Pediatric Fellowship Programs Research Articles

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.

29. FELLOWS ABROAD: NATIONAL LANDSCAPE OF GLOBAL HEALTH OPPORTUNITIES IN PEDIATRIC FELLOWSHIPS

Background In the past decade, interest in global health (GH) among graduating pediatric residents has grown. The availability of these opportunities can influence their ranking of fellowship programs. Current GH opportunities in pediatric fellowship programs in the United States (US) are not well described. Methods This was a cross-sectional study by pediatric GH educators including representatives from the Association of Pediatric Program Directors (APPD) GH Learning Community and the American Board of Pediatrics. Program directors and GH educators at US pediatric fellowship programs were surveyed using REDCap®. Data were analyzed using standard descriptive statistics. Results Data were collected from 473 of 819 (58%) eligible US pediatric fellowship programs representing 111 institutions across all APPD regions and ABP subspecialties. 47% offered GH training opportunities as either GH electives (n=209, 44%) or formal GH fellowships (n=15, 3%). There was variable pretravel preparation (Table 1) and supervision for research projects, with almost 20% of programs indicating a lack of GH faculty on fellows' scholarship oversight committees. Programs offering any GH opportunities, compared to those without, were more likely to report that available GH training improves fellow education (82% vs. 38%, p Conclusions GH experiences are an integral part of many US fellowship programs, and programs offering GH perceive that these opportunities improve the education and recruitment of fellows. Data suggest that standards for GH opportunities during fellowship training would be useful, particularly pertaining to pre-travel preparation, supervision, and mentorship for trainees.

Funding Sources and Perceived Financial Insecurity in Pediatric Subspecialty Fellowship Programs

ObjectiveShortages of pediatric subspecialists exist in many fields with insufficient recruitment of new fellows. The current system of funding graduate medical education is inadequate. We examined funding sources for trainee salary and educational expenses in pediatric fellowship programs, effects of funding constraints, and program characteristics associated with financial insecurity as reported by fellowship program directors (FPD). MethodsWe conducted a national survey of FPD between November 1, 2016 and February 9, 2017. We used multivariable logistic regression to examine the association between perceived financial insecurity, program characteristics, and funding sources for fellow salary. ResultsWe obtained data from 519 FPD, representing 14 different pediatric subspecialties. FPD reported that funding limitations restricted program size and educational resources in 22% and 36% of programs, respectively. Nineteen percent of FPD perceived funding of their program to be insecure. Programs with 7 or more fellows (OR .50 [95% CI .27–.90], P = .03) or hospital or graduate medical education/Children's Hospital graduate medical education funding (OR .58 [95% CI .35–.96], P = .04) were less likely to be perceived as insecure. Conversely, programs with extramural (OR 1.74 [95% CI 1.07–2.81], P = .03) or division funding (OR 1.70 [95% CI 1.02–2.82], P = .04) or in subspecialties with more than 25% unfilled positions or programs (OR 1.86 [95% CI 1.11–3.09], P = .02) were more likely to be perceived as insecure. ConclusionsPerceived financial insecurity of fellowship programs was strongly associated with program size, funding source, and unfilled positions, limiting recruitment and resources. Stable funding of fellowship programs is critical to maintain an adequate pediatric subspecialty workforce.

