Developing a framework for promoting interest and engagement of scholarship of teaching and learning for medical students

BACKGROUND

The scholarship of teaching and learning (SoTL) is a field of academic research that focuses on improving learning through reflective and informed teaching. Currently, most SoTL-related work is faculty-driven; however, student involvement in SoTL has been shown to benefit both learners and educators. Our study aims to develop a framework for increasing medical students' interest, confidence, and engagement in SoTL.

METHODS

A student-led SoTL interest group was developed and a year-round program of SoTL was designed and delivered by student leaders of the group under the guidance of a faculty advisor. Individual post-session surveys were administered to evaluate participants' perceptions of each session. Pre- and post-program surveys were administered to evaluate the program impact.

RESULTS

The year-round SoTL program consistently attracted the participation of medical students and faculty. Survey responses indicated strong medical student interest in the program and positive impact of the program. Increased interest and confidence in medical education research were reported by the student participants. The program design provided opportunities for student participants to network and receive ongoing feedback about medical education research they were interested or involved in.

CONCLUSION

Our study provides insights for developing a framework that other institutions can reference and build upon to educate and engage students in SoTL.

Current state of musculoskeletal fellowship program directors and future directions

OBJECTIVE

To better understand the current state of musculoskeletal fellowship program directors and identify opportunities for formal training that could increase job satisfaction, provide a broader knowledge base for mentoring/advising trainees and increase diversity in musculoskeletal radiology.

MATERIALS AND METHODS

Eighty-one fellowship program directors who signed the Fellowship Match Memorandum of Understanding with the Society of Skeletal Radiology were sent a survey with questions about demographics, career, background, and training both for musculoskeletal radiology and for the fellowship director role.

RESULTS

A 57/81 (70%) of program directors responded, representing 27 different states with a range of 1-9 fellowship positions. Nearly half are in their forties (48%) with most identifying as White (67%) followed by Asian (30%). The majority are male (72%) with over half (60%) remaining at the institution where they completed prior training. Over half plan to change roles within 5 years and do not feel adequately compensated. Top qualities/skills identified as important for the role include effective communication, being approachable, and clinical excellence. Other than clinical excellence, most do not report formal training in skills identified as important for the role.

CONCLUSIONS

Given the high amount of interaction with trainees, program directors play a key role in the future of our subspecialty. The low diversity among this group, the lack of formal training, and the fact that most do not feel adequately compensated could limit mentorship and recruitment. Program directors identified effective communication, organizational/planning skills, and conflict resolution as the top skills they would benefit from formal training.

European Pediatric Cardiac Anesthesia Fellowship Program: A First Proof of Concept

The Pediatric Cardiac Anesthesia (PCA) fellowship is a demanding training program in Europe and the United States. Successful completion of the program requires years of training in anesthesiology, a thorough understanding of cardiovascular anatomy and physiology, and extensive experience in the perioperative management of neonates and children with heart disease. In the context of the first candidate to successfully complete the PCA program in Europe, this article presents excerpts from the design and structure of the European PCA program. The PCA program is evaluated critically by both external and internal reviewers, and points are highlighted that could be included in the next version of the program.

Assessing Pediatric Rheumatology Fellow Competence in the Milestone Era: Past, Present, and Future

Starting in 2015, pediatric rheumatology fellowship training programs were required by the Accreditation Council for Graduate Medical Education to assess fellows' academic performance within 21 subcompetencies falling under six competency domains. Each subcompetency had four or five milestone levels describing developmental progression of knowledge and skill acquisition. Milestones were standardized across all pediatric subspecialties. As part of the Milestones 2.0 revision project, the Accreditation Council for Graduate Medical Education convened a workgroup in 2022 to write pediatric rheumatology-specific milestones. Using adult rheumatology's Milestones 2.0 as a starting point, the workgroup revised the patient care and medical knowledge subcompetencies and milestones to reflect requirements and nuances of pediatric rheumatology care. Milestones within four remaining competency domains (professionalism, interpersonal and communication skills, practice-based learning and improvement, and systems-based practice) were standardized across all pediatric subspecialties, and therefore not revised. The workgroup created a supplemental guide with explanations of the intent of each subcompetency, 25 in total, and examples for each milestone level. The new milestones are an important step forward for competency-based medical education in pediatric rheumatology. However, challenges remain. Milestone level assignment is meant to be informed by results of multiple assessment methods. The lack of pediatric rheumatology-specific assessment tools typically result in clinical competency committees determining trainee milestone levels without such collated results as the foundation of their assessments. Although further advances in pediatric rheumatology fellowship competency-based medical education are needed, Milestones 2.0 importantly establishes the first pediatric-specific rheumatology Milestones to assess fellow performance during training and help measure readiness for independent practice.

