Specialty Fellowship Research Articles

Implementing a Specialty Fellowship Program for Nurses New To PeriAnesthesia

Implementing a Specialty Fellowship Program for Nurses New To PeriAnesthesia

Regional Institute of Ophthalmology and Government Ophthalmic Hospital: The Heart of Heritage

Regional Institute of Ophthalmology and Government Ophthalmic Hospital: The Heart of Heritage

Resident Autonomy and Performance Independence in Surgical Training Are Time- and Skill-Dependent

IntroductionAppropriate faculty supervision and conditional independence of residents during training are required for autonomous and independent postgraduate practice. However, there is a growing concern that competence for transition to independent practice is not universally met. We hypothesize that surgery residents play a significant and active role in achieving their own independent status. MethodsOver seven academic years (July 2014 through June 2021), 46 surgeons supervised and intraoperatively assessed the performance of 51 residents using validated Objective Structured Assessment of Technical Skill (OSATS) and Zwisch Operative Autonomy (ROA) assessments. Resident readiness to perform procedures independently (RRI) was graded as yes, no, or not applicable. Data were analyzed using descriptive statistics with categorical variables reported as frequencies and percentages. ResultsA total of 1657 elective procedures were performed by residents supervised by faculty. Association between RRI and postgraduate year (PGY), OSATS scores, ROA, resident and faculty gender, and case complexity was analyzed. Results indicated positive correlation between RRI and summative OSATS score (r = 0.510, P < 0.001), PGY (r = 0.535, P < 0.001) and ROA (r = 0.473, P < 0.001). Percentage of overall RRI increased from 7% at PGY1 to 87.4% at PGY5. Meaningful autonomy ratings increased from 23.6% at PGY1 to 92.5% at PGY5. Variations in ratings was observed when considering case category and complexity. ConclusionsRRI increases with years of training with variation when considering the specialty/The Accreditation Council for Graduate Medical Education procedure category and the complexity of cases. Specialty fellowships are a viable option to address the gap in The Accreditation Council for Graduate Medical Education categories when residency alone cannot reach appropriate independence. Residents’ technical skills play a crucial role in evaluating RRI and granting operative autonomy.

Unforeseen Collateral Damage of COVID-19 With the Virtualization of Fellowship Interviews.

Unforeseen Collateral Damage of COVID-19 With the Virtualization of Fellowship Interviews.

Effect of virtual interviewing on applicant approach to and perspective of the Maternal-Fetal Medicine Subspecialty Fellowship Match