Pediatric Anesthesia

P ediatric Anesthesia: A Problem-Based Learning Approach by Lalwani et al provides a concise, problem-based learning methodology as an educational tool to build clinical knowledge and decision-making skills. The use of a problem-based learning approach for learners and consultants has shown to foster reflection through learning and experience and to improve clinical practice and patient care.1 This book is a valuable resource that sets out to undertake common pediatric conditions and approaches them in a way that fosters learning and knowledge retention for daily clinical practice and reference. Rather than focusing solely on the information, it helps the reader learn how to approach clinical problems. In this regard, it is a clinical resource that practitioners have likely been seeking and one that trainees would value during residency, fellowships, and current clinical practices. Several aspects of this book make it a unique resource for learning and set it apart from other textbooks in pediatric anesthesia. Most valuable is its incorporation of a problem-based learning educational format to engage the reader. Since the introduction of problem-based learning into medical curriculums in the late 1960s, it has been widely incorporated into medical education, but comparatively few textbooks use this as their primary method to facilitate learning. Lalwani et al use the problem-based learning format effectively in this respect with learning modules presented first as clinical cases and a series of directed questions that promote further inquiry followed by a concise detailed summary covering virtually all aspects that should be explored and answered about the clinical presentations. Finally, self-evaluation occurs through a series of multiple-choice questions followed by answers with provided rationales. This approach engages the reader to actively think through clinical presentations and problems, use cases and questions to facilitate self-study, and further synthesize knowledge through each detailed summary and self-examination. The true essence of evidence-based discussion takes place using case description and discussion, reflection, and evaluating one’s learning (which this book effectively demonstrates) throughout each section and chapter. Using this style of problem-based learning method is truly unique to this book and offers the reader a better opportunity to grasp the concepts and topics for knowledge assessment and retention. The authors and editors have outstanding qualifications and positions with involvement in various departments surrounding the subspecialty of pediatric anesthesiology including directors of pediatric fellowship programs and those with expertise in faculty development, education, and perioperative assessment testing. Most authors and editors contributing to this book have affiliations or direct clinical practices in major pediatric hospitals and academic institutions in the United States. The book covers a range of relevant topics to pediatric anesthesia training. Sections are broadly organized into 11 areas: prematurity and neonatal surgery; cardiovascular; thoracic; head, neck, and respiratory; neuromuscular and spine; gastrointestinal; renal and urinary; endocrine and metabolic system; hematologic system; pediatric pain; and miscellaneous topics. Within each section, the case-based learning modules and format are easy-to-read, and many sections provide adequate background information, definitions of clinical conditions, in-depth presentations of clinical cases and pathologies, differential diagnoses for presentations, anesthetic considerations specific to pediatric cases and conditions, and perioperative management in all stages of anesthesia care. Some sections could benefit from including more color pictures, figures, and summary tables to help satisfy those who learn best or retain knowledge from visual representation. Sections that included these components greatly facilitated knowledge retention of specific topics, and these were often helpful as a means to further explain or represent the text or content being discussed. Another suggestion in future additions or upcoming texts in this series would be to have the formatting within each section more standardized so that key components are consistently addressed and more uniform, which we understand is challenging when a large number of authors are writing the chapters. An electronic version is also available. Overall, we definitely recommend this book to others in our profession especially colleagues with an interest in or practicing pediatric anesthesia and as a supplemental resource for those with an existing knowledge of pediatric anesthesia practice. This will only enhance their current knowledge application to specialized pediatric conditions and presentations. In the future, we anticipate and look forward to this series continuing to expand on current books and topics and incorporating the problem-based learning style learning approach to other aspects in anesthesia practice including obstetrics, trauma, and critical care. This would surely benefit learners and practitioners at all stages of their training and careers. Stefanie Smulski, MDDepartment of Anesthesia and Pain MedicineThe Hospital for Sick ChildrenUniversity of TorontoToronto, Canada David Faraoni, MD, PhD, FAHADivision of Cardiac AnesthesiaDepartment of Anesthesia and Pain MedicineThe Hospital for Sick ChildrenUniversity of TorontoToronto, Canada[email protected]

39 - Funding Sources and Financial Insecurity in Pediatric Fellowship Programs

Background: Shortages of pediatric subspecialists exist in many fields accompanied by insufficient recruitment of new fellows. The current system of funding graduate medical education is inadequate. No prior studies have described the funding sources of pediatric fellowships or the effects of funding constraints, including financial insecurity.

Validity of Level of Supervision Scales for Assessing Pediatric Fellows on the Common Pediatric Subspecialty Entrustable Professional Activities.

