Pediatric Fellowship Programs Research Articles

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

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

Impact of Program Region and Prestige on Industry Supplemental Earnings for Pediatric Orthopedic Surgery Fellowships in the United States: A Retrospective Analysis

Introduction: With the passage of the Physician Payment Sunshine Act, there has been increased transparency regarding the industrial financial relations that physicians have. Orthopedic surgeons have been highly studied in this domain with approximately 50% of all orthopedic surgeons engaging in industrial financial relationships. Furthermore, an increasing number of orthopedic surgeons are seeking fellowship training with pediatric fellowship programs gaining popularity in recent years. The purpose of this study is to evaluate the impact various pediatric orthopedic fellowship programs have on industry earnings and academic productivity. Methods: Pediatric orthopedic fellowship programs were identified via the Orthopedic Society of North America (POSNA) website. Information on individual fellowship programs was obtained from their respective websites. Academic productivity was measured via an aggregate of all employed physicians’ H-index at a specific fellowship as found on the Scopus website. The Open Payments Database (OPD) website was used to assess lifetime industry earnings. Other variables such as Newsweek or Doximity ranking were taken directly from relevant websites. Statistical analysis was performed using a Kruskal–Wallis test with Bonferroni correction and Mann–Whitney U-test. Results: A total of 43 pediatric orthopedic surgery fellowships in the United States were identified with a total of 392 physicians as fellowship faculty. Complete OPD and H-index information were available for 336 of those physicians (85.7%). On average, there were 7.81 ± 5.18 physicians and 1.56 ± 0.93 fellows per program. The mean combined physician H-index was 117.23 ± 122.51, and the mean combined physician lifetime supplemental earnings in dollars was $646,684.37 ± $1,159,507.17. There was no significant relationship between region of pediatric orthopedic fellowship, Newsweek ranking of affiliated hospital, Doximity ranking of affiliated hospital, presence of MBA program, type of program (public, private, mixed), and the lifetime industry earnings or academic productivity of program graduates. Conclusions: Despite the observed lack of statistical significance, there were clear trends observed with fellowship programs in the northeast and west coast regions being the highest earning and fellowship programs with top 10 Newsweek ranking of affiliated hospital having by far the greatest industry earnings. Sample size limitations likely prevented the detection of statistical significance. Future studies should examine if any relation exists when accounting for type of industry payment received and case volume per fellowship program.

Analysis of fellowship program director opinions of entrustable professional activities in adolescent medicine fellowship.

This study aimed to explore the minimum entrustable professional activity (EPA) supervision levels at which pediatric fellowship program directors (FPDs) would be willing to graduate fellows and the levels deemed necessary for safe and effective practice for each of the common pediatric subspecialty and the four adolescent medicine-specific EPAs. This cross-sectional study utilized survey data from pediatric FPDs in 2017. FPDs indicated the minimum level of supervision (LOS) for fellows at graduation and for safe and effective practice. 82 percent (23/28) of adolescent medicine FPDs completed the survey. For each EPA, there were differences (p<0.05) between LOS expected for graduation and for safe and effective practice. There was also variability in the level at which FPDs would graduate fellows. This study summarizes pediatric FPD opinions regarding the minimum levels of supervision required for fellows at the time of graduation as well as the levels deemed necessary for safe and effective practice. The difference between the minimum LOS at which FPDs would graduate a fellow and that deemed appropriate for safe and effective practice, along with variability in minimum LOS for graduation, highlight the need for clearer standards for fellowship graduation as well as more structured early career support for ongoing learning. These data highlight variability in FPD opinion regarding such expectations and both the need to better define desired training outcomes and potential need for post-graduation supervision in clinical practice.

A Pilot Survey on the Perceptions of Pediatric Subspecialty Fellows and Program Directors on Virtual Compared with In-Person Interview Experiences

Pediatric fellowship programs have conducted virtual interviews since the start of the COVID-19 pandemic in 2020. In this national survey of fellowship program directors (FPDs) and fellows interviewed in-person and virtually, FPDs and fellows formed accurate impressions, regardless of format, but our data did not clearly support one interview format over another.