The 2020 application cycle for the Maternal-Fetal Medicine Specialty Fellowship Match was the first to be exclusively virtual. Our study was designed to compare approaches and perspectives of the MFM fellowship candidates who applied with virtual interviews with those of the current Maternal-Fetal Medicine fellows, who applied with in-person interviews in 2017, 2018, or 2019. A survey was developed by the Society for Maternal-Fetal Medicine Fellowship Affairs Committee to ascertain applicant approaches to and perspectives of the Maternal-Fetal Medicine Fellowship Match and was disseminated after 2020 Maternal-Fetal Medicine interviews ended and completed before Fellowship Match Day. Participants were contacted by means of active Listservs maintained by the Society for Maternal-Fetal Medicine. Current fellows were instructed to complete the survey using their experiences on the application cycle in which they successfully matched. Those who elected to participate entered their survey responses through the electronic link; answers were recorded in a secure Research Electronic Data Capture database. Outcomes were compared between those who applied during the virtual 2020 Maternal-Fetal Medicine interview cycle and those that applied during the in-person interview cycles in 2017, 2018, or 2019. Of the 140 completed surveys, 46 people participated in the 2020 Maternal-Fetal Medicine Match and were categorized as "virtual applicants," whereas the remaining 94 people participated in the 2017 (n=28), 2018 (n=33), or 2019 (n=33) Maternal-Fetal Medicine Match and were categorized as "in-person applicants." The overall distribution of number of programs to which each applicant applied differed between groups (P=.02); for example, nearly 75% of virtual applicants applied to at least 25 fellowship programs, compared with less than 50% of in-person applicants. Although the number of interviews received was similar between virtual and in-person applicants, virtual applicants were significantly less likely to cancel scheduled interviews (n=18 [39.1%] vs n=68 [72.3%]; P<.001). There were also differences between virtual and in-person applicants in terms of overall cost of the fellowship intervention process and total days away from work for interviewing (P<.001 for both). In particular, nearly two-thirds of virtual applicants reported spending less than $1000 in the Maternal-Fetal Medicine fellowship application process, compared with the nearly two-thirds of in-person applicants who reported spending more than $5000. Among the 46 virtual applicants, nearly 80% reported the experience was better or slightly better than expected, and none reported the experience was slightly worse or worse than expected. Nearly two-thirds of the virtual applicants reported that, compared with their in-person residency interviews, they received a comparable representation of Maternal-Fetal Medicine fellowship programs and could effectively assess their "fit" during interviews (60.9% and 63.0%, respectively). Only 20% of virtual Maternal-Fetal Medicine applicants would recommend returning to exclusive in-person interviews should that be possible in future Maternal-Fetal Medicine matches. Virtual Maternal-Fetal Medicine fellowship interviewing was viewed favorably by applicants but corresponded with significant changes to their application approaches. The differences between virtual and in-person fellowship applicant tendencies identified in this study should inform next year's application cycle for Maternal-Fetal Medicine and possibly other obstetrics and gynecology subspecialty fellowships.

FRCS General Surgery section-2 examination preparation during COVID-19 pandemic: an innovative and sustainable model.

Background: The Joint Committee on Intercollegiate Examinations (JCIE- domestic) is responsible for the supervision of standards, policies, regulations and professional conduct of the UK/Ireland Specialty Fellowship Examinations. The Joint Surgical Colleges’ Fellowship Examination (JSCFE- International) is organised by the JSCFE Committee in five specialities, and one of them is General Surgery. The syllabus for the examination is extensive and needs rigorous preparation. The Specialty Trainees (ST) get supervised structured training and regular assessments, and hence their pass rate is not only comparatively higher, but they are better prepared for the challenge. However, trainee surgeons who are outside the UK training programmes find the examination difficult. The COVID-19 pandemic has impacted surgical training and education by limiting access to conventional teaching methods and available resources. We have been running a teaching and formative assessment platform since May 2017. This teaching resource has helped several trainees in passing the examination and has proven to be a valuable learning resource in the pandemic. Materials and Methods: We provided examination support, guidance and supervision by running Skype/ Microsoft Teams sessions and weekend courses. We emphasised five critical steps in all our sessions and used our course website- WWW.PHOENIXFRCSCOURSE.COM for material 1- Using Landing Sentences to start at the MRCS level 2- 0- 60 mph concept - a safe but quick pace to move from the MRCS zone onto the FRCS zone 3- The MISTER-model of simulation and learning 4- Maintaining pace and grace under pressure 5- Interleaving- revising, rehearsing and consolidating difficult topics The sessions included model scenarios, table viva, academic reading, virtual clinics and peer to peer learning (Examiners’ Drills). The faculty were recent examination graduates and had attended such sessions before their exam success. We followed the JCIE marking descriptors for formative assessment and timely feedback. Results: The first such course was organised in May 2017 and since then (over 40 months) a total of 100 attendees: 90 candidates (domestic FRCS and International FRCS) and 10 observers went through our sessions and workshops. Some 50 virtual sessions and 8 courses (16 days of simulation workshops) have been held so far. 66 (15 CCT and 51 non-CCT) candidates took the examination and 54 passed (82%). Sum 23 candidates have either deferred their examination dates or have been delayed because of the COVID-19 pandemic and are being regularly supported. Conclusions: Simulation-based virtual teaching supplemented with weekend inhouse courses has the potential to improve FRCS Section-2 examination preparation and the success rate during COVID-19 pandemic.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Perspectives on COVID-19 from Singapore: Impact on ESKD Care and Medical Education.