Entrustable professional activities (EPAs) represent the routine and essential activities that physicians perform in practice. Although some level of supervision scales have been proposed, they have not been validated. In this study, the investigators created level of supervision scales for EPAs common to the pediatric subspecialties and then examined their validity in a study conducted by the Subspecialty Pediatrics Investigator Network (SPIN). SPIN Steering Committee members used a modified Delphi process to develop unique scales for six of the seven common EPAs. The investigators sought validity evidence in a multisubspecialty study in which pediatric fellowship program directors and Clinical Competency Committees used the scales to evaluate fellows in fall 2014 and spring 2015. Separate scales for the six EPAs, each with five levels of progressive entrustment, were created. In both fall and spring, more than 300 fellows in each year of training from over 200 programs were assessed. In both periods and for each EPA, there was a progressive increase in entrustment levels, with second-year fellows rated higher than first-year fellows (P < .001) and third-year fellows rated higher than second-year fellows (P < .001). For each EPA, spring ratings were higher (P < .001) than those in the fall. Interrater reliability was high (Janson and Olsson's iota = 0.73). The supervision scales developed for these six common pediatric subspecialty EPAs demonstrated strong validity evidence for use in EPA-based assessment of pediatric fellows. They may also inform the development of scales in other specialties.

Perceived Mentoring Practices in Developmental-Behavioral Pediatrics Fellowship Programs.

Junior physicians describe mentoring relationships as integral to their career development and success. Current evidence suggests that mentoring is under-utilized despite interest from trainees. The purpose of this study is to describe the mentoring practices in developmental-behavioral pediatric (DBP) fellowship programs and identify mentoring needs of DBP fellows and recent graduates. DBP fellows and recent graduates less than 5 years out of training from US-based DBP fellowship programs were contacted to complete a survey on their mentoring experiences in fellowship and early career. A total of 90 respondents completed the entire survey including 47 current DBP fellows and 43 recent graduates. Only 52% of respondents reported having a formal faculty mentor during their fellowship. Only 45% of recent graduates reported that they currently have a mentor, of those without a current mentor 83% said they would like to have a mentor. Adequate mentoring during fellowship was lowest for career development and research (34% and 27%). Satisfaction with mentoring was associated with having a formal mentor (p < .001) and receiving mentoring in multiple areas (p < .001). Qualitative responses suggested that effective mentoring addresses the mentee's career goals, provides insight into being a developmental-behavioral pediatrician, assists in navigating academics, and involves a personal relationship. Results suggest opportunities for improved mentoring in DBP fellowship programs, particularly in the areas of career development and research and that there is a significant need for mentorship among recent graduates. Findings from this study can inform program improvement in mentoring for DBP fellows and recent graduates.

Robotic surgery start-up with a fellow as the console surgeon

Objective: Owing to the encouraging data on fellowship training in robotic pyeloplasty and the documented benefits of robotic pyeloplasty, the aim of this study was to test the feasibility of starting up pediatric urological robotic surgery in a center with a limited case volume.Materials and methods: The operative parameters and clinical outcome of the first 25 robotic pyeloplasties performed were compared to data on open and laparoscopic procedures from the previous 5 year period. The fellow was the only console surgeon. An experienced non-robotic pediatric urologist was supervising at the patient site.Results: The learning curve was in accordance with previously published data on fellows. The median operating time in robotic surgery was 182 min and was significantly shorter than in laparoscopic surgery (median 250 min) and the postoperative inpatient length of stay was significantly shorter after robotic surgery (median 1 day) than after both laparoscopic (median 2 days) and open surgery (median 3.5 days). For robotic cases, postoperative renography showed either stable or increased function of the hydronephrotic kidney. The only complication was in one case with ureteral orifice edema after JJ-stent removal, requiring nephrostomy for 6 weeks.Conclusions: The benefits of overall shorter postoperative hospital stay after robotic pyeloplasty and faster operating time compared to the laparoscopic procedure are clearly in accordance with data from the recent literature. The fast learning curve for robotic pyeloplasty will allow pediatric urology fellowship programs to be integrated in the start-up phase of a pediatric robotic program even though the case material is limited. Operative success rates were in accordance with the gold standard of open surgery.

The African Pediatric Fellowship Training Program in Pediatric Pulmonology: A Model for Growing African Capacity in Child Lung Health.

