Subspecialty Fellowship Training Research Articles

Global health opportunities within pediatric subspecialty fellowship training programs: surveying the virtual landscape.

BackgroundThere is growing interest in global health among medical trainees. Medical schools and residencies are responding to this trend by offering global health opportunities within their programs. Among United States (US) graduating pediatric residents, 40% choose to subspecialize after residency training. There is limited data, however, regarding global health opportunities within traditional post-residency, subspecialty fellowship training programs. The objectives of this study were to explore the availability and type of global health opportunities within Accreditation Council for Graduate Medical Education (ACGME)-accredited pediatric subspecialty fellowship training programs, as noted by their online report, and to document change in these opportunities over time.MethodsThe authors performed a systematic online review of ACGME-accredited fellowship training programs within a convenience sample of six US pediatric subspecialties. Utilizing two data sources, the American Medical Association-Fellowship and Residency Electronic Interactive Database Access (AMA-FREIDA) and individual program websites, all programs were coded for global health opportunities and opportunity types were stratified into predefined categories. Comparisons were made between 2008 and 2011 using Fisher exact test. All analyses were conducted using SAS Software v. 9.3 (SAS Institute Inc., Cary, NC).ResultsOf the 355 and 360 programs reviewed in 2008 and 2011 respectively, there was an increase in total number of programs listing global health opportunities on AMA-FREIDA (16% to 23%, p=0.02) and on individual program websites (8% to 16%, p=0.004). Nearly all subspecialties had an increased percentage of programs offering global health opportunities on both data sources; although only critical care experienced a significant increase (p=0.04, AMA-FREIDA). The types of opportunities differed across all subspecialties.ConclusionsGlobal health opportunities among ACGME-accredited pediatric subspecialty fellowship programs are limited, but increasing as noted by their online report. The availability and types of these opportunities differ by pediatric subspecialty.

Geographic differences in academic promotion practices, fellowship training, and scholarly impact

PurposePrevious literature described how clinical fellowship training impacts scholarly production among academic otolaryngologists, finding that fellowship-trained practitioners had higher research productivity than their non-fellowship-trained peers, and head and neck (H&N) surgeons and otologists had the highest scholarly impact. In this analysis we investigate whether geographic differences in academic promotion and scholarly impact exist, and whether such differences are associated with emphasis on regional fellowship training patterns. MethodsThe Scopus database was used to determine scholarly impact (as measured by the h-index) of 1109 academic otolaryngologists from 97 departments. Online faculty listings were organized by fellowship training, academic rank, and location. ResultsFellowship-trained practitioners had greater research productivity than non-fellowship-trained otolaryngologists (H=9.5±0.26 SEM vs. 6.5±0.43, p<0.001), a finding that persisted throughout except in the Mountain and East South Central Regions. H&N surgeons and otologists had the highest h-indices. Practitioners in the West had the highest h-index, with differences persisting upon examination of junior faculty. The West (62.1%) and Midwest (60.5%) had the highest proportions of senior faculty. Regional differences in scholarly impact and academic promotion were further noted upon organizing faculty by subspecialty fellowship training. ConclusionsGeographic differences in academic promotion and scholarly impact exist, most markedly among junior faculty. Practitioners in the West had high impact and were more represented at senior ranks. Upon examination by fellowship training status, fellowship-trained otolaryngologists had higher impact in most, but not all, geographic regions. Regional variations in promotion were noted upon organizing faculty by subspecialty, although association with scholarly impact differs by region.

