Evaluating the Impact of Residency Research Productivity on Craniofacial Surgeons' Career Trajectory

OBJECTIVE

To elucidate trends in publication productivity over the past 50 years and how they correlate with the stage of training as well as the competitiveness of residency and fellowship programs. The authors hypothesize that research qualifications play an important role in obtaining a competitively ranked craniofacial surgery fellowship and that over the past 50 years, there has been an upward shift in the research qualifications held by applicants at the time of application.

DESIGN

A cross-sectional study was performed involving all 121 academic craniofacial surgeons in the United States for whom sex, years since fellowship, current institution rank, current academic position, and years since graduation were available.

MAIN OUTCOME MEASURES

The relationship between research qualifications, as determined by the overall number of publications, number of first authorship publications, H-index scores, and years since fellowship completion, was examined. The study also analyzed the placement of surgeons at programs ranked in the top 25 versus the lower 25.

RESULTS

As the number of decades since beginning craniofacial fellowship decreased, the average number of first authorship publications and average H-index increased. Those who attended higher-ranking residency and fellowship programs had a higher average number of publications, number of first authorship publications, and H-index.

CONCLUSIONS

Over the past 5 decades, research productivity at all stages of medical training has surged, potentially fueled by the trend toward pass/fail grading in medical school evaluations and standardized exams and the need to differentiate oneself in an increasingly competitive field.

Gender Bias in Letters of Recommendation: Relevance to Urology Match Outcomes and Pursuit of Fellowship Training/Academic Career

OBJECTIVE

To review applications to a single urology residency program to determine application characteristics predictive of (1) successful match into urology residency and (2) pursuit of fellowship training and/or academic practice after completion of residency. Our principal variables of interest were gender bias as assessed in letters of recommendation (LOR), personal statements, Medical Student Performance Evaluation (MSPE), race, and gender.

MATERIALS AND METHODS

Applications submitted to our urology residency program in the 2014 cycle were reviewed. Twenty-three variables were analyzed, including applicant demographics, application materials, and gender bias. Deidentified text from LOR, personal statements, and MSPE was evaluated for gender bias using an open-source gender bias calculator. A subanalysis of applicants who matched at a top 25 urology program was performed. Logistic regression analysis was performed to identify applicant variables associated with (1) match success and (2) fellowship training or academic employment as of September 2021.

RESULTS

Two hundred and twenty-two completed applications were analyzed. First authorship of a published manuscript was significantly associated with greater odds of matching. Female gender and top 25 medical school attendance were both significant predictors of matching at a top 25 urology program. The number of first-author publications was associated with completion of fellowship training or current employment in an academic position.

CONCLUSION

First-author publications are the most important preinterview determinant of match success and subsequent pursuit of academic practice/fellowship training. Certain applicant characteristics are associated with matching at highly ranked programs. Gender bias in application materials (including LOR) does not appear to exert a significant influence on match and early career outcomes.

Perceptions of Readiness for Practice After Complex General Surgical Oncology Fellowship: A Survey Study

BACKGROUND

Surgical subspecialty training aims to meet the needs of practicing surgeons and their communities. This study investigates career preparedness of Complex General Surgical Oncology (CGSO) fellowship graduates, identifies factors associated with practice readiness, and explores potential opportunities to improve the current training model.

METHODS

The Society of Surgical Oncology partnered with the National Cancer Institute to conduct a 36-question survey of CGSO fellowship graduates from 2012 to 2022.

RESULTS

The overall survey response rate was 38% (221/582) with a slight male predominance (63%). Forty-six percent of respondents completed their fellowship after 2019. Factors influencing fellowship program selection include breadth of cancer case exposure (82%), mentor influence (66%), and research opportunities (38%). Overall, graduates reported preparedness for practice; however, some reported unpreparedness in research (18%) and in specific clinical areas: thoracic (43%), hyperthermic intraperitoneal chemotherapy (HIPEC) (15%), and hepato-pancreato-biliary (15%) surgery. Regarding technical preparedness, 70% reported being "very prepared". Respondents indicated lack of preparedness in robotic (63%) and laparoscopic (33%) surgery approaches. Suggestions for training improvement included increased autonomy and case volumes, program development, and research infrastructure. Current practice patterns by graduates demonstrated discrepancies between ideal contracts and actual practice breakdowns, particularly related to the practice of general surgery.

CONCLUSIONS

This study of CGSO fellowship graduates demonstrates potential gaps between trainee expectations and the realities of surgical oncology practice. Although CGSO fellowship appears to prepare surgeons for careers in surgical oncology, there may be opportunities to refine the training model to better align with the needs of practicing surgical oncologists.

Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs

The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.

A Qualitative Exploration of Pediatric Resident Perceptions of Autonomy in the Era of Pediatric Hospital Medicine Fellowship

OBJECTIVE

Some pediatric residents report experiencing less autonomy when working clinically with pediatric hospital medicine (PHM) fellows than with attendings alone. We sought to explore pediatric senior resident (SR) experiences working clinically with PHM fellows, with a focus on characterizing fellow behaviors that could impact perceived resident autonomy.

METHODS

In this qualitative study, we conducted virtual semistructured interviews with pediatric SRs. We recorded, deidentified, and transcribed interviews for codebook thematic analysis, making iterative adjustments to our codebook and themes until reaching thematic sufficiency.

RESULTS

We conducted 17 interviews. A subanalysis identified key components of the resident mental model of autonomy, including independent clinical decision-making with 3 core qualifiers: 1) plan follow-through, 2) availability of a safety net, and 3) ownership. Our primary analysis identified 4 key themes (with a total of 7 contributory subthemes) describing resident experiences of autonomy, scaffolded based on an organizing framework adapted from Bronfenbrenner's ecological model including 1) microsystem factors (based on direct resident-fellow or resident-leadership team interactions), 2) mesosystem factors (based on fellow-attending interactions), 3) exosystem factors (based on fellow-intrinsic characteristics), and 4) macrosystem factors (cultural values, norms, and policies governing academic pediatrics).

