Second-year Fellows Research Articles

Consistency of ablations with trainee and increasing independence during fellowship training-Analysis of ablation data by CARTONET.

Training in clinical cardiac electrophysiology (CCEP) involves the development of catheter handling skills to safely deliver effective treatment. Objective data from analysis of ablation data for evaluating trainee of CCEP procedures has not previously been possible. Using the artificial intelligence cloud-based system (CARTONET), we assessed the impact of trainee progress through ablation procedural quality. Lesion- and procedure-level data from all de novo atrial fibrillation (AF) and cavotricuspid isthmus (CTI) ablations involving first-year (Y1) or second-year (Y2) fellows across a full year of fellowship was curated within Cartonet. Lesions were automatically assigned to anatomic locations. Lesion characteristics, including contact force, catheter stability, impedance drop, ablation index value, and interlesion time/distance were similar over each training year. Anatomic location and supervising operator significantly affected catheter stability. The proportion of lesion sets delivered independently and of lesions delivered by the trainee increased steadily from the first quartile of Y1 to the last quartile of Y2. Trainee perception of difficult regions did not correspond to objective measures. Objective ablation data from Cartonet showed that the progression of trainees through CCEP training does not impact lesion-level measures of treatment efficacy (i.e., catheter stability, impedance drop). Data demonstrates increasing independence over a training fellowship. Analyses like these could be useful to inform individualized training programs and to track trainee's progress. It may also be a useful quality assurance tool for ensuring ongoing consistency of treatment delivered within training institutions.

Development of a neonatal cardiac curriculum for neonatal-perinatal medicine fellowship training.

The topic of neonatal cardiovascular care in neonatal-perinatal medicine (NPM) fellowship training has continued to transform due to increased complexity of patients, development of specialized units, continued Accreditation Council for Graduate Medical Education requirements, and clinical practice variation across centers that care for neonates with congenital heart disease (CHD). We developed a neonatal cardiac curriculum comprised of eight interactive sessions with novel active learning concepts specific to our NPM fellows. A self-assessment survey in comfort in managing infants with CHD and perceived competency in neonatal cardiology topics was performed by all neonatology fellows at baseline and after completion of the curriculum. The American Board of Pediatrics Subspecialty In-training Exam (SITE) scores for fellows were compared to that of the national average. The average comfort score (0-100) of the first-year fellows increased from 33 to 76, and that of the second and third-year fellows increased from 72 to 86, and 75 to 86, respectively. The first-year fellows improved their competency score by 44 points (3 standard deviations), the second-year fellows improved their score by about 26 points (one standard deviation), and there was an overall 9-point increase in the competency score of all fellows (one standard deviation). The average local SITE score was lower than the national average before the initiation of this curriculum, became nearly equal to the national average score at the end of the first year the curriculum was implemented, and has progressively become higher since then. Due to the variable clinical exposure and differing practice models of managing CHD a neonatal cardiac curriculum may be beneficial to NPM trainees.

Evaluating Inpatient Care Team Models in Hematology and Oncology Fellowship Programs in the United States