The State of Diversity, Equity, Inclusion, and Justice in Pediatric Fellowship Programs

Diversity, equity, inclusion, and justice (DEIJ) lie at the center of excellent patient care and safety. The way we interact with our pediatric patients and families and develop and discuss treatment plans should all be done under the lens of DEIJ. The foundation of DEIJ begins in medical school and is further honed during general pediatric residency training by ensuring residents are exposed to diverse patient populations. During fellowship training, the focus is shifted to research and scholarly activities for that same population. There is a vast catalog of curricula on DEIJ education for medical schools, some exist for general pediatric residency programs, but there is a lack of such curricula for subspecialty pediatric fellowship programs. In this article, we will address the state of DEIJ education in pediatric fellowship education, make a case for the importance of DEIJ education in pediatric fellowship programs, and provide recommendations to address the gap to include a holistic approach that involves holding departments, program leaders, and individuals accountable for continued medical education. [ Pediatr Ann . 2023;52(7):e261–e265.]

Parental leave during pediatric fellowship training: A national survey.

Until recently, no uniform requirements for parental leave (PL) existed in graduate medical education. We implemented a national survey, with the objective of ascertaining fellows' perceptions of PL policies and their impact. This is the first study to focus exclusively on pediatric subspecialty fellows. An online survey instrument was created targeting pediatric fellows. The survey was accessed by 1003 (25%) of the estimated 4078 pediatric subspecialty fellows and 853 (21%) submitted surveys. Respondent demographic data paralleled the data reported by the American Board of Pediatrics. Half of respondents did not know whether their program had a written PL policy. Over 40% reported ≥ 5 weeks of paid PL. Most indicated that fellows use vacation, sick leave, and unpaid time for PL. Almost half of respondents (45%) indicated that their program's PL policy increases the stress of having a child. Fellows chose establishing/extending paid leave and intentionally fostering a more supportive program culture as the most crucial candidate improvements. The importance of equitable PL polices between parent fellows and co-fellows was an important theme of our qualitative data. Fellows feel there is a moral misalignment between the field of pediatrics' dedication to maternal and child health and current PL policies governing pediatric trainees. PL policies vary widely among pediatric fellowship programs and are often not known by fellows. Fellows are not satisfied with PL policies, which often exacerbate stress for new parents and burden their co-fellows. Targeted modification of several aspects of PL policies may improve their acceptance.

Fellow Entrustment for the Common Pediatric Subspecialty Entrustable Professional Activities Across Subspecialties.

To determine the relationship between level of supervision (LOS) ratings for the Common Pediatric Subspecialty Entrustable Professional Activities (EPAs) with their associated subcompetency milestones across subspecialties and by fellowship training year. Clinical Competency Committees (CCCs) in 14 pediatric subspecialties submitted LOS ratings for 6 Common Subspecialty EPAs and subcompetency milestone levels mapped to these EPAs. We examined associations between these subcompetency milestone levels and LOS ratings across subspecialty training year by fitting per-EPA linear mixed effects models, regressing LOS rating on milestone level and on training year. CCCs from 211 pediatric fellowship programs provided data for 369 first, 336 second, and 331 third year fellows. Mean subcompetency milestone levels increased similarly among subspecialties for most EPAs compared with the reference, Adolescent Medicine. Mean subcompetency milestones mapped to each EPA and mean EPA LOS ratings generally increased by training year across all subspecialties. Subcompetency milestones levels mapped to each Common Subspecialty EPA and the EPA LOS ratings increase similarly across subspecialties and by training year, providing validity evidence for using EPA LOS to assess pediatric subspecialty trainee performance. This study supports the development of tools to facilitated the CCC evaluation process across all pediatric subspecialties.

Gaps in adolescent and young adult oncology education during medical and pediatric hematology/oncology fellowship training.