Review of the demographic and educational profiles of abdominal imaging fellowship program directors in the United States

PURPOSE

To evaluate demographics, academic backgrounds, and scholarly activities of Program Directors (PDs) in Abdominal Imaging Fellowships in the United States (US), emphasizing gender representation, international origins, and academic milestones.

METHODS

A list of Fellowships in Abdominal Imaging programs in the US was obtained from the Society of Abdominal Radiology. The search was expanded using the Fellowship and Residency Electronic Interactive Database. Data for PDs were sourced from program websites, Healthgrades, Doximity, and Elsevier's Scopus. Metrics such as age, gender, education, academic rank, additional qualifications, prior leadership roles, publications, and h-indices were analyzed using R software. A two-tailed unpaired t-test was used to calculate the difference in means of scholarly activity between male and female PDs.

RESULTS

113 programs were identified: South (36.28%), Northeast (25.66%), Mid-West (20.35%), West (17.69%). Of 107 PDs, 54% male, 41% female, and average age 48 ± 9.4 years. 66.6% were US graduates, 29.2% were international graduates. Most were Assistant Professors (36.28%). 19.46% had degrees like M.P.H. or M.B.A. 45% had prior leadership roles. Average year of residency graduation was 2007. Mean publication count was 54.16, and mean h-index was 14.663. Male PDs had higher publication counts and h-indices than female PDs (p= 0.009 and p= 0.0019 respectively).

CONCLUSION

In Abdominal Imaging Fellowship programs in the US, there is an increasing representation of females in Program Director roles. However, research led by female PDs remains less prevalent. The field of Abdominal Imaging values contributions from international graduates and insights from Assistant Professors.

National survey of infectious disease fellowship program directors: A call for subspecialized training in infection prevention and control and healthcare epidemiology

OBJECTIVE

The importance of infection prevention and control and healthcare epidemiology (IPC/HE) in healthcare facilities was highlighted during the COVID-19 pandemic. Infectious disease (ID) clinicians often hold leadership positions in IPC/HE teams; however, there is no standard for training or certification of ID physicians specializing in IPC/HE. We evaluated the current state of IPC/HE training in ID fellowship programs.

DESIGN

A national survey of ID fellowship program directors was conducted to assess current IPC/HE training components in programs and plans for expanded offerings.

SETTING AND PARTICIPANTS

All ID fellowship program directors in the United States and Puerto Rico.

METHODS

Surveys were distributed using Research Electronic Data Capture (REDCap) to program directors in March 2023, with 2 reminder emails; the survey closed after 4 weeks.

RESULTS

Of 166 program directors, 54 (32.5%) responded to the survey. Among respondent programs, 49 (90.7%) of 54 programs reported didactic training in IPC/HE averaging 4.4 hours over the course of the fellowship. Also, 18 (33.3%) of 54 reported a dedicated IPC/HE training track. Furthermore, 23 programs (42.6%) reported barriers to expanding training. There was support (n = 47, 87.0%) for formal IPC/HE certification from a professional society within the standard fellowship.

CONCLUSIONS

Despite the COVID-19 pandemic highlighting the need for ID medical doctors with IPC/HE expertise, formal training in ID fellowship remains limited. Most program directors support formalization of IPC/HE training by a professional organization. Creation of standardized advanced curriculums for ID fellowship training in IPC/HE could be considered by the Society of Healthcare Epidemiology of America (SHEA) to grow, retain, and enhance the IPC/HE physician workforce.