CONCLUSIONS

Many factors impact perceived resident autonomy on PHM fellow-inclusive teams. Although some are related to direct resident-fellow interactions, many others are more complex and may reflect resident interactions with the leadership team, attending-fellow dynamics, and the influence of cultural context. Based on our analysis, we propose several best-practice recommendations directed at fellows, attendings, the fellow-attending dyad, and Graduate Medical Education programs overall.

Impact of the Coronavirus Disease 2019 Pandemic on Surgical Volumes Among Fellowship-Trained Glaucoma Subspecialists

PRCIS

The change in glaucoma surgical volumes due to the coronavirus disease 2019 pandemic was not uniform across procedure types and was unequal between rural and urban practice locations.

PURPOSE

To quantify the impact of the coronavirus disease 2019 pandemic on surgical volumes performed by fellowship-trained glaucoma subspecialists.

MATERIALS AND METHODS

This retrospective cohort analysis of the Centers for Medicare and Medicaid Services Medicare Public Use File extracted all glaucoma surgeries, including microinvasive glaucoma surgeries (MIGSs), trabeculectomy, goniotomy, lasers, and cataract surgery, performed by fellowship-trained glaucoma surgeons in rural and urban areas between 2016 and 2020. Predicted estimates of 2020 surgical volumes were created utilizing linear squares regression. Percentage change between predicted and observed 2020 surgical volume estimates was analyzed. Statistical significance was achieved at P <0.05.

RESULTS

In 2020, fellowship-trained glaucoma surgeons operated mostly in urban areas (N = 810, 95%). A 29% and 31% decrease in predicted cataract surgery volumes in urban and rural areas, respectively, was observed. Glaucoma surgeries experienced a 36% decrease from predicted estimates (N = 56,781). MIGS experienced an 86% and 75% decrease in rural and urban areas, respectively. Trabeculectomy in rural areas experienced a 16% increase relative to predicted estimates while urban areas experienced a decrease of 3% ( P > 0.05). The number of goniotomies decreased by 10% more in rural areas than in urban areas (-22% and -12%, respectively). Laser procedures decreased by 8% more in urban areas than in rural areas (-18% and -10%, respectively).

CONCLUSIONS

Among glaucoma-trained surgeons, glaucoma surgeries experienced a greater volume loss than cataract surgeries. In urban US areas, relative reductions in MIGS and goniotomy volumes in urban areas may have been compensated by greater laser and trabeculectomy volumes. Trabeculectomies in rural areas were the only group exceeding predicted estimates. Glaucoma subspecialists may utilize these findings when planning for future events and in overcoming any remaining unmet need in terms of glaucoma care.

Characterizing the Role of Surgical Vice Chair of Education: Stakeholder Needs and Current Practices

INTRODUCTION

The role of a Department of Surgery (DoS) Vice Chair of Education (VCE) is a relatively new position intended to address the many changes and initiatives in medical education. The primary responsibilities and functions of a surgical VCE are not well described in the literature. This study examines the perceptions of stakeholders and current VCEs to develop a newly established position of VCE within an academic DoS.

METHODS

We conducted semistructured interviews of 13 faculties in our DoS. Each of these faculties hold the role of fellowship or residency program director. We also interviewed 13 VCEs from other departments within the same hospital system. Transcripts of these interviews were analyzed using reflexive thematic analysis, comparing the data gathered from the two populations.

RESULTS

There was a consensus of positivity about the new VCE position by the stakeholders with some residual uncertainty about how it would affect their work. Four themes resulted from analysis of stakeholder interviews including advocacy for education, balance of clinical, research, and educational duties, departmental integration, and faculty development as educators. Three themes were generated from analysis of interviews of VCEs including leverage of experience, framework establishment, and leadership in education.

CONCLUSIONS

Although exact VCE roles and responsibilities will be department dependent, this study may help other institutions craft their VCE positions and create a framework for understanding important stakeholder views.

A multi-institutional study from the US ROPE consortium examining factors associated with endocrine surgery exposure for general surgery residents

BACKGROUND

Prior analyses of general surgery resident case logs have indicated a decline in the number of endocrine procedures performed during residency. This study aimed to identify factors contributing to the endocrine operative experience of general surgery residents and compare those who matched in endocrine surgery fellowship with those who did not.

METHODS

We analyzed the case log data of graduates from 18 general surgery residency programs in the US Resident Operative Experience Consortium over an 11-year period.

RESULTS

Of the 1,240 residents we included, 17 (1%) matched into endocrine surgery fellowships. Those who matched treated more total endocrine cases, including more thyroid, parathyroid, and adrenal cases, than those who did not (81 vs 37, respectively, P < .01). Program-level factors associated with increased endocrine volume included endocrine-specific rotations (+10, confidence interval 8-12, P < .01), endocrine-trained faculty (+8, confidence interval 7-10, P < .01), and program co-location with otolaryngology residency (+5, confidence interval 2 -8, P < .01) or endocrine surgery fellowship (+4, confidence interval 2-6, P < .01). Factors associated with decreased endocrine volume included bottom 50th percentile in National Institute of Health funding (-10, confidence interval -12 to -8, P < .01) and endocrine-focused otolaryngologists (-3, confidence interval -4 to -1, P < .01).

CONCLUSION

Several characteristics are associated with a robust endocrine experience and pursuit of an endocrine surgery fellowship. Modifiable factors include optimizing the recruitment of dedicated endocrine surgeons and the inclusion of endocrine surgery rotations in general surgery residency.