Advancing the practice of nursing through specialty fellowship development for pediatric nurse practitioners.

Fellowship training for physicians has historically been a training model for physicians to specialize their practice and develop research skills following medical school and residency. Advanced practice registered nurses, specifically nurse practitioners (NPs) practice in primary care, acute care, and specialty settings across the lifespan. Fellowship programs have emerged as a way for NPs to specialize their practice and meet the needs of an expanding health care system. This article describes the design, implementation, and outcomes of two similar yet distinct specialty NP fellowship programs: one in Developmental-Behavioral Pediatrics and one in Pediatric Physical Medicine and Rehabilitation.

How to Succeed in Fellowship Acquisition: A Survey of Pathology Residents

Medical school curricula limit students’ exposure to pathology practice while pathology subspecialty training programs require residents to apply for fellowships as early as the end of their first year of training. Thus, limited exposure to pathology practice creates significant confusion and anxiety, often making the fellowship application process premature. Additionally, early focus on subspecialty training in order to acquire a fellowship adds to the initial lack of emphasis on general pathology training. We prepared a voluntary online survey with questions developed through focus groups and advice from an expert in survey design to determine which fellowships are desired and how successful residents are in their pursuit of these fellowships. The survey was distributed through the Pathology Residency Program Directors' (PRODS) listserv. Answers were solicited from pathology trainees throughout the entire training cycle. There were 141 (4.6% response rate) total respondents with each postgraduate year represented. One hundred twenty-two (95%) of 129 residents plan on completing 1 or 2 fellowships after residency training. Encouragingly, 94 (75%) of 126 pathology residents attained their desired specialty fellowship. However, 32 (32%) of 99 residents who acquired at least one fellowship chose a general surgical pathology fellowship. Furthermore, 33 (24%) respondents had already decided to pursue a specific specialty while still in medical school. An additional 32 (23%) came to their decision during postgraduate year 1. Therefore, although most residents are successful in attaining their desired fellowship, further research is needed to understand the effect of early commitment to a subspecialty and its impact on pathology education.

Physician training in critical care in the United States: Update 2018.

Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001-2017). The number of critical care fellowship training programs has increased 22.6%, with a 49.4% increase in the number of on-duty residents annually, over the last 16 years. This is in contrast to the period of 1995 to 2000 when the number of physicians enrolled in critical care fellowship programs had decreased or remained unchanged. Although more than 80% of intensivists in the US train in internal medicine critical care Accreditation Council for Graduate Medical Education-approved fellowships, there has been a significant increase in the number of residents from surgery, anesthesiology, pediatrics, emergency medicine, and other specialties who complete specialty fellowship training and certification in critical care. Matriculation in neurocritical care fellowships is rapidly rising with 60 programs and over 1,200 neurocritical care diplomates. Critical care is now an increasingly popular fellowship in all specialties. This rapid growth of all critical care specialties highlights the magnitude of the heterogeneity that will exist between intensivists in the future.

Intensive Care Unit Rotations and Predictors of Career Choice in Pulmonary/Critical Care Medicine: A Survey of Internal Medicine Residency Directors.

