Subspecialty Fellowship Research Articles

Neurosurgery Fellowships and the Residencies That Enfold Them: A Nationwide Correlational Analysis.

Accredited neurosurgery fellowship training is available in 10 subspecialties and can sometimes be completed during the postgraduate year (PGY)-7 residency year. However, it is not clear whether there are sufficient residency graduates to fill the number of positions available, and residency curriculum structure to support enfolded training is evolving. Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training, respectively. Information about residency chief year structure (PGY-6 vs PGY-7) was obtained electronically from each program. An analysis was performed to correlate residency and fellowship training characteristics at each program. The total number of neurosurgery fellowship positions available per year (352) is much higher than the total number of residency positions (237). Eighty-eight (75%) institutions with a neurosurgery residency offer at least 1 fellowship, and 51 of these have more fellowships than graduating residents. The resident complement at each program correlates with the number of fellowships offered (r2 = .56, P < .05), and the average institutional resident complement where fellowships are offered is greater than 2 per year. Thirty-eight residencies (32%) use a PGY-6 chief model (allowing for enfolded fellowships), and these programs offer significantly more fellowship programs on average than those using a traditional PGY-7 chief model (3.0 vs 2.1, P < .05). For most subspecialties, a minority of fellowships are offered in programs with a PGY-6 chief model. The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training. There may be advantages to a uniform approach that standardizes subspecialty training across programs and matches fellowship availability to demand.

8006 Feedback For Fellows: Opening The Pandora's Box Of "Confidence" In Feedback

Abstract Disclosure: S. Ananthakrishnan: None. C. Noronha: None. Background: Feedback is a key component of training at any level. Sub-specialty fellowship training has unique goals and barriers to feedback exchange, such as faculty tension with giving negative feedback to potential future colleagues, that are uncommon in other training environments. A common characteristic that may be discussed in feedback exchanges is a supervisor’s perception of a trainee’s confidence. Concerns have been raised both at the local and national level regarding the potential negative effects of the word “confidence” in medical education, due to cultural, gendered, and racial biases, which can be harmful to the learning environment in endocrinology where many trainees hail from diverse geographic and cultural backgrounds. Methods: Within our institution, ACGME annual survey data between 2015-2019 indicated that a large portion of internal medicine specialty fellows were not satisfied with the feedback they received. Pilot data from a survey administered to trainees in the Department of Medicine at our institution indicated that 66.67% (n=31) of trainees had received feedback about their confidence level as observed in the clinical setting. Over 70% of those trainees felt the feedback was actionable less than half the time. The themes of frustration and ambiguity in interpreting the feedback around “confidence” emerged from the trainee data. To address perceived deficiencies in supervisor knowledge, skills and attitudes around fellowship-specific feedback exchange, we implemented departmental workshops focused on highlighting tools related to giving feedback to fellow trainees and case-based discussions to understand how and why the word “confidence” is used in feedback and how it may be interpreted by trainees. Results: This feedback workshop has been instituted within our Department of Medicine and was piloted with a focus on fellowship education in the Endocrinology section by the time of this abstract (further data forthcoming). Following the workshop, attendees (n=13) were surveyed. 76.9% of respondents had experience delivering feedback with the word or theme of “confidence”, despite 69.2% of respondents being aware of the varied meanings of the word. Following the workshops, data from faculty attendees indicated 92% of respondents were aware of the varied meaning and 99% felt more comfortable using behavioral-based, as opposed to personality-based, language to support actionable changes in fellow skills. Conclusions: This workshop curriculum suggests further need to explore the impact of the word “confidence” in feedback exchanges. Our pilot data is a call to action for further research on the development of effective strategies on how to move past use of the word “confidence” in feedback, with the goal of providing more specific, bias-free and behavioral-based feedback that can support a more inclusive learning environment for fellowship trainees. Presentation: 6/3/2024

Salary Equity among Subspecialty Fellows: A Call to Action

Salary Equity among Subspecialty Fellows: A Call to Action

The Leaders in Informatics, Quality, and Systems (LInQS) Fellowship.

Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership. This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians. From 2019 to 2023, 32 fellows have been accepted into the program with 13 graduates and 16 currently enrolled. Fellows have been predominately female, physicians, and from multiple specialties but predominantly hospital medicine. Fellows' evaluations of the fellowship are highly positive, rating the didactics and mentorship aspects of the curriculum most favorably. Most fellows' projects utilized informatics solutions including clinical decision support tools to increase quality of care, improve patient outcomes, and reduce costs of care resulting in manuscript publications, national presentations, and a national specialty society award. Since matriculation, 50% of fellows received certification as Epic Physician Builders and 34% received leadership positions in clinical informatics, quality, and education. Our experience supports the need to provide health care providers more expansive training in the areas of QI, clinical informatics, and leadership for improving health care delivery. Additional in-depth knowledge and experience in these fields may produce and benefit leaders in these fields.

Linguistic analysis of letters of recommendation for pediatric otolaryngology: A pilot study

ObjectivesTo analyze the language of letters of recommendation for pediatric otolaryngology fellowship for possible gender and/or racial bias. To refine methodology for future investigation of gender and language within letters of recommendation for pediatric otolaryngology fellowship. MethodsPracticing pediatric otolaryngologists were recruited as survey participants. A total of 10 letters of recommendation were screened to represent an equal number of applicants who identify as male and female and an equal number of applicants who identify as White and applicants who identify as Black, Indigenous, or a Person of Color. Names, pronouns, location, and other identifying information were removed from the letters. Survey participants were asked to read each letter and categorize the applicant's gender and race as well as that of the letter writer. The letters were also subject to analysis by WordStat linguistic software. ResultsA total of 35 pediatric otolaryngologists participated in the survey. Participants assigned gender of the applicant correctly in 43 % of letters and gender of the letter writer correctly in 53 % of letters. Race of the applicant was judged correctly in 65 % of letters. Participants indicated words such as caring, hard-working, and prepared led them to assume the applicant was female, which was corroborated by linguistic analysis. No such words were identified as predictive of race. ConclusionThis pilot study suggests that while there are certain linguistic associations with gender among applications to pediatric otolaryngology fellowship, they may not impact biases held by the reader. This is relevant given a recent rise in the number of female applicants to this subspecialty and ongoing unfilled fellowship positions. Future studies are needed to determine if such associations exist and ultimately affect match potential and success within the field. These studies will require analysis of more letters and with more survey respondents, along with a higher in-depth linguistic analysis. Lay summaryThis pilot study aims to evaluate letters of recommendation for pediatric otolaryngology fellowship applications for gender bias with the goal of outlining future studies. There were certain words associated with a given gender, which could impact applicants’ potential to match. Level of evidenceNA.

Learning from our patients: An exploratory study to inform the development of a case tracking dashboard for internal medicine subspecialty fellows

Background Case tracking (following-up prior patient encounters) can help inform future clinical decisions and supplement experiential learning. Internal medicine subspecialty fellows see a high volume of patients and need to become subject matter experts within a short time frame, yet little is known about their specific needs and motivations around case tracking. Objective The objective of this study was to explore internal medicine subspecialty fellows’ motivations, preferences, and practices around case tracking. Methods We conducted interviews with internal medicine subspecialty fellows at a single academic medical center during the 2022–2023 academic year. Interviews were analyzed using qualitative content analysis. Results 22 fellows were interviewed for our study. We found that most fellows engaged in case tracking with lists in the electronic health record (EHR). Fellows primarily tracked cases of clinical uncertainty and patients with specific diseases or conditions of interest. Fellows sought information on patients’ health outcomes, results, and clinical notes. Motivations for tracking were predominantly related to curiosity, professional growth, and development of practice patterns. Barriers to case tracking included time, challenges maintaining patient lists, losing track of patients, and lack of motivation to develop and maintain an organized system. Conclusions Internal medicine subspecialty fellows engaged in and valued case tracking as a way to supplement their experiential learning. Our study highlighted their current practices, motivations, preferences, and challenges related to case tracking. We plan to use these findings to help develop an EHR-embedded dashboard to facilitate case tracking among subspecialty fellows.