Introduction. In response to a growing and increasingly older population with complex medical needs, the hematology and oncology (HO) care system has integrated the hospitalist model into inpatient systems alongside HO trainees and faculty. The inclusive workforce is comprised of hospitalists and advanced practice providers (APPs) who co-manage patients with specialists or form separate non-trainee (NT) teams. Despite multiple advantages of the hospitalist model, the optimal care team structure and the impact on HO fellowship training have not been previously explored. We aimed to survey HO fellowship programs in the United States to identify the structure of inpatient HO staffing models implemented at their institution, and collect data on perceptions of the NT model within the fellowship programs. Methods. We constructed and distributed two national web-based surveys targeting all adult HO fellowship program directors (PDs) and fellows from Accreditation Council for Graduate Medical Education (ACGME)-accredited programs. The surveys were designed to assess various aspects of HO inpatient services, including team compositions, individual responsibilities, and availability of NT services. We also assessed the PDs' and fellows' perception on the impact of NT teams on their training and education. The surveys were emailed weekly between 6/20/23-7/29/23. Results.We identified 147 HO training programs.A total of 35 PDs and 101 fellows responded our survey (Table 1). The majority of PDs (83%) were from university training programs in the Midwest (43%) and Northeast (33%), with fellow class sizes of 6-12 (47%). Most (67%) programs had both trainee (T) and NT teams included in their inpatient medicine models (Figure 1). The most commonly reported NT team was the bone marrow transplant and cellular therapy service (BMT) (57%), supported primarily by APPs (55%). Only 33% of respondents reported a dedicated sickle cell disease (SCD) inpatient team within their institution. Hospitalists were included in the care model of the inpatient oncology (27%), inpatient malignant hematology (23%) and SCD (13%) teams. Most PDs agreed that the fellows are primarily responsible for most inpatient tasks and over 50% agreed that APPs are responsible for direct patient care, admissions and discharge planning. 83% of PDs reported that their program had an appropriate balance between inpatient and outpatient care. Half (50%) of PDs reported that fellows had a positive perception of NT teams at their institution, and 35% were neutral. The fellows who responded were predominantly second-year fellows (43%) in Northeastern (43%) university hospitals (92%) from programs with 6-12 fellows (63%). Most (71%) respondents had both T and NT teams included in their inpatient model. Inpatient malignant hematology (53%) and inpatient solid oncology (53%) teams were the most commonly reported NT teams, followed by BMT (40%) (Figure 1). Fellows reported their primary responsibilities to include procedures and tumor board discussions (94%), communication with outpatient teams (91%) and resident education and supervision (89%). APPs were primarily responsible for discharge planning (63%), admissions (59%) and direct patient care (58%). Most (85%) fellows agreed that their program had an appropriate balance between inpatient and outpatient care. Most fellows (69%) reported the impact of NT teams on fellows' inpatient and training experience to be neutral. Fellows from institutions without NT teams responded that the addition on NT team would have a positive impact in their training experience (69%). Most PDs and fellow respondents perceived a financial barrier to the implementation of NT teams at their institutions. Conclusions.Our findings highlight the existing heterogeneity in the distribution and composition of services among HO programs nationwide. PD respondents and fellows without NT teams perceived these teams as a beneficial addition to the program, in contrast to fellows in programs with existing NT teams who reported a neutral impact. Further investigation of the reasons for this discrepancy is essential to identify areas of improvement. Additional insights from the ongoing survey will be presented during the meeting.

APA Foundation Welcomes 2023 Class of Fellows

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA Foundation Welcomes 2023 Class of FellowsSearch for more papers by this authorPublished Online:24 May 2023https://doi.org/10.1176/appi.pn.2023.06.7.13The American Psychiatric Association Foundation has announced the names of its 2023 class of fellows. With a total of 116 members, the 2023 class is its largest ever, as well as its most diverse—over 77% of participants self-identify as people of color, 61% as women, and 24% as LGBTQ+.The APA Foundation Resident Fellowship Program complements psychiatry residency training by providing experiential learning, mentorships, and professional development opportunities. Twenty-seven U.S. states and 80 medical institutions are represented in this class.“We couldn’t be more excited to add this impressive class into our community of fellows and fellowship alumni at this critical time in mental health care,” said APA Foundation Executive Director Rawle Andrews Jr., Esq. “This cohort has already proven themselves to be a valuable source of talent and innovation. The future of psychiatry is in good hands.”Each fellow participates in one of nine fellowships on such topics as child and adolescent psychiatry, psychiatric research, and public psychiatry. They will join 61 second-year fellows for a total of 177. ■The names of the fellows. ISSUES NewArchived

Early findings and strategies for successful implementation of SIMPL workplace-based assessments within vascular surgery residency and fellowship programs