Background The United States (US) is experiencing a growing shortage of critical care medicine (CCM) trained physicians. Little is known about the exposures to CCM experienced by internal medicine (IM) residents or factors that may influence their decision to pursue a career in pulmonary/critical care medicine (PCCM). Methods We conducted a survey of US IM residency program directors (PDs) and then used multivariable logistic regression to identify factors that were predictive of residency programs with a higher percentage of graduates pursuing careers in PCCM. Results Of the 249 PDs contacted, 107 (43%) completed our survey. University-sponsored programs more commonly had large ICUs (62.3% versus 42.2%, p=0.05), primary medical ICUs (63.9% versus 41.3%, p=0.03), and closed staffing models (88.5% versus 41.3%, p < 0.001). Residents from university-sponsored programs were more likely to pursue specialty fellowship training (p < 0.001) overall but equally likely to pursue careers in PCCM as those from community-sponsored programs. Factors predictive of residencies with a higher percentage of graduates pursuing training in PCCM included larger ICUs (>20 beds), residents serving as code leaders, and greater proportion of graduates pursuing specialization. Conclusions While numerous differences exist between the ICU rotations at community- and university-sponsored IM residencies, the percentage of graduates specializing in PCCM was similar. Exposure to larger ICUs, serving as code leaders, and higher rates of specialization were predictive of a career choice in PCCM.

A Comprehensive Clinical Lifestyle Medicine Specialty Fellowship Program: What Intensive Lifestyle Treatment Can Do.

Lifestyle medicine (LM) is recognized as an essential component of evidence-based medical treatment, particularly for chronic diseases. Multiple studies have shown that intensive therapeutic lifestyle change can arrest and reverse disease, including heart disease, type 2 diabetes, essential hypertension, metabolic syndrome, and autoimmune and inflammatory conditions. While more modest lifestyle changes can slow the onset or prevent disease, studies reveal that intensive therapeutic changes are required to arrest and reverse disease. As increasing numbers of clinicians have learned about the powerful treatment effects of intensive lifestyle interventions, interest in LM has greatly increased. This, in turn, has led to the need for evidence-based clinical LM training in how to effectively provide intensive LM interventions that can arrest and reverse disease. As with all clinical training, such training must include actual patient care guided by knowledgeable expert LM clinicians. The purpose of this article is to (1) describe the need for and function of clinical LM specialists, (2) describe the key components in the training of clinical LM specialists to treat and reverse chronic disease, and (3) describe the steps/components in establishing and implementing a clinical LM specialty-training program.

Geriatrics Education Team Model Results in Sustained Geriatrics Training in 15 Residency and Fellowship Programs and Scholarship.

Caring for the growing elderly population will require specialty and subspecialty physicians who have not completed geriatric medicine fellowship training to participate actively in patient care. To meet this workforce demand, a sustainable approach to integrating geriatrics into specialty and subspecialty graduate medical education training is needed. This article describes the use of a geriatrics education team (GET) model to develop, implement, and sustain specialty-specific geriatrics curricula using a systematic process of team formation and needs assessment through evaluation, with a unique focus on developing curricular interventions that are meaningful to each specialty and satisfy training, scholarship, and regulatory requirements. The GET model and associated results from 15 specialty residency and fellowship training programs over a 4-year period include 93% curriculum sustainability after initial implementation, more than half of the programs introducing additional geriatrics education, and more than 80% of specialty GETs fulfilling their scholarship requirements through their curriculum dissemination. Win-wins and barriers encountered in using the GET model, along with the model's efficacy in curriculum development, sustainability, and dissemination, are summarized.

Specialty Fellowships Within General Surgery

Specialty Fellowships Within General Surgery

Outcomes of a Novel Training Program for Physician-Scientists: Integrating Graduate Degree Training With Specialty Fellowship.