11026 Background: There are limited data on the extent of adolescent and young adult (AYA) education in pediatric and medical oncology fellowship programs. The purpose of this study was to assess the prevalence and content of AYA-focused training during pediatric and medical oncology fellowship and identify knowledge gaps for targeted educational curricular development. Methods: An anonymous, web-based survey for educators and trainees was developed, piloted and optimized by a study team comprising pediatric and adult oncologists. The survey contained questions on respondent demographics, AYA curriculum, provider comfort in managing specific AYA care domains, and priorities for future AYA educational content. In October 2021, email invitations containing the survey link were sent to program directors (PDs) and associate program directors (APDs) at 251 hematology/oncology fellowship programs (with 119 pediatric and 178 adult PDs/APDs) identified through the American Medical Association’s Fellowship and Residency Electronic Interactive Database Access. PDs were asked to participate and also distribute the survey to current fellows. The survey remained open for 3 months. Fisher’s exact test was used to assess for associations between discrete variables including amount of current education vs level of importance and demographic groups. Results: Respondents represented 69 programs (27%). There were 130 respondents who completed curriculum and demographic questions and 112 who completed detailed topic questions. Respondents comprised 51 PDs/APDs (32 pediatric and 19 adult) and 58 fellows (33 pediatric and 25 adult). 85% of PDs (44/51) do not have a formal AYA curriculum. Of these, 80% (35/44) offer some topic-specific lectures, while 20% (9/44) provide little/no education in any topics. For nearly all topics, at least 45% of respondents reported little/no education. Although onco-fertility and survivorship are the most frequently taught topics, 36% and 42% of respondents, respectively, reported little/no education in these areas. Substance abuse is least commonly taught. Both PDs and fellows believe that AYA topics are more important for inclusion in future curricula despite how infrequently they are currently taught (very/extremely important for inclusion vs moderate/great deal of current amount of education, p = 0.0001 for all topics). Overall, respondents indicated the most important topics for inclusion in fellowship curriculum were onco-fertility (82%), survivorship (78%), and communication (77%). Conclusions: These data highlight the large gap in hematology/oncology fellowship education in AYA topics and a paucity of formal educational curricula. Efforts are needed to provide both medical and pediatric oncology fellows with the knowledge and skills required to provide optimal care for AYAs.

Replace, amplify, transform: a qualitative study of how postgraduate trainees and supervisors experience and use telehealth for instruction in ambulatory patient care

BackgroundLittle is known about using telehealth patient visits as an educational mode. Therefore, rapid implementation of telehealth during the COVID-19 pandemic had to be done without understanding how to optimize telehealth for education. With the likely sustained/post-pandemic use of telehealth in ambulatory patient care, filling gaps in our understanding of how telehealth can be used for instruction in this context is critical. This study sought to understand perceptions of pediatric postgraduate trainees and supervisors on the use of telehealth for instruction in ambulatory settings with the goal of identifying effective ways to enhance learning during telehealth visits.MethodsIn May–June of 2020, the authors purposefully sampled first- and third-year postgraduate trainees and supervising attendings from pediatric fellowship programs at one institution that implemented telehealth for instructional activities. They conducted semi-structured interviews; interviews lasted a median of 51 min (trainees) and 41 min (supervisors). They conducted interviews and data analysis iteratively until reaching saturation. Using thematic analysis, they created codes and constructed themes from coded data. They organized themes using the Replace-Amplify-Transform (RAT) model, which proposes that technology can replace in-person learning and/or amplify and transform learning.ResultsFirst-year trainees (n = 6), third-year trainees (n = 5) and supervisors (n = 6) initially used telehealth to replace in-person learning. However, skills that could be practiced in telehealth visits differed from in-person visits and instructional activities felt rushed or awkward. Trainees and supervisors adapted and used telehealth to amplify learning by enhancing observation and autonomy. They also transformed learning, using telehealth to develop novel skills.ConclusionsTo harness telehealth for instructional activities, our findings indicated that trainees and supervisors should shift from using it as a direct replacement for in-person education to taking advantage of novel opportunities to amplify and transform education in PGME. The authors provide data-driven recommendations to help PGME trainees, supervisors and educators capitalize on the educational advantages of telehealth.

