Percent Of Fellows Research Articles

Which obstetrics-gynecology residency programs are training future reproductive endocrinology and infertility fellows? An observational study

To identify where reproductive endocrinology and infertility (REI) fellows trained for residency. Observational, cross-sectional study. Not applicable. Reproductive endocrinology and infertility fellows. Not applicable. Percentage of fellows who completed residency training at an institution with an REI fellowship program. A total of 289 fellows were identified among the graduating fellowship classes from 2023-2027. Of those fellows, 69.9% completed residency at an institution that had an associated REI fellowship program, and 19.7% remained at the same institution for residency and fellowship. In the last 5 years, 34.4% of obstetrics and gynecology residency programs have had at least 1 resident enter REI fellowship. Most matriculated REI fellow physicians train at residency programs that have an associated REI fellowship program.

Gender, Race, and Ethnicity in Critical Care Fellowship Programs in the United States From 2016 to 2021.

The purpose of this study is to determine the trends in gender, race, and ethnicity of U.S. critical care fellowships over the past 6 years (2016-2021). Data on gender, race, and ethnicity of critical care fellows in five Accreditation Council on Graduate Medical Education-accredited training programs (internal medicine, pulmonary and critical care, anesthesiology, surgery, and pediatrics) from 2015 to 2016 to 2020-2021 were obtained from the joint reports of the American Medical Association (AMA) and Association of American Medical Colleges published annually in the Journal of the AMA. From 2016 to 2021, the number of U.S. critical care fellows increased annually, up 23.8%, with the largest number of fellows in pulmonary critical care medicine (60.1%). The percentage of female critical care fellows slightly increased from 38.7% to 39.4% (p = 0.57). White fellows significantly decreased from 57.4% to 49.3% (p = 0.0001); similarly, Asian fellows significantly decreased from 30.8% to 27.5% (p = 0.004). The percentage of Black or African American fellows was not statistically significantly different (4.9% vs 4.4%; p = 0.44). The number of fellows who self-identified as multiracial significantly increased from 52 (1.9%) to 91 (2.7%) (p = 0.043). The percentage of fellows who identified as Hispanic was not significantly different (6.7% vs 7.5%; p = 0.23). The percentage of women and racially and ethnically minoritized fellows (Black and Hispanic) remain underrepresented in critical care fellowship programs. Additional research is needed to better understand these demographic trends in our emerging critical care physician workforce and enhance diversity.

P0675 / #906: PEDIATRIC CRITICAL CARE FELLOW ENGAGEMENT WITH AN OPEN-ACCESS E-LEARNING RESOURCE

Aims & Objectives: Pediatric critical care medicine (PCCM) fellows must provide acute, complex clinical care while addressing numerous knowledge gaps, and so may particularly benefit from online educational support. Limited data illustrate the e-learning behaviors or interests of PCCM fellows specifically. Such information may help guide design and targeting of educational interventions. To explore this, we characterized PCCM fellow usage of OPENPediatrics, a worldwide open-access e-learning resource, from June 2018 through June 2019. Methods: IRB-approved retrospective analysis of automatically collected activity log data from users who self-identified as PCCM fellows. The most popular resources (based on percent of fellows who accessed the resource) are reported. Timestamps were used to calculate the duration of time spent by individual users on the website. Results: 299 fellows from 39 countries were included. The distribution of time spent on the site was bimodal, with 105/299 (35%) of users logging <=60 minutes on the site in the analyzed interval, and 100/299 (33%) logging >=240 minutes (Figure 1). These users accessed an average of 9 resources on the site (range 1-89). Table 1 reports the most frequently accessed resources by this cohort of users.Conclusions: The majority of PCCM fellows spent at least 30 minutes on the site. Over 33% of included fellows spent >=4 hours using the site in one year. Courses and simulators were especially popular. Specific popular items included PCCM fellowship-specific curricula, materials for cardiology and congenital heart disease, and interactive online simulators teaching mechanical ventilation and hemodialysis. Our findings can help shape educational interventions and strategies for PCCM fellows.

A multicentered academic medical center experience of a simulated root cause analysis (RCA) for hematology/oncology fellows.