Mentorship in Orthopaedic Surgery—Road Map to Success for the Mentor and the Mentee

There are unique challenges and opportunities associated with mentoring of orthopaedic residents. Relative to medical students, there is a much greater duration, intensity, and responsibility for teaching, while relative to fellowship training, the educator teaches and mentors a much less knowledgeable and less skilled protege. Although physicians receive their medical degree following completion of medical school, they learn how to become orthopaedic surgeons during the five years of their residency education. Graduating medical students have very little knowledge of musculoskeletal disease and its treatment1; however, it is expected that at the end of five years, they are prepared for their board examinations and the independent practice of orthopaedic surgery. Even the most outstanding residents require frequent assessment and feedback, and the need to constantly challenge and critique the knowledge and skills of the resident has the potential to compromise the unique closeness and sense of empathy and support that serve as the foundation of the mentoring relationship. The factors noted above have implications for the ten stages of the mentoring relationship described by Mendler2. The first five phases (attraction, cliche exchange, recounting, personal disclosure, and bonding) compose the developmental phase of the relationship, during which time the “chemistry” of the relationship evolves, mutual interests and goals are identified, and the supportive framework is established. Although most residents ultimately pursue subspecialty fellowship training, our belief is that they need to experience the various subspecialties before coming to this decision, something that may not occur prior to the conclusion of their postgraduate year 3. Therefore, in many situations, the relationship with the junior resident is more one of a supportive advisor, which may ultimately evolve into that of true mentoring or plateau at that level as the resident becomes the protege of a different mentor whom the resident …

Fellowship Training in Pediatric Pathology: A Guide for Program Directors

ABSTRACT The Accreditation Council for Graduate Medical Education (ACGME) has provided guidance for specialty and subspecialty fellowship training programs by defining 6 core competencies that must be met. Furthermore, the ACGME has defined several program requirements for pathology training, including those applicable to several pathology subspecialties. However, the requirements are broad and lack specific details, particularly as they pertain to the unique nature of pediatric pathology. The Fellowship Committee of the Society for Pediatric Pathology examined the ACGME requirements and interpreted the guidelines with respect to their application to training in pediatric pathology. The Committee worked within the ACGME guidelines to provide an expanded and more comprehensive set of guidelines for use by pediatric pathology fellowship directors and trainees. The resultant document lists the educational goals, core competencies, and program requirements with specific application to pediatric pathology. In addition, methods for assessing and documenting the progress of the individual trainees as they progress through each requirement are provided. It is to be emphasized that many of the guidelines set forthwith are flexible, and allowances should be made for individual differences of each training program.

Views of Recently First-Certified US Child Neurologists on Their Residency Training

We surveyed child neurologists first certified in "Neurology with Special Qualification in Child Neurology" by the American Board of Psychiatry and Neurology (ABPN) between 2001 and 2010 using a 24-item questionnaire. Respondents (n = 204, 54% response rate) were between the ages of 30 and 59 years (54% male), and 68% completed adult neurology training in a 10- to 12-month, primarily inpatient block. Sixty-two percent of the sample completed subspecialty fellowship training and 82% currently reported practicing within a hospital or hospital-based/owned clinic. Current practice data showed just 3% provide general neurology services to adults. A majority reported using adult neurology residency training "less than weekly" and believed the ideal model for residency training in diagnosis and management of both common and rare neurologic conditions would involve less time in adult neurology and more time (mean 6 months) in child neurology, most prominently in genetics and developmental and behavioral areas.

Pursuit of Accredited Subspecialties by Graduating Residents in Obstetrics and Gynecology, 2000–2012

To estimate whether there has been an increase in resident graduates pursuing fellowship training in the currently accredited subspecialties and to compare whether any trend toward subspecialization is similar to those seen in other specialties. This descriptive study examined data from the National Residency Match Program for academic years 2000-2012. Annual comparisons were made between the numbers of residents who either pursued careers in their specialty or were accepted into fellowship training in an accredited subspecialty. We compared the numbers in each group who took the American Board of Obstetrics and Gynecology (ABOG) written board examination and who became board-certified. Although the annual number of residency graduates in obstetrics and gynecology remained essentially the same (1,185 ± 56), the proportion of graduates accepted into fellowships increased steadily in all subspecialties (from 7.0% in 2000 to 19.5% in 2012). All other core specialties saw higher proportions of their graduates pursuing subspecialties except for family medicine. Coincident with rises in fellowship programs and positions was eventual increase in trainees who took the ABOG written examination for the first time in the three established subspecialties (maternal-fetal medicine, gynecologic oncology, reproductive endocrinology and infertility) and who became board-certified. Like with residents in other specialties, more graduates in obstetrics and gynecology are pursuing accredited subspecialty fellowship training, adding to the complexities of workforce planning. The percent of obstetrics and gynecology residents who pursued accredited subspecialty fellowship training was lower than all but one other specialty.