Diversity, Equity, and Inclusion in Hematology and Oncology Fellowship Programs

BackgroundThe National Institutes of Health define African Americans or Blacks, American Indians, Alaska Natives, Hispanics or Latinos, Native Hawaiians, and other Pacific Islanders as being underrepresented in medicine. A number of studies have demonstrated that improving diversity of such underrepresented demographics within the medical profession improves patient outcomes, medical education and reduces health disparities in patients from vulnerable racial or socioeconomic groups. Despite this recognition, significant underrepresentation of various racial, ethnic, and sexual identities still exists within nearly all medical specialties.AimsThe purpose of this study was to a gain a greater understanding of the current state of diversity, equity, and inclusion (DEI) efforts among U.S. hematology and medical oncology fellowship training programs. We explored the perspectives of adult and pediatric fellowship program directors regarding current recruitment strategies and suggestions for improvement to help mitigate the effects of implicit and explicit bias. Here, we present an interim analysis of the data using descriptive statistics.Methods:We convened a multi-institutional collaboration of fellowship program directors, teaching faculty, and staff members of the American Society of Hematology to develop a survey examining perceptions of DEI efforts among hematology and medical oncology fellowship program directors. The survey was pilot tested in a small group of program directors representing 6 different academic programs (5 adult, 1 pediatric). The final online survey was distributed via email to 224 fellowship program directors at U.S. adult and pediatric hematology and medical oncology fellowship programs. The survey included 29 questions regarding perspectives on bias within the fellowship selection process, current DEI initiatives, and current faculty and fellow demographics. Survey respondents were asked to rate the importance of numerous factors in determining which applicants to invite utilizing a scale of 0-10, with 0 and 10 representing lowest and highest importance, respectively. To measure program director perceptions of certain applicant groups, survey respondents were asked to rate applicant demographics as being advantaged/disadvantaged based on survey options ranging from 0-5, with 0 and 5 representing very disadvantaged and very advantaged, respectively.Results:At interim analysis, 41 of 224 program directors completed the survey for an interim response rate of 21%, including 25 adult program directors and 16 pediatric program directors, with representation from university and community programs. Of the program directors surveyed, 28 (68%) reported having access to a dedicated diversity committee or DEI policies in place to improve recruitment of underrepresented applicants. In determining which applicants to invite, respondents placed highest value on the applicant's program director letter (mean score ± standard deviation: 7.44±1.93), caliber of the applicant's residency program (7.28±2.06) and letters of recommendations (7.15±2.23). Survey respondents viewed white and male applicants as representing the most advantaged demographic group, while LGBTQI, age>40, and U.S. citizen and non-citizen international medical graduates were the most disadvantaged (Table 1). Suggestions regarding improving DEI in the fellowship selection process included implementing bias training, identifying potentially disadvantaged applicants in ERAS, increasing faculty diversity, and pairing underrepresented applicants with interviewers based on applicant preference.Conclusion:While the majority of hematology and medical oncology fellowship program directors report having DEI programs or policies to improve recruitment of underrepresented applicants, perceptions of advantaged/disadvantaged groups may extend beyond demographics traditionally viewed as being underrepresented in medicine. As our survey is ongoing, we plan to reanalyze our data when the survey has been finalized with a higher response rate utilizing multivariable regression to identify themes that may further improve DEI efforts within the fellowship selection process. [Display omitted] DisclosuresLaCasce: Bristol-Myers Squibb Company.: Other: Data Safetly and Monitoring. Murphy: North American Thrombosis Foundation: Honoraria. Naik: Rigel: Research Funding. Podoltsev: Pfizer: Honoraria; Blueprint Medicines: Honoraria; Incyte: Honoraria; Novartis: Honoraria; Celgene: Honoraria; PharmaEssentia: Honoraria; Bristol-Myers Squib: Honoraria; CTI BioPharma: Honoraria.

Making the Match: Three Program Directors’ Thoughts on Successfully Matching into Pediatric Cardiology Fellowship

Successfully matching into a pediatric cardiology fellowship program is difficult, and there is currently a paucity of helpful material for prospective applicants. To address this gap and to guide pediatric cardiology fellowship applicants in navigating this process, three fellowship program directors have compiled a list of recommendations on how residents can improve their chances for a successful match. Detailed descriptions of the following recommendations are provided: become a great pediatrician, show consistent interest in pediatric cardiology, complete a research project, ensure great letters of recommendation, don't botch the personal statement, and apply wisely and interview effectively.