Future leaders in a learning health system: Exploring the Health System Impact Fellowship

The Canadian health system is reeling following the COVID-19 pandemic. Strains have become growing cracks, with long emergency department wait times, shortage of human health resources, and growing dissatisfaction from both clinicians and patients. To address long-needed health system reform in Canada, a modernization of training is required for the next generation health leaders. The Canadian Institutes of Health Research Health System Impact Fellowship (HSIF) is an example of a well-funded and connected training program which prioritizes embedded research and embedding technically trained scholars with health system partners. The program has been successful in the scope and impact of its training outcomes as well as providing health system partners with a pool of connected and capable scholars. Looking forward, integrating aspects of evidence synthesis from both domestic and international sources and adapting a general contractor approach to implementation within the HSIF could help catalyze learning health system reform in Canada.

Colon and Rectal Surgery Fellowship Applicant and Matching Trends in the United States: An Analysis of National Resident Matching Program Data

BACKGROUND

Colon and Rectal Surgery fellowships are training programs that aim to train surgeons in the management of small bowel, colon, rectal, and anal pathologies.

OBJECTIVE

We investigated trends in Colon and Rectal Surgery fellowship match to help applicants anticipate future fellowship application cycles.

DESIGN

This was a retrospective cohort study of applicants in the Colon and Rectal Surgery match from 2009 to 2023. Proportion of positions filled, match rates, and rank-order lists were collected. The impact of US-MD, non-US-MD, and DO status on match rate was assessed. We used the Mann Kendall trend test to obtain tau statistic and P-value for temporal trends over time, while associations between categorical variables were investigated by a chi-square test.

RESULTS

Fellowship programs increased from 43 to 67, positions increased from 78 to 110, and number of applicants rose from 113 to 135. Nearly all positions were filled from 2009 to 2023 (range: 96.3%-100%). The overall match rate fluctuated between 67.3% and 80.7%. The match rate over the past 5 years was 72.0%. The match rate for US-MDs was 80.0%, while non-US-MDs had a 56.2% match rate. The percentage matching at each rank were first choice 28.0%, second choice 10.4%, third choice 6.9%, and fourth choice or lower 23.5%.

CONCLUSION

Despite an increase in Colon and Rectal Surgery fellowship positions, the overall match rate has not changed significantly over the years, mainly as a result of increased applicants.

The Canadian Pediatric Surgery Workforce: A 10-year Prospective Assessment

BACKGROUND

The Canadian Association of Paediatric Surgeons launched a 10-year prospective assessment of the Canadian pediatric surgery workforce and training environment, beginning in 2013. The results of the first 5 years (2013-2017) were previously published. Here, we present the results of the last 5 years (2018-2022), and the cumulative results of the past decade.

METHODS

With IRB approval, a web-based survey was sent to all pediatric surgery division chiefs in Canada each year (2013-2022). The survey gathered workforce data on pediatric surgery practices, as well as data regarding fellowship graduates from Canadian training programs.

RESULTS

Complete responses were received from all 18 divisions (100% response rate). Over the decade studied, the number of pediatric surgeons and full-time equivalent positions increased from 73 to 81, and 65 to 82, respectively. Thirty positions were vacated (15 retirement, 6 new Canadian practice, 8 leaving Canada, 1 other), and 38 were filled (20 new Canadian fellowship graduates, 8 Canadian surgeons moving from other sites in Canada, 10 surgeons coming from outside Canada). Seventy-five fellows completed training eligible for North American certification, including 34 Canadians, 31 Americans, and 10 non-North American foreign nationals (9 of whom left North America after training). The proportion of Canadian graduates who desired, but could not find, a Canadian position improved from 44% in the first 5 years to 20% in the second 5 years.