ObjectiveAs medical education systems increasingly move toward competency-based training, it is important to understand the tools available to assess competency and how these tools are utilized. The Society for Improving Medical Professional Learning (SIMPL) offers a smart phone-based assessment system that supports workplace-based assessment of residents’ and fellows’ operative autonomy, performance, and case complexity. The purpose of this study was to characterize implementation of the SIMPL app within vascular surgery integrated residency (0+5) and fellowship (5+2) training programs. MethodsSIMPL operative ratings recorded between 2018 and 2022 were collected from all participating vascular surgery training institutions (n = 9 institutions with 5+2 and 0+5 programs; n = 4 institutions with 5+2 program only). The characteristics of programs, trainees, faculty, and SIMPL operative assessments were evaluated using descriptive statistics. ResultsOperative assessments were completed for 2457 cases by 85 attendings and 86 trainees, totaling 4615 unique operative assessment ratings. Attendings included dictated feedback in 52% of assessments. Senior-level residents received more assessments than junior-level residents (postgraduate year [PGY]1-3, n = 439; PGY4-5, n = 551). Performance ratings demonstrated increases from junior to senior trainees for both resident and fellow cohorts with “performance-ready” or “exceptional performance” ratings increasing by nearly two-fold for PGY1 to PGY5 residents (28.1% vs 40.6%), and from first- to second-year fellows (PGY6, 46.7%; PGY7, 60.3%). Similar gains in autonomy were demonstrated as trainees progressed through training. Senior residents were more frequently granted autonomy with “supervision only” than junior residents (PGY1, 8.7%; PGY5, 21.6%). “Supervision only” autonomy ratings were granted to 21.8% of graduating fellows. Assessment data included a greater proportion of complex cases for senior compared with junior fellows (PGY6, 20.9% vs PGY7, 26.5%). Program Directors felt that faculty and trainee buy-in were the main barriers to implementation of the SIMPL assessment app. ConclusionsThis is the first description of the SIMPL app as an operative assessment tool within vascular surgery that has been successfully implemented in both residency and fellowship programs. The assessment data demonstrates expected progressive gains in trainees’ autonomy and performance, as well as increasing case complexity, across PGY years. Given the selection of SIMPL as the assessment platform for required American Board of Surgery and Vascular Surgery Board Entrustable Professional Activities assessments, understanding facilitators and barriers to implementation of workplace-based assessments using this app is imperative, particularly as we move toward competency-based medical education.

Self-Assessment of Research Skills and Barriers to Research Careers among Pulmonary and Critical Care Fellows.

Recruitment and retention of Pulmonary and Critical Care Medicine (PCCM) trainees into academic research positions remain difficult. Factors influencing graduates, like salary and personal circumstances, remain unchangeable. However, some program-level factors, like research skill acquisition and mentorship, may be modifiable to encourage matriculation into academic research positions. We aim to identify proficiency in research-specific skills in PCCM trainees and barriers to careers as research-focused academic faculty. We surveyed PCCM fellows in a nationwide cross-sectional analysis including demographics, research intent, research skills self-assessment, and academic career barriers. The Association of Pulmonary and Critical Care Medicine Program Directors approved and disseminated the survey. Data were collected and stored using the REDCap database. Descriptive statistics were used to assess survey items. 612 fellows received the primary survey with 112 completing the survey for a response rate of 18.3%. A majority were male (56.2%) and training at university-based medical centers (89.2%). Early fellowship trainees (first-/second-year fellows) comprised 66.9% of respondents with 33.1% being late fellowship trainees (third-/fourth-year fellows). Most early trainees (63.2%) indicated they intended to incorporate research into their careers. A chi-square testing of independence was performed to examine the relationship between training level and perceived proficiency. Significant relationships in perceived proficiency were identified between early and late fellowship trainees with an absolute difference of 25.3% (manuscript writing), 18.7% (grant writing), 21.6% (study design), and 19.5% (quantitative/qualitative methodology). The most prevalent barriers were unfamiliarity with grant writing (59.5%) and research funding uncertainty (56.8%). With an ongoing need for academic research faculty, this study identifies self-perceived gaps in research skills including grant writing, data analytics, and study conception and design. These skills map to fellow-identified barriers to careers in academics. Mentorship and innovative curriculum focusing on the development of key research skills may enhance academic research faculty recruitment.

Factors associated with burnout among minimally invasive gynecologic surgery fellows