General surgery graduates may be ill prepared to enter rural or community surgical practice

BackgroundRural/community surgery presents unique challenges to general surgeons. Not only are they required to perform “classic” general surgery procedures, but they are also often expected to be competent in other surgical disciplines. MethodsFinal-year Canadian-trained residents in general surgery were asked to complete the survey. The survey explored chief residents' career plans for the following year and whether or not they would independently perform various procedures, some general surgical, and others now considered within the domain of the subspecialties. ResultsSixty-four residents (71%) completed the survey. Twenty percent planned to undertake a rural surgical practice, 17% an urban community practice, and 55% had confirmed fellowships. Most residents (>90%) expressed comfort with basic general surgical procedures. However, residents were less comfortable with subspecialty procedures that are still performed by general surgeons in many rural practices. ConclusionsMore than half of graduating general surgery residents are choosing subspecialty fellowship training over proceeding directly to practice. Those choosing a rural or community practice are likely to feel ill prepared to replace existing surgeons.

The Royal College diploma program: credential creep or value added?

Subspecialty fellowship training in anesthesia undertaken after the completion of residency offers multiple benefits to the profession and to society. Fellowships offer focused teaching in knowledge domains and technical skills that are supplementary and complementary to those taught during residency. In addition, fellows provide academic contributions to their departments, their hospitals, and the profession. Completion of a Canadian fellowship in anesthesia is sometimes awarded with a diploma from a university or hospital, but traditionally this investment in training has not been recognized by an accredited national certifying body. There is an opportunity for that to change. In 2011, the Royal College of Physicians and Surgeons of Canada (RCPSC) launched its Area of Focused Competence (AFC) diploma certification in subspecialties. This certification program is intended to provide, among other things, recognition to physicians who have special skills that add to, but do not replace, skills utilized during the practice of a primary specialty. According to the RCPSC,

Rural General Surgery: A Review of the Current Situation and Realities from a Rural Community Practice in Central Nebraska

Purpose: To examine the reasons fewer students and residents are entering general surgery, to educate residents about the realities of rural general surgery based on the experience of three general surgeons in central Nebraska, and to suggest a strategy for individual general surgeons and for residency programs to maintain the rural surgical workforce. Methods: A systematic literature review of surveys, review articles, and editorials through PUBMED was performed. Relevant studies were included in a review of the current literature on the rural general surgery workforce, general surgery residency, fellowship training, and rural surgery education. Findings: There is an insufficient supply of general surgeons in many parts of the country, particularly in rural settings. More general surgery residents are entering into subspecialty fellowship training and fewer are practicing general surgery than in the past. Residents may have inaccurate perceptions about rural general surgery practice. Those residency programs with dedicated rural and community surgery rotations have had more success in producing rural general surgeons. Conclusions: Although specialization in surgery has many positive effects, maintenance of a general surgical workforce in rural America is crucial to the health care of many citizens. Increasing the numbers of mentoring and training programs could provide medical students and general surgery residents with more educational opportunities that may lead to increased interest in rural surgery.

The San Francisco Project Assessment Tool: Validity and Reliability

In medical education completing a scholarly project is encouraged. In fact, this is required by the American Board of Pediatrics (ABP) for subspecialty fellowship training. Despite its growing importance, valid and reliable measures of the quality of scholarly projects are lacking.