CONCLUSIONS

The Canadian pediatric surgery workforce has experienced a modest increase over a decade. A mismatch still exists between Canadian pediatric surgery graduates and attending staff positions, but the situation has improved during the last 5 years.

TYPE OF STUDY

Survey.

LEVEL OF EVIDENCE: 5

Demographics and Career Trends of Urology Fellowship Directors in the United States

INTRODUCTION

Fellowship directors (FDs) hold significant leadership roles within the academic urology community. We sought to characterize common trends in training and academic productivity among urology FDs. Moreover, we aimed to characterize gender differences across subspecialties to better inform gender-based inclusion efforts and contemporary leadership pathways.

METHODS

FDs were studied across 6 urologic subspecialties. Society and institutional websites were queried for demographics, education/training institutions, timelines of career milestones, and academic productivity. χ2, Mann-Whitney U, and Kruskal-Wallis tests and Kendall tau rank correlation were employed with an alpha cutoff of .05.

RESULTS

There were 219 FDs included, representing 208 fellowship programs at 93 institutions. FDs were 176 (80%) males and 43 (20%) females. There was a significant association between gender and subspecialty. The median age for all FDs was 52 years old. Significant differences in age were demonstrated across subspecialties. For all FDs, females were younger than males, at 49 and 53 years, respectively (P = .001). The median H-index for all FDs was 23.5. H-index was significantly different between genders and subspecialities. There was a strong, positive correlation between age vs H-index for all FDs. Half of FDs had completed fellowship training at one of 14 institutions.

CONCLUSIONS

We describe the landscape of leadership in urology subspecialty training. There are an increasing number of female FDs. Composition of leadership varies by subspecialty; however, the careers of all current urology FDs are marked by lifelong achievements in academic productivity. Moreover, a small group of institutions produce a substantial number of FDs.

Granting access: Development of a formal course to demystify and promote predoctoral fellowship applications for graduate students

Strong scientific writing skills are the foundation of a successful research career and require training and practice. Although these skills are critical for completing a PhD, most students receive little formal writing instruction prior to joining a graduate program. In 2015, the University of Iowa Medical Scientist Training Program (MSTP) addressed this issue by developing the scientific writing course Grant Writing Basics (GWB). Here we describe the structure of this course and its effectiveness. GWB is an interactive, workshop-based course that uses a National Institutes of Health (NIH) F30 predoctoral fellowship proposal as a platform for building writing expertise. GWB incorporates established pedagogical principles of adult learning, including flipped classrooms, peer teaching, and reiterative evaluation. Time spent in class centers on active student analysis of previously submitted fellowship applications, discussion of writing resources, active writing, facilitated small group discussion of critiques of student writing samples, revision, and a discussion with a panel of experienced study section members and a student who completed a fellowship submission. Outcomes of GWB include a substantial increase in the number of applications submitted and fellowships awarded. Rigorous evaluation provides evidence that learning objectives were met and that students gained confidence in both their scientific writing skills and their ability to give constructive feedback. Our findings show that investment in formal training in written scientific communication provides a foundation for good writing habits, and the knowledge and skills needed to succeed in this vital aspect of a scientific research career. Furthermore, they highlight that evaluation is valuable in guiding course evolution. Strategies embedded in GWB can be adapted for use in any graduate program to advance scientific writing skills among its trainees.

Impact of fellowship training for specialists on thyroidectomy outcomes of patients with thyroid cancer

We aimed to evaluate the impact of fellowship training (FT) for thyroid specialists on the outcomes of patients with thyroid cancer. We reviewed surgeries performed for thyroid cancer before (non-FT group) and after (FT group) fellowship training and compared several variables, including length of stay of patients, tumor diameter, surgical method, lymph node dissection, parathyroid implantation, surgical duration, intraoperative blood loss, and postoperative complications. Compared with the non-FT group, the FT group had a shorter hospital stay, more adequate fine needle aspiration biopsy of the thyroid, less intraoperative blood loss, higher rate of parathyroid implantation, higher lymph node dissection rate, and lower nerve injury and hypoparathyroidism rates. When the surgical duration was < 200 min and/or only central lymph node dissection was performed, the FT group had a lower incidence of postoperative complications than the non-FT group. When, the incidence of postoperative complications, including postoperative nerve injury and hypoparathyroidism. In conclusion, FT for thyroid specialists is beneficial for patients with thyroid cancer and may allow a shorter hospital stay and reduced incidence of postoperative complication. Accordingly, FT may facilitate a more appropriate surgical approach with a preoperative pathological diagnosis.