ШЛЯХИ СПІВПРАЦІ ЛІКАРІВ УКРАЇНСЬКОЇ ДІАСПОРИ КАНАДИ ТА ЛІКАРІВ УКРАЇНИ В УМОВАХ СУЧАСНИХ ВИКЛИКІВ

In the article, the current state of cooperation between Canadian Ukrainians and Ukrainian doctors analyzes. The urgency of modern challenges for cooperation is determined, in particular: pandemic restrictions due to the rapid spread of Covid-19 virus and a sharp restriction of direct professional contacts; the politicization of professional international cooperation in the conditions of Russian aggression; bureaucracy on the part of the management of medical institutions of Ukraine, unfinished state regulation of charitable organizations and international cooperation; insufficient development of charity in Ukraine. The activity of the main Cooperation programs between doctors Canadian Ukrainians and Ukrainian doctors is analyzed. The main focus of the article is on the analysis of the effectiveness of the Canadian-Ukrainian Pediatric Fellowship Program. The Medical Director of the Program is Professor James Rutka, and the Program Coordinator is Professor Myroslava Romach. The stages of organizing training meetings within the Program are indicated: planning and preparation for the meeting (goal setting and detailed planning); choice of locations, according to pre-thought-out criteria; the meeting itself (lectures and practical training, joint operations in 7 cities of Ukraine); further observation, assessment of the impact and results of the meeting, as well as planning of long-term cooperation. Analysis of the concrete results of cooperation is one of the most important stages of international cooperation, as it not only increases its efficiency but also ensures the targeted use of funds. It is determined that important factors that increase the effectiveness of interstate programs in the field of medicine are awareness of cooperation at the diplomatic level, coordinated cooperation at the local level, selection of reliable partners for cooperation, systematic contacts, activities, targeted, premeditated assistance, careful selection of applicants, changes in the means of communication in today's challenges. The work of the above-mentioned medical Ukraine Paediatric Fellowship Program can serve as an example of the organization of international cooperation in various directions of social and political life of modern Ukraine, and a guarantee of its high efficiency in clear strategic planning.

Scholarly Activity During Pediatric Fellowship

The educational requirements for pediatric fellows include at least 12 months of scholarly activity and generation of a work product. Yet there lacks detailed guidance on how programs can best integrate scholarly activity training into fellowships. Our objectives were to understand the resources and barriers to training and identify factors associated with productivity. We surveyed pediatric fellowship program directors (FPDs) nationally in 2019. Data analysis included descriptive statistics, χ2 and Fisher's exact tests, and multivariable modeling to identify factors associated with high productivity (>75% of fellows in the past 5 years had an article from their fellowship accepted). A total of 499 of 770 FPDs responded (65%). A total of 174 programs (35%) were highly productive. The most frequent major barriers were a lack of funding for fellows to conduct scholarship (21%, n = 105) and lack of sufficient divisional faculty mentorship (16%, n = 79). The median number of months for scholarship with reduced clinical obligations scholarship was 17. A total of 40% (n = 202) of FPDs believed training should be shortened to 2 years for clinically oriented fellows. Programs with a T32 and a FPD with >5 publications in the past 3 years were twice as likely to be productive. Not endorsing lack of adequate Scholarship Oversight Committee expertise and a research curriculum as barriers was associated with increased productivity (odds ratio = 1.83-1.65). Despite significant protected fellow research time, most fellows do not publish. Ensuring a program culture of research may provide the support needed to take projects to publication. The fellowship community may consider reevaluating the fellowship duration, particularly for those pursing nonresearch focused careers.

Current Efforts in Diversity for Pediatric Subspecialty Fellows: Playing a Zero-sum Game

* Abbreviation: URiM — : underrepresented in medicine Medicine in the United States has been hampered by a lack of diversity for centuries. Over the past few decades, greater attention and efforts have been focused on tackling this problem. A diverse workforce is important for many reasons, including a commitment toward a representative workforce in the name of social justice, improved patient care in the form of increased access and patient satisfaction,1 and service to communities for whom we provide care.2 Programs aimed at increasing diversity exist at every level of medical training, from premedical programs to the subspecialty match. Programs throughout are important because structural and individual racism impede minority success at every level, but the earliest interventions are the most likely to succeed. Efforts aimed at increasing diversity will not succeed by simply targeting subspecialty trainees alone. In essence, at the subspecialty level, this is a zero-sum game. The gains made by any one program are exactly balanced by the losses borne by others. A significant impact on increasing the pool of underrepresented in medicine (URiM) candidates for fellowship positions requires that efforts begin early and continue throughout the entire educational journey. The Association of American Medical Colleges defines URiM as “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” This … Address correspondence to Angela C. Weyand, MD, Division of Pediatric Hematology and Oncology, Department of Pediatrics, Medical School, University of Michigan, 1150 W Medical Center Dr, Medical Sciences Research Building III, Room 8220E, Ann Arbor, MI 48109. E-mail: acweyand{at}med.umich.edu