Demonstrating causality, bestowing honours, and contributing to the arms race: Threats to the sustainability of HPE research

As the field of health professions education (HPE) continues to evolve, it is necessary to occasionally pause and reflect on the potential effects and outcomes of our research practices. While future-casting does not guarantee that impending negative consequences will be evaded, the exercise can help us avoid pitfalls. In this paper, we reflect on two terms that have taken hold as powerful idols in HPE research that stand above questioning and apart from critique: patient outcomes and productivity. We argue that these terms, and the ways of thinking they uphold, threaten the sustainability of HPE research-one at the level of the community and one at the level of the scholar. First, we suggest that HPE research's history of endorsing a linear and causal association ethos has driven its quest to connect education to patient outcomes. To ensure the sustainability of HPE scholarship, we must deconstruct and disempower patient outcomes as one of HPE's god-terms, as the pinnacle goal of educational activities. To be sustained, HPE research needs to value all of its contributions equally. A second god-term is productivity; it impairs the sustainability of the careers of individual researchers. Problems of honorary authorship, research output expectations, and comparisons with other fields have constructed a space where only scholars with sufficient privilege can prevail. If productivity persists as a god-term, the field of HPE research could decay into a space where new scholars are silenced-not because they fail to make important contributions, but because access is restricted by existing research metrics. These are two of many god-terms threatening the sustainability of HPE research. By highlighting patient outcomes and productivity and by acknowledging our own participation in propagating them, we hope to encourage others to recognize how our collective choices threaten the sustainability of our field.

What Social Workers Need to Know about Muslims: An Analysis of the Contemporary Social Work Scholarship

This article analyzes peer-reviewed English-language social work scholarship on Islam and Muslims published between 2011 and 2021. Of these 127 articles, 70 journal venues are represented, and first authors are primarily American (44 percent), followed by British (15 percent) and Canadian (11 percent). A total of 70 journals published studies analyzing data related to Muslims/Islam and social work, with 46 consisting of only one publication between 2011 and 2021. A total of 13 of these journals had a SCImago Journal Rank indicator of over 0.5, and three with rankings over 1.0. The volume of publications was high in 2015 and 2020, in particular. Major themes include faith-aligned and strengths-based approaches, the importance of mosques in the lives of Muslims, the relevance of the hijab in the lives of Muslim women, and the prevalence and impact of sociopolitical stereotypes. The conclusion calls for still greater culturally respectful approaches to the profession that include Islam and Muslim individuals/communities and ensuring that ethics and practice/research continue to evolve in ways that are culturally relevant to diverse communities.

The Infectious Diseases Specialist, At Risk of Extinction

The results of the Infectious Diseases (ID) fellowship match over the past decade have raised concerns that the future of our specialty is in peril, despite the unprecedented demand for ID expertise as exemplified by the COVID-19 pandemic. While there was a modest increase in ID fellowships applicants attributable to the pandemic, the disappointing 2023 match results indicate that the increase was short-lived. Multiple factors contribute to low interest in ID including but not only low salaries relative to other specialties. Solutions to grow the ID workforce are urgently needed and are critical to the public health of this nation.

Trends in Mohs surgery fellowship directors

The purpose of this study is to illustrate demographic trends among Mohs Micrographic Surgery (MMS) Fellowship Directors. Our search was constructed from the 2022 to 2023 Mohs Micrographic Surgery Fellowship Directory on the Accreditation Council for Graduate Medical Education (ACGME) website. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. We identified 77 FDs, of which all 77 were included in this study. The mean age was 55.5 years; 55 (71.4%) were men and 20 (26.0%) were women. Most of the FDs who completed the survey did not self-report ethnicity or race, so these measures were not included. The top residency institutions that produced the most FDs were Cleveland Clinic (n = 4), Mayo Clinic (n = 4), New York University Medical Center (NYU, n = 4), and University of California-Los Angeles (UCLA, n = 4); the top fellowship institutions were NYU (n = 7), UCLA (n = 5), Cleveland Clinic (n = 4), and Geisinger Medical Center (n = 4). The mean H-index was 15.9, the mean number of peer-reviewed publications was 71, and the mean time from training completion until FD appointment was 10 years. Our results indicate that a majority of FDs are men (71.4%) and that FDs are more likely to have graduated from certain residency and fellowship programs.

Laying the Groundwork for a Fulfilling Career in Pediatric Infectious Diseases: The Transition From Fellowship to Faculty

There are limited resources for guidance on the transition from fellowship into a new faculty role in pediatric infectious diseases. This review aims to address this gap and provides a framework for a successful transition that is composed of four essential pillars-(1) stepping into your role, (2) finding your niche, (3) building your network, and (4) self-care-all of which are supported by strong mentorship/sponsorship and continual realignment with one's personal mission statement. In addition to providing general principles and guidance, this review also outlines specific steps that a junior faculty member can take to expand their influence and build a successful, fulfilling career in pediatric infectious diseases.

Career selection trends among recent gastroenterology fellowship graduates

Various career paths exist for gastroenterology (GI) fellowship graduates across the country. These include further training, clinical or nonclinical job opportunities. Clinical career paths for those seeking jobs include academic positions or nonacademic positions (nonacademic hospital employed and private practice jobs). Data regarding career placement trends are limited. This study aims to explore temporal trends in career selection among new GI graduates. This is an observational cohort study. A list of GI fellowship programs was obtained from the FREIDA American Medical Association database. Programs with sufficient information on past graduate or alumni career placement after fellowship between 2017 and 2022 were included. Baseline characteristics and relevant information were collected. A Chi-square test was performed to assess the relationship between the categorical variables. A total of 203 GI fellowship programs were reviewed, among which only 21% (43/203) reported sufficient graduate career information. Across the 43 programs, 636 graduates were included. Thirty-three percent (210/636) of graduates were female. Forty-eight percent (308/636) of the graduates pursued nonacademic positions (nonacademic hospital employed and private practice jobs), 34% (216/636) into academic positions, and 17% (112/636) elected to do additional fellowship training. Both males and females were more likely to be employed in private practice (X2 = 12.8, df = 2, P = .002). Navigating through the decision-making process of selecting the first job after fellowship can be challenging. Our study reveals higher preference for nonacademic roles among graduates, consistent over 5 years, suggesting need to explore obstacles for academic positions or further training.

Trends in Aesthetic Surgery Fellowship Training: An Analysis of Supply and Demand

BACKGROUND

Aesthetic surgery fellowship applications were consolidated under the San Francisco Match in 2018. The impact of these changes on aesthetic program and applicant numbers had not yet been investigated.