Although physician-scientists generally contribute to the scientific enterprise by providing a breadth of knowledge complementary to that of other scientists, it is a challenge to recruit, train, and retain physicians in a research career pathway. To assess the outcomes of a novel program that combines graduate coursework and research training with subspecialty fellowship. A retrospective analysis was conducted of career outcomes for 123 physicians who graduated from the program during its first 20 years (1993-2013). Using curricula vitae, direct contact, and online confirmation, data were compiled on physicians' subsequent activities and careers as of 2013. Study outcomes included employment in academic and nonacademic research, academic clinical or private practice positions, and research grant funding. More than 80% of graduates were actively conducting research in academic, institutional, or industrial careers. The majority of graduates (71%) had academic appointments; a few (20%) were in private practice. Fifty percent had received career development awards, and 19% had received investigator-initiated National Institutes of Health (NIH) R01 or equivalent grants. Individuals who obtained a PhD during subspecialty training were significantly more likely to have major grant funding (NIH R series or equivalent) than those who obtained a Master of Science in Clinical Research. Trainees who obtained a PhD in a health services or health policy field were significantly more likely to have research appointments than those in basic science. Incorporation of graduate degree research, at the level of specialty or subspecialty clinical training, is a promising approach to training and retaining physician-scientists.

Do Plastic Surgery Programs with Integrated Residencies or Subspecialty Fellowships Have Increased Academic Productivity?

Background:The aim of this study was to evaluate the effect of different surgical training pathways on the academic performance of plastic surgical divisions.Methods:Eighty-two academic parameters for 338 plastic surgeons (PS), 1737 general surgeons (GS), and 1689 specialist surgeons (SS) from the top 55 National Institutes of Health (NIH)-funded academic departments of surgery were examined using data gathered from websites, SCOPUS, and NIH Research Portfolio Online Reporting Tools.Results:The median size of a PS division was 7 faculty members. PS faculty had lower median publications (P)/citations (C) (ie, P/C) than GS and SS (PS: 25/328, GS: 35/607, and SS: 40/713, P < 0.05). Publication and citation differences were observed at all ranks: assistant professor (PS: 11/101, GS: 13/169, and SS: 19/249), associate professor (PS: 33/342, GS: 40/691, and SS: 44/780), and professor (PS: 57/968, GS: 97/2451, and SS: 101/2376). PS had a lower percentage of faculty with current/former NIH funding (PS: 13.5%, GS: 22.8%, and SS: 25.1%, P < 0.05). Academic productivity for PS faculty was improved in integrated programs. P/C for PS faculty from divisions with traditional 3-year fellowships was 19/153, integrated 6-year residency was 25/329, and both traditional and 6-year programs were 27/344, P < 0.05. Craniofacial and hand fellowships increased productivity within the integrated residency programs. P/C for programs with a craniofacial fellowship were 32/364 and for those that additionally had a hand fellowship were 45/536. PS faculty at divisions with integrated training programs also had a higher frequency of NIH funding.Conclusions:PS divisions vary in degree of academic productivity. Dramatically improved scholarly output is observed with integrated residency training programs and advanced specialty fellowships.

Have the New Training Pathways Enhanced Academic Productivity in Plastic Surgery?

OBJECTIVE: To evaluate the effect of different surgical training pathways on the academic performance of plastic surgical (PS) divisions. METHODS: Eighty-two academic parameters for 338 PS, 1737 general (GS), and 1689 specialist (SS) surgeons from the top-50 NIH funded academic departments of surgery were examined using data gathered from websites, SCOPUS, and NIH RePORT. RESULTS: The median size of a PS division was seven faculty. PS faculty had lower median publications/citations than GS and SS (PS: 25/328, GS: 35/607, SS: 40/713, p < 0.05). Publication (P) and citation (C) differences were observed at all ranks: assistant professor (PS: 11/101, GS: 13/169, SS: 19/249), associate professor (PS: 33/342, GS: 40/691, SS: 44/780) and professor (PS: 57/968, GS: 97/2451, SS: 101/2376). PS had a lower percentage of faculty with current/former NIH funding (PS: 13.5%, GS: 22.8%, and SS: 25.1%, p < 0.05). Academic productivity for PS faculty was dramatically improved in integrated residency programs. P/C for PS faculty from divisions with traditional 3-yr fellowships were 19/153, integrated 5-yr residency were 25/329, and both traditional and 5-yr programs were 27/344, p < 0.05. Cranio-facial reconstructive and hand fellowships further increased productivity within the integrated residency-fellowship programs. P/C for programs that also had a cranio-facial reconstructive fellowship were 32/364, and for those that additionally had a hand fellowships were 45/536. PS faculty at divisions with integrated training programs also had a higher frequency of NIH funding (PS% with current/former NIH funding, 2-yr fellowships: 5.8%, integrated 5-yr residency: 7.9%, and both 5-yr/2-yr programs: 18.7%). CONCLUSION: PS divisions vary in degree of academic productivity. Dramatically improved scholarly output is observed with integrated residency training programs and advanced specialty fellowships. Recruiting trainees into earlier in their careers into PS and providing advanced additional training options may represent successful mechanisms to improve research productivity within PS divisions.

