Factors influencing the selection of general internal medicine fellowship programs: a national survey

Addressing Barriers to Entry and Retention of Women in Interventional Vascular Specialties With Proposed Solutions: A Scientific Statement From the American Heart Association

Representation of women in interventional vascular fields (interventional cardiology, interventional radiology, and vascular surgery) lags behind that in other specialties. With women representing half of all medical school graduates, encouraging parity of women in these fields needs to start in medical school. Barriers to pursuing careers in vascular intervention include insufficient exposure during core clerkships, early mentorship, visibility of women in the field, length of training, lifestyle considerations, work culture and environment, and concerns about radiation exposure. This scientific statement highlights potential solutions for both the real and perceived barriers that women may face in pursuing careers in vascular intervention, including streamlining of training (as both interventional radiology and vascular surgery have done with a resultant increase in percentage of women trainees), standardization of institutional promotion of women in leadership, and professional and industry partnerships for the retention and advancement of women.

Factors influencing the development and implementation of nurse practitioner candidacy programs: A scoping review

BACKGROUND

To meet the growing needs of a diverse population, it is critical that healthcare service provision is underpinned by innovative, cost-effective, and sustainable services and solutions. The role of the nurse practitioner creates an opportunity to meet the increasing demands of complex care and enables greater access to high quality care. Understanding how best to support nurse practitioner candidates to develop into the nurse practitioner role will create greater opportunities to transform service delivery and improve healthcare outcomes.

AIM

To identify key factors that support and positively impact the implementation of nurse practitioner candidacy programs and candidate experiences.

METHODS

A scoping review of research and grey literature was conducted using Joanna Briggs Institute methodology. For the research literature, eight electronic databases (Embase, Medline, CINAHL, Web of Science, Cochrane Library, Joanna Briggs Institute, PubMed and PsycINFO) were searched followed by a hand search of the reference lists of published systematic reviews and relevant topical papers. A review of national and international grey literature sources was completed.

FINDINGS

Identification of a service gap, developing and promoting a clear role for the nurse practitioner candidate, integration into a multi-disciplinary team with strong mentorship/preceptorship support, continuing professional development, and evaluation of the program were identified as key factors in the research and grey literature.

CONCLUSION

A well-designed candidacy program can facilitate transition of the candidate into an autonomous, fully independent nurse practitioner. Recommendations to support the implementation of these roles into the clinical setting have been generated. Tweetable abstract: Key to nurse practitioner candidate programs: Identification of a service gap, clear role, integration, mentorship, training and evaluation.

Research Productivity of Orthopaedic Sports Medicine Fellowship Programs in the United States

Purpose

To survey orthopaedic sports medicine fellowship program directors to determine the current research productivity of both fellows and faculty in Accreditation Council for Graduate Medical Education-accredited orthopaedic sports medicine fellowship programs in the United States.

Methods

An anonymous 18-question survey was distributed via e-mail to all 95 Accreditation Council for Graduate Medical Education-accredited orthopaedic sports medicine fellowship program directors in the United States. Descriptive statistics were used for data analysis. Questions included whether fellows are required to complete a certain number of projects during their fellowship year and whether fellows have protected research time.

Results

Of the programs, 31 (33%) responded to the survey. Twenty-four programs (80%) require fellows to complete 1 to 4 projects. Twenty-one programs (71%) provide 4 to 8 hours of weekly protected research time. Twenty-four programs (77%) publish 1 to 2 manuscripts per fellow during the fellowship. Twenty-two programs (71%) have fellows work on 1 to 2 projects at a time. Annually, 26 programs (84%) give 0 to 5 podium presentations, 24 (80%) present 0 to 5 posters, and 15 (48%) report 0 to 5 publications. Twenty-four programs (77%) have research fellows and/or assistants to help with research. The presence of dedicated research assistants and more than 25 annual fellowship program publications were found to be useful screening data for more than 2 and more than 4 average publications per fellow, respectively.

Conclusions

The research productivity of orthopaedic sports medicine fellowship programs may be an important consideration for applicants. Applicants who desire to be productive in research during their fellowship year should consider programs with dedicated research assistants and/or programs that publish more than 25 times annually.

Clinical Relevance

This is a descriptive epidemiologic study that helps define the research productivity landscape in orthopaedic sports medicine fellowships. A more accurate understanding of sports medicine fellowship research experience may facilitate a better match between a program's research expectations and an applicant's research interests.

North American urogynecology fellowship programs: value of program website content

INTRODUCTION AND HYPOTHESIS

Urogynecology fellowship program websites are an important source of information to potential applicants, especially given the ongoing COVID-19 pandemic and resulting travel restrictions. Our study evaluated the publicly available information on American and Canadian urogynecology fellowship websites and present recommendations for website content development to promote the subspecialty of urogynecology.

METHODS

Data were collected from all active American and Canadian urogynecology fellowship program websites between May and June 2020 against 72 criteria developed from previously published studies. The criteria included the following sections: Recruitment, Faculty Information, Current Fellows, Research and Education, Surgical Program, Clinical Work, Benefits and Career Planning, Wellness, and Environment.

