Motivations, job procurement, and job satisfaction among current and former ultrasound fellows

A Primary Care Ultrasound Fellowship: Training for Clinical Practice and Future Educators

As ultrasound devices become smaller, more portable, and more user friendly, there is now widespread use of this technology by physicians of all specialties, yet there are currently few structured opportunities for ultrasound education outside of emergency and critical care medicine. Anticipating the rising educational demand in the primary care specialties, the University of South Carolina School of Medicine created a primary care ultrasound fellowship in 2011, the first yearlong training program in point-of-care ultrasonography for graduates of internal medicine, medicine-pediatrics, pediatrics, and family medicine residencies. This paper reviews the history of point-of-care ultrasonography fellowships and then provides an overview of the primary care ultrasound fellowship.

Professional paradox: identity formation in qualified doctors pursuing further training

CONTEXT

Many newly qualified specialists and subspecialists pursue additional training. Although their motivations are many, the pursuit of further training as an alternative to unemployment is an emerging trend. Paradoxically, doctors continue as trainees with a consultant's credentials, and without the guarantee of eventual employment. This study explores seven doctors' experiences, the effects of further training on their professional identity formation (PIF), and how these effects are reconciled on a personal and professional level.

METHODS

This phenomenological study involved interviews with seven qualified Canadian specialists (three were female) who pursued additional training in response to a lack of available positions in their respective specialties. Template analysis generated theoretical constructs of influences on their PIF, and characteristics of their lived experiences.

RESULTS

Four themes shaped PIF: setting and context; language and communication; responsibilities and privileges; and participants' visions of their future selves. Professional identity formation (PIF) continued to develop in further training, but was inconsistently affirmed by participants' communities of practice. Four major themes characterised training experiences: prescription; managing multiple masters; limiting access to others and community ties; and constantly questioning the value of extra training.

CONCLUSION

Qualified doctors traverse professional paradoxes as they seek further education with no guarantee of employment and provide consultant-level care as 'trainees'. An identity dissonance emerges that may continue until a clear identity is prescribed for them. Although disruptive to these doctors' PIF and personal and professional lives, the long-term effects of additional training are unknown. Its utility and influence on securing employment and future job satisfaction are areas for further research.

Emergency Ultrasound: A Survey Study of Fellowship Graduate Characteristics and Career Paths

OBJECTIVES

There are sparse data on the career pathways of graduates of emergency ultrasound fellowships. The authors sought to define the characteristics of graduates and their reported career paths after training through this survey study.

METHODS

A 26-question anonymous survey was emailed to 597 graduates of 70 fellowships over a 4-week period. No incentives were provided for completion of the questionnaire. Descriptive statistics are reported. For qualitative data, open- and axial-coding methods were used.

RESULTS

A total of 336 participants completed the study for a response rate of 56%. The average age of respondents was 36.4 years, and 58% were male. Most graduates had MD degrees (89%) or DO degrees (10%). Sixty percent of graduates attended a 3-year emergency medicine residency, and 29% attended a 4-year residency. Only 11% pursued additional fellowship training, most commonly pediatric emergency medicine (n = 14). After fellowship, 63% (95% confidence interval [CI], 62.9, 63.1) of graduates began working full-time in an academic setting, whereas 24% (95% CI, 23.9, 24.1) worked full-time in a community setting. Thirty-three percent (95% CI, 32.7, 33.3) took an immediate position as ultrasound division director, whereas 4% (95% CI, 3.7, 4.3) became fellowship directors and 3% (95% CI, 2.7, 3.3) became ultrasound medical student directors. Currently, 67% (95% CI, 66-68%) identify ultrasound as their leading academic focus.

CONCLUSIONS

Although not all fellowship graduates pursue academic positions, most note the impact of fellowship on their career paths. Graduates hold a variety of leadership positions. Approximately two thirds still consider ultrasound as their academic focus.

Emergency ultrasound fellowship training: a novel team-based approach

OBJECTIVES

To describe our experience with implementation of a novel team-based emergency ultrasound (EUS) fellowship training program.

METHODS

We conducted a retrospective review at an academic medical center. All emergency department (ED) faculty and residents were divided into 3 teams, and a fellow was assigned to each team. Each fellow was responsible for ultrasound (US) education of their team members and faculty credentialing. Additionally, each fellow was assigned to one of these specific responsibilities every month: (1) education, (2) quality assurance/billing, and (3) equipment. The fellows also received a checklist at the beginning of the fellowship training, which outlined research, reading, teaching, and scanning requirements.

RESULTS

With a team-based approach, all US examinations were reviewed for quality control within 1 week after the scans were performed. The number of US examinations billed by faculty increased by 180%. The US billing revenue increased by 60% during the study period. Fifteen additional faculty members were credentialed to use US in the ED. Compliance with bedside documentation of US findings increased from 30% to 90%. There was increased resident engagement, and the number of scans performed by residents increased by 130%. There was also a substantial decrease in the funds required to replace damaged transducers.

CONCLUSIONS

A team-based EUS fellowship training program had a substantial impact on US use in the ED, quality control review, faculty credentialing, US billing revenue, compliance with documentation, and resident US education.

Do emergency ultrasound fellowship programs impact emergency medicine residents' ultrasound education?

OBJECTIVES

Recent years have seen a rapid proliferation of emergency ultrasound (EUS) programs in the United States. To date, there is no evidence supporting that EUS fellowships enhance residents' ultrasound (US) educational experiences. The purpose of this study was to determine the impact of EUS fellowships on emergency medicine (EM) residents' US education.

METHODS

We conducted a cross-sectional study at 9 academic medical centers. A questionnaire on US education and bedside US use was pilot tested and given to EM residents. The primary outcomes included the number of US examinations performed, scope of bedside US applications, barriers to residents' US education, and US use in the emergency department. The secondary outcomes were factors that would impact residents' US education. The outcomes were compared between residency programs with and without EUS fellowships.

RESULTS

A total of 244 EM residents participated in this study. Thirty percent (95% confidence interval, 24%-35%) reported they had performed more than 150 scans. Residents in programs with EUS fellowships reported performing more scans than those in programs without fellowships (P = .04). Significant differences were noted in most applications of bedside US between residency programs with and without fellowships (P < .05). There were also significant differences in the barriers to US education between residency programs with and without fellowships (P < .05).

CONCLUSIONS

Emergency US fellowship programs had a positive impact on residents' US educational experiences. Emergency medicine residents performed more scans overall and also used bedside US for more advanced applications in programs with EUS fellowships.