63. USE OF A NOVEL TOOL TO COMPARE FEEDBACK CULTURE IN A PEDIATRIC RESIDENCY AND FELLOWSHIP PROGRAMS.

Introduction Effective feedback is essential for trainees to achieve clinical competence. An unsupportive institutional feedback culture can diminish the credibility and subsequent uptake of feedback. Data on feedback culture in pediatric training programs is limited. We, therefore, used a validated feedback environment survey (FES) tool to assess and compare the cultures in our pediatric residency and fellowship programs. Methods Pediatric fellows and residents at Yale New Haven Hospital were invited to anonymously complete the FES using Qualtrics. The FES has a 7-point Likert scale response format, measures various aspects of the feedback environment, and has demonstrated good reliability, internal structure and relationship to other variables validity in an industrial setting. Fellow and resident ratings were compared using two-sided Fisher's exact test. Results Fifty-two (65%) residents and 21 (47%) fellows completed the survey. Most trainees reported that they respect their attendings’ opinion (76.7%), feel that they are fair (67.1%) and have confidence in their feedback (64.3%). However, the majority felt that the feedback they received was not useful (60.2%) and that attendings did not encourage them to ask for feedback (67.1%). When compared to fellows, more residents felt that attendings were unfamiliar with their performance (61.5% vs. 14.3%, p Conclusions We have demonstrated deficiencies in the feedback culture of our pediatric residency and fellowship programs, which are more pronounced in the residency program. Identification of the factors contributing to the difference is important and will inform targeted interventions.

16. DEVELOPMENT OF VALIDATED SURVEYS TO STANDARDIZE EVALUATION OF GLOBAL HEALTH TRACKS

Introduction Global health (GH) tracks are becoming increasingly common in pediatric residency and fellowship programs around the country. A recent Delphi process 1 identified a consensus definition for GH tracks within pediatric residency programs, determined key educational and institutional components, and established target outcomes for programmatic evaluation. The aim of this project was to develop and validate a set of standardized surveys to be used as an evaluation tool for pediatric GH tracks. Methods The authors, all committee members of the American Association of Pediatric Program Directors Global Health Learning Community (APPD GHLC), created a set of standardized surveys to serve as an evaluation tool to facilitate comparison of resources and outcomes among GH tracks within pediatric residency programs. Based on consensus outcomes identified in a previous Delphi, 1 the authors created surveys for four stakeholder groups: (1) current GH track residents, (2) GH track alumni, (3) GH track directors, and (4) GH track host sites/partners. Surveys sought to assess resident perceptions, educational outcomes, influence of tracks on career paths, and the human and monetary programmatic resources required to run tracks. As initial validation steps, the authors developed survey questions based on previously identified outcomes and input from stakeholders. The survey was reviewed by a survey methodologist to support content validity. To collect evidence of response process validity, structured cognitive interviews were conducted for each survey with 1 or more stakeholder group members with further edits incorporated. Results The resulting surveys will be piloted among three pediatric residency GH tracks in Spring 2020 with subsequent analysis of pilot data planned to assess reliability and further construct validity. Data will be used by individual GH tracks for programmatic improvement and will allow comparison among GH tracks for future research. Conclusion This is the first standardized tool for evaluating GH tracks within pediatric residency programs. The evaluation tool will be available on the APPD GHLC website.

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.