Foot and ankle fellowship-trained osteopathic orthopaedic surgeons: a review, analysis, and understanding of current trends.

Over the past several decades, orthopedic surgery has seen a substantial increase in the number of surgeons completing fellowship training. Doctors of Osteopathic Medicine (DOs) continue to advance their orthopedic education through subspecialty fellowship training. DOs have represented between approximately 6 % and 15 % of American Orthopaedic Foot and Ankle Society (AOFAS) fellows. Although historical representation has been considered strong, the fellowship match years 2020 and 2021 have seen a decline in osteopathic orthopedic surgeons participating in foot and ankle fellowships. This deviates from the recent trends of increasing participation across orthopedic subspecialities. To investigate and review the trends of orthopedic foot and ankle fellowship training. Data was reviewed from the AOFAS regarding number of fellows matched and degree obtained. Data from the Federation of State Medical Boards (FSMB), American Orthopaedic Foot and Ankle Society (AOFAS) and Association of American Medical Colleges (AAMC) were reviewed for physician trends and match statistics. Fellowship match years 2020 and 2021 have seen a decline in osteopathic orthopedic surgeons participating in foot and ankle fellowships, with only roughly 3% of AOFAS fellows being osteopathic trained. Orthopedic surgery has the highest rate of subspecialty training of all surgical specialties. Although there is hope for an increasing osteopathic presence in orthopedic surgery, recent literature has pointed to potential for continued bias in opportunities for osteopathic students. We hope that increased participation of osteopathic graduates in orthopedic surgery training programs will result in the continued expansion of osteopathic orthopedic surgeons completing fellowship training, including in foot and ankle surgery.

Current Communication Practices Between Internal Medicine Subspecialty Fellowship Applicants and Program Directors: A National Survey

PurposeAs fellowship applications increasingly transition to virtual interviews, the role of social media in this process remains uncertain. This study explores internal medicine subspecialty program directors' (PDs) perspectives on current communication practices, including the use of social media and email, between applicants and programs. MethodA national survey was conducted among U.S. internal medicine subspecialty fellowship PDs from November to December 2023. The survey collected demographic information about PDs, program-level information, and their views on using social media platforms (Twitter/X and Instagram) and email for program promotion and application review. ResultsOut of 297 PDs who responded (18.5% response rate), 52% were male, 69% identified as White/Caucasian, majority from age group 46-50 years. The subspecialties with the highest representation were infectious disease (15%), pulmonology and critical care (14%), and cardiology (12%). Among respondents, 41% used Twitter/X and 24% used Instagram for program promotion. A smaller fraction reviewed applicants through these platforms for interview invitations (14% via Twitter/X and 7% via Instagram). PDs reported receiving an average of 35 letters of intent emails and calling 36% of applicants for interviews. ConclusionsThis study is the first to assess the value PDs place on social media and email in the fellowship application review process across various internal medicine subspecialties. While social media is a valuable tool for program promotion and engagement, traditional email outreach remains crucial in the interview selection process.

A Novel Mental Health Curriculum Pilot for Pediatric Cardiology Fellows: Preparing the Subspecialist to Expand the Team.

Mental health (MH) is an important, yet understudied area of care for patients with congenital heart disease (CHD). Pediatric subspecialty fellows believe MH should be within their scope of practice, but few feel confident in their ability to appropriately screen, evaluate, manage, and make treatment referrals for youth with CHD and concurrent MH concerns. A 6-session, didactic-based curriculum was designed by an interprofessional team of experts. It was administered to pediatric cardiology fellows over 9months during two academic years. Topics included the following: Introduction to MH and CHD, MH Screening and Clinic-Based Interventions, Psychopharmacology, Delirium, Trauma-Informed Care, and Adult CHD and Transitional Care. An investigator-designed survey was developed to assess fellow comfort with MH knowledge, screening, and treatment recommendation domains. Twenty-three fellows participated with 14 completing the pre-post survey (58% participation, 11/17 in year 1, 3/6 in year 2). Most participants were in their first year of training (9/14, 57%). Overall, fellow comfort with MH topics increased significantly (mean score 2.89 ± 0.46 vs. 3.4 ± 0.4, p = 0.0005), with improved comfort in the MH knowledge (p = 0.003) and treatment recommendation domains (p = 0.001). A didactic-based MH curriculum improves the comfort of pediatric cardiology fellows to address the MH concerns of their patients. The topics in this curriculum will continue to be refined over time and could be generalized to training programs, both nationally and across pediatric specialties, to improve MH care for high-risk populations.