OBJECTIVES

In this study we sought to evaluate changes in programs, positions, applications, match rates, and fill rates since aesthetic surgery joined the San Francisco Match. We also aimed to compare these trends to craniofacial surgery, microsurgery, and hand surgery fellowships over this same time period.

METHODS

San Francisco and National Resident Matching Program (NRMP) match data for aesthetic, craniofacial, microsurgery, and hand fellowships were obtained from 2018 to 2022, and the number of applications, positions, programs, and successful matches were evaluated.

RESULTS

The number of aesthetic fellowship positions increased from 17 to 41 (141%) over the period studied. This resulted in increased match rates and more unfilled positions. Over the same period, fellowship positions for craniofacial, hand, and microsurgery increased by 3.4%, 6%, and 2.5% respectively. There was no increase in applications to any postgraduate subspecialty, nor was there any change in the number of residents pursuing fellowship. Similarly, there was no change in the percentage of fellowship-bound residents applying to any given discipline.

CONCLUSIONS

The increase in aesthetic fellowship programs and positions did not generate an increase in applications. Applications to other plastic surgery subspecialties also failed to increase. Unlike aesthetic fellowships, their program numbers have remained stable. Given the limited fellowship applicant pool, our focus should be on enhancing the quality of existing aesthetic programs rather than continuing to increase the number of aesthetic positions.

LEVEL OF EVIDENCE: 3

Using the making Visible the ImpaCT Of Research (VICTOR) questionnaire to evaluate the benefits of a fellowship programme for nurses, midwives and allied health professionals

BACKGROUND

There is increasing emphasis in the UK on developing a nurse, midwife and allied health professional (NMAHP) workforce that conducts research. Training for clinical academic careers is provided by the National Institute for Health and Care Research (NIHR). However, the low number of successful applicants suggested there were barriers to achieving this. The Centre for Nursing and Midwifery Led Research (CNMR) launched a fellowship programme in 2016 to backfill two days a week of NMAHPs' time for up to a year, to give them time to make competitive applications to the NIHR.

AIM

To report a study evaluating the CNMR fellowship programme.

DISCUSSION

The making Visible the ImpaCT Of Research (VICTOR) tool ( Cooke et al 2019 ) was developed to describe the organisational impact of research. The 2016-17 CNMR fellows completed VICTOR and their responses were analysed using a framework approach. The analysis found the main benefits of participating in the programme were protected time for research, opportunities to develop collaborations, increasing intra- and inter-professional awareness of NMAHPs' research, peer-reviewed publications, and conference presentations. Challenges included a lack of support from line managers, limited value placed on NMAHPs' research and failure to backfill posts.

CONCLUSION

There were some challenges with the fellowship programme, but all recipients found it to be a positive experience and undertook significant scholarly activity.

IMPLICATIONS FOR PRACTICE

A contractual agreement must be established to foster committed partnerships between higher education institutions (HEIs) and the NHS. HEIs and the NHS should conduct frank discussions of the challenges encountered in fellowship programmes. Positive initiatives and outcomes in tertiary education and clinical settings should be shared to improve fellows' experiences and enhance partnerships between HEIs and the NHS. Job descriptions should include time allocation to review fellowship candidates' applications regardless of outcome. The showcasing of research successes and the benefits of NMAHP research must evolve to secure organisational 'buy in', which is the precursor to widening access to clinical academic pathways.

Assessment of Inflammatory Bowel Disease Training Among Gastroenterology Fellows

In this multicenter survey study, we found that many gastroenterology fellows lacked confidence and desired a “moderate to a lot more” training in important inflammatory bowel disease management domains.

Gender Disparities in General Surgery Resident Subspecialization

BACKGROUND

There are an increasing number of women entering medical school and general surgery residency. Despite this, there remains an underrepresentation of women in some surgical specialties. The purpose of this study is to examine gender differences in fellowship subspecialization of recent general surgery graduates.

METHODS

Graduating residents from general surgery residencies from 2016 to 2020 were identified. Referring to each residency's graduating resident website, we noted whether or not listed alumni were reported to have entered a fellowship. If applicants were listed as having completed a fellowship, the fellowship was noted along with each applicant's expressed gender. Differences across groups were analyzed using SPSS.

RESULTS

The majority (82.4%) of graduates pursued a fellowship after residency training. Men were more likely to enter fellowships in Cardiothoracic Surgery, Plastic and Reconstructive Surgery, Vascular Surgery, and practice than women. Women were more likely to enter fellowships in Breast Surgery, Acute Care Surgery/Trauma Surgery, Pediatric Surgery, and Endocrine Surgery than men.

CONCLUSIONS

The majority of general surgery residency graduates pursue fellowship training. Gender disparities continue for a minority of subspecialties for both men and women.

Characterization of neurosurgery fellowship directors: strengths and room for improvement

BACKGROUND

While many current and aspiring neurosurgeons are looking to supplement their clinical practices with leadership positions, there has not been research characterizing current leadership positions such as fellowship directors (FDs) in neurosurgery to provide insight into objective qualities that distinguish these individuals from the rest of the workforce. This study aims to outline the current characterization of spine, endovascular, pediatric, and stereotactic and functional neurosurgery fellowship directors.

METHODS

A list of accredited neurosurgical fellowship programs located within the US and their respective directors was acquired through the AANS Neurosurgical Fellowship Training Program Directory. This study obtained educational, demographic, institutional, research, and professional background variables through curriculum vitae, institutional profiles, personal websites, emails, and the Scopus database.

RESULTS

Of the 152 FDs analyzed, 143 (94%) were male, 9 (6%) were female, and the mean age was 52.2±8.5 years. The mean Scopus H-index and mean total citations for all FDs was 27±15.7 and 3782.1±4526.7, respectively. Furthermore, the majority of FDs were Caucasian (69.1%), followed by Asian (20.4%), Black or African American (5.3%), and Hispanic or Latino (5.3%). The mean number of years as FD was 8.9±7.2.

