Start Of Fellowship Research Articles

Fellow perceptions of robotic surgery preparedness for fellowship.

Many surgical fellowship programs incorporate robotic surgery, yet not all residency programs offer robotic training for residents. Given the variability of pre-fellowship robotic exposure, the goal of this study was to explore whether standardized robotic skills assessment would be useful to fellows at the start of their training. In partnership with the Fellowship Council, we surveyed current fellows of accredited Thoracic, Colorectal, HPB, and Advanced GI/MIS/Bariatrics/Foregut Fellowship programs. Main outcome measurements included amount of robotic exposure during residency, fellows' robotic skills at the start of fellowship, and fellows' attitudes towards a standardized skills assessment. In total, 78 fellows completed the survey. Mean percentage of cases performed robotically during fellowship was 38.1% (SD ± 32.25%). From our respondents, 46% had no robotic curriculum during residency and 86.9% felt a standardized robotic curriculum during residency would have been beneficial. When asked if they started fellowship with adequate robotic skills to operate autonomously, 31% strongly agreed, but 24.4% strongly disagreed. The majority of fellows reported their fellowship program did not conduct an assessment of their robotic skills (71.5%), or provide a specific robotic curriculum (75.6%). On the other hand, 73.3% felt a formal proficiency assessment at the start of fellowship would be helpful for individualized support and training. Given the significant variability in resident exposure to robotic surgery, a standardized robotic curriculum during residency would likely be beneficial. Additionally, a robotic skills assessment at the start of fellowship could help provide a tailored training experience for fellows interested in this skillset.

The transition to Pediatric Hospital Medicine fellowship: A national survey-based needs assessment.

Each year, the number of fellows entering Pediatric Hospital Medicine (PHM) fellowship is increasing. Residency curricula do not always prepare trainees for all aspects of PHM as a specialty and gaps often exist in the transition to fellowship. To explore the preparedness of PHM fellows for clinical, teaching, and scholarship tasks at the start of fellowship and to identify opportunities for residency and fellowship program development. Quantitative survey. Current and recently graduated PHM fellows (matriculation years 2019-2022). We conducted a national cross-sectional survey from July 2022 to February 2023. We designed survey questions based on PHM fellowship core competencies. We asked participants to rate preparedness for tasks on a 5-point Likert scale (1 = very unprepared, 5 = very prepared). We analyzed numerical data using descriptive and comparative statistics and free-response data using inductive content analysis. We received 223 responses to our survey (response rate 74%). Of the respondents, 25% reported no PHM-specific orientation at their program (n = 55). Respondents reported lower median preparedness for research (3, interquartile range [IQR] [2,4]) and teaching tasks (4, IQR [4,4]) compared to clinical tasks (4, IQR [4,5]) at the start of fellowship (p < 0.01, p < 0.01). Content analysis revealed most fellows wished they had received more training around scholarship at the start of fellowship. Many PHM fellows enter fellowship feeling inadequately prepared, particularly in scholarship and teaching. Our findings suggest that residency and fellowship programs need to develop more robust curricula to better prepare trainees for successful PHM fellowship. This national survey-based needs assessment should serve as a guide for further program development.

Bringing the teaching close to home: Implementation of a near-peer model for an introductory hematology-oncology fellowship lecture series.