Subspecialty Selection and Fellowship Training Satisfaction among American and Canadian Geriatric Psychiatry Fellows.

The Geriatric Psychiatry Fellowship Subspecialty survey aimed to identify key motivating factors associated with choosing geriatric psychiatry as a career, and to assess training satisfaction among geriatric psychiatry fellows/residents in Canada and the United States. American and Canadian geriatric psychiatry program directors were asked to distribute an online survey to their fellows. Descriptive statistics for quantitative items and Mann-Whitney U tests were performed to assess for differences by country of training. Thirty-one geriatric psychiatry fellows completed the survey. The most important motivating factors for pursuing a career in geriatric psychiatry were found to be "working with patients and families", "working in an interdisciplinary environment", and "intellectual stimulation". Fellows' overall training satisfaction was high, with American fellows more satisfied than Canadian residents (p = .047) on average, especially with regard to biomedical aspects of training (p = .01).

Influential Factors in the Selection of Subspecialty Fellowship Training Among Surgical Trainees in Oman.

Surgical training has evolved over the past few decades, with an increasing number of surgeons pursuing subspecialty training through fellowship programs across various surgical specialties. While published reports confirm this trend, few studies explored the factors that determine which fellowship training surgical residents would pursue. This cross-sectional study aims to investigate the factors influencing fellowship choices made by surgical trainees in Oman. An online questionnaire, developed based on previously validated instruments, included 14 factors considered crucial for choosing a future career. Statistical analysis was performed to determine item-level validity, scale-level validity, and reliability. The survey was distributed via email and closed after six weeks for data analysis. The survey achieved a response rate of 60.9%. The analysis revealed that the most influential factor among surveyed surgeons in selecting a subspecialty was prestige, with an average score of 2.7. The least reported influential factors were variety of cases (average score of 1.8) and personal interest (average score of 1.4). Only 57.7% of respondents received career choice guidance. Factors influencing the choice of surgical subspecialties vary among the different groups. This information can be valuable in designing programs and structuring professional career guidance and counseling.

Analysis of National Resident Matching Program for Radiology Fellowships: Factors Affecting Program Fill Rates

PurposeThe National Resident Matching Program (NRMP) is used by an increasing number of diagnostic radiology (DR) residents applying to subspecialty fellowships. Data characterizing match outcomes on the basis of program characteristics are limited. The aim of this study was to determine if fellowship or residency size, location, or perceived reputation was related with a program filling its quota. MethodsUsing public NRMP data from 2004 to 2022, DR residency, breast imaging (BI), musculoskeletal imaging (MSK), interventional radiology (IR), and neuroradiology (NR) fellowship programs were characterized by geography, DR and fellowship quota, applicants per position (A/P), and reputation as determined by being an Aunt Minnie best DR program semifinalist, Doximity 2021-2022 top 25 program, or U.S. News & World Report top 20 hospital. The DR program’s reputation was substituted for fellowships at the same institution. A program was considered filled if it met its quota. ResultsThe 2022 A/P ratios were 1.02 for IR, 0.83 for BI, 0.75 for MSK, and 0.88 for NR. IR was excluded from additional analysis because its A/P was >1. The combined BI, MSK, and NR fellowships filled 78% of positions (529 of 679) and 56% of programs (132 of 234). Factors associated with higher program filling included Doximity top 25 program, Aunt Minnie semifinalist, and U.S. News & World Report top 20 hospital affiliation (P < .001 for all); DR residency quota greater than 9, and fellowship quota of three or more (P < .01). The Ohio Valley (Ohio, western Pennsylvania, West Virginia, and Kentucky) filled the lowest, at 39% of programs (P = .06). ConclusionsLarger fellowship programs with higher perceived reputations and larger underlying DR residency programs were significantly more likely to fill their NRMP quota.