BACKGROUNDWhile burnout has been identified in half of practicing physicians, no validated questionnaires have assessed burnout among minimally invasive gynecologic surgery fellows.OBJECTIVEThis study aimed to assess factors associated with burnout among minimally invasive gynecologic surgery fellows.STUDY DESIGNCross-sectional online survey including the validated Copenhagen Burnout Inventory: 100 minimally invasive gynecologic surgery fellows in the United States were invited, including the classes of 2021 and 2022. Of the 100 fellows invited, 60 fellows completed the Copenhagen Burnout Inventory survey. Descriptive statistics were used to report the demographic variables, the mean Copenhagen Burnout Inventory score, and the responses to the survey questions. Logistic and linear regression models were created to assess relationships between fellow characteristics and Copenhagen Burnout Inventory scores.RESULTSOf the 60 fellows with complete Copenhagen Burnout Inventory survey data, 73% were female, 50% were first-year, and 50% were second-year fellows. The mean Copenhagen Burnout Inventory score was 39.2 (standard deviation, 14.4), indicating moderate burnout, and 21.7% of fellows had scores >50, indicating high burnout. Personal and work-related burnout were highest, with Copenhagen Burnout Inventory scores of 47.9 (standard deviation, 16.8) and 45.1 (standard deviation, 17.6), respectively. Patient-related burnout scores were the lowest at 23.5 (standard deviation, 16.5).Factors associated with overall burnout included career choice dissatisfaction (beta, 5.6; 95% confidence interval, 0.9–10.3; P=.02) and absence of a positive and respectful work environment (beta, 5.9; 95% confidence interval, 1.0–10.9; P=.02). Fellows who were somewhat satisfied with their career choice scored 11.2 points higher than those who were highly satisfied. Fellows whose work environment was almost never positive and respectful scored 17.8 points higher than those whose work environment was always positive and respectful. Female fellows were significantly less likely to have a low Copenhagen Burnout Inventory score than male fellows (odds ratio, 0.05; 95% confidence interval, 0.004–0.3; P=.004).Only one-third of fellows reported regular individual wellness behaviors: mindfulness (23%), exercise (35%), 7 to 8 hours of sleep (37%), and recreation (27%); however, these factors were not associated with lower burnout scores.CONCLUSIONFellows had moderate to high personal and work-related burnout, whereas patient-related burnout was low. Factors associated with burnout were negative work culture, lack of control over work schedule, and decreased career satisfaction. Individual wellness behaviors were not associated with burnout, highlighting the need to look beyond individual behavior in the fight against physician burnout.

Online Learning for Infectious Disease Fellows-A Needs Assessment.

BackgroundOnline resources and social media have become increasingly ubiquitous in medical education. Little is known about the need for educational resources aimed at infectious disease (ID) fellows.MethodsWe conducted an educational needs assessment through a survey that aimed to describe ID fellows’ current use of online and social media tools, assess the value of online learning, and identify the educational content preferred by ID fellows. We subsequently convened focus groups with ID fellows to explore how digital tools contribute to fellow learning.ResultsA total of 110 ID fellows responded to the survey. Over half were second-year fellows (61, 55%). Although many respondents were satisfied with the educational resources provided by their fellowship program (70, 64%), the majority were interested in an online collaborative educational resource (97, 88%). Twitter was the most popular social media platform for education and the most valued online resource for learning. Focus groups identified several themes regarding social medial learning: broadened community, low barrier to learning, technology-enhanced learning, and limitations of current tools. Overall, the focus groups suggest that fellows value social media and online learning.ConclusionsID fellows are currently using online and social media resources, which they view as valuable educational tools. Fellowship programs should consider these resources as complementary to traditional teaching and as a means to augment ID fellow education.

Trainee experience on ischemic times and outcomes following orthotopic heart transplantation

ObjectiveThis study was designed to evaluate the association of surgical training on outcomes following orthotopic heart transplantation in all levels of cardiothoracic surgery fellows. MethodsA retrospective cohort analysis was performed on all heart transplants at a single institution from 2011 to 2020. Transplants performed using organ preservation systems (n = 10) or with significant missing data were excluded (n = 37), resulting in 154 transplants performed by faculty surgeons and 799 total transplants performed by first-year Accreditation Council for Graduate Medical Education fellows (n = 73), second-year Accreditation Council for Graduate Medical Education fellows (n = 124), or non-Accreditation Council for Graduate Medical Education fellows (n = 602) in a transplantation and mechanical circulatory support fellowship. Primary outcome was warm ischemic time analyzed by year of fellowship. Additional secondary outcomes included 30-day mortality, primary graft dysfunction, reoperation for bleeding, and 5-year survival. Median follow-up was 3 years (interquartile range [IQR], 1.0-5.5 years) and 100% complete. ResultsThe median number of transplants performed was 30 (IQR, 19.5-51.8) during the study period performed by 22 trainees. Baseline transplant characteristics performed were similar amongst the trainee years, although the first-year Accreditation Council for Graduate Medical Education fellows approached significantly fewer re-do transplants (1.4% vs 8.1% and 4.3%; P = .07). Warm ischemic time was lower in the first-year fellows (49 minutes; IQR, 42-63 minutes) versus second-year fellows (56.5 minutes; IQR, 45.5-69 minutes) and mechanical circulatory support/transplant fellows (56 minutes; IQR, 46-67 minutes) (P = .028). Crossclamp time was also lower in the first-year fellows than in second-year and mechanical circulatory support/transplant fellows, respectively (79 minutes; IQR, 65-100 minutes vs 147 minutes; IQR, 125-176 minutes and 143 minutes; IQR, 119-175 minutes) (P = .008). Secondary outcomes, including 30-day mortality (4.1% [n = 3] vs 2.4% [n = 3] vs 2.7% [n = 16]; P = .76), primary graft dysfunction (5.5% [n = 4] vs 4.0% [n = 5] vs 4.3% [n = 26]; P = .88), reoperation for bleeding (2.7% [n = 2] vs 4.8% [n = 6] vs 4.2% [n = 25]; P = .78), and 5-year survival (82.2%; 95% CI, 66.7%-84.9% vs 77.3%; 95% CI, 66.7%-84.9% vs 79.3%; 95% CI, 74.9%-83.1%; P = .84) were comparable in all groups. ConclusionsThis cohort of nearly 800 operations demonstrates that orthotopic heart transplantation may be performed by cardiac fellowship trainees all levels of training with acceptable short- and long-term outcomes.