Pathology Subspecialty Fellowship Application Reform, 2007–2010

The specialty of pathology and laboratory medicine has entered a phase in which the 4-year sequence of residency training is almost universally followed by 1 or more years of subspecialty fellowship training. Such training may occur in an American Board of Pathology-recognized subspecialty or any number of "subspecialty fellowships" that do not lead to subspecialty board certification. Unlike the application process for first-year pathology residency, which is run through the National Resident Matching Program, applications for subspecialty pathology fellowships have no consistent coordination. Responding to widespread dissatisfaction voiced in 2007 by national pathology resident organizations, the Association of Pathology Chairs began evaluation and potential intervention in the fellowship application process. After 3 years of effort, the Council of the Association of Pathology Chairs has recommended implementation of a pathology subspecialty fellowship matching program starting in the 2011-2012 recruiting year for applicants matriculating in fellowship programs in July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process.

Associations between subspecialty fellowship interest and knowledge of internal medicine: A hypothesis-generating study of internal medicine residents

BackgroundLittle is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM).MethodsA questionnaire was emailed to 48 categorical postgraduate-year (PGY) two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE) for the same year was used to determine objective knowledge.ResultsForty-five of 48 residents (response rate was 93.8%) completed the survey. Twenty-two (49%) were PG2 residents and 23(51%) were PGY3 residents. Sixty percent of respondents were male. Six (13%) residents were graduates of U.S. medical schools. Eight (18%) reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75%) had training in IM and 6 (75) % reported a training length of 3 years or less. Thirty-seven of 45 (82%) residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04) as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p < 0.02) across three content areas.ConclusionsMore than half of surveyed residents indicated interest in pursuing a subspecialty fellowship. Fellowship interest appears positively associated with general medical knowledge in this study population. Further work is needed to explore motivation and study patterns among internal medicine residents.

Proposal for Subspecialty Physician Fellowship Training in Nutrition and Health Promotion

Subspecialty fellowship training programs in nutrition and health promotion (NHP) are necessary for any comprehensive solution to address physician shortages in this discipline. After a careful needs and resource assessment, current or future program directors can decide on 1 of 3 potential NHP training models: dedicated continuous, dedicated carve-out, or concurrent continuous. Each of these models will need to provide complete elements of core curricula and a sufficient amount of specialized modular NHP training. At the conclusion of the training program, NHP fellows should have fulfilled board certification eligibility requirements so that they may later become NHP experts and mentors to perpetuate this subspecialty.

Pathology subspecialty fellowship application reform 2007 to 2010

The specialty of Pathology and Laboratory Medicine has entered into a phase when the 4-year sequence of Anatomic Pathology and/or Clinical Pathology Residency Training is almost universally followed by 1 or more years of Subspecialty Fellowship Training. Such training may occur in one of the American Board of Pathology-recognized subspecialties or any number of "subspecialty fellowships" that, although not leading to subspecialty board certification, may nevertheless fall under the oversight of the local institutional Graduate Medical Education Committee and the Accreditation Council for Graduate Medical Education Review Committee for Pathology. Unlike the application process for first-year Pathology Residency, which is run through the National Resident Matching Program, applications for Subspecialty Pathology Fellowships are not coordinated by any consistent schedule. Competition for Subspecialty Pathology Fellowships has consistently resulted in undesirable drift of the fellowship application process to dates that are unacceptably early for many fellowship applicants. Responding to widespread dissatisfaction voiced by national pathology resident organizations, in 2007, the Association of Pathology Chairs began evaluation and potential intervention in the fellowship application process. Three years of intermittently intense discussion, surveys, and market analysis, have led the Council of the Association of Pathology Chairs to recommend implementation of a Pathology Subspecialty Fellowship Matching program starting in the 2011 to 2012 recruiting year, for those Applicants matriculating in fellowship programs July 2013. We report on the data that informed this decision and discuss the pros and cons that are so keenly felt by the stakeholders in this as-yet-incomplete reform process.

