Are pediatric emergency medicine training programs meeting their goals and objectives? A self-assessment of individuals completing fellowship training in 1993

Current Roles and Perceived Needs of Pediatric Hospital Medicine Fellowship Graduates

OBJECTIVES

Pediatric hospitalists report the need for additional training in clinical and nonclinical domains. Pediatric hospital medicine (PHM) fellowships seek to provide this training and produce leaders in the field. Our objective is to describe current roles and perceived training needs of PHM fellowship graduates.

METHODS

In 2014, all PHM fellowship graduates were asked to complete a Web-based survey. Survey questions addressed demographics, past training, current roles, and training needs in clinical care, research, education, and administration. Associations between fellowship experiences and outcomes were examined.

RESULTS

Fifty-one of 61 eligible individuals completed the survey. Average duration as a pediatric hospitalist was 5 years. Ninety percent completed pediatric categorical residency, whereas 10% completed an Internal Medicine-Pediatrics Residency. Most respondents completed a 1- (38%) or 2-year (46%) fellowship program. Ninety-six percent of respondents currently work in academic environments. The perceived need for additional clinical training was low, except procedures (44%). Nearly all teach medical students and pediatric residents, reporting adequate training in variety of teaching strategies. The majority of respondents conduct research, most commonly quality improvement (QI; 67%) and education (52%). Two-thirds are first authors on at least 1 peer-reviewed article. Research training needs include QI methodology (44%), biostatistics (43%), and obtaining funding (54%). A considerable number of respondents have academic leadership positions.

CONCLUSIONS

PHM fellowship graduates are academic hospitalists with diverse responsibilities. Despite a short average career span, many have achieved leadership roles and been academically productive. Future curriculum development should focus on procedures, QI, and research training.

Essentials of Pediatric Emergency Medicine Fellowship: Part 3: Clinical Education and Experience

This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the clinical aspects of fellowship training including the impact of the clinical environment, modalities for teaching and evaluation, and threats and opportunities in clinical education.

An automated electronic case log: using electronic information systems to assess training in emergency medicine

As part of the Outcome Project of the Accreditation Council for Graduate Medical Education, training programs are required to evaluate trainees across six general competencies. Assessment of the patient-care competency by direct observation can be supplemented with a quantification of overall experience through the use of case logs. However, manual entry of information into such registries frequently is incomplete. The authors report on the development of an automated electronic case log as a novel tool for evaluating the experience of individual trainees or an entire training program. Specific examples of use of the case log are provided. The authors use a pediatric emergency medicine fellowship as a paradigm to demonstrate the potential utility across all emergency medicine training programs. In addition, the authors discuss how additional information technologies might be incorporated to further these evaluative efforts in the future.

[Professional activity of fellows in French pediatric intensive care units. North American fellowship programs: a comparative study]

OBJECTIVES

The study of fellows professional activity in French pediatric intensive care units monitors: their workload, their distribution between bedside care and academic activities, their scientific papers production and at knowing perceptual impact their workload had on their professional and personal lives.

METHODS

The 2000 survey according to all 31 fellows of these units obtained a response rate of 94%.

RESULTS

Fellows of these units reported spending an average of 76 hours in the hospital per week. The bedside care took up 80% of their total professional activity. Impact of the workload was perceived as negative on themselves, on patient, their parents, on the care team. Fellows suggested a larger time needed to be dedicated to research, the support of a research mentor and the increase of medical staff, to favor their academic activity and improve unit functioning.

CONCLUSION

The workload reported seemed to affect the patient bedside care and diminished the implication of the fellows of French pediatric intensive care unit for the research activity. An increase of medical staff, a protected time for research would contribute to balancing professional activity of these medical doctors and would maintain the objective of training good clinicians.

Research training among pediatric emergency medicine fellows

This study examined research training characteristics among pediatric emergency medicine (PEM) fellows. A 45-question survey was mailed to all registrants of the 1998 National PEM Fellows' Conference. Descriptions of curricular design and administrative support components, perceived barriers, and subjective stress related to research were obtained. Surveys were returned by 67 of 79 fellows (85%). A total of 92.5% reported didactic instruction relating to research with relatively higher amounts in research design and biostatistics, and lower amounts in electronic review of the literature, applying to the institutional review board, ethics, and applying for grants. The most commonly cited barriers to more active participation in research were inadequate experience, inadequate time, and lack of administrative help. Stress in relationship to research was high (5.1 on a 1-7 Likert scale). PEM fellows report increasing levels of didactic exposure and administrative support for conducting research, however, PEM fellows still report experiencing significant amounts of stress and a number of perceived barriers.

Fellowship training in medical toxicology: characteristics, perceptions, and career impact

STUDY OBJECTIVE

To determine the number of physicians who have received fellowship training in medical toxicology and to describe fellowship-trained medical toxicologists' perceptions of fellowship training and its career impact.

METHODS

All current medical toxicology fellowship directors were contacted by mail for information on who had trained at their program. Subsequently, a written survey was mailed to all current American College of Medical Toxicology members regarding work force and educational issues pertaining to medical toxicology. Fellowship-trained toxicologists were asked about their clinical and research experiences during fellowship, and career impact of toxicology fellowship training.

RESULTS

Fellowship directors from 21 programs reported that 147 physicians had completed a toxicology fellowship since 1970. Of the 236 current American College of Medical Toxicology members surveyed, 160 (68%) responded. Ninety-four of the 160 (59%) are fellowship trained. Sixty-four of the 94 (68%) fellowship-trained toxicologists are emergency medicine board certified. About half the respondents believed they did not have enough inpatient and outpatient experiences during fellowship, but poison center time was more than adequate. After fellowship, 91% remain in medical toxicology although 78% spend less than 3/4 time in toxicology-related activities. More than 50% of respondents believed that fellowship training impacted their career by choosing an academic career, developing a toxicology clinical program, and altering clinical responsibilities.

CONCLUSIONS

Most fellowship-trained toxicologists only work part-time in medical toxicology, but fellowship training has significant impact on choice of academic career and altering clinical responsibilities. Training concerns include limited bedside experiences, particularly outpatient, and uncertain job prospects.