Childhood respiratory diseases are the major cause of mortality and morbidity in African children. However, there is limited expertise in pediatric pulmonology in Africa. The African Pediatric Fellowship Program (APFP) was developed in the Department of Paediatrics and Child Health at the University of Cape Town in partnership with African academic institutions beyond South Africa to promote training of African child health professionals and to build capacity. From 2008 to 2016, 11 fellows have completed APFP training in pediatric pulmonology. Fellows have come from Kenya, Nigeria, Ghana, and Uganda. All but one returned to their home institutions, where they are building academic departments, improving clinical service delivery, growing research capacity, and advancing advocacy and policies to improve child lung health. In parallel, training of South African pediatric pulmonologists has been strengthened with a further nine South African fellows trained during this period. The African Pediatric Pulmonology program provides a highly successful model, with high retention of graduates in their home countries. The long-term goal is to grow African clinical capacity and strengthen services, research, training, and advocacy for child lung health in Africa.

The feasibility of implementing a communication skills training course in pediatric hematology/oncology fellowship

ABSTRACTCommunication skills are a competency highlighted by the Accreditation Council on Graduate Medical Education; yet, little is known about the frequency with which trainees receive formal training or what programs are willing to invest. We sought to answer this question and designed a program to address identified barriers. We surveyed pediatric fellowship program directors from all disciplines and, separately, pediatric hematology/oncology fellowship program directors to determine current use of formal communication skills training. At our institution, we piloted a standardized patient (SP)-based communication skills training program for pediatric hematology/oncology fellows. Twenty-seven pediatric hematology/oncology program directors and 44 pediatric program directors participated in the survey, of which 56% and 48%, respectively, reported having an established, formal communication skills training course. Multiple barriers to implementation of a communication skills course were identified, most notably time and cost. In the pilot program, 13 pediatric hematology/oncology fellows have participated, and 9 have completed all 3 years of training. Precourse assessment demonstrated fellows had limited comfort in various areas of communication. Following course completion, there was a significant increase in self-reported comfort and/or skill level in such areas of communication, including discussing a new diagnosis (p =.0004), telling a patient they are going to die (p =.005), discussing recurrent disease (p <.001), communicating a poor prognosis (p =.002), or responding to anger (p ≤.001). We have designed a concise communication skills training program, which addresses identified barriers and can feasibly be implemented in pediatric hematology/oncology fellowship.

Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey

V IEW F ROM THE A SSOCIATION OF P EDIATRIC P ROGRAM D IRECTORS Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey Geoffrey M. Fleming, MD; Michael M. Brook, MD; Bruce E. Herman, MD; Chris Kennedy, MD, PhD; Kathleen A. McGann, MD; Katherine E. Mason, MD; Pnina Weiss, MD; Angela L. Myers, MD, MPH From the Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tenn (Dr Fleming); University of California San Francisco, San Francisco, Calif (Dr Brook); Department of Pediatrics, Primary Children’s Hospital, University of Utah, Salt Lake City, Utah (Dr Herman); Children’s Mercy Kansas City, University of Missouri–Kansas City School of Medicine, Kansas City, Mo (Drs Kennedy and Myers); Department of Pediatrics, Duke University Medical Center, Durham, NC (Dr McGann); Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, Ohio (Dr Mason); and Department of Pediatrics, Yale University, New Haven, Conn (Dr Weiss) The authors declare that they have no conflict of interest. Address correspondence to Geoffrey M. Fleming, MD, Department of Pediatrics, Division of Critical Care Medicine, Vanderbilt University School of Medicine, 5112 DOT, 2200 Children’s Way, Nashville, TN 37232 (e-mail: geoffrey.fleming@vanderbilt.edu). A CADEMIC P EDIATRICS 2016;16:415–418 core program requirements: “The program director must devote a minimum of 0.5 FTE regardless of the size of the program.” 14 Core pediatric residency programs have recommendations for additional effort support in a graded increase on the basis of the size of the program and includes PDs, associate PDs, residency coordinators, and liaisons. Currently the “ACGME Program Requirements for Graduate Medical Education in the Subspecialties of Pediatrics” do not delineate any specific required time allotment for fellowship PDs but requires “sufficient pro- tected time.” 2 The goal of this study was to describe current time allotted for PDs in pediatric subspecialty fellowship training programs and to delineate the minimum time required for program administration to meet the regula- tions outlined by the ACGME. P EDIATRIC FELLOWSHIP TRAINING programs are the primary source of subspecialty practitioners who care for our nation’s children. There are 16 Accreditation Council for Graduate Medical Education (ACGME)-accredited pe- diatric subspecialties made up of 837 individual training programs that graduated over 8500 trainees from 2004 to 2013 in addition to those who graduated from combined board specialty programs that include a pediatric training component. 1 Explicit in the requirements for graduate medical education (GME) accreditation is the key role of the program director (PD), who is responsible for over- seeing all educational activities, assessing all trainee and faculty performance, maintaining and distributing all pro- gram policies and procedures, directing programmatic evaluation and process improvement, and monitoring compliance with all ACGME regulations. 2 Prior study has identified inadequate PD time as a barrier to complying with ACGME requirements in the nonpediatric subspe- cialties. 3 Dedicated administrative time has been identified as necessary for innovation and curricular design, and has been linked to ongoing accreditation by the ACGME. 4–12 The ACGME program requirements for core residency programs and many nonpediatric subspecialties now delin- eate program administration time requirements for PDs, associate PDs, and other support staff. The time allotted differs by specialty and varies in specification from hours per week to a percentage of total effort. 13 Current require- ments set forth by the ACGME range from 10% to 50% full-time equivalent (FTE) staff for the core medical and surgical specialties and for many of the subspecialty fel- lowships accredited by the American Board of Medical Specialties. For core pediatric residency programs, support of administrative efforts are specifically delineated in the A CADEMIC P EDIATRICS Copyright a 2016 by Academic Pediatric Association M ETHODS The study was conducted in 2 phases through the use of an anonymous national survey of fellowship PDs. An initial survey was created by the author group using a modified Delphi technique through 5 iterations and con- sisted of 23 items, including demographic data, definition of an FTE in the respondent’s institution, time allotted to administer the program, and the time needed by the respondent to administer their program. The survey was created in REDCap hosted by Vanderbilt University Med- ical Center. 15 This survey was distributed from August 20, 2013, to October 16, 2013, using the Association of Pediatric Program Directors (APPD) Fellowship Program Director (FPD) e-mail list. As a result of an initial low response rate, these data were considered pilot data. Volume 16, Number 5 July 2016