Fellowship Selection Criteria in Ophthalmic Plastic and Reconstructive Surgery

Competition for subspecialty fellowship positions in ophthalmology continues to grow, and there is increasing interest regarding the factors considered important in fellowship selection. While a previous report evaluated the characteristics and criteria used by ophthalmology subspecialty program directors to select fellows in retina, cornea/external disease, and glaucoma fellowship programs, to the authors' knowledge no such study has evaluated Ophthalmic Plastic and Reconstructive Surgery (OPRS) fellowships. The authors surveyed the program directors of all American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS)-sponsored fellowships in the United States and Canada. The survey contained 16 criteria related to the selection of fellows. A Likert scale ranging from 1 (not important) to 9 (very important) was used for prioritizing the criteria. Opportunity was afforded for comment on other measures, and program directors were also asked to select their most important factor used for fellow selection. The return rate of the completed surveys was 35 of 48 (73%). The 3 criteria with the highest mean Likert scale scores were the interview process (8.7), the ability to work and communicate with others (8.5), and letters of recommendation from subspecialty faculty (7.8). Likewise, the criterion selected as the single most important by respondents was the interview (58%), the ability to work and communicate with others (15%), and letters of recommendation from subspecialty faculty (15%). The authors' findings demonstrate that OPRS program directors place greater emphasis on qualities assessed during the interview, letters of recommendation from same specialty faculty, and the ability of the applicant to work and communicate with others. While not identical, our findings were similar to those noted for other ophthalmology subspecialties. The results support the suggestion that residents interested in fellowship training may benefit from faculty mentors in their area of interest early in their training. With the high interest in OPRS and other ophthalmology subspecialty fellowship training, the authors hope that this report will be useful to applicants, residency programs, and fellowship directors.

Characteristics of Physicians Who Choose Fellowship Training in Obstetrics and Gynecology

: To determine the attributes and motivation of physicians who pursue fellowship training in the subspecialties of Obstetrics and Gynecology (Ob/Gyn). : We surveyed current fellows and recent graduates from the ABOG recognized subspecialties in Ob/Gyn. Demographics and reasons for pursuing fellowship training were obtained. Significant differences between and among groups were determined using the Mann-Whitney U test and Pearson χ test. : Forty-two percent of those sent a survey responded. The majority were between ages 30 to 35 (65.7%), female (60.5%), married (74.5%), and White (68.8%). Over 55% in each subspecialty cited interest in subject area as the primary reason for choosing their fellowship. : Interest in subject remains the primary motivation for the majority of physicians choosing subspecialty fellowship training in Ob/Gyn. There is considerably more variation regarding what physicians' secondary motivation is and these reasons appear to vary according to the particular subspecialty.

Career Plans of Graduating Plastic Surgery Trainees in 2009: The Impact of an Uncertain Economic Climate

Trainees in plastic surgery graduating in the midst of the current economic recession face unique financial challenges. These issues have the potential to affect future training and practice plans. A 13-item questionnaire regarding issues influencing career plans was administered to senior plastic and reconstructive surgery trainees attending the 2009 American Society of Plastic Surgery Senior Residents Conference, in Austin, Texas. Of 97 conference attendees, 57 (58.7 percent) completed the survey representing all regions of the United States (33.3 percent of trainees nationwide). Trainees in the traditional training model (i.e., plastic surgery fellowship after surgery residency) were significantly less likely to pursue additional subspecialty training (29.6 percent) compared with trainees in integrated (76.9 percent) or combined programs (58.8 percent) (p = 0.012). Trainees who have dependents were significantly more likely to go into practice without fellowship (69 versus 38.2 percent, p = 0.031). Outstanding educational debt (>$50,000 or >$100,000) did not influence future practice plans. Trainees who are concerned about the national economic recession trended toward entering practice without fellowship training (70.0 versus 40.5 percent, p = 0.052). Of the factors surveyed, only anticipated fellowship training was significantly associated with plans to pursue academic practice (p = 0.002). The majority of graduating trainees enter private practice without additional subspecialty fellowship training. Neither exceptional debt nor concern about the current economic recession was the primary determinant of future career plans, whereas trainees in a traditional model of plastic surgery and trainees with dependents were more likely to enter practice without further fellowship training.

