Practice Patterns Among Fellowship-Trained Rhinologists: A Survey of Past American Rhinologic Society Fellows

BACKGROUND

The goals of this study were to understand the trends in recent and past rhinology fellows concerning their demographics, goals, and experiences.

METHODS

An anonymous web-based survey was sent to graduates of the 35 rhinology fellowship programs. The survey included questions regarding the scope of practice, research contribution, societal involvement, fellow satisfaction with training, and current practice patterns. Chi-square testing and logistic regression were used to compare variables across cohorts: 0-5 years versus 6+ years from fellowship graduation, gender, and practice settings.

RESULTS

Based on 171 respondents, we found no significant differences in 0-5 versus 6+ year graduates in their desire for an academic job post-fellowship. However, those who graduated 6+ years ago had significantly more success securing one (74% vs 96%, P = 0.004). Between males and females, there were no differences in goal of obtaining an academic job or success in obtaining an academic career. Females were more likely to report they attend academic society meetings regularly. Female rhinologists also reported less satisfaction with overall work-life balance and decreased satisfaction with clinical practice. Physicians in academic settings have poorer work-life balance.

CONCLUSIONS

Our findings suggest that finding an academic job may be more difficult for recent rhinology fellowship graduates, although still very possible for the majority of graduates. Understanding the reason for these changes may provide insight to current rhinology fellowship directors and trainees interested in pursuing fellowship training.

Factors Influencing Career Decisions and Satisfaction Among Newly Practicing Ophthalmologists

PURPOSE

To describe the career choices of newly practicing ophthalmologists and explore factors influencing career decisions and satisfaction.

METHODS

A cross-sectional study was conducted using data from an electronic survey of ophthalmologists who completed training within the prior 5 years. The survey included questions about demographic information, medical education, current practice, factors affecting career choices, and career satisfaction. Statistical comparisons were made based on gender, type of practice, subspecialty training, and practice area.

RESULTS

Surveys were completed by 696 (32%) newly practicing ophthalmologists, including 276 (40%) women, 179 (29%) academicians, and 465 (67%) subspecialists. A higher proportion of female respondents entered academics than male respondents (36% vs 26%, P = .009). Female and male respondents pursued fellowship training with similar frequency (64% vs 68%, P = .32), but men were more likely to seek vitreoretinal fellowships (30% vs 11%, P < .001) and women were more likely to undertake fellowships in pediatric ophthalmology (21% vs 8%, P < .001), uveitis (10% vs 2%, P = .002), and neuro-ophthalmology (6% vs 2%, P = .042). A total of 514 (83%) respondents reported being happy with work life.

CONCLUSIONS

The career choices of newly practicing ophthalmologists differ based on gender, type of practice, subspecialty training, and practice area. Many factors affect career decisions, and they have varying influence on subgroups within ophthalmology. Ophthalmologists have high levels of career satisfaction. This information may prove useful when developing workforce strategies to meet future eye care needs. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Predictors of academic career placement and scholarly impact in fellowship-trained rhinologists

BACKGROUND

As rhinology fellowship positions outpace the availability of academic rhinology jobs, it is increasingly important to identify characteristics that are associated with academic placement after fellowship completion. In this study, we evaluated the association of academic characteristics during training with current job placement and posttraining scholarly impact.

METHODS

Previous rhinology fellows were identified using publicly available data. Bibliometric indices, training institutions, graduate degrees, and job placement data were used in bivariate and multivariable regression analyses to assess for association with predictors and academic trajectory.

RESULTS

Data from 265 rhinologists, all graduating between 1991 and 2020, were included. Most surgeons (n = 185, 70%) held an academic position and 80 (30%) surgeons worked in a nonacademic setting; 93.2% had a Doctor of Medicine (MD) degree and 80.3% were male. Multivariable logistic regression indicated that a designation of MD, compared with Doctor of Osteopathic Medicine (DO; odds ratio [OR], 5.93; 95% confidence interval [CI], 1.97-21.9), number of publications during fellowship (OR, 1.19; 95% CI, 1.02-1.41), and h-index during training (OR, 1.25; 95% CI, 1.07-1.49]) were independently predictive of academic job placement. Meanwhile, number of primary authorships during fellowship (β = 1.47; 95% CI, 1.07-1.88]), h-index during training (β = 0.48; 95% CI, 0.25-0.71), and PhD (β = 4.16; 95% CI, 1.57-6.76) were associated with posttraining h-index. Medical school ranking; graduate degrees, including Master of Science (MS), Master of Business Administration (MBA), and Master of Public Health (MPH); and research metrics before residency were not associated with either academic placement or posttraining h-index.

CONCLUSION

The predictors of academic job placement in rhinology are unclear, but h-index during training, and research productivity during fellowship may serve as indicators of an academic career.