CONCLUSIONS

This analysis showed neurosurgery fellowship directors are primarily Caucasian males. Neurosurgery training pedigree seems to play a role in FD attainment. In addition, these directors are largely distinguished by their research productivity. This analysis serves as an insight into the current climate for students aspiring to serve as academic leaders in the field of neurosurgery.

The Impact of Congenital Cardiac Surgery Fellowship on Training and Practice

BACKGROUND

In 2007, congenital cardiac surgery became a recognized fellowship by the American Council of Graduate Medical Education (ACGME). Beginning in 2023, the fellowship transitioned from a 1-year to a 2-year program. Our objective is to provide current benchmarks by surveying current training programs and assessing characteristics contributing to career success.

METHODS

This was a survey-based study in which tailored questionnaires were distributed to program directors (PDs) and graduates of the ACGME accredited training programs. Data collection included responses to multiple-choice and open-ended questions relevant to didactics, operative training, training center characteristics, mentorship, and employment characteristics. Results were analyzed using summary statistics and subgroup and multivariable analyses.

RESULTS

The survey yielded responses from 13 of 15 PDs (86%) and 41 of 101 graduates (41%) from ACGME accredited programs. Perceptions among PDs and graduates were somewhat discordant, with PDs more optimistic than graduates. Of PDs, 77% (n = 10) believed current training adequately prepares fellows and is successful in securing employment for graduates. The responses from graduates demonstrated 30% (n = 12) were dissatisfied with operative experience and 24% (n = 10) with overall training. Being supported during the first 5 years of practice was significantly associated with retention in congenital cardiac surgery and greater practicing case volumes.

CONCLUSIONS

Dichotomous views exist between graduates and PDs regarding success in training. Mentorship during the early career was associated with increased case volumes, career satisfaction, and retention in the congenital cardiac surgery field. Educational bodies should incorporate these elements during training and after graduation.

Characterizing gender trends in head and neck fellowship graduates from 2008 to 2018

OBJECTIVES

Evaluation of potential gender gaps among Head and Neck (H&N) surgeons can highlight areas for increased support of female H&N surgeons and improve gender diversity within the subspecialty. To evaluate gender trends in representation and career trajectory among recent H&N surgery fellowship graduates.

METHODS

This cross-sectional analysis included graduates from Head and Neck Surgery fellowships accredited by the American Head and Neck Society (AHNS) from 2008 to 2018. Additional demographic data was collected via publicly available websites including gender, years in practice, practice location, type of practice, h-index, and academic rank. The primary outcomes were the proportion of female Head and Neck fellowship graduates and gender trends in career trajectory and academic productivity (via h-index).

RESULTS

Between 2008 and 2018, 449 surgeons graduated from Head and Neck surgery fellowship with females comprising 99 of 449 graduates (22%). Female representation increased from 1 of 30 (3%) graduates in 2008 to 17 of 52 (33%) in 2018. A proportionally similar number of women graduating fellowship also practiced in an academic setting (23%). There were fewer female assistant, associate and full professors compared with their male counterparts. Women had lower h-indices compared with men even when controlling for years in practice (mean 11.4 vs. 8.2, p < 0.03).

CONCLUSION

Despite the increase in women graduating from H&N surgery fellowships, gender disparities within academic rank and academic productivity as measured by h-index remain. While a proportional number of women completing fellowship are entering academic practice, additional investigation and support is needed to address the potential gender gaps identified within academic H&N surgery.

Socially responsible leadership and the social change model

The social change model is one of the most used leadership models at colleges and universities around the globe. With this article, we explore the social change model (SCM) as a framework for socially responsible leadership program design. We discuss the SCM, its history, and the evolution of this approach. Furthermore, we highlight critiques of the SCM, which are important considerations in program design. The Aspen Young Leaders Fellowship is featured in this article and serves as an example of a holistic program designed for impact grounded in socially responsible leadership. We conclude with a summary of relevant research as well as resources to learn more about the SCM and socially responsible leadership.

Supporting underrepresented minority students and advancing educational and health equity: Travelers Summer Research Fellowship (TSRF) program radiology panel

OBJECTIVE

The COVID-19 pandemic has highlighted the racial disparities in health outcomes within our nation. This is especially relevant in the field of radiology where the lack of minority representation is particularly striking. The purpose of this paper is to describe a pipeline program designed to support underrepresented minority (URM) students and provide a model to bridge URMs to careers in medicine hence cultivating health equity.

METHODS

We designed a radiology pipeline program within The Travelers Summer Research Fellowship Program (TSRF) to give underrepresented students an opportunity to engage with radiologists. Participants experience a rich inquiry-based curriculum and completed pre- and post-intervention surveys that measured motivational factors for medical education and interest level in medical careers.

RESULTS

29 undergraduate students participated in the 2021 TSRF Program. The data comparing the pre- and post-surveys demonstrated that the TSRF program played a positive role in sparking interest in radiology, debunking misperceptions about radiologists, and boosting participant confidence regarding medical school applications.

DISCUSSION

We created an interactive curriculum for URM students to cultivate a new generation of radiologists that will reflect and better meet the needs of the populations they are serving thereby mitigating the current health disparities in our nation.

Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship-Trained Women

BACKGROUND

The "leaky pipeline" phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The purpose of this study was to evaluate the current representation of women in academic microsurgery and to determine the impact of mentorship on career progression.

METHODS

An electronic survey was designed to determine the availability and quality of mentorship respondents received at different stages of their career (from medical student to attending physician). The survey was distributed to women who completed a microsurgery fellowship and were current faculty at an academic plastic surgery program.

RESULTS

Twenty-seven of 48 survey recipients participated (56.3% response rate). Most held an associate professor (20.0%) or assistant professor (40.0%) position. Respondents had an average of 4.1 ± 2.3 mentors throughout their entire training. A minority of mentors were microsurgery trained (28.3%), and only 29.2% of respondents reported female mentorship throughout their training. Attending physicians least often received formative mentorship (52.0%). Fifty percent of respondents sought female mentors, citing that they desired female insight. Of those who did not seek female mentors, 72.7% cited a lack of access to female mentors.

