this study, we investigated the importance of research productivity, career duration, leadership, and gender on attaining professorship...

Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part II: Innovations in Clinical Care Workflow, Clinical Supervision, Job Satisfaction, and Postgraduation Mentorship for Pain Fellows During the COVID-19 Pandemic

BackgroundPain fellowship programs are facing unique challenges during the COVID-19 pandemic. Restrictions by state governments and the Centers for Disease Control and Prevention have resulted in a rapidly changing and evolving learning environment for today’s fellows. Innovative solutions must be sought to maintain proper education and ensure the well-being of our trainees.Methods: We assembled a panel of pain program directors who serve as officers/board members of the Association of Pain Program Directors, offering guidance and recommendations to pain fellowship directors nationwide. Panel members evaluate best available evidence and expert opinion on use of remote and virtual platforms in clinical care, adaptability to alterations in clinic and referral management, and provide guidance on post-graduate impact.ConclusionsThe country is in the midst of an unprecedented pandemic. The impact on pain management fellowships has been significant and will likely last for months, resulting in extraordinary challenges to the administration of pain fellowship programs and the education of our fellows. Several strategies will help address these challenges, including employing telehealth capabilities to continue clinical experiences, and providing trainees with opportunities to continue their professional growth beyond fellowship completion. Together, we can implement innovative solutions to overcome these challenges.

Maintaining High-Quality Multidisciplinary Pain Medicine Fellowship Programs: Part I: Innovations in Pain Fellows’ Education, Research, Applicant Selection Process, Wellness, and ACGME Implementation During the COVID-19 Pandemic

BackgroundPain fellowship programs are facing unique challenges during the COVID-19 pandemic. Restrictions from state governments and the Centers for Disease Control and Prevention have resulted in a rapidly changing and evolving learning environment for todays’ fellows. Innovative solutions must be sought to guarantee proper education is maintained and ensure the well-being of our trainees.MethodsWe assembled a panel of pain program directors who serve as officers/board members of the Association of Pain Program Directors to provide guidance and formulate recommendations to pain fellowship directors nationally. This guidance is based on reviewing current changes to Accreditation Council Graduate Medical Education (ACGME) and American Board Anesthesiology policies and best available evidence and expert opinion on use of remote educational activities, research endeavors, and trainee wellness.ConclusionsThe country is in the midst of an unprecedented pandemic. The impact on pain management fellowships has been severe and will likely last for months, resulting in extraordinary challenges to the administration of pain fellowship programs and the education of our fellows. Understanding revisions in ACGME policies, use of technology to promote remote learning opportunities, and providing trainees with opportunities to alleviate their anxieties and encourage mental health are beneficial strategies to implement. Together, we can implement innovative solutions to help overcome these challenges.

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.

Representation of Women in Pain Medicine Fellowships in the United States, 2017-2018.

To quantify the representation of women trainees and faculty and to explore associations between them at Pain Medicine (PM) fellowship programs in the United States. PM fellowship programs accredited by the Accreditation Council for Graduate Medical Education. All PM programs approved for at least four fellows as of December 2017 were identified. Websites of these programs were reviewed to determine the number and gender of current fellows and faculty, and programs were contacted to verify the information. A total of 56 PM programs were eligible; of these, 48 PM programs (86%) provided information about the gender distribution of fellows. Women comprised ∼25% of PM fellows. PM programs with a female rather than male fellowship program director (PD) had 2.40 times increased odds of a female trainee. Proportion of female faculty and division chief gender were not significantly associated with trainee gender composition. The adjusted odds of a faculty member being female was 1.99 times greater for PM programs with a female vs male PD and 3.13 times greater for programs with a female vs male division chief. Women are underrepresented throughout all levels of academic pain medicine. The presence of women in leadership roles is associated with higher proportions of female trainees and faculty, highlighting the need for more female role models in academic pain medicine.