Defining the Role of a Pediatric Surgery Fellowship Program Director: Results of a National Cross-sectional Survey

Defining the Role of a Pediatric Surgery Fellowship Program Director: Results of a National Cross-sectional Survey

The African Pediatric Fellowship Program: Training in Africa for Africans.

Africa has a significant burden of childhood disease, with relatively few skilled health care professionals. The African Paediatric Fellowship Programme was developed by the Department of Pediatrics and Child Health at the University of Cape Town to provide relevant training for African child health professionals, by Africans, within Africa. Trainees identified by partner academic institutions spend 6 months to 2 years training in the Department of Pediatrics and allied disciplines. They then return to their home institution to build practice, training, research, and advocacy. From 2008 to 2015, 73 physicians have completed or are completing training in general pediatrics or a pediatric subspecialty. At 1 year posttraining, 98% to 100% are practicing back in their home institution. The impact of the returning fellows is evident from their practice interventions, research collaborations, and positions as stakeholders who can change health care policies. Thirty-three centers in 13 African countries are partners with the program, and the program template is now followed by other partner sites in Africa. Increasing and retaining the skills pool of African child health specialists is building a network of motivated, highly skilled clinicians who are equipped to advance child health in Africa.

Selection of subspecialty fellows in anesthesia for pediatric anesthesia: a national survey of program directors in the United States

Several studies have investigated the selection process for medical students, residents, and fellows across different specialties. Currently, the selection criteria used by pediatric anesthesia program directors to select prospective pediatric anesthesia fellows are unknown. To evaluate the criteria used by program directors in the selection of prospective pediatric anesthesia fellows in the United States. Survey responses were solicited from 51 pediatric anesthesia fellowship directors in the United States. Questions evaluated department demographic information, the importance of fellowship selection criteria, and program satisfaction with the Match process. Forty-two of 51 fellowship directors responded to the survey (a response rate of 82%). The personal statement was reported as extremely/very important for 30 of 42 (71%) program directors, while research experience and prior publications were reported as extremely/very important for 16 of 41 (39%) and 16 of 41 (39%) program directors, respectively. Programs that offered all the spots through the Match were smaller, median (IQR) number of fellows of 3 (2-6) compared to the ones that did not offer all the spots through the Match, 8 (2-12), P = 0.03. In contrast, no difference in program directors' satisfaction with the Match was detected between smaller (≤ 3 fellows) and larger programs (>3 fellows), P = 0.25. A minority of pediatric fellowship program directors rated prior research experience as an important factor in the selection of prospective fellows. The lack of emphasis on research qualities for fellows is potentially concerning for the future of our specialty.