Emphasis of Diversity, Equity, and Inclusion on US Adult Infectious Disease Fellowship Program Websites in the Era of Virtual Recruitment

Women and underrepresented-in-medicine applicants value a climate for diversity when selecting graduate medical education training programs. Climate may not be accurately represented during virtual recruitment. Optimizing program websites may help overcome this barrier. We reviewed websites for adult infectious disease fellowships that participated in the 2022 National Resident Matching Program for emphasis on diversity, equity, and inclusion (DEI). Fewer than half expressed DEI language in their mission statement or had a dedicated DEI statement or webpage. Programs should consider emphasizing their commitment to DEI prominently on their websites, which may help recruit candidates from diverse backgrounds.

Job search strategies and early careers of clinical informatics fellowship alumni (2016-2022)

OBJECTIVE

To report on clinical informatics (CI) fellows' job search and early careers.

MATERIALS AND METHODS

In the summer of 2022, we performed a voluntary and anonymous survey of 242 known clinical informatics fellowship alumni from 2016 to 2022. The survey included questions about their initial job search process; first job, salary, and informatics time after training; and early career progression over the first 1-6 years after fellowship.

RESULTS

Nearly half (101, 41.7%) responded to the survey. Median informatics time was 50%; most were compensated similar/better than a purely clinical position. Most reported CI fellowship significantly impacted their career, were satisfied with their first and current job after training, and provided advice for current fellows and CI education leaders. Graduates in 2022 had a median job search of 5 months, beginning 3-15 months before graduation; most had a position created for them. Nearly all graduates from 2016-2021 (61, 93.8%) had at least one change in roles/benefits since finishing training, with a trend for increased informatics time and salary.

DISCUSSION

There was a wide variety of roles, salary, and funding sources for CI positions. This highlights some of the unique challenges CI fellows face and the importance of networking. These results will help CI education leaders, fellows, alumni, and prospective fellowship applicants.

CONCLUSION

Graduates felt that CI fellowship had a significant impact on their career, were pleased with their first jobs and early career trajectory. Continued follow-up of the experience of new graduates and alumni is needed to assess emerging patterns over time.

Quality of Office-based Procedure Training During Laryngology Fellowship

OBJECTIVES

The primary objective was to assess the perspectives of recent laryngology fellowship graduates on office-based procedure training, with a secondary objective to compare this with previous research on perspectives of fellowship directors.

METHODS

Recent laryngology fellowship graduates were surveyed via an online survey platform regarding post-fellowship practice and various aspects of office-based procedure training, including perceived competence, mentorship, and barriers.

RESULTS

There were 51 respondents. Seventy-six percent of respondents felt they "definitely" received adequate office procedure training. Number of procedures as primary surgeon was significantly associated with perception of adequate training (OR 1.54, 95% CI: 1.08-2.19, p = 0.018) and high post-fellowship office procedure volume (OR 1.56, 95% CI: 1.02-2.39, p = 0.040). Fellows reported a lower percentage of procedures as primary surgeons compared with program directors (46.8% vs. 61.9%, p = 0.028). Fellows and directors agreed that informal debriefs were more commonly employed than more structured training elements such as checklists and simulators. Of nine office procedures, laryngeal electromyography, KTP laser, and transnasal esophagoscopy had the greatest decreases in practice after training.

CONCLUSION

Although most recent laryngology fellowship graduates endorse adequate office-based procedure training, a range of individual experiences exists, and office procedure volume, both overall and across individual procedures, may decrease after fellowship. Fellows performing office procedures as primary surgeons may be linked to perceived quality of training and post-fellowship volume.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:1802-1806, 2024.