188 Background: Quality improvement and patient safety education is an Accreditation Council for Graduate Medical Education (ACGME) common program requirement for hematology/oncology fellowships. Specifically, the ACGME requires trainee participation in interprofessional clinical patient safety activities, such as root cause analyses. These can be challenging to incorporate into busy schedules and are intimidating to some trainees, but simulated RCAs are a novel way to assure trainees gain important patient safety skills. We report on a multicentered experience utilizing a simulated RCA educational module in an attempt to provide fellows with the tools needed to participate in a live RCA and to increase awareness of the need to analyze patient safety events. Methods: The two-hour module included a didactic session explaining the basics of an RCA including common terminology, effective chart review, and personal interviews. The fellows assessed a patient safety event of a missed coagulopathy and created an event flow map and fishbone analysis. They then formed root cause/contributing factor statements and proposed a solution. Seventeen fellows from two institutions completed pre- and post-session surveys regarding the experience. Results: There was a 47% increase in both the percentage of fellows who felt comfortable participating in live RCAs in the future, and in the number of fellows who felt comfortable with using the tools typically utilized in an RCA. 70.59% of respondents felt that as a result of the mock RCA, they were more likely to report a near miss or adverse event. Conclusions: Mock RCAs are a feasible method of incorporating ACGME-required patient safety activities into hematology/oncology fellow education and are effective in increasing their comfort and understanding of important quality improvement skills

Preferences and comfort of maternal fetal medicine fellows in the United States with operative vaginal deliveries

Objective The objective of this study was to determine the current landscape of vacuum and forceps-assisted vaginal delivery (FAVD) preferences and comfort across maternal fetal medicine (MFM) fellows in the United States (U.S.). Methods A survey was sent to MFM fellowship program directors for distribution to current MFM fellows across U.S. Geographic regions, as determined using Census Bureau-designated regions. The survey looked at comfort and experience with FAVDs and vacuum-assisted vaginal deliveries (VAVD) throughout their post-graduate training. Descriptive statistics were used to analyze survey responses. Respondents were compared by post-graduate year (PGY) and region. Results One hundred six MFM fellows (32%) completed the survey. 22.6% of MFM fellows had performed greater than 30 FAVDs, with 33% having performed ≤10 FAVDs. In comparison, 35.8% of fellows had performed more than 30 VAVDs. While 95.2% of fellows feel prepared to perform a VAVD independently, only 59.4% feel prepared to do FAVDs independently. Never the less, 53% of MFM fellows favor performing a FAVD. While some regional differences were seen, there was no significant difference in the percent of fellows by geographic region who have performed >30 FAVD (p = .87). MFM fellows in the West are most likely to have performed >30 FAVD at 57.8%, compared to 42.3, 35, and 11.4% in the Midwest, South, and Northeast, respectively. Conclusion MFM fellows are more confident with VAVD compared to FAVD. Despite feeling less confident performing FAVD (versus VAVD), the majority of MFM fellows feel comfortable performing FAVDs independently. Region of training fellowship training does not significantly affect one’s confidence in FAVDs. A coordinated nationwide effort to increase exposure to and confidence for FAVDs should be considered.

Focused Research Infrastructure for Postgraduate Pediatric Emergency Medicine Fellows Increases Dissemination of Scholarly Work.

Many fellows in clinically driven subspecialties may have difficulty completing and publishing their scholarly projects due to lack of prior experience in research, selection of projects that are difficult to complete during fellowship, or mentorship challenges. This may be particularly true in pediatric emergency medicine (PEM) because research time may be longitudinally integrated with clinical rotations, rather than blocked as is common in other subspecialties. We describe the creation and outcomes of a structured program to increase academic productivity of PEM fellows. This was a retrospective cohort study of scholarly productivity (publications in peer-reviewed journals, presentation at national meetings) for PEM fellows over 17years in one fellowship program, before and after the implementation of a structured program. We reviewed obstacles to publication for prior fellow projects when developing the curriculum. Our multifaceted program consisted of milestone development, four in-person committee meetings, and abstract and manuscript development workshops. We utilized existing faculty members, most of whom were junior faculty, as committee members. Our primary outcome was the percentage of fellows who were first authors for peer-reviewed publications for their fellowship projects. National conference presentations were the secondary outcome. Data for 76 PEM fellows were eligible for analysis: 44 (58%) before and 32 after programmatic implementation. There was a statistically significant increase in the percentage of fellows who published their studies (32% vs. 63%; odds ratio [OR]= 3.6, 95% confidence interval [CI]= 1.4 to 9.3) after programmatic implementation. There were no differences in conference presentations (45% vs. 63%; OR= 2.0, 95% CI= 0.8-5.1) after implementation. Utilizing a small group of existing, predominantly junior faculty members, we created a structured program that enhanced PEM fellows' scholarly productivity and increased publications. We believe that this model is sustainable for and generalizable to other PEM fellowship programs.