Acquisition of Behavioral Skills after Manikin-Based Simulation of Neonatal Resuscitation by Fellows in Neonatology.

Behavioral performance of health professionals is essential for adequate patient care. This study aimed to assess the behavioral skills of fellows in neonatology before and after a simulation training program on neonatal resuscitation. From March 2019 to February 2020, a prospective cohort with 12 second-year fellows in neonatology were evaluated during three training cycles (16 hours each) in manikin-based simulation of neonatal resuscitation with standardized scenarios. Each cycle lasted 1 month, followed by a 3-month interval. One video-recorded scenario of approximately 10 minutes was performed for each fellow at the beginning and at the end of each training cycle. Therefore, each fellow was recorded six times, before and after each one of three training cycles. Anxiety of the fellows was assessed by the Beck Anxiety Inventory applied before the first training cycle. The videos were independently analyzed in a random order by three trained facilitators using the Behavioral Assessment Tool. The behavioral performance was evaluated by repeated measures of analysis of variance adjusted for anxiety and for previous experience in neonatal resuscitation. Fellows' overall behavioral performance improved comparing the moment before the first training and after the second training. The specific skills, such as communication with the team, delegation of tasks, allocation of attention, use of information, use of resources, and professional posture, showed a significant improvement after the second month of training. No further gains were noted with the third training cycle. Anxiety was observed in 42% of the fellows and its presence worsened their behavioral performance. An improvement in behavioral performance was observed, comparing the moment before the first training and after the second training, without further gains after the third training. It is worth noting the important role of anxiety as a modulator of acquisition and retention of behavioral skills in health professionals in training. · Simulation training should improve technical and behavioral skills of providers. · Behavioral skills improve after a first cycle of training, but not after a repeat cycle. · Anxiety modulates trainees' behavioral performance.

Mentoring First-Generation and Underrepresented in Medicine Physician-Scientists by Expanding Conversations.

Mentoring First-Generation and Underrepresented in Medicine Physician-Scientists by Expanding Conversations.

An Opportunity for Improvement: Evaluation of Diabetes Technology Education Among Adult Endocrinology Training Programs.

Despite increases in continuous glucose monitor (CGM) and insulin pump use in adults with diabetes, there is room for expansion. Technology adoption may be influenced by the training environment and fellowship education. However, little is known about adult endocrinology trainee comfort with, understanding of, or methods by which trainees receive education about diabetes technology. Mixed methods, sequential explanatory evaluation using survey and semi-structured interviews of endocrinology trainees and fellowship leadership in Accreditation Council for Graduate Medical Education (ACGME)-accredited adult endocrinology fellowship programs to assess trainee and leadership comfort with, perceived knowledge of, and current methods for diabetes technology education. Seventy-seven respondents completed the survey. The majority of training programs have curricula for training on insulin pumps (74%) and CGM (75.3%); 52% of fellows felt curricula are adequate. First- and second-year fellows were more comfortable with CGM than insulin pump use. Only half of third-year fellows felt comfortable with starting insulin pump therapy or recommending insulin dose adjustments based on CGM rate of change arrows. Qualitative interviews identified the importance of both direct instruction and experiential learning in diabetes technology education. Almost half of trainees feel that curricula for learning to use and manage insulin pumps and CGM are inadequate and feel uncomfortable with critical aspects of technology use, demonstrating the need for increased attention to trainee education in the use of diabetes technology. Based on a better understanding of current and preferred methods for instruction, this study provides direction for future development of initiatives to improve fellow education in this field.