RESULTS

54 American urogynecology program websites and 11 Canadian urogynecology program websites were analyzed. The mean score of American and Canadian websites was 46.46% (n = 33.45 ± 7.20 out of 72) and 27.40% (n = 19.73 ± 3.77 out of 72), respectively. American program websites scored significantly higher on available information than Canadian websites. The highest prevalence section across American websites was Wellness (64%, n = 1.92 ± 0.85 out of 3 criteria) while the lowest prevalence section was Clinical Work (15.17%, n = 0.91 ± 1.02 out of 6 criteria). Comparatively, Canadian websites scored highest in the Faculty Information section (43.12%, 3.45 ± 2.02) and lowest in the Clinical Work section (6%, n = 0.36 ± 0.67 out of 6 criteria).

CONCLUSIONS

American and Canadian websites thoroughly covered the Wellness and Faculty Information sections, respectively. Program websites should consider adding details about Benefits and Career Planning and Clinical Work.

MENTOR study: Matching expectations and needs to optimize relationships in cardiovascular fellowship training

Study objective

Mentorship is a key component of successful cardiology training. This study sought to understand the alignment of mentorship priorities for fellow-in-training (FIT) mentees and faculty mentors.

Design

Cross-sectional survey study.

Setting

Online.

Participants

Cardiology mentors and FIT mentees in the State of Connecticut.

Interventions

None.

Main outcome measures

Likert-scale graded valuations on the importance of and satisfaction with various categories of mentorship by both mentors and mentees. Results were analyzed using Mann-Whitney, Kruskal-Wallis and Wilcoxon signed-rank tests, where appropriate.

Results

Forty-eight percent of FITs (n = 34) and 16% of faculty mentors (n = 34) responded to the survey. Of those, 74% of FITs identified a mentor within the first year of fellowship either by directly contacting the mentor or meeting them through a clinical rotation. Mentors significantly undervalued the importance to FITs of providing research opportunities (4.5 vs 3.6, p < 0.05), helping them make contacts (4.5 vs 3.7, p < 0.05) and providing job-search support (4.3 vs 3.3, p < 0.05). In contrast, mentors overestimated the value of work-life balance and clinical mentorship to FITs.

Conclusions

FITs value support in research, job search support, and networking more than mentors realize, leading to an expectation-satisfaction gap in those areas of mentorship. Further studies to examine how mentors and mentees can best align their expectations may improve the efficacy of the mentorship process.

The Art and Science of Mentorship in Cardiothoracic Surgery: A Systematic Review of the Literature

BACKGROUND

As academic cardiothoracic surgeons focus on producing a new generation of successful surgeon leaders, mentorship has emerged as one of the most important variables influencing professional and personal success and satisfaction. We explore the literature to determine the benefits, qualities and features of the mentor relationship.

METHODS

A comprehensive review was performed in February for 2020 of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and the SCOPUS Database using 'mentor' as a primary search term. The titles and abstracts of these publications were then reviewed by 2 of the authors to identify relevant sources addressing topics related to mentorship in cardiothoracic surgery and identify 4 specific areas of focus (1) the value of mentorship, (2) the skills needed to be an effective mentor, (3) effective approaches for identifying and receiving mentorship, and (4) the unique considerations associated with mentorship for traditionally underrepresented populations in surgery.

RESULTS

Of 16,469 articles reviewed, 167 relevant manuscripts were identified and 62 were included.

CONCLUSIONS

There is undeniable value in mentorship when navigating a career in cardiothoracic surgery. By sharing the most significant features and skills of both ideal mentors and mentees, we hope to provide a framework to improve the quality of mentorship from both sides.

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.

Women's Health Fellowships: Examining the Potential Benefits and Harms of Accreditation

This commentary responds to the assertions by Foreman et al. that credentialing of women's health (WH) fellows by the American Board of Medical Subspecialties and accreditation of current and future WH fellowships by the Accreditation Council for Graduate Medical Education would improve the health and healthcare of women by increasing the number of primary care providers competent to meet a growing clinical need. They speculate that such accreditation would raise the status of WH fellowships, increase the number of applicants, and result in more academic leaders in WH. They assert that curricular deficiencies in WH exist in physician training and that WH fellowships are the preferred means of training physicians to care for midlife women. We review the evidence to support or refute these claims and conclude that accrediting WH fellowships would not have the forecasted outcomes and would jeopardize the success of current WH fellowships.

American Society of Ophthalmic Plastic and Reconstructive Surgery fellowship survey: fellows selection criteria for training programs

PURPOSE

To investigate the characteristics that American Society of Ophthalmic Plastic and Reconstructive Surgery fellows seek in fellowship training programs.

METHODS

A 14-question anonymous SurveyMonkey survey was created for the 2011 to 2014 American Society of Ophthalmic Plastic and Reconstructive Surgery graduates. The survey evaluated fellow demographics, the interview process, and qualities fellows seek in fellowship training programs. A Likert scale was used to rate different qualities (1: not important, 9: very important), and summary statistics are reported as overall means and standard deviations. Analysis of variance comparisons were made between the different Ophthalmic Plastic and Reconstructive Surgery fellow graduate years, gender, and future practice goals.