Factors Important in the Selection of a Rhinology/Skull Base Surgery Fellow: A National Survey of Fellowship Directors

Background

The numbers of Rhinology/Skull Base Surgery fellowship programs and applicants have been increasing in recent years. However, little information is currently available with regards to the most important aspects of the application process.

Objective

The goal of this study was to determine the factors that Rhinology/Skull Base Surgery fellowship directors consider most important when selecting a fellow.

Methods

An anonymous, online survey was distributed to current Rhinology/Skull Base Surgery fellowship directors. 28 of 31 fellowship directors (90%) completed the survey. Respondents were asked to provide basic information regarding the program and to rank various selection factors they deem most important.

Results

For assessing the quality of an application, fellowship directors placed the highest value on LORs. Research experience and publications were also important considerations. The traditional strength of an applicant’s residency program was a factor, while medical school performance, USMLE scores, and OTE score did not play a significant role in the selection process. For subjective assessment of applicants, the most value was placed on faculty assessment of the applicant during their interview. Attention was also given to personality fit with the program and the perceived maturity and initiative of the applicant.

Conclusion

Numerous academic achievements and personal characteristics are given consideration in the Rhinology/Skull Base Surgery fellowship selection process, but recommendation from a trusted colleague and performance on interviews were viewed to be the most critical factors for fellowship programs in selecting applicants. This is consistent with studies that have explored the selection process for other otolaryngology fellowship programs.

Faculty Attitudes Toward Rhinology Fellowship Training: A Survey of Rhinology Fellowship Programs

Background

The number of rhinology fellowship programs has grown rapidly over the past decade. To date, no standardization or accreditation process exists, raising the potential for disparate programs. The attitudes of faculty regarding training are important to elucidate the educational experience of rhinology fellowship.

Methods

An anonymous, web-based survey of rhinology faculty assessed the subjective attitudes toward various domains of fellowship training including surgery, office-based procedures, research, and career development. A 5-point Likert-type scale assessing importance was used (1—not at all important, 5—extremely important).

Results

A total of 34 faculty (response rate 35.8%) completed the survey. The surgical procedures that received the highest mean importance scores were endoscopic surgery for advanced inflammatory disease (median = 5), cerebrospinal fluid leak closure (5), and extended endoscopic sinus surgery (5). The procedures with the lowest scores were nasal valve repair (2), inferior turbinate surgery (3), and open approaches to the sinuses (4). A wide range of responses was noted for the minimum target number of fellow cases for the surveyed procedures. Higher importance scores were noted for direct attending supervision (5) when compared to fellow autonomy (4, P < .001) or shadowing (3.5, P < .001) in the operating room. Higher scores were noted for career preparation in academic (4) versus private practice (3, P < .001) and providing opportunities for clinical (4) versus basic science research (2, P < .001). The majority of faculty felt that there were too many fellowship positions with respect to the market place for private practice (58.8%), academic jobs (85.3%), and overall societal need (61.8%).

Conclusion

A range of faculty attitudes with respect to fellowship training was noted in this study. Continued assessment and refinement of the educational experience in rhinology fellowships is necessary.

Fellowship training: a qualitative study of scope and purpose across one department of medicine

BACKGROUND

Fellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an "invisible phase of postgraduate training" lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education.

METHODS

During the 2013-14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data.

RESULTS

We interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment.

CONCLUSIONS

Fellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education.

A Survey of Neurophysiology Fellows in the United States

PURPOSE

Fellowship training in Clinical Neurophysiology (CNP) is often sought following Neurology residency. However, data documenting the reasons for choosing CNP fellowship, and experiences therein, are sparse.

METHODS

Current Neurophysiology fellows across the United States participated in a 17-item, Internet-based survey. Data regarding demographics, reasons for choosing fellowship, adequacy of training, and future plans were collected.

RESULTS

Among respondents (n = 49), 84% graduated from a US medical school. Personal interest in CNP was the most common reason for choosing the fellowship. Program choice was guided by location and clinical strength of the program. Choosing a program based on clinical strength was likely to result in higher satisfaction scores. Overall, most (87%) were satisfied with their current program giving a satisfaction score of 4 or 5 on a 1-5 Likert scale. Lesser time spent in the epilepsy monitoring unit and EEG was also associated with higher satisfaction scores-these were also the areas that seemed to be most stressed during training. No differences emerged between male and female respondents in their answers to the various survey questions.

CONCLUSIONS

The authors encountered a group of academically minded CNP trainees who are satisfied with their choice of fellowship, the current application process, and training received. Most intend to have a future in academic medicine. The CNP areas that seem to need further development in providing a well-rounded fellowship include training in sleep, evoked potentials, and intraoperative monitoring. The findings would be informative to future fellowship trainees and to program officers.