522 Is the Future of Gastroenterology Being Prepared to Prevent Work Related Injuries and Allow for a Long Healthy Career: Question Answered

INTRODUCTION: Gastroenterologists practicing in the United States perform on average 12 endoscopies and 22 colonoscopies per week and spend 43% of their time performing endoscopy. 39-89% of endoscopists report pain and/or injuries related to performing procedures. Recently, there has been an emphasis on optimizing physician trainee mental health, while education and training on managing the physical strain associated with endoscopy is lacking. We hypothesized that gastroenterology fellows are receiving insufficient training in the ergonomics of endoscopy. METHODS: A survey consisting of nine questions was distributed to all gastroenterology fellowship coordinators and program directors to distribute to their fellows. Primary outcome targets were the percentage of fellows having undergone any ergonomics training as well as the number of hours of instruction received. Secondary outcomes included the type of work-related injury and the responder's opinion on the need for additional training. Demographic data obtained included age, sex, year in training and overall physical fitness level. RESULTS: Ninety-nine fellows completed the survey. The average age was 32.9 years old, 74.8% male, and first/second/third years were equally represented (28.3% vs 34.3% vs 32.3%) with only 5.1% being advanced fellows (5.1%). 53.5% reported good overall health. Only 45.5% have received any training in ergonomics, 8.1% reported more than 2 hours and 92.9% felt they would benefit from additional training. Procedurally related injuries were reported in 27.3% of fellows. Despite a trend towards more females reporting work related injuries it was not statistically significant (P = 0.098). Once again, a trend was seen in second and third years reporting more injuries (P = 0.076). There was no significant difference in perceived health of respondents reporting injuries (P = 0.864) or amount of training received (P = 0.232). CONCLUSION: Despite a limited sample size clear trends in endoscopic ergonomics training were identified. The majority of fellows have received no or minimal training and an overwhelming amount believe that they would benefit from additional instruction. With more than 25% of fellows reporting an injury as a direct result of endoscopy, if no changes are made in training curriculum we can assume this number will grow as their careers progress. Our survey demonstrated a need and desire for more formal training in the ergonomics of endoscopy.

Endoscopy-related musculoskeletal injuries in gastroenterology fellows.

Background and study aims Gastroenterologists are at high risk for work-related musculoskeletal injuries. Studies have shown that 37 % to 89 % of endoscopists have work-related musculoskeletal injuries. While all surveys until now have focused on practicing endoscopists, there have been no publications assessing the prevalence of musculoskeletal injuries among gastrointerology fellows, which we sought to investigate. Methods A 22-question survey about ergonomics and work-related musculoskeletal injuries was sent to 114 gastroenterology fellows in different programs across the United States in June 2016, and an additional 103 surveys were distributed at Digestive Disease Week in May 2017. Responses were collected, and data were analyzed. Results A total of 156 surveys were collected. Of these, 74 fellows (47 %) reported a new musculoskeletal injury related to endoscopy. Injuries occurred mostly in the first year of fellowship (85 %, P < 0.001). The most common sites of injury were the right wrist (53 %), left thumb (42 %), back (27 %), and neck (22 %). Only 26 % those who had endoscopy-related musculoskeletal injuries had received training in ergonomics compared to 45 % of those who did not have injury ( P = 0.012), and ergonomics training was highly desirable among respondents, particularly among those with previous injuries ( P = 0.0030) Conclusion Musculoskeletal injuries related to endoscopy are very common among gastroenterology fellows, particularly during the first year of fellowship. While the overall percentage of fellows who received training in ergonomics was low, those who did receive training were less like to report a musculoskeletal injury. There is an urgent need for ergonomics training among Gastroenterology fellows.

Forceps-Assisted Vaginal Deliveries: What Is the Training Landscape of Current MFM Fellows? [7I