Fellowship Program Directors Perspectives on Fellowship Training

BACKGROUND: Recently the American Board of Pediatrics has undertaken an effort to examine the components and structure of pediatric fellowship training. To provide the current status of training programs and the perspectives of those in positions of leadership regarding fellowship training, a study of all fellowship program directors in the United States was undertaken. METHODS: We conducted a mail survey of all 719 pediatric fellowship program directors in the United States. RESULTS: The response rate was 82.2%. Fellowship directors were almost evenly divided regarding whether they believe that there is a need to change the expected amount of clinical training time in their own subspecialty, with 51% stating the amount was appropriate and 48% believing it should be increased. Fewer than half (42%) of program directors believe that the amount of scholarly training time should be the same for all fellows in their subspecialty regardless of career path (ie, primarily clinical versus primarily research). The majority (58%) stated that regardless of career path, the required training for all fellows in their own subspecialty should remain 3 years. Only one-third of program directors strongly believed that quality improvement activities were an important component of fellowship training. CONCLUSIONS: Variation exists among fellowship program directors in their perceptions of the goals and structure of fellowship training. Determining the best way to both account for and recognize the specific nuances of each subspecialty, while maintaining a common set of standards for the profession, will be an important and ongoing effort into the future.

Improving pediatric radiology in India

India had a population of 1,259,271,000 in 2012, with 31% of its population composed of children younger than 15 years. In comparison, children younger than 15 compose 20% of the population in the United States and 16% in Canada. Despite the differences in this demographic, little emphasis is placed on pediatric radiology in India. To conduct a needs assessment evaluating the adequacy of pediatric radiology in India and to establish a pediatric radiology education program in India. We developed a questionnaire to assess radiologists' perspective on the quality of training in pediatric radiology. Responses were obtained from attendees at a pediatric radiology education program in Mumbai. These data were used to obtain funding and implement a program to increase awareness and stimulate pediatric radiology training at select institutions across India. Out of 86 respondents, 82% indicated that their academic institutions did not place emphasis on dedicated pediatric radiology training, and 63% indicated they received less than 2 weeks of dedicated training. Of the respondents, 77% said their institutions practiced pediatric radiology with inadequate standard of care and 75% of respondents said pediatric radiology would gain increasing importance in the future. Outcomes of the implemented program included increased awareness of pediatric radiology and establishment of a pediatric radiology fellowship program in India. Education and training in pediatric radiology in India is inadequate. Focused initiatives have the potential to improve the standards set for pediatric radiology in India. Similar initiatives could help develop pediatric radiology in other developing countries.

Pediatric Dermatology Training Survey of United States Dermatology Residency Programs

Variability exists in pediatric dermatology education for dermatology residents. We sought to formally assess the pediatric dermatology curriculum and experience in a dermatology residency program. Three unique surveys were developed for dermatology residents, residency program directors, and pediatric dermatology fellowship program directors. The surveys consisted of questions pertaining to residency program characteristics. Sixty-three graduating third-year residents, 51 residency program directors, and 18 pediatric dermatology fellowship program directors responded. Residents in programs with one or more full-time pediatric dermatologist were more likely to feel very competent treating children and were more likely to be somewhat or extremely satisfied with their pediatric curriculums than residents in programs with no full-time pediatric dermatologist (50.0% vs 5.9%, p = 0.002, and 85.3% vs 52.9%, p < 0.001, respectively). Residents in programs with no full-time pediatric dermatologist were the only residents who were somewhat or extremely dissatisfied with their pediatric training. Residency program directors were more satisfied with their curriculums when there was one or more pediatric dermatologist on staff (p < 0.01). Residents in programs with pediatric dermatology fellowships were much more likely to report being extremely satisfied than residents in programs without a pediatric dermatology fellowship (83.3% vs 21.2%; p < 0.001). The results of this survey support the need for dermatology residency programs to continue to strengthen their pediatric dermatology curriculums, especially through the recruitment of full-time pediatric dermatologists.