The Oral Surgery trainee perspective

AbstractAimThis study aims to gather information about Oral Surgery training programmes by carrying out a survey of the trainees currently in post.Materials and methodsA web‐based questionnaire was sent to current Oral Surgery trainees. Questions about training environment, clinical exposure, examinations and future career aspirations were included.ResultsThirty of the 40 trainees contacted responded by part or fully completing the questionnaire. The mean time period of qualification from dental school to Oral Surgery training was 5.1 years. The majority, 80%, of trainees were on a 3‐year full‐time programme that entitled them to sit the Membership in Oral Surgery Examination (M Oral Surg) only. Four trainees who responded were eligible to sit both M Oral Surg and the Intercollegiate Specialty Fellowship Exam.ConclusionsThe questionnaire highlighted areas Oral Surgery trainees perceived to be important for their training and development. Identification of these issues will allow attention to be focused in addressing them.

Quality assuring faculty examinations

A fundamental role of the Faculty of Dental Surgery is the development, implementation, delivery and quality assurance of examinations at all points in dental training; from the Licenciate in Dental Surgery through the Membership of the Joint Dental Faculties, to specialist accreditation and Intercollegiate Specialty Fellowships.

TU‐E‐137‐01: In‐House Credentialing

The issue of in‐house credentialing has taken on added importance with more complex procedures and the recent emphasis on safety, especially in imaging and radiation oncology procedures. Medical Physicists have been categorized as Allied Health Professionals on most hospital and facility rosters with little more than proof of board certification as their chief credentialing statistic. Now, medical staff credentialing bodies have required more specific training in specialty procedures such as IMRT, SRS, SBRT, IGRT and specialized brachytherapy procedure like HDR, eye plaques, prostate seed implants, etc. Vendor training both on and off site for complex planning and treatment delivery systems like VMAT, RapidArc, TrueBeam, Tomotherapy and GammaKnife/ CyberKnife, to list but a few of the new technologies, are paramount in understanding the accurate and safe use of these systems. Societies offer guidelines and standards that may be useful in their applications and should be considered required reading. Departmental guidelines may require proctoring on a minimum number of cases. Although Board Certification bodies credential candidates over a broad range of specialty procedures, practitioners are more and more called on to have a greater detailed knowledge base of these complex systems and procedures. Many Medical Physicists have limited themselves to becoming proficient at one or two of these more specialized technologies. Indeed, the radiological community has answered this call by instituting additional certifications, the CAQ (Certificate of Added Qualification). These are achieved through spending an additional year of fellowship training to attain this detailed training. And, perhaps, Medical Physicists need to look to this additional fellowship training to achieve similar proficiency in one or more of these fields. Perhaps CAMPEP could take on sanctioning of these specialty fellowships. However it is structured, each department will have the onus of deciding on a program to credential Medical Physicists in these new specialty categories.Learning Objectives:1. Understand the structure of hospital and facility credentialing procedures2. Make use of guidelines and standards to apply new technologies properly3. Understand the departmental evaluation of skill sets for complex procedures, proctoring number of case, etc.4. Finally, explore the possibility of a medical physics fellowship to gain more skills and experience in focused specialties