RESULTS

In total, 87 surveys were e-mailed with 67 responses, a 77% response rate. The qualities with the highest mean were variety of surgical procedures (mean ± standard deviation: 8.6 ± 0.7), volume of procedures/surgeries (8.6 ± 0.7), personality of the program director (8.2 ± 1.3), and interview (7.7 ± 1.4). The characteristics that ranked the lowest in descending order were presence of a county hospital (5.1 ± 2.2), proximity to family (4.8 ± 2.7), didactics (4.7 ± 1.9), and benefits (4.4 ± 2.0). There was no statistically significant difference when comparing the groups according to gender and year of graduation. Fellows who want to pursue a career in academic medicine ranked academic fellowships higher in importance (8.0 ± 1.0) than those who wanted a career in private practice (5.3 ± 2.2).

CONCLUSIONS

American Society of Ophthalmic Plastic and Reconstructive Surgery fellows place an emphasis on surgical experience, the program director's personality, and the interview process when ranking fellowship training programs. This information is valuable for program directors to better recruit fellows.

Palliative medicine fellowship: a study of resident choices

CONTEXT

There are no data on the motives or characteristics of physicians choosing fellowship training in Hospice and Palliative Medicine (HPM).

OBJECTIVES

To understand more about the residents who choose HPM and what leads them to this decision.

METHODS

An electronic survey of HPM fellows initiating training in July 2009.

RESULTS

Seventy-six physicians began the study, with 62 responders (82%) completing all questions. Fifty-five percent were aged 30-40 years, and 61% were female. Sixty-eight percent were non-Hispanic Caucasian, 24% were Asian, and none were African American. Fifty-five percent were trained in internal medicine. Most (86%) asserted that the care of a dying, critically ill, or symptomatic person impacted their decision to enter the field of HPM. Sixty-three percent did not feel prepared to manage dying patients, and 41% felt personal regret about the care they delivered. The major reasons for choosing the specialty were a desire to contribute to relief of suffering (79%), enhance end-of-life care (73%), and improve communication (78%). Ninety-five percent received negative comments about their career choice. Fifty-nine percent had no exposure to hospice or palliative medicine in medical school, whereas 61% had an exposure available during residency. Forty-seven percent decided to enter a fellowship in the third year of residency, and 33% applied after practicing in their primary specialty for a median of 10 years. Accreditation, strength of education, and a hospital palliative medicine service were required by the majority for selection of a fellowship program.

CONCLUSION

Negative experiences with end-of-life care in residency, particularly in the intensive care unit, continue to be a factor in selection of HPM as a specialty. Many residents make their decision to enter the field and apply during Postgraduate Year 3. Most received negative comments about the choice. Fellows require a broad range of experience when selecting a fellowship program.

Characteristics of physicians who choose fellowship training in obstetrics and gynecology

INTRODUCTION

: To determine the attributes and motivation of physicians who pursue fellowship training in the subspecialties of Obstetrics and Gynecology (Ob/Gyn).

METHODS

: We surveyed current fellows and recent graduates from the ABOG recognized subspecialties in Ob/Gyn. Demographics and reasons for pursuing fellowship training were obtained. Significant differences between and among groups were determined using the Mann-Whitney U test and Pearson χ test.

RESULTS

: Forty-two percent of those sent a survey responded. The majority were between ages 30 to 35 (65.7%), female (60.5%), married (74.5%), and White (68.8%). Over 55% in each subspecialty cited interest in subject area as the primary reason for choosing their fellowship.

CONCLUSION

: Interest in subject remains the primary motivation for the majority of physicians choosing subspecialty fellowship training in Ob/Gyn. There is considerably more variation regarding what physicians' secondary motivation is and these reasons appear to vary according to the particular subspecialty.

Working in London hospitals: Perceptions of place in nursing students’ employment considerations

During the past decade, a distinct body of research has started to investigate the dynamics between nursing and place. However, despite attention being paid to a wide-range of nursing subjects, few studies have engaged with the important topic of labour force recruitment. In this context, this study uses a combined questionnaire (n=650), interview (n=30) and focus group (n=7) survey of London-based students, and investigates the complex mix of experiences and perceptions that result in hospitals having varying degrees of popularity as potential workplaces. The findings suggest experiences and perceptions of institutions-often gained on clinical placements-to be important, particularly relating to feeling valued, the quality of patient care, clinical and educational opportunities and team cohesion. These are often combined with experiences and perceptions of locality, relating to factors such as cost of living, travel considerations and sense of personnel safety. The study demonstrates that place is relevant to employment decision-making on multiple scales from wards to regions. Furthermore, that perceptions of potential workplaces result from engagements with complex mixes of cultural, economic and physical features, many of which are the consequences of management. It is argued that in order to effectively unpack workplaces, geographical research of nursing labour may benefit from researching simultaneously both 'inside' institutions, focusing on their dominant cultures of production and sub-cultures, and 'outside', focusing on their local urban or rural contexts.