CONCLUSIONS

Evidenced by female trainees being unable to find female mentors and low rates of mentorship at the attending physician level, there is currently not enough capacity to meet the demand for female mentorship by women pursuing academic microsurgery. Many individual and structural barriers to quality mentorship and sponsorship exist within this field.

Pediatric Hospitalists' Performance of Recommended Minor Procedures: A Multicenter Study

BACKGROUND AND OBJECTIVES

Performance of minor procedures is highly variable among pediatric hospitalists. Our objective was to describe procedural frequency and measure self-assessed competence in recommended minor procedures among practicing hospitalists.

METHODS

An electronic survey was administered across 20 US institutions. An individual survey assessed training, frequency, independence, and success in performing 11 minor procedures. The site survey described practice settings at participating study sites. The primary outcome was respondents' self-assessed competence (SAC), derived by averaging self-assessed independence and success scores (each on a 5-point Likert scale) across all 11 minor procedures. Associations between predictor variables and SAC were determined through analysis of variance for categorical variables and fitted regression models for continuous variables.

RESULTS

Of the 360 survey respondents, the majority were female (70%), not fellowship trained (78%), and had 10 years or fewer experience as a hospitalist (72%). Lumbar puncture and bag mask ventilation were most frequently performed. Greater procedural frequency and time since graduation from training were associated with higher SAC scores among respondents. Practice characteristics, including comanagement of patients and reserved time for practicing procedures, were associated with higher SAC scores. The presence of a simulation center and fellowship program was not associated with higher SAC scores.

CONCLUSIONS

Pediatric hospitalists that performed procedures more frequently had higher self-assessed procedural competence. Tailored opportunities with increased hands-on experience in performing minor procedures may be important to develop and maintain procedural skills.

Implementation and Evaluation of a Curriculum for Ergonomics Training During GI Fellowship

BACKGROUND AND AIMS

Training in ergonomics is either fragmented or lacking in most GI programs. There are limited real-world data on fellows' perceptions and change in practice after the delivery of a curriculum for ergonomics. We aim to implement a curriculum for endoscopy for our GI fellows and evaluate their response to the same.

METHODS

We devised and implemented a curriculum with three components, delivered over 6 months for all GI fellows in an academic hospital center. These were one, a comprehensive, hour-long didactics session conducted by an experienced faculty member; two, an interactive session with a physical therapist; and three, provision of free resistance bands and compression stockings to fellows. We conducted a pre- and post-curriculum test. Data are presented as proportions and medians with interquartile range.

RESULTS

We surveyed 23 fellows. At baseline, 13.6% (3) had sustained ERI during their training. Only 63.6% (14) of trainees reported confidence in being able to recognize signs and symptoms of ERI. Their median self-reported understanding of ergonomics was 3 on a Likert scale of 1-5, corresponding with "average understanding." The majority of trainees had never reviewed any material on ergonomics prior to this curriculum. In the post-test evaluation, the median self-reported understanding of ergonomics improved to 4, corresponding with "above average understanding." All fellows requested a repeat of the curriculum, either semi-annually or annually.

CONCLUSION

Our data show a positive perception of trainees of a practical, reproducible, and low-cost curriculum for endoscopy incorporated during GI fellowship.

The impact of virtual interviews on the Fellowship Council application and main match process

BACKGROUND

The COVID-19 pandemic led the Fellowship Council (FC) to transition rapidly from in-person to virtual interviews. We investigated the impact of this transition on the FC application and main match process.

METHODS

Five years (2018-2022) of deidentified FC applicant, program, and match rank data were used to assess differences between in-person (2018-2019) and virtual interview (2021-2022) cycles. Data are expressed as mean ± SD and one-way and two-way MANOVA tests were applied.

RESULTS

Trainees applied to an average of 30.4 ± 24.3 programs and ranked an average of 10.7 ± 9.7 programs with a 57% match rate and average rank position of 3.6 ± 3.3. Fellowship programs received an average of 64.9 ± 28.6 applications and ranked an average of 15.4 ± 8.8 applicants with a 95% match rate and average applicant rank position of 3.0 ± 3.4. Applicants who interviewed virtually applied to a greater number of programs (32.7 vs. 27.0; p < 0.001) and ranked a greater number of programs (11.5 vs. 10.0; p = 0.004) with no difference in match rates (58% vs. 55%, p = 0.291). Among matched applicants, there was a significant difference in average rank position (3.20 vs. 4.30, p < 0.001), favoring the in-person cohort. Fellowship programs had more applicants per program (69.2 vs. 57.8; p < 0.001) and ranked more applicants (17.4 vs. 13.3; p < 0.001) during the virtual interview cycles. No difference in either match rates (93% vs. 96%, p = 0.178) or applicant rank position (3.09 vs. 2.93, p = 0.561) was seen between in-person and virtual application cycles.

CONCLUSION

Virtual interviews were associated with an increased number of applications for fellowship and applicants ranked by programs but did not impact match rates of either group. Rank match position declined somewhat for applicants but not for fellowship programs. Virtual interviews offer more opportunities for applicants and a greater number of candidates for fellowship programs with only a slight decrement in fellow match rank position.

Modelling the rate of trainees transitioning to Fellowship before achieving competence under the RANZCP's Alternative Assessment Pathway to the Objective Structured Clinical Examination

OBJECTIVE

The Objective Structured Clinical Examination (OSCE) has been removed from the Royal Australian and New Zealand College of Psychiatrists' (RANZCP) training pathway. This decision occurred in the context of an Alternative Assessment Pathway (AAP) necessitated by Covid-19, justified by logistical, methodological and equity concerns. The false positive rate of trainees progressing to Fellowship before achieving competence is a key indicator for evaluating any assessment leading to psychiatric Fellowship. Variations in the statistical properties of the AAP and OSCE were analysed for their impact on pre-competent trainees progressing to Fellowship.