Pediatric Infectious Diseases Fellowship Training in Healthcare Epidemiology A National Needs Assessment

Pediatric infectious diseases (ID) fellows are required to receive training in hospital epidemiology and infection control and prevention. We sought to assess the current state of healthcare epidemiology training for fellows and to determine which topics are considered important by key stakeholders. US pediatric ID fellowship program directors and hospital epidemiologists. We conducted an anonymous Web-based survey in February 2012. We assessed the presence and content of curricula, perceived importance of specific topics, and barriers to career development. Of 97 eligible participants, 76 (78%) completed the survey, representing 54 programs. Respondents were program directors (60%), hospital epidemiologists (25%), or both (15%). A total of 82% of programs with didactic curricula have infection control sessions, most commonly 1-2 hours in total duration. Of 17 identified topics, only 3 were covered by more than 50% of programs: isolation precautions (54%), central line-associated bloodstream infection (CLABSI; 53%), and hand hygiene (51%). Of the 76 respondents, 35% indicated that fellows participate in a dedicated infection control rotation. Six topics were considered very important by more than 75% of respondents: antimicrobial stewardship (94%), isolation precautions (93%), hand hygiene (90%), CLABSI (90%), surveillance for resistant bacteria (81%), and communicable disease exposure management (81%). Pediatric ID fellowship programs dedicate little time to didactic or experiential learning in healthcare epidemiology. There are a wide array of topics that the majority of programs do not cover, including several subjects that are considered to be very important by program directors and hospital epidemiologists. Creating a standardized pediatric infection control curriculum would likely benefit fellows in training.

Council of Pediatric Subspecialties (CoPS): The First Five Years

The Council of Pediatric Subspecialties (CoPS) was founded in September 2006 largely due to concerns about the nonuniformity of the fellowship application process. Working with the pediatric subspecialty community, CoPS has been successful in promoting a uniform process with many more pediatric fellowship programs now using a matching program and the Electronic Residency Application Service. More important, the organization has created a bidirectional network of communication among the pediatric subspecialties and has used this to accomplish a great deal more than improving the entry of residents into subspecialty training. CoPS has provided a united voice for the subspecialties in response to the Institute of Medicine's Duty Hours report, participated in the development of educational conferences geared toward the subspecialist, promoted careers in the subspecialties, and worked with other pediatric organizations to advocate for improved health care for children. This article highlights CoPS' many achievements and describes the methods it used to accomplish them, illustrating how pediatric subspecialists can develop a communication network and use this to work together to achieve common goals.

Tracking the Careers of Academic General Pediatric Fellowship Program Graduates: Academic Productivity and Leadership Roles

Objective Little is known about the careers of graduates of academic general pediatric (AGP) fellowship programs. We evaluated the careers of 2 cohorts of AGP fellowship graduates: an early cohort trained during 1978 to 1988, and a later cohort trained during 1989 to 1999. Methods We surveyed all known AGP fellowship graduates in both cohorts by using a confidential mailed survey. We assessed graduates' current professional work and analyzed curricula vitae for principal investigator (PI) grants; first-authored, peer-reviewed publications; and leadership positions. Results From the early cohort, 95 of 131 eligible graduates (73%) responded; from the later cohort, 93 of 133 (70%) responded. Two thirds of each cohort remain in academics; of these, nearly half are on tenure tracks and over half have major educational roles within their university. The percentage in the early cohort who have been PI on a research grant by 5, 10, and 15 years postfellowship was 44%, 53%, and 54%, respectively; in the later cohort, it was 62%, 75%, and 75%, respectively ( P = .004 vs early cohort). During the 10 years postfellowship, the early and later cohorts averaged 5.5 and 7.4 first-authored, peer-reviewed papers, respectively ( P = .4). By 10 years, a high proportion of both cohorts had become division chief (19% vs 16%), had other academic leadership positions (43% vs 59%), or were leaders in professional organizations (20% vs 30%; all P = NS). Conclusions Graduates of AGP fellowship programs have achieved considerable academic success. Recently trained fellows appear even more successful. The academic outcomes of these AGP fellows bode well for the future of AGP.