Recently Trained Pediatric Subspecialists: Perspectives on Training and Scope of Practice

Little is known regarding the factors influencing the decision to pursue pediatric subspecialty fellowship training and the timing of when such a decision is made. In addition, there is no information regarding whether the general pediatrics training received in residency is perceived as valuable by subspecialists. This study was conducted to characterize the strengths and weaknesses of residency and fellowship training from the perspective of recently trained pediatric subspecialists and to assess their current and future career goals and intended scope of practice. A random sample of 550 subspecialists whose initial application for pediatric subspecialty certification occurred between 2002 and 2003 (4-5 years out of training) and 550 subspecialists who applied for board certification between 2005 and 2006 (1-2 years out of training) received a structured questionnaire by mail. The survey focused on decision-making in selection of residency and fellowship programs, strength of residency training in preparation for clinical care provision, and scope of current practice. The overall response rate was 77%. More than half (54%) of the recently trained subspecialists would have shortened either their pediatric residency or fellowship training if given the opportunity, and 7% were unsure. More than one third of the respondents made the decision to pursue subspecialty training before the start of residency (36% [n = 198]), whereas approximately half of them made this decision during the first (19% [n = 106]) or second (27% [n = 150]) year of residency. Many subspecialists would have been interested in modifications to their pediatric residency and fellowship training programs, which may reflect changing patterns of professional activities or the preferences of a younger generation of subspecialists. Given that a substantial proportion of subspecialists decide to pursue subspecialty training before or early in residency, greater flexibility in configuring some residency experiences to meet their career goals would be feasible.

Core Competencies for Gynecologic Endoscopy in Residency Training: A National Consensus Project

Residents and educators in obstetrics and gynecology have identified the need to improve endoscopic surgical education. The Canadian Endoscopy Education Project aims to create a national standardized endoscopy curriculum. The objective of the current project was to identify the core competencies for a gynecologic endoscopy (GE) curriculum in residency training programs. This expert consensus project (Canadian Task Force Classification III) included all 16 academic obstetrics and gynecology residency programs in Canada. Each university program selected their leading endoscopy educator to participate in the consensus process. Competencies for proficiency in GE were identified and then reviewed in 3 sequential rounds of consensus building using the Delphi technique. Overall, 213 objectives were reviewed and 199 (93%) of the items achieved consensus agreement. Competencies that were deemed outside the realm of general residency education were also collated and may represent a guide to subspecialty fellowship training in the future. The core competencies for GE training in obstetrics and gynecology residency were determined through national expert consensus. This provides the basis for a national standardized endoscopy curriculum for general obstetrics and gynecology training.

Financing Graduate Medical Education to Meet the Needs of Children and the Future Pediatrician Workforce

This policy statement articulates the positions of the American Academy of Pediatrics on graduate medical education and the associated costs and funding mechanisms. It reaffirms the policy of the American Academy of Pediatrics that graduate medical education is a public good and is an essential part of maintaining a high-quality physician workforce. The American Academy of Pediatrics advocates for lifelong learning across the continuum of medical education. This policy statement focuses on the financing of one component of this continuum, namely residency education. The statement calls on federal and state governments to continue their support of residency education and advocates for stable means of funding such as the establishment of an all-payer graduate medical education trust fund. It further proposes a portable authorization system that would allocate graduate medical education funds for direct medical education costs to accredited residency programs on the basis of the selection of the program by qualified student or residents. This system allows the funding to follow the residents to their program. Recognizing the critical workforce needs of many pediatric medical subspecialties, pediatric surgical specialties, and other pediatric specialty disciplines, this statement maintains that subspecialty fellowship training and general pediatrics research fellowship training should receive adequate support from the graduate medical education financing system, including funding from the National Institutes of Health and other federal agencies, as appropriate. Furthermore, residency education that is provided in freestanding children's hospitals should receive a level of support equivalent to that of other teaching hospitals. The financing of graduate medical education is an important and effective tool to ensure that the future pediatrician workforce can provide optimal heath care for infants, children, adolescents, and young adults.