Variations of Technique in Transforaminal Epidural Steroid Injections and Periprocedural Practices by Interventional Pain Medicine Physicians in the United States

Background: Interlaminar and transforaminal epidural steroid injections (ILESI and TFESI) are commonly performed procedures. However, the United States Food and Drug Administration has required the addition of drug warning labels for injectable corticosteroids. Updated evidence and scrutiny from regulatory agencies may affect practice patterns. Objective: To characterize TFESI practices as well as to provide an update on periprocedural practices for any type of epidural steroid injection (ESI), we surveyed pain medicine physicians in the United States. Study Design and Setting: This was a cross-sectional survey of pain medicine physicians in the United States. Methods: A web-based survey was distributed to pain medicine physicians in the United States selected from the Accreditation Council for Graduate Medical Education accredited pain medicine fellowship program list as well as the American Society of Interventional Pain Physicians membership database. Physicians were queried about TFESI practices, including needle size, use of image guidance, methods to detect vascular uptake, and preference for injectate. Results: A total of 249 responses were analyzed. Only a minority of respondents reported performing cervical TFESI. There were variations in needle size, methods to detect vascular uptake, and choice of injectate. There were also variations in monitoring practices. Limitations: The response rate is a limitation. Thus the results may not be representative of all US pain medicine physicians. Conclusions: Though all respondents used image guidance for TFESI, variations in other TFESI practices exist. There are also differences in periprocedural practices. Since the closure of this survey, a multisociety pain workgroup published recommendations regarding ESI practices. Our survey findings support the need for more evidence-based guidelines regarding ESI. Key words: Epidural steroid injections, transforaminal epidural steroid injection, steroids, local anesthetic, survey, interventional pain

Variations in Interlaminar Epidural Steroid Injection Practice Patterns by Interventional Pain Management Physicians in the United States

Background: Previous surveys have identified variations in practice patterns related to epidural steroid injections. Since then, the United States Food and Drug Administration (FDA) has required the addition of drug warning labels for injectable corticosteroids. Updated evidence, as well as scrutiny from regulatory agencies, may affect practice patterns. Objective: To provide an update on interlaminar epidural steroid injection (ILESI) practice patterns, we surveyed interventional pain management (IPM) physicians in the United States. Study Design and Setting: This was a cross-sectional survey of IPM physicians in the United States. Methods: A web-based survey was distributed to IPM physicians in the United States selected from the Accreditation Council for Graduate Medical Education accredited pain medicine fellowship program list as well as the American Society of Interventional Pain Physicians membership database. Physicians were queried about ILESI practices, including needle size, use of image guidance, level of injection, identification of the epidural space, and preference for injectate. Results: A total of 249 responses were analyzed. All respondents used image guidance for ILESI. There were variations in needle size, use of contrast, number of fluoroscopic views utilized, technique for identifying the epidural space, and choice of injectate. Limitations: The response rate is a limitation, thus the results may not be representative of all United States IPM physicians. Conclusions: Though all respondents used image guidance for ILESI, variations in other ILESI practices still exist. Since the closure of this survey, a multi-society pain workgroup published recommendations regarding ESI practices. Our survey findings support the need for more evidencebased guidelines regarding ESI. Key words: Epidural injection, epidural steroids, survey, low back pain, neck pain, technique

Do Pain Medicine Fellowship Programs Provide Education in Practice Management? A Survey of Pain Medicine Fellowship Programs

We hypothesized that there is a gap between expectations and actual training in practice management for pain medicine fellows. Our impression is that many fellowships rely on residency training to provide exposure to business education. Unfortunately, pain management and anesthesiology business education are very different, as the practice settings are largely office- versus hospital-based, respectively. Because it is unclear whether pain management fellowships are providing practice management education and, if they do, whether the topics covered match the expectations of their fellows, we surveyed pain medicine program directors and fellows regarding their expectations and training in business management. A survey. Academic pain medicine fellowship programs. After an exemption was obtained from the University of Texas Medical Branch Institutional Review Board (#13-030), an email survey was sent to members of the Association of Pain Program Directors to be forwarded to their fellows. Directors were contacted 3 times to maximize the response rate. The anonymous survey for fellows contained 21 questions (questions are shown in the results). Fifty-nine of 84 program directors responded and forwarded the survey to their fellows. Sixty fellows responded, with 56 answering the survey questions. The responder rate is a limitation, although similar rates have been reported in similar studies. The majority of pain medicine fellows receive some practice management training, mainly on billing documentation and preauthorization processes, while most do not receive business education (e.g., human resources, contracts, accounting/financial reports). More than 70% of fellows reported that they receive more business education from industry than from their fellowships, a result that may raise concerns about the independence of our future physicians from the industry. Our findings support the need for enhanced and structured business education during pain fellowship. Business education, practice management, fellowship training, curriculum development, knowledge gaps, private practice.