11025 Background: Hematology/oncology fellowship has a steep learning curve. Foundational knowledge at the start of fellowship is essential, given limited exposure to key disease-specific concepts in prior training. We have previously employed an expert faculty-led “introductory boot camp” during the first 2 months of fellowship training. Trainees provided feedback that this was not best meeting fellows’ needs. We hypothesized that a near-peer teaching model, led by senior fellows, would better align lecture content and scope with the needs of new fellows and improve senior fellows’ mastery of clinical knowledge and comfort with teaching skills. Methods: Using a constructivist theory of learning, we selected the most relevant topics from the curriculum and assigned each senior fellow 1-2 hour-long sessions on clinical areas of interest, paired with expert faculty. A one-hour workshop on lecturing techniques and instructional design was held for all senior fellows. Educational sessions led by senior fellows and expert faculty occurred July-September 2022 in a hybrid format. An IRB-exempt anonymous survey was sent to participating fellows and faculty regarding effectiveness of the educational sessions and the process of preparing to lead sessions. Results: 15 of 17 fellows (88%) and 12 of 15 faculty (80%) completed the survey. Overall, 71% (95% CI 33-82) of fellows and 75% (95% CI 43-95%) of faculty felt the new series was taught at an appropriate level for new fellows. All fellow respondents felt the approach was helpful for clinical practice and board preparation. All participating senior fellows felt equipped to teach and that the exercise improved confidence in the content and their teaching skills. No fellows proposed a return to the prior model, and 80% of faculty felt the near-peer approach should be continued in future years. Qualitative analysis of narrative responses identified several strengths, including emphasis on focused, introductory frameworks and the generation of living resources for future reference. Areas identified for future improvement include providing more guidance and structure for pre-lecture faculty-fellow preparations. Conclusions: A near-peer model of introductory lectures is feasible to implement, produces improved satisfaction with the curriculum, and can be a means of presenting foundational content in hematology and oncology concordant with the learners’ needs. This method has important implications for developing learner-concordant, expert-driven curricula in large and rapidly changing content areas within hematology/oncology.

Advancing spinal fellowship training: an international multi-centre educational perspective.

The purpose of this article is to review the importance of contemporary spine surgery fellowships and educational strategies to assist with fellowship design and delivery. Spine surgery fellowship includes trainees from orthopaedic and neurosurgical backgrounds and is increasingly indicated for individuals wishing to pursue spine surgery as a career, recognizing how spinal surgery evolved significantly in scope and complexity. We combine expert opinion with a review of the literature and international experience to expound spine fellowship training. Contemporary learning techniques include boot camps at the start of fellowship which may reinforce previous clinical learning and help prepare fellows for their new clinical roles. There is good evidence that surgical specialty training boot camps improve clinical skills, knowledge and trainee confidence prior to embarking upon new clinical roles with increasing levels of responsibility. Furthermore, as simulation techniques and technologies take on an increasing role in medical and surgical training, we found evidence that trainees' operative skills and knowledge can improve with simulated operations, even if just carried out briefly. Finally, we found evidence to suggest a role for establishing competence-based objectives for training in specific operative and technical procedures. Competence-based objectives are helpful for trainees and trainers to highlight gaps in a trainee's skill set that may then be addressed during training. Spinal fellowships may benefit from certain contemporary strategies that assist design and delivery of training in a safe environment. Interpersonal factors that promote healthy teamwork may contribute to an environment conducive to learning. These slides can be retrieved under Electronic Supplementary Material.

Assessing Resident Surgical Volume Before and After Initiation of a Female Pelvic Medicine and Reconstructive Surgery Fellowship

The effect of fellowship programs on resident training for gynecologic surgery volume has not been clearly defined. The purpose of our study is to assess resident surgical volume for laparoscopic and vaginal hysterectomy before and after initiation of a female pelvic medicine and reconstructive surgery (FPMRS) fellowship. A retrospective review of Accreditation Council for Graduate Medical Education Resident Case Logs of obstetrics and gynecology residents who graduated in the 3 years before and after initiation of a FPMRS fellowship was performed. Mean values of vaginal and laparoscopic hysterectomies were compared using two-tailed t-tests with statistical significance set at p < 0.05. Obstetrics and gynecology resident case logs at the Ronald Reagan University of California Los Angeles (UCLA) Medical Center were assessed. The UCLA Medical Center, located in Los Angeles, CA, is a tertiary referral center with a graduating class of 7 obstetrics and gynecology residents yearly. Obstetrics and gynecology residents who graduated from residency 3 years before and after imitation of a FPMRS fellowship were included. In the 3 years before the start of the fellowship, 20 residents graduated, whereas 21 residents graduated after the start of the fellowship. Residents who graduated in the 3 years after the start of the FPMRS fellowship, finished with 4.6 less vaginal hysterectomies compared with residents who graduated before the fellowship (p = 0.022). Residents who graduated in the 3 years after the start of the FPMRS fellowship finished with 3.2 more laparoscopic hysterectomies compared with residents who graduated before the fellowship although this was not significant (p = 0.25). Resident surgical volume was significantly decreased for vaginal hysterectomy after the initiation of a FPMRS fellowship, whereas laparoscopic hysterectomy volume was not significantly changed. Longer follow-up and a national assessment are necessary to determine the broader effect of fellowship training on resident surgical experience.