METHOD

Starting with the false positive scenario presented to justify discontinuing the OSCE, false positive rates associated with the AAP and OSCE were calculated based on different assumptions about reliability and accuracy.

RESULTS

The analyses suggest that less reliable and less accurate alternatives to the OSCE, such as the AAP, increase the number of pre-competent trainees progressing to Fellowship.

CONCLUSIONS

Given possible increases in pre-competent trainees progressing to Fellowship while alternatives to the OSCE are finalised, confidence in the RANZCP's training program demands robust public analyses of those alternatives.

Virtual Learning and Assessment in Rheumatology Fellowship Training: Objective Structured Clinical Examination Revisited

OBJECTIVE

With the onset of the COVID-19 pandemic, an annual multi-institutional face-to-face rheumatology objective structured clinical examination (ROSCE) was transformed into a virtual format. The educational goals of the virtual ROSCE (vROSCE) were to reproduce the educational value of the previous in-person ROSCE, providing a valuable formative assessment of rheumatology training activities encompassing the 6 Accreditation Council for Graduate Medical Education (ACGME) core competencies for fellows-in-training (FITs). This article describes the novel design, feasibility, and stakeholder value of a vROSCE.

METHODS

Through an established collaboration of 5 rheumatology fellowship training programs, in February 2021, a vROSCE was created and conducted using a Zoom platform. Station development included learning objectives, FIT instructions, faculty proctor instructions, and a checklist by which to provide structured formative feedback. An anonymous, optional web-based survey was sent to FIT participants to evaluate the experience.

RESULTS

Twenty-three rheumatology FITs from 5 institutions successfully rotated through 6 stations in the vROSCE. Immediate feedback was given to each FIT using standardized rubrics structured around ACGME core competencies. A total of 65% of FITs (15 of 23) responded to the survey, and 93% of survey respondents agreed or strongly agreed that the vROSCE was a helpful educational activity and identified individualized opportunities for improvement.

CONCLUSION

A vROSCE is an innovative, feasible, valuable, and well-received educational technology tool. The vROSCE enriched rheumatology FITs' education and offered collaborative learning experiences across institutions.

Digital Equity in Hematology-Oncology Fellowship Websites: Toward Standardization, Quality, and Transparency

Improving trainee program websites may help applicants and programs in the era of virtual interviews

Impact of the SARS-CoV-2 outbreak on ACGME-accredited orthopaedic trauma fellowship training

INTRODUCTION

The SARS-CoV-2 viral outbreak created unprecedented challenges in surgical education. Yet, its impact on reported case volume during orthopaedic trauma fellowship training remains poorly understood. We hypothesized that cases performed during orthopaedic trauma fellowship training would decrease by 8 %-17 % during the 2019-2020 academic year corresponding to the 1-2 month moratorium of non-essential cases during the initial SARS-CoV-2 outbreak in the United States.

METHODS

We designed a retrospective cohort study of orthopaedic trauma fellows at Accreditation Council for Graduate Medical Education (ACGME)-accredited training programs (2018-2019 to 2021-2022). Mean case volumes were compared by case category across academic years.

RESULTS

There was a -13 % year-over-year decrease in reported case volume during the 2019-2020 academic year (505 ± 126 vs 441 ± 94, P = 0.079, Fig. 1). Case categories with the greatest percentage declines were Treatment of Nonunion / Malunion (-31 %), Fasciotomy (-25 %), External Fixation (-21 %), Forearm / Wrist (-21 %), and Intra-articular Distal Humerus Fracture (-17 %). There was a 7 % year-over-year increase in case volume during the subsequent 2020-2021 academic year with near universal increases in case volume across case categories.

CONCLUSION

There was a 13 % decrease in orthopaedic trauma case volume during the 2019-2020 academic year, corresponding to the SARS-CoV-2 outbreak. Certain trauma case categories experienced the greatest negative impact, which subsequently recovered during the next academic year. These results may help inform accrediting bodies and surgical educators on the impact of future viral outbreaks on orthopaedic trauma fellowship training.

A Literary Pediatric Retina Fellowship With Michael T. Trese, MD

Michael T. Trese, MD (1946-2022), a vitreoretinal surgeon, made significant contributions to the field of retina. Although most known for his work in pediatric retina surgery, he was a pioneer in areas such as medical retina, translational research, and telemedicine. This article reviews his major contributions to spread his knowledge more widely to vitreoretinal trainees and specialists. We discuss six areas where Trese made a lasting impact: lens-sparing vitrectomy, familial exudative vitreoretinopathy, congenital X-linked retinoschisis, autologous plasmin enzyme, regenerative medicine, and telemedicine. [Ophthalmic Surg Lasers Imaging Retina 2023;54:701-712.].

NP and PA transition to practice: A scoping review of fellowships and onboarding programs

OBJECTIVES

Newly graduated NPs and physician associates/assistants (PAs) benefit from transition to practice (TTP) support to move successfully into practice. TTP programs (such as onboarding programs, fellowships, and residencies) hold promise for improving workforce outcomes. The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs.

METHODS

Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included if they addressed fellowships, residencies, or onboarding programs for NPs or PAs. Final data extraction involved 216 articles.

RESULTS

The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships or residencies, NPs, and programs set in nonrural, acute care US settings and in academic health centers.

CONCLUSIONS

A gap exists in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, few articles assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.

Incorporating Telemedicine in Rheumatology Fellowship Training Programs: Needs Assessment, Curricular Intervention, and Evaluation

OBJECTIVE

To increase the confidence of rheumatology fellows in training (FITs) in delivering virtual care (VC) and prepare them for independent practice, we developed educational materials addressing gaps in their skills.

METHODS

We identified gaps in telemedicine skills based on FIT performance in a virtual rheumatology objective structured clinical examination (vROSCE) station on VC delivery using video teleconference technology and survey (survey 1) responses. We created educational materials including videos of "mediocre" and "excellent" VC examples, discussion/reflection questions, and a document summarizing key practices. We measured change in the confidence levels of FITs for delivering VC with a post-intervention survey (survey 2).