A Qualitative Study of Internal Medicine Subspecialty Fellowship Program Directors' Perspectives on Short-Term Hospitalist Employment Prior to Fellowship.

Background Some internal medicine (IM) residents pursuing subspecialty training choose short-term hospitalist employment prior to fellowship, or "pre-fellowship hospitalist years." Residency and fellowship program directors (PDs) advise residents on this decision, but PD experience with fellows pursuing pre-fellowship hospitalist years and the impact on fellowship applications is unknown. Objective We aimed to explore perceptions of fellowship PDs regarding experience with fellows who pursued pre-fellowship hospitalist years, including perceived effects on how such years affect fellowship application candidacy. Methods A purposive sample of 20 fellowship PDs in the most highly competitive and commonly selected IM fellowships (cardiology, pulmonology/critical care medicine, hematology/oncology, gastroenterology) from 5 academic institutions were approached for participation in fall 2021. Interviews included semi-structured questions about pre-fellowship hospitalist employment. Utilizing rapid qualitative analysis, interview transcripts were summarized and reviewed to identify themes and subthemes describing fellowship PDs' perspectives of pre-fellowship hospitalist years. Results Sixteen fellowship PDs (80%) participated. PDs identified 4 major themes as important for trainees considering pre-fellowship hospitalist years: (1) Explain the "Why"-why the year was pursued; (2) Characteristics of the Hospitalist Position-what type of employment; (3) The Challenges-potential concerns faced with pre-fellowship hospitalist years; and (4) Describe the "What"-the experience's contribution to resident professional development. Conclusions Fellowship PDs in 4 competitive IM subspecialities placed a strong emphasis on explaining a clear, logical reason for seeking short-term hospitalist employment prior to fellowship, describing how it fits into the overall career trajectory, and selecting activities that demonstrate continued commitment to the subspecialty.

Pneumococcal Perplexity: Improving Awareness of Updated Pneumococcal Vaccination Recommendations in Two Large Military Treatment Facilities.

Vaccinations are an essential aspect of preventive medicine. In October 2021, the pneumococcal conjugate vaccine-20 (PCV-20) and PCV-15 were authorized for use in adults by the U.S. FDA. In 2022, the Advisory Committee on Immunization Practices (ACIP) subsequently published updated pneumococcal vaccination recommendations that incorporate both PCV-20 and PCV-15. Pneumococcal vaccination is effective in reducing pneumococcal disease, particularly in high-risk patient groups such as those with chronic lung disease; however, the updated dosing schedule for pneumococcal vaccinations can be quite confusing, especially if patients have previously received "older" vaccinations, such as pneumococcal polysaccharide vaccine-23 or PCV-13. The purpose of this quality improvement project was to increase providers' knowledge of current ACIP pneumococcal vaccination recommendations, including indications and dosing schedule, and to improve pneumococcal vaccination rates among eligible adults and children. Focused education sessions were presented to primary care and subspecialty residents, fellows, and staff at Brooke Army Medical Center and Wilford Hall Ambulatory Surgical Center regarding current ACIP pneumococcal vaccination recommendations. Sessions included information about PCV-15 and PCV-20 vaccines, indications for vaccination, and dosing schedules. Subjective knowledge of updated ACIP pneumococcal vaccination recommendations was assessed among primary care and subspecialty residents, fellows, and staff via an anonymous survey both pre- and post-intervention. Number of PCV-20 vaccinations given and estimated vaccination rates of patients aged 19 to 64 years with asthma were assessed pre- and post-intervention over a 6 month time span. Of surveyed providers, only 9% discussed vaccinations at every visit and 11% did not discuss vaccinations at all. There was a statistically significant increase in providers' knowledge of pneumococcal vaccination guidelines for children post-intervention (P = .01) but no statistically significant increase in knowledge for guidelines for adults, for patients that have received prior pneumococcal vaccines, or in overall confidence in recommending pneumococcal vaccines. There was a 17% increase in the number of PCV-20 vaccinations given post-intervention (198 pre-intervention, 232 post-intervention). The estimated PCV-20 vaccination rate for adults aged 19 to 64 years with asthma increased from 14.9% pre-intervention to 19.5% post-intervention (P = .33). There is a significant knowledge gap regarding ACIP pneumococcal vaccination recommendations among military providers and a low pneumococcal vaccination rate for adults aged 19 to 64 years with asthma at Joint Base-San Antonio MTFs. Focused education sessions were effective in increasing providers' knowledge of updated pneumococcal vaccination recommendations, confidence in recommending vaccines, total number of pneumococcal vaccinations given, and estimated pneumococcal vaccination rate for adults with asthma. The validity of conclusions drawn from our data were limited because of discordant numbers of survey respondents as well as potentially inaccurate estimates of pneumococcal vaccination rates pre- and post-intervention. Despite this, the results warrant continued education of pneumococcal vaccines, indications, and dosing schedules.