Factors Influencing Hematology Career Choice in Hematology and Oncology Fellows at a Major Academic Institution

INTRODUCTION/BACKGROUNDThe majority of graduating fellows from hematology/oncology subspecialty training programs in the U.S. pursue careers in medical oncology or in non-academic fields. A workforce shortage of physicians specializing in hematology has been predicted for the next decade. Large-scale surveys have identified a number of factors responsible for this trend, including financial considerations, educational debt, work-life balance, and fellowship exposure. Qualitative studies in other subspecialty fields have yielded unique insights into specific factors motivating career decisions, but no such study has been conducted in hematology. We performed a qualitative study to identify factors influencing trainees' perceptions of careers in hematology.METHODSSenior or graduating fellows in the hematology/oncology training program at Yale School of Medicine were invited to participate in this study. Semi-structured interviews lasting between 30 and 90 minutes were conducted. Recordings were transcribed and analyzed using the framework method.RESULTSEight trainees participated in the study, five in their senior year of training, three shortly after graduation. Five were female. Three held dual M.D. and Ph.D. degrees. Most were planning on an academic career or a career with an academic affiliation; two were specifically pursuing careers in benign or malignant hematology. Trainees' career decisions and perceptions of hematology revolved around five major themes: serendipity, mentorship, clinical exposure and teaching, intellectual interest, and lifestyle factors. Most trainees identified seminal, career-defining experiences prior to medical school but were not influenced by medical school classroom experiences and were not differentiated at the start of fellowship with respect to a hematology- or oncology-oriented career. By the end of their first year of fellowship, almost all had decided to pursue careers in solid tumor oncology owing to clinical exposure and research opportunities. Mentorship was identified as the single most important determinant, with mentorship opportunities tending to occur "randomly" or by "happenstance," and with oncology having "more" "available mentors" who played a "huge role" in the career-decision process. Trainees characterized hematology as having a less desirable work/life balance than oncology, and trainees' experiences on the inpatient hematology services caused some of them to feel "burned out." Despite this, fellows commonly perceived hematology to be more "interesting" and "challenging" than oncology, with "much more complex" disease pathology. Financial considerations were of importance to only a minority of trainees.CONCLUSIONSMentorship and research opportunities are the major factors guiding career decisions among hematology/oncology fellows. An increase in structured mentorship opportunities in hematology may lead to greater trainee recruitment. Trainees view hematology as an intellectually engaging field although lifestyle factors render it less desirable than oncology. DisclosuresPodoltsev:Incyte: Consultancy, Honoraria; Ariad: Consultancy, Honoraria.

Pediatric Cardiology Boot Camp: Description and Evaluation of a Novel Intensive Training Program for Pediatric Cardiology Trainees.

The transition from residency to subspecialty fellowship in a procedurally driven field such as pediatric cardiology is challenging for trainees. We describe and assess the educational value of a pediatric cardiology "boot camp" educational tool designed to help prepare trainees for cardiology fellowship. A two-day intensive training program was provided for pediatric cardiology fellows in July 2015 at a large fellowship training program. Hands-on experiences and simulations were provided in: anatomy, auscultation, echocardiography, catheterization, cardiovascular intensive care (CVICU), electrophysiology (EP), heart failure, and cardiac surgery. Knowledge-based exams as well as surveys were completed by each participant pre-training and post-training. Pre- and post-exam results were compared via paired t tests, and survey results were compared via Wilcoxon rank sum. A total of eight participants were included. After boot camp, there was a significant improvement between pre- and post-exam scores (PRE 54±9% vs. POST 85±8%; p≤0.001). On pre-training survey, the most common concerns about starting fellowship included: CVICU emergencies, technical aspects of the catheterization/EP labs, using temporary and permanent pacemakers/implantable cardiac defibrillators (ICDs), and ECG interpretation. Comparing pre- and post-surveys, there was a statistically significant improvement in the participants comfort level in 33 of 36 (92%) areas of assessment. All participants (8/8, 100%) strongly agreed that the boot camp was a valuable learning experience and helped to alleviate anxieties about the start of fellowship. A pediatric cardiology boot camp experience at the start of cardiology fellowship can provide a strong foundation and serve as an educational springboard for pediatric cardiology fellows.