Academic rhinology: a survey of residency programs and rhinology faculty in the United States

BACKGROUND

Rhinology has rapidly evolved as a subspecialty over the past decade. The professional activities of rhinology faculty in otolaryngology residency programs is an important defining feature of this process but remains incompletely understood.

METHODS

An examination of faculty profiles of otolaryngology residency programs in the United States was performed to examine the professional activities of rhinologists. An anonymous, web-based survey of rhinology faculty was also performed to query professional activities and career satisfaction.

RESULTS

Nine percent of chairmen and 12% of residency program directors were rhinologists. The number of full-time rhinology faculty members varied significantly among departments (mean 1; range, 0-4). Rhinology faculty members were noted to have a high number of scientific publications over the past 5 years (mean 15 per faculty), a high level of membership to the American Rhinologic Society (90%) and modest levels of membership to other societies. As reported by the 45 respondents who successfully completed the survey, higher percentages of professional time was devoted to clinical medicine when compared with administrative and research activities. Inflammatory sinusitis represented the most common clinical condition treated, and there was variability with respect to other disorders and procedures. Career satisfaction scores were highest for medical and surgical care, teaching activities, financial and emotional well being, and overall career to date. Lower satisfaction scores were noted for research and administrative activities and for balance of personal life with work.

CONCLUSION

This study further defines the professional, clinical, and surgical activities of academic rhinologists. Continued analysis of the subspecialization of rhinology is required.

Rhinology Fellowship Training and its Scholarly Impact

Background

Previous examination of the impact of fellowship training on scholarly productivity among otolaryngologists found that head and neck surgeons and otologists had a higher mean h–index than fellowship-trained rhinologists. Because fellowship training in rhinology is a historically newer trend, the objectives of the present analysis were to further characterize research productivity among fellowship-trained academic rhinologists, including geographic and temporal trends, to gain insight into the future direction of scholarly pursuits within the field.

Methods

Fellowship-trained rhinologists in academic practices were identified from the American Rhinologic Society online listings and organized by academic rank, number of years in practice, location, and h-index, as calculated using the Scopus database.

Results

Mean h-index rose with increasing years in practice after fellowship. The h-index, number of publications, and the E-factor (a newly described bibliometric) increased with successive academic rank. The E-factor for rhinologists in this current analysis was not statistically different from the values calculated for other otolaryngology subspecialties (p > 0.05).

Conclusion

Fellowship-training in rhinology is a relatively recent development, with half of the academic rhinologists included in this analysis having completed fellowship training within the past 5 years. Scholarly productivity among academic rhinologists increases with academic seniority. As the current cohort of fellowship-trained rhinologists progress in their academic careers, previously described deficits in scholarly productivity relative to other subspecialties are expected to diminish.

The subspecialty of rhinology: a survey of otolaryngology chairmen

BACKGROUND

The past decade has witnessed the emergence of rhinology as a distinct subspecialty within otolaryngology. A critical evaluation of this process is necessary to define the field and to determine the impact of subspecialization on residency education.

METHODS

An Internet-based survey of otolaryngology residency chairmen was performed to query attitudes about the importance of various aspects of rhinologic education including didactics, presence of rhinology faculty, exposure to research, office-based rhinology, and various surgical procedures. A 7-point Likert scale was used to rate responses.

RESULTS

A 30.2% response rate was noted for the chairmen survey. From the chairmen's perspective, overall high levels of importance were ascribed to rhinology education and surgical training in otolaryngology residency. Lower scores for importance were noted for basic science research, exposure to office-based allergy care, and advanced surgical procedures. High scores were noted for the importance of fellowship training in the professional development of a resident interested in pursuing a career in rhinology.

CONCLUSION

Overall high levels of importance were ascribed by the participating chairmen to the importance of rhinology education in residency. As the subspecialty of rhinology continues to develop, the role of the various educational, research and clinical activities will require continued evaluation.

Surgical fellowship training in Canada: what is its current status and is improvement required?

This paper examines current issues concerning surgical fellowship training in Canada. Other than information from a few studies of fellowship training in North America, there are scant data on this subject in the literature. Little is known about the demographic characteristics of those who pursue fellowship training in Canada, what the experiences and expectations are of fellows and their supervisors with respect to the strengths and weaknesses of this level of training, or how this level of education fits in with Canadian undergraduate and postgraduate medical training. We summarize current knowledge about fellowship training in Canada as it pertains to demographic characteristics, finances, work hours, residency training, preparation for clinical and research work and satisfaction with training. Most information on surgical fellowship training comes from the United States. As such, we used information from American studies to supplement the Canadian data. Because a surgical fellowship experience in Canada may be different from that in the United States, we propose that Canadian surgical fellows and their supervisors should be surveyed to gain an understanding of such information. This knowledge could be used to improve surgical fellowship training in Canada.