A Pilot Survey on the Perceptions of Pediatric Subspecialty Fellows and Program Directors on Virtual Compared with In-Person Interview Experiences

Pediatric fellowship programs have conducted virtual interviews since the start of the COVID-19 pandemic in 2020. In this national survey of fellowship program directors (FPDs) and fellows interviewed in-person and virtually, FPDs and fellows formed accurate impressions, regardless of format, but our data did not clearly support one interview format over another.

Use of In-Training Examination Scores as a Fellowship Candidate Evaluation Metric: Time for a Change.

In the field of obstetrics and gynecology (OB/GYN), the Council on Resident Education in Obstetrics and Gynecology (CREOG) administers an annual in-training examination to all OB/GYN residents as a formative educational tool for assessing medical knowledge and promoting self-improvement. Although the CREOG examination is not designed or intended for knowledge certification, many OB/GYN subspecialty fellowship programs request and use CREOG examination scores as a metric to evaluate fellowship candidates. Among the 57 gynecology-based urogynecology fellowship programs, 30 programs (53%) request CREOG examination scores to be submitted by candidates, as of March 2023. Although the use of CREOG examination scores as an evaluation metric may constitute a minor component within the fellowship match process, this practice fundamentally contradicts the intended purpose of the examination as an educational self-assessment. In addition, it introduces the potential for bias in fellowship recruitment, lacks psychometric validity in predicting specialty board examination failure, and shifts the CREOG examination from its original intention as low-stakes self-assessment into a high-stakes examination akin to a certification examination. For these reasons, we call upon the urogynecology community to prioritize the educational mission of the CREOG examination and reconsider the practice of requesting or using CREOG examination scores in the fellowship match progress.

Chalk Talks for the Clinical Setting: Evaluation of a Medical Education Workshop for Fellows.

Chalk talks are effective teaching tools in the clinical setting. However, data on optimal strategies for teaching medical educators how to develop and deliver them are limited. We designed and implemented two 50-minute workshops to help subspecialty fellows across GME create and deliver a chalk talk. The first workshop comprised a demonstration of an effective chalk talk and a discussion of best practices for creating chalk talks; the second was a practice session where fellows presented their chalk talks and received feedback from faculty and peers. We evaluated pre- and postworkshop confidence in the ability to create and deliver a chalk talk and develop learning objectives. Secondary outcomes were faculty and peer evaluations of the chalk talks. Eighteen of 33 participants (54% response rate) completed both pre- and postsession surveys. Fellows reported improved confidence in their ability to create a chalk talk (22% vs. 83%, p < .001), deliver a chalk talk (17% vs. 83%, p < .001), and develop well-written learning objectives (11% vs. 83%, p < .001). After the workshop, participants were more likely to correctly identify a chalk talk that made use of an advanced organizer (67% vs. 89%, p < .05). Thirty-eight faculty and peers completed feedback evaluations of participants' chalk talks; most rated fellows' chalk talks highly in domains of content, delivery, design, learning objectives, and engagement. The incorporation of these workshop within a course on medical education can effectively develop clinical teaching skills among subspecialty fellows in GME.