Participation of Pediatric Surgery Training Programs in Fertility Preservation Initiatives

Purpose: The significant reduction in childhood cancer mortality has allowed for greater emphasis on survivorship issues, including infertility. This study evaluated the participation of pediatric surgery training programs in fertility preservation (FP) and exposure of fellows to adnexal cases. Materials and Methods: A survey was distributed to pediatric surgery fellowship program directors in the United States and Canada through email. Questions focused on FP participation, operative cases, FP program limitations, and fellow completion of adnexal cases. Results: Survey participation was 49% (28/57). Overall, 43% (12/28) of training programs report participation in FP initiatives. Of those who participated, the most common procedures performed were testicular tissue biopsy (58%) and testicular sperm extraction (42%) in males, and surgical transposition of the ovaries (83%) and laparoscopic oophorectomy (67%) in females. The greatest cited limitations on participation were that FP was another department's responsibility (50%) and lack of multidisciplinary team (31%). Notably, lack of operative experience in benign ovarian and testicular procedures (0%) was not a limitation. All programs, regardless of participation in FP, noted that their fellows performed benign and malignant adnexal cases. Conclusion: Less than half of pediatric surgery training programs participate in FP initiatives, despite adequate advanced minimally invasive training of fellows to perform these procedures.

Global Health Opportunities in Pediatric Fellowships.

Interest in global health (GH) among pediatric residents continues to grow. GH opportunities in pediatric fellowship programs in the United States are poorly described. We aimed to evaluate GH offerings among accredited general and subspecialty pediatric fellowship programs and identify implementation barriers. This was a cross-sectional study by pediatric GH educators from the Association of Pediatric Program Directors Global Health Learning Community and the American Board of Pediatrics Global Health Task Force. Fellowship program directors and GH educators at accredited US pediatric fellowship programs were surveyed. Data were analyzed by using descriptive and comparative statistics. Data were obtained from 473 of 819 (57.8%) fellowship programs, representing 111 institutions. Nearly half (47.4%) offered GH opportunities as GH electives only (44.2%) or GH tracks and/or fellowships (3.2%) (GHT/Fs). Pretravel preparation and supervision were variable. Programs offering GH opportunities, compared to those without, were more likely to report that GH training improves fellow education (81.9% vs 38.3%; P < .001) and recruitment (76.8% vs 35.9%; P < .001). Since 2005, 10 programs with GHT/Fs have graduated 46 fellows, most of whom are working in GH. Of those with GHT/Fs, 71% believe national accreditation of GH fellowships would define minimum programmatic standards; 64% believe it would improve recruitment and legitimize GH as a subspecialty. GH experiences are prevalent in accredited US pediatric fellowship programs, and programs offering GH perceive that these opportunities improve fellow education and recruitment. Responses suggest that standards for GH opportunities during fellowship would be useful, particularly regarding pretravel preparation and mentorship for trainees.

Utility of Residency Milestones Reported to Fellowship Directors: A National Survey of Pediatric Fellowship Program Directors.

The Accreditation Council for Graduate Medical Education recently made available final residency Milestones for first-year fellows to fellowship program directors (FPDs). Usefulness of residency Milestones for fellows is unknown. Our objective was to determine how many pediatric FPDs downloaded final residency Milestones for their first-year fellows and FPD perspectives about usefulness of residency Milestones. Mixed methods survey of pediatric FPDs, assessing FPD use of residency Milestones for first-year fellows, and FPD opinions about utility of residency Milestones for fellowship, including during fellow recruitment. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using content analysis. The response rate was 67.8% (544 of 802). Only 39.3% (209 of 532) of FPDs downloaded final residency Milestones for their first-year fellows. Twenty-four percent (129 of 532) of all FPDs thought residency Milestones were useful. Forty-one percent (218 of 532) thought residency Milestones would be useful during recruitment; others believed this may harm applicants. Of FPDs that downloaded and reviewed residency Milestones, 27% (50 of 185) used them for individualized education. FPDs felt residency Milestones might allow for identification of trainee needs and baseline assessments, but thought that residency Milestones had limited usefulness during fellowship due to concerns about lack of validity evidence, relevance, and how Milestones are assessed and reported. Most FPDs find residency Milestones to be of limited utility for their fellows and do not use residency Milestones to tailor education for their first-year fellows. Improving relevance of residency Milestones to fellowship training, validity, and how Milestones are assessed and reported may improve their usefulness for fellow training.