Board 106 - Program Innovations Abstract Development, Implementation and Evaluation of a Simulation Based Boot Camp for Fellows from Multiple Specialties - The Integrated Fellows Simulation Training Program (Submission #861)

Introduction/Background Simulation based boot camps have grown in popularity within teaching institutions over the last five years. The goals of these programs are to improve competence and clinical performance in new postgraduate medical trainees at the start of fellowship in an era of limited work hours and experience during residency training, increasing concerns for patient safety and the rapid growth of simulation programs within teaching institutions. Traditionally, these boot camps have been developed for a single discipline such as pediatric critical care, internal medicine or surgery.1-5 They can be limited to specialties with high volumes of trainees given the time, resources and expense of developing an intensive simulation training program. Additionally, at large institutions like ours, with over 23 fellowship programs, it can be a challenge to provide the space, equipment, and time needed to implement simulation based boot camps during the month of July when new trainees arrive. In order to meet this challenge, we found a need to provide simulation based boot camps applicable to multiple specialties for improved efficiency and education for all postgraduate pediatric trainees. Methods The objectives were to develop, implement, and evaluate the efficacy of a one day simulation based boot camp for pediatric, medical and surgical trainees from multiple specialties. An experienced group of simulation trained educators from three diverse specialties (Pediatric Emergency Medicine, Pediatric Critical Care Medicine and Neonatal Intensive Care Medicine) gathered to discuss goals and objectives for a simulation based boot camp for all pediatric medical and surgical trainees. A formal needs assessment was conducted via a survey with program directors from all pediatric subspecialties to identify educational gaps. Curricular objectives were made based on results of the survey and identification of common patient safety and educational goals for any pediatric medical and surgical trainee - basic pediatric resuscitation skills (airway management, CPR and defibrillation, code cart familiarity and emergency access), effective teamwork and communication including crisis resource management and difficult conversations (delivery of bad news and disclosure of medical errors). Detailed course documents were developed including didactics, skills station objectives, high fidelity manikin and standardized patient scenarios, performance checklists and scripted debriefs. Instructors, including both physicians, nursing and respiratory therapists, were trained in simulation based methodologies and regularly teach within our simulation program. In order to create true multi disciplinary training opportunities, new and experienced nurses, respiratory therapists and pharmacists were invited to participate as learners with the fellow trainees. The Integrated Fellows Simulation-based Training Course (IFST) has been implemented for the last three years during the month of July. Since then, postgraduate fellowship trainees from multiple subspecialties have attended including pediatric surgery, pediatric otolaryngology, pediatric neurosurgery, rheumatology, endocrinology, pediatric hospital medicine, pediatric critical care and pediatric emergency medicine. Average scores for course evaluations on a 5-point Likert scale (1 strongly disagree to 5 strongly agree) have shown a high degree of satisfaction. Average ratings for "I plan to apply what I learned here to my clinical practice", "I would recommend this course to my colleagues" and "I feel that this course has improved my ability to care for my patients" were 4.75, 4.66, and 4.66 respectively. Average scores for "I feel that this course has improved communication skills and patient safety" were 4.69 and 4.71. Conclusion A simulation based boot camp for a diverse group of postgraduate learners can be developed and implemented with a high level of learner satisfaction. Combined simulation based boot camps can effectively provide valuable education to trainees who might not otherwise have this opportunity, due to a lack of resources or sufficient numbers to implement specialty specific programs. Future evaluation will look at six month follow-ups on skill utilization and retention.