Providing 0.1 Full-Time Equivalent (FTE) Support to Fellowship Core Faculty Improves Faculty Involvement in Fellowship Education and Recruitment.

In 2022, the American Council for Graduate Medical Education (ACGME) recommended that core faculty (CF) in medical subspecialty fellowships receive at least 0.1 full-time equivalent (FTE) salary support, with plans to enforce compliance in July 2023. After early feedback raised concerns about potential unintended consequences, ACGME deferred enforcement to July 2024. Hence, there is an urgent need to understand the ramifications of providing FTE support for CF. In 2020, the Yale hematology and medical oncology (HO) fellowship program began providing 0.1 FTE support to all CF. Perceptions regarding this were assessed via surveys distributed to all CF in 2021 and 2022 and to all HO fellows in 2021. The vast majority (83.3%) of CF survey respondents reported improved job satisfaction and an increased sense of involvement in the fellowship program as a result of the new 0.1 FTE-supported CF program. Most CF increased attendance at fellowship conferences, devoted more time to mentorship, and increased participation in recruitment. In free text comments, CF respondents described that providing 0.1 FTE support made them "feel rewarded," gave them "a sense of commitment" to the fellowship, and helped "offset clinical requirements." HO fellows reported "a positive impact" of the new program with faculty being "more present at lectures." The median number of times faculty were available to interview fellowship applicants rose markedly after introduction of the program. The FTE-supported CF program was viewed enthusiastically by fellows and faculty, resulting in increased CF involvement in fellowship education and recruitment.

Characteristics and academic career outcomes of Godina Fellowship recipients

The American Society for Reconstructive Microsurgery (ASRM) sponsors the Godina Fellowship to expand the careers of talented early career microsurgeons. This study characterizes the scholarly impact and academic career outcomes of Godina Fellows. The ASRM provided a list of Godina Fellows since program inception (1993 – 2020). An Internet based search obtained demographic, academic pedigree, and scholarly impact metrics. Curriculum vitae were reviewed to characterize future career outcomes including academic leadership positions. Of the 28 Godina Fellows, most were men (96%) and from the United States (61%). The average age of selection was 44 ​± ​4 years. Training pedigrees consisted primarily of plastic surgery residency training (93%) followed by orthopedic surgery (3%) and otolaryngology (3%). 32% completed reconstructive microsurgery fellowship training, 25% completed hand fellowship training, and 32% had no sub-specialty fellowship training. A minority of Fellows had a PhD (32%) and Master's Degree (14%). The average h-index was 33 ​± ​11 resulting from 160 ​± ​90 peer-reviewed manuscripts cited 3998 ​± ​2516 times. At the time of selection, Godina fellows had an average of 65 ​± ​42 peer-reviewed manuscripts. Most selected academic careers (79%), including 43% serving as chief of a sub-specialty service line (25%) or chair of a division or department (18%). Godina Fellowship recipients make important contributions to the field of reconstructive microsurgery through research impact and leadership at academic departments.

Pediatric End-of-Life Simulation Workshop to Clinical Care: Lasting Implications on Clinical Practice.

Simulations are an important modality for practicing high-acuity, low-frequency events. We implemented a deliberate practice simulation-based workshop to improve pediatric end-of-life care skills (PECS) competence. To understand pediatric subspecialty fellows' perceptions about influences of a simulation-based workshop on PECS provided at the bedside several months following participation. Pediatric subspecialty fellows were recruited to voluntary focus groups during regular educational sessions six months following PECS workshop participation with aims to identify perceptions about their workshop participation and any implication on their clinical practice. Inductive qualitative content analysis of focus group interview data was performed adhering to the Standards for Reporting Qualitative Research. Ten fellows participated in one of three focus groups. Researchers identified three major themes of fellow experience: burden, safe practice space, and self-efficacy. Fellows described practice implications from workshop participation, including incorporation of specific practices, improved anticipatory guidance, and increased team leader confidence. Targeted, deliberate simulation-based practice of PECS can help close the gap from learning to practice, contributing to provider self-efficacy and potentially improving clinical care for pediatric patients and families at end of life.