INTRODUCTION: The goal of this study is to determine the current landscape of forceps-assisted vaginal delivery (FAVD) training across the United States (U.S.) amongst MFM fellows. METHODS: An online survey was created on REDCap and sent to MFM Fellowship Program Directors for distribution to current MFM fellows in the U.S. Geographic regions were determined using Census Bureau-designated regions. RESULTS: The survey was completed by 106 MFM fellows (42% of U.S. fellows). Only 22.6% of fellows had performed >30 FAVDs, with 33% having performed ≤10 FAVDs. In comparison, 35.8% of fellows had performed more than 30 vacuum-assisted vaginal deliveries (VAVD). While 95.2% of fellows feel prepared to perform a VAVD independently, only 59.4% feel prepared to do FAVDs independently. Nonetheless, 53% of MFM fellows favor performing a FAVD. There is no significant difference in the percent of fellows by geographic region who have performed >30 FAVD (P=0.87). MFM fellows in the West are most likely to have performed >30 FAVD at 57.8%, compared to 42.3%, 35% and 11.4% in the Midwest, South and Northeast, respectively. CONCLUSION: MFM fellows are more confident with VAVD compared to FAVD. Despite lower confidence with FAVD, the majority of MFM fellows feel comfortable performing FAVDs independently. Region of training does not significantly affect one's training in FAVDs. A coordinated nationwide effort to increase exposure to and confidence for FAVDs should be considered.

Variability in structure of university pulmonary/critical care fellowships and retention of fellows in academic medicine.

Individual fellowship programs are challenged to find a format of training that not only meets the Accreditation Council for Graduate Medical Education requirements, but also grooms fellows to be trusted clinicians, and encourages them to enter academic careers. This study was undertaken as part of an internal effort to evaluate and revise the program structure of the pulmonary/critical care medicine fellowship at the Medical University of South Carolina. Our objectives were to characterize variation in the training structure and specifically research opportunities of university pulmonary/critical care medicine fellowship programs, and to identify factors associated with fellow retention in academic medicine and research. A 30-item survey was developed through rigorous internal review and was administered via email. Descriptive statistics, Cronbach's alpha, correlations, Wilcoxon sign-rank test, and ANOVA were carried out. We had a response rate of 52%. Program directors reported that, within the past 5 years, 38% of their fellows remained in academic medicine and 20% remained in academics with significant research focus. We found a statistically significant association between obtaining a master's degree and remaining in academics (r = 0.559; P < 0.008). The survey also revealed statistically significant relationships between scholarly requirements (grant proposals, peer-reviewed original research projects) and the percent of fellows who graduated and remained in academics. This survey offers some insights that may be useful to fellowship program directors. In particular, advanced education in research and maximizing scholarly activities might be associated with increased academic retention among fellowship trainees.

Improving knowledge and process for international emergency medicine fellowship applicants: a call for a uniform application.

Background. There are currently 34 International Emergency Medicine (IEM) fellowship programs. Applicants and programs are increasing in number and diversity. Without a standardized application, applicants have a difficulty approaching programs in an informed and an organized method; a streamlined application system is necessary. Objectives. To measure fellows' knowledge of their programs' curricula prior to starting fellowship and to determine what percent of fellows and program directors would support a universal application system. Methods. A focus group of program directors, recent, and current fellows convened to determine the most important features of an IEM fellowship application process. A survey was administered electronically to a convenience sample of 78 participants from 34 programs. Respondents included fellowship directors, fellows, and recent graduates. Results. Most fellows (70%) did not know their program's curriculum prior to starting fellowship. The majority of program directors and fellows support a uniform application service (81% and 67%, resp.) and deadline (85% for both). A minority of program directors (35%) and fellows (30%) support a formal match. Conclusions. Program directors and fellows support a uniform application service and deadline, but not a formalized match. Forums for disseminating IEM fellowship information and for administering a uniform application service and deadline are currently in development to improve the process.

Lack of a Uniform Approach to Clinical Research Training for Hematology Oncology Fellows

Preparing hematology/oncology clinical investigators is a major challenge for the advancement of translational cancer research. The goal of this study was to evaluate the experience of fellowship programs in this area. We conducted a cross-sectional study using an electronic survey e-mailed to the listserv members of the hematology/oncology fellowship program directors (130 members). The survey included questions about the program type, size and duration, length of designated research time (mandatory or elective), fellows' participation in study development and/or conduction, and the different training opportunities offered. A total of 38 surveys were completed (one formally declined). The mean number of fellows per program was 8 (range, 3-14). Research training was mandatory in 17 programs (45 %), with a variable number of months spent (range, 2-12). The percentage of fellows who participated in a study design was 51%, collected and analyzed data was 50%, and presented at national meetings such as the American Society of Clinical Oncology, the American Association of Cancer Research, or the American Society of Hematology was 31%. Training programs offered training in research using didactic lectures in 72%, workshops in 75%, 1-to-1 mentoring in 81%, and other strategies in 14%. The percentage of graduating trainees in the last 3 years who pursued academic career was 24% versus private practice at 75%. Training hematology/oncology investigators was variable and inconsistent among the fellowship programs. The need of establishing curriculum and clear approach to such training is critically required.