RESULTS

Thirty-seven FITs (19 first-year, 18 second- plus third-year fellows) from 7 rheumatology fellowship training programs participated in a vROSCE and demonstrated gaps in skills mapping to several Rheumatology Telehealth Competency domains. Confidence levels of FITs improved significantly from survey 1 to survey 2 for 22 of 34 (65%) questions. All participating FITs found the educational materials helpful for learning and reflecting on their own VC practice; 18 FITs (64%) qualified usefulness as "moderately" or "a lot." Through surveying, 17 FITs (61%) reported implementing skills from the instructional videos into VC visits.

CONCLUSION

Continually assessing our learners' needs and creating educational materials addressing gaps in training are requisite. Using a vROSCE station, needs assessments, and targeted learning with videos and discussion-guidance materials enhanced the confidence level of FITs in VC delivery. It is imperative to incorporate VC delivery into fellowship training program curricula to ensure breadth in skills, attitudes, and knowledge of new entrants into the rheumatology workforce.

Underrepresented Groups and Perceived Educational Barriers for Residency and Fellowship Success

BACKGROUND

The study aimed to compare barriers perceived by medical students and resident physicians identifying as of underrepresented groups in medicine (UIM) and/or as sexual and gender minorities (SGM) to individuals not identifying with these groups, especially for trainees with an interest in dermatology.

METHODS

Cross-sectional survey of medical students and resident physicians based in the United States from February 2021 to July 2021, with subgroup analysis of trainees with interest in dermatology.

FINDINGS

Among trainees interested in dermatology, the most notable barriers for the UIM group were 1) lack of home program in specialty/fellowship of interest (4.71±1.73); 2) lack of connections/networking opportunities (4.14±1.29); 3) lack of opportunity to obtain AOA membership (4.00±1.96); 4) obtaining mentorship (4.00±1.47); and lack of diversity in specialty/fellowship of interest (3.93±1.14).

CONCLUSIONS AND RELEVANCE

Increasing focused mentorship programs and fostering environments that embrace diversity are key to reducing perceived barriers for minority candidates. J Drugs Dermatol. 2023;22(12):1210-1215. doi:10.36849/JDD.7528R1.

Do gender differences exist in letters of recommendation for reproductive endocrinology and infertility fellowship?

OBJECTIVE(S)

To determine if gender differences exist in letters of recommendation (LORs) for reproductive endocrinology and infertility fellowship.

DESIGN

Cohort study.

SETTING

Academic medical center.

PATIENTS

A cohort of applicants to a reproductive endocrinology and infertility fellowship program at a single Midwestern academic institution in a single year.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Quantitative measures included linguistics inquiry and word count analysis, with 4 summary variables and 25 word categories, to quantify tone and themes present by gender. Performing qualitative analysis in parallel to linguistic analysis allowed for the exploration of themes not conveyed in quantitative methods alone. Qualitative measures included the frequency of code themes in LOR by applicant gender.

RESULTS

There were 272 letters from 72 applicants, 54 (76%) of which were women and 17 (24%) were men. One applicant was excluded because gender information was not specified; 269 letters were included in the quantitative linguistics and qualitative coding analysis. One hundred 10 letters (41%) were written by women and 159 (59%) by men. LOR written for men had a higher mean word count than those written for women (537 vs. 474, P=.04). Linguistics Inquiry and Word Count analysis exhibited more risk words used to describe men applicants (P=.01). When comparing word categories by letter writer gender, women letter writers more frequently used communal, affect, and home word categories whereas men writers more frequently used affiliation-related words. Qualitative analysis revealed that letters for men applicants described leadership, altruism, rapport with patients, and strong endorsements more frequently, whereas women applicants' letters more often mentioned doubt raisers and disclosures of personal life. In addition, letters for women applicants more often described candidates as drama free, not easy to "fluster," and not complainers. Furthermore, letters for women more frequently disclosed parenthood status.

CONCLUSIONS

Gender differences exist among both letter writers and applicants. Qualitative analysis revealed that women applicants were more likely to be described with doubt raisers and personal life disclosures, whereas men were more likely to be described by their altruism and with a strong endorsement. Increasing bias awareness and implementing mitigation strategies would improve gender equity in LOR.

Fellowships in Complex Medical Dermatology

Complex medical dermatology fellowships currently are offered at 5 institutions in the United States. The decision to pursue this fellowship is individualized; however, additional training can prove to be beneficial when practicing in an environment with medically challenging patient populations.

Education and Perspectives on the Use of Oral Skin Cancer Chemoprophylaxis: A Cross-Sectional Survey of Current Fellows in Mohs Micrographic Surgery & Dermatologic Oncology

BACKGROUND

According to the curriculum guidelines of the Accreditation Council of Graduate Medical Education and the American Board of Dermatology, Mohs micrographic surgery & dermatologic oncology (MSDO) fellows must demonstrate competency in the use of oral skin cancer chemoprophylaxis. The current level of education in this area is unknown.

OBJECTIVE

To characterize oral skin cancer chemoprophylaxis education for acitretin and nicotinamide among current MSDO fellows and to compare the clinical indications felt most appropriate for prescribing to a previously published expert consensus.

METHODS

An electronic survey was distributed to all active MSDO fellows by the American College of Mohs Surgery.

RESULTS

Responses were received from 63 (69.2%) MSDO fellows. Twenty (31.7%) and 37 (58.7%) fellows reported receiving fellowship training on acitretin and nicotinamide, respectively. Fifty-seven (90.5%) intend to prescribe chemoprophylaxis after training. Sixteen (28.1%) and 43 (75.4%) report feeling very comfortable prescribing acitretin and nicotinamide, respectively. Fellow concordance with a previously published expert consensus opinion on appropriate prescribing indications is variable. Forty-one (65.1%) indicated that additional education would increase the likelihood to prescribe after training.

CONCLUSION

Although most MSDO fellows intend to prescribe oral skin cancer chemoprophylaxis, a standardized curriculum may promote increased use and concordance with expert consensus recommendations.