Multicenter Survey of Attitudes and Perceptions of Pain Medicine Fellows Toward the Use of Lateral Versus Contralateral-Oblique Fluoroscopic View for Interlaminar Cervical Epidural Injection

For interlaminar cervical epidural steroid injections (CESI) the lateral fluoroscopic view (LAT) is often considered to improve needle localization. However, the contralateral-oblique view (CLO) is a useful alternative with potential advantages to improve identification of cervical anatomy and needle depth assessment. The authors explored the attitudes and perceptions of pain medicine fellows currently training in two ACGME-accredited pain medicine fellowship programs regarding the use of these two types of fluoroscopic views. The survey was conducted online following a request by e-mail. Of a total of 20 fellows who were contacted, there were 17 respondents who had experience with both techniques, and they were included for analysis. The response rate for participation was 95%. Whereas 70.6% respondents reported they were very certain about the assessment of anatomy with the CLO view, only 17.6% felt very certain with the LAT view. Compared with learning to perform interlaminar CESI using the LAT view only, the majority of fellows thought that using the CLO technique was easier to learn (P < 0.01) and offered better visualization of contrast dye spread pattern to confirm the cervical epidural space (P = 0.013). All respondents perceived that the likelihood of interlaminar CESI complications would be lower with CLO technique. Overall, 82.4% of respondents considered CLO visualization as a preferred technique for interlaminar CESI. Respondents stated that the likelihood of using the CLO technique as an independent physician was significantly higher than using only the LAT technique (P < 0.001), particularly for patients who are obese and have short necks. For interlaminar CESI, using the CLO is perceived to provide better definition of anatomy and yet is easier to learn. Trainees may become more confident in performing interlaminar CESI with the CLO. We encourage all fellowship programs to include the CLO technique for interlaminar CESI as part of the training.

Misrepresentation in Multidisciplinary Pain Medicine Fellowship Applications to a Single Academic Program

Publication misrepresentation by residency applicants has been well documented, but fewer studies have investigated it in fellowship applicants, specifically in pain medicine. We therefore sought to evaluate the demographics of pain medicine fellowship applicants and the type, number, and accuracy of referenced publications they reported. Applications to the Multidisciplinary Pain Medicine fellowship program in the Mayo School of Graduate Medical Education, Rochester, Minnesota were reviewed for three consecutive academic years (2009-2012). Demographic information and publications claimed by applicants were compiled, and publications were scrutinized by a medical librarian for accuracy. Over a 3-year period, 179 fellowship applications were received. Of the 179 applicants, more than half (106 [59%]) listed at least one publication. Of 324 listed publications, 263 were verifiable; of these, 14 (5.3%) were deemed fraudulent, and six (2.3%) contained an inaccuracy possibly conferring a competitive advantage. In our small sample size, we found no difference in the rate of publications or in the accuracy of listed publications across subspecialties, or between US medical graduates and international medical graduates. The lack of national data, specifically on applicant misrepresentation, due to the heretofore absence of a universal application process or match, impedes assessment of the extent to which these findings are representative of the national applicant pool. We observed notable trends (few female applicants; numerous international medical graduate applicants) different from those reported by other specialties. Despite the low rate (5.3%) of fraudulent publications, fellowship program directors and selection committees should be aware of this possibility to ensure selection of fellows with the highest degree of professional and ethical integrity.