Implementation of a Longitudinal Critical Care Fellowship Ultrasound Curriculum.

BackgroundThe use of point-of-care ultrasound as a diagnostic and interventional tool is rapidly becoming standard of care in critical care medicine; a standardized training curriculum is needed to ensure provider proficiency.ObjectiveThis study aimed to describe a longitudinal critical care ultrasound (CCUS) curriculum in a pulmonary critical care medicine (PCCM) fellowship training program. It evaluated the curriculum’s impact on fellows’ knowledge, skills, and self-reported confidence and retention of these attributes.MethodsWe conducted a prospective observational study of a longitudinal CCUS training program within a single PCCM fellowship training program. Knowledge, skills, and confidence of 22 fellows were assessed at baseline; after initial training; and at 6, 12, and 18 months in five domains (ultrasound basics, vascular, lung/pleural, abdomen, and cardiac). We quantified changes in CCUS knowledge, confidence, and skills by fellowship class and assessed for longitudinal retention of these three attributes. The difference in scores between new first-year fellows undergoing formal training and second-year fellows with previous informal training was compared at matched time points.ResultsAfter the initial formal training, there was a significant increase in knowledge, skills, and confidence scores, which were maintained or continued to increase up to 18 months. Fellows with 1 year of formal training also had a higher level of knowledge and skills than fellows with 1 year of informal training, although they had similar levels of self-reported confidence in their skills.ConclusionA formal, longitudinal CCUS curriculum implemented in a PCCM fellowship program improves trainees’ knowledge and skills in various ultrasound domains in addition to their confidence in using ultrasound for patient care. A longitudinal curriculum results in retention of all three attributes and appeared to be more effective than an informal training program based on teaching during rounds, but this needs to be replicated in a larger cohort.

Assessment of Variation in Liver Transplant Training in North America: A National Survey of Transplant Surgery Fellows

Introduction: The current requirement for the fellows to receive the certificate of completion is to participate and log 45 liver transplant cases performed as "principal role." The study aims to address fellow readiness and independence, stratified by median MELD (Model for End-Stage Liver Disease) of the center. Methods: An anonymous survey was created using the Qualtrics panel. Questions evaluated demographics, program structure, operative autonomy, and confidence in managing postoperative complications. Results: The response rate was 69%. Second-year fellows in low MELD programs were more likely to perform liver transplants as primary surgeons (25% vs. 50%; p-0.02) and arterial reconstructions (12.5% vs. 50%; p-0.04) than fellows in a high MELD program. In terms of comfort level in managing postoperative complications – bleeding, vascular complications, biliary complications we found no difference between the fellows when stratified by regional MELD scores. Conclusions: Significant regional variations exist in liver transplant training in the US. Therefore, the American Society of Transplant Surgeons (ASTS) should incorporate MELD into the total case requirement for graduation.

956. Neurosurgical Infectious Disease Curriculum for Infectious Disease Fellows and Application of a Novel Surgical Infectious Disease Framework

BackgroundInfectious disease (ID) consultations from surgical services account for 30-41% of all ID consults at academic medical centers. However, adult ID fellows in the United States complete residency training in Internal Medicine and may have limited prior exposure to patients on surgical services. We surveyed 16 first and second-year fellows of the combined Massachusetts General Hospital/Brigham and Women’s Hospital ID Fellowship to evaluate their self-perceived ability to approach ID consults from surgical services. While 75% self-reported confidence in their ability to approach general surgery consultations, only 33% reported confidence with neurosurgical related consultations. MethodsWe created a novel framework for approaching surgical ID consult questions (Figure 1). We then developed two interactive case-based discussion sessions for first-year fellows to address common neurosurgical consult scenarios (post craniotomy/ craniectomy surgical site infections and cerebral spinal fluid shunt infections). The session materials, including images of common surgical approaches and risk factors for infection, were reviewed by a neurosurgeon content expert. An ID faculty member facilitated the discussions. Each discussion took place during a 30-minute teleconference. The learners then completed a self-assessment survey to evaluate the extent to which they could meet the educational objectives (Table 1) using a 1-5 Likert scale.Figure 1. Surgical Infectious Diseases Framework Table 1. Educational Objectives for Case 1 and 2 ResultsAll sixteen learners (eight per case) completed the educational objective self-assessment surveys. The educational objectives were achieved with all questions reaching a mean response of 4 or greater indicating that the mean of learners agreed (4) or strongly agreed (5) that they were able to meet the outlined educational objectives after participating in the discussion session for Case 1 (Figure 2) and Case 2 (Figure 3). Figure 2. Educational Objective Self-Assessment Scores for Case 1 Figure 3. Educational Objective Self-Assessment Scores for Case 2 ConclusionBased on self-assessment surveys, our educational objectives were achieved. In turn, these first-year fellows may be better prepared to address ID consults from neurosurgical services in the future. While the case-based discussions were designed to address specific neurosurgical ID cases, our standardized framework could be adapted to a variety of surgical ID cases. Disclosures Molly L. Paras, MD, Deckermed (Other Financial or Material Support, Payment for book chapter)

The Effect of Supervision and Out-of-Hours Surgery on the Outcomes of Primary Macula-On Retinal Detachments Operated by Vitreoretinal Fellows: A Review of 435 Surgeries

Purpose: During bank holidays and weekends (BHWE), many primary macula-on retinal detachments (RD) across the United Kingdom are performed unsupervised out-of-hours by experienced vitreoretinal (VR) fellows. We aimed to determine whether first-year (F1) and second-year (F2) fellows could safely operate out-of-hours independently with remote supervision on primary macula-on RDs. Methods: This is a retrospective consecutive series of 435 patients attending the Birmingham and Midlands Eye Centre from January 2017 to July 2020. We evaluated (i) 6-month re-detachment rate and (ii) visual outcomes of F1, F2, and consultants during office hours and BHWE as well as the effects of supervision versus non-supervision. Results: For the re-detachment rate, no difference was found between surgeon grade (p = 0.821), whether supervised (p = 1.000), whether BHWE (p = 1.000), unsupervised BHWE and supervised mid-week (p = 0.757), and unsupervised F1 and F2 (p = 1.000), with non-significance maintained on multivariate regression. No difference was detected in the level of supervision (15.7%) between fellow grades during BHWE (p = 0.761) or mid-week (p = 0.295) or between surgeon grade and logMAR letters gained pre-postoperatively (p = 0.834). Conclusion: Safe VR services can be provided by experienced VR fellows during office hours, BHWE, supervised, or unsupervised, with similar primary success and visual outcomes to consultants in this patient subgroup. Initial intensive supervision and feedback and a gradual increase in independence is fundamental for VR fellows to gain confidence and become safe independent surgeons.

A Survey of Grit, Mindset, and Happiness Among Participants Completing a Fellowship in Minimally Invasive Gynecology Surgery Program

<h3>Study Objective</h3> To determine the mindset amongst AAGL FMIGS participants. <h3>Design</h3> Cross-sectional survey. Comparisons were performed with Wilcoxon rank sum tests and Spearman's Test of Correlation. Statistical analysis was performed using R Statistical Software (Vienna, Austria). <h3>Setting</h3> An anonymous electronic survey involving four validated questionnaires (Duckworth Grit Scale, Implicit Theories of Interest, Implicit Theories of Intelligence, and Subjective Happiness Scale) was distributed in fall 2019. <h3>Patients or Participants</h3> Current participants in an FMIGS program. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> A total of 43 of 76 (56.6%) FMIGS participants in AAGL-accredited programs completed a survey regarding grit, mindset, and subjective happiness. There were 18 first-year fellows (41.9%) and 25 second-year fellows (58.1%). Most fellows were working either 40-60 hours per week (76.7%) or 60-80 hours per week (18.6%). The majority would apply for a fellowship again if given the opportunity (72.1%) and were satisfied with their program (76.7%). Median age was 32 years (range 28 – 38 years). Associations of fellow characteristics of interest with the four mindset questionnaires were assessed. Generally, fellows demonstrated grit (3.8, scale 1-5), growth mindset tendencies (3.9 and 3.6, scale 1-5), and happiness (73.4, scale 1-100). There was a significant association between increased number of PubMed publications and a higher Subjective Happiness Score (P=0.032), and between increased number consultations of education videos on the SurgeryU website and a lower Intelligence Score (P=0.004). No other significant associations with responses of the questionnaires were identified (all P≥0.070). <h3>Conclusion</h3> FMIGS is gaining popularity as a post-graduate career choice. Previous research has indicated that participants seek out this fellowship for personal fulfillment. Our results indicate that FMIGS participants tend towards grittiness, growth mindset, and are overall happy, and certain inherent educational characteristics play a factor in mindset. Additional research comparing FMIGS participants to other subspecialty programs is warranted to further understand personal motivators for seeking additional training.

Step-wise learning of laparoscopic low anterior resection.

A primary goal of training is the development of one’s own procedure by self-learning, which can be facilitated by laparoscopic surgery owing to its recordable system. This video demonstrates laparoscopic low anterior resection for a 56-year-old male diagnosed with synchronous S-colon cancer and rectal cancer. The surgery was performed by a second-year fellow in the colorectal division under supervision.

The Impact of COVID-19 on Job Prospects and Educational Training for Pediatric Gastroenterology Fellows.

ABSTRACTObjectives:The COVID-19 pandemic has significantly affected graduate medical education with redistribution of trainees, altered clinical care, and decreased research. For graduating trainees, there remains concern that financial stability of health systems will affect the availability of new positions and hiring practices. This survey aims to evaluate the pandemic's impact from pediatric gastroenterology fellows’ perspectives.Methods:An anonymous survey was distributed by e-mail from June 11 to July 1, 2020 to all North American pediatric gastroenterology and advanced training fellows. The survey was tailored for the fellows’ year of training including questions on education, clinical experience, research, and job outlook.Results:Of the 434 pediatric gastroenterology fellows, 145 completed the survey. Of all respondents, negative impact was reported in 52% on clinical training, 46% research projects, and 41% procedural confidence. A majority (93%) of third-year respondents had a job contract signed at the time of the survey; however, 18% of those contracts were subsequently altered with 5 respondents having job contracts rescinded due to hiring freezes. Fifty-four percent of first- and second-year fellow respondents reported concern regarding finding a job with the majority being second-year fellows (78%).Conclusions:The COVID-19 pandemic continues to affect the medical system and healthcare professionals. This survey identified significant impact on job acquisition for graduating pediatric gastroenterology fellows and other critical components of training, which are likely applicable to other pediatric trainees. The survey results raise questions about potential strategies to improve medical education and job search success for graduating trainees.

GENDER DIFFERENCES IN SELF-REPORTED PROCEDURAL VOLUME AMONG VITREORETINAL FELLOWS.

A prior study revealed discrepancies in self-reported surgical numbers between male and female ophthalmology residents. This study further investigates the gender differences in self-reported procedural volume among vitreoretinal surgery fellows and examines the differences for surgical, medical, and total self-reported procedural volume between male and female vitreoretinal fellows. A retrospective review of case logs submitted to the American Society of Retina Specialists by first-year and second-year vitreoretinal fellows from July 1, 2018, to June 30, 2019, was performed. Fellows who reported fewer than 100 pars plana vitrectomies were excluded. A total of 133 fellows were included. Overall, 37 of 57 (65%) first-year fellows and 59 of 76 (78%) second-year fellows were male. An average of 1,120 procedures were self-reported among all vitreoretinal fellows. In the group of second-year fellows at the completion of fellowship, men reported more total procedures (1,171 [864-1,600] vs. 1,005 [719-1,257]; P = 0.072). Women reported statistically significant fewer endolaser (P = 0.018), internal limiting membrane peel (P = 0.042), and cryoretinopexy (P = 0.002) procedures compared with men. When splitting the data by total surgical versus medical procedures, men reported more procedures than women both surgically (1,077 [799-1,490] vs. 925 [622-1,208]; P = 0.085) and medically (72 [41-116] vs. 56 [20-94]; P = 0.141), although these differences were not statistically significant. There is a trend for female vitreoretinal fellows to report fewer surgical procedures than their male counterparts, raising concerns for gender gaps in vitreoretinal surgical training. Further research is needed to verify this discrepancy and identify potential barriers that female vitreoretinal surgeons are facing in training.