Grief Training in Palliative Care Fellowships

INTRODUCTION

No prior study has assessed grief and bereavement curriculum in Hospice and Palliative Medicine (HPM) fellowship programs in the United States.

METHODS

A 14-item survey was created and distributed to Accreditation Council for Graduate Medical Education (ACGME)-accredited HPM fellowship Program Directors to assess program demographics, curriculum emphasis, grief and bereavement programming, and attitudes toward grief and bereavement training for HPM fellows.

RESULTS

The overall survey response rate was 63%. Most palliative care programs were academic (74%) and had four or fewer fellows (85%). 90% devoted a minority (0%-10%) of their curriculum to grief and bereavement training. Most programs reported at least some program-led grief and bereavement programming (69%); however, 53% endorsed that fellows are not very or not at all involved in this programming. Almost half of programs only have a small amount of programming related to supporting families after loss (49%). The majority endorsed having a great deal of programming for debriefing or supporting fellows through professional grief (55%), and the most common modalities were debriefing sessions (62%) and ensuring access to mental health resources (41%). The most common ways of teaching grief and bereavement were through bedside/anecdotal teaching and lectures/case conferences. Most program directors felt that palliative care fellowships should provide grief and bereavement training (81%) and consider it important or very important for fellows to learn how to process grief and bereavement (92%).

DISCUSSION

It was widely reported by program directors that grief and bereavement training are important curricular components for HPM fellows. Acknowledging professional grief remains an underrecognized need in palliative care training and practice. Our study suggests that for grief and bereavement curricula in HPM fellowships, the time dedicated, specific types, and amount of fellow involvement was highly variable. It will be critical for programs to disseminate best practices to help move toward a more uniform approach for ensuring basic competency in grief and bereavement training in HPM fellowship programs in the United States.

Welcome to the 2024 ACMT Annual Scientific Meeting

Two hundred sixteen abstracts were selected for presentation at the 2024 American College of Medical Toxicology (ACMT) Annual Scientific Meeting on April 12-14, 2024, in Washington, DC. The quality and breadth of toxicology scholarship continues to grow as our field expands. The complete 2024 ASM abstract book in the April issue of JMT includes original research studies from around the world and the ToxIC Investigators Consortium, clinically significant case reports describing toxicologic phenomena, and selected encore research presentations from other scientific meetings.

Health Professionals Organizing for Climate Action: A Novel Community Organizing Fellowship

PROBLEM

Climate change is a public health and health equity crisis. Health professionals are well positioned to advance solutions but may lack the training and self-efficacy needed to achieve them.

APPROACH

The Center for Health Equity Education and Advocacy at Cambridge Health Alliance, a Harvard Medical School Teaching Hospital, developed a novel, longitudinal fellowship that taught health professionals about health and health equity effects of climate change, as well as community organizing practices that may help them mitigate these effects. The fellowship cohort included 40 fellows organized into 12 teams and was conducted from January to June 2022. Each team developed a project to address climate change and received coaching from an experienced community organizer coach. Effects of the fellowship on participants' knowledge, skills, and attitudes were evaluated using pre- and postfellowship surveys.

OUTCOMES

Surveys were analyzed for 38 of 40 (95%) participants who consented to the evaluation and completed both surveys. Surveys used a 7-point Likert scale for item responses. McNemar's test for paired data was used to assess changes in the proportion of respondents who agreed ("somewhat agree"/"agree"/"strongly agree") with statements in pre- vs postfellowship surveys. Statistically significant improvements were found for 11 of the 17 items assessing knowledge, skills, and attitudes. Participants' views of the fellowship and its effects were assessed through additional items in the postfellowship survey. Most respondents agreed that the fellowship increased their knowledge of the connections between climate change and health equity (32/38, 84.2%) and prepared them to effectively participate in a community organizing campaign (37/38, 94.7%). Each of the 12 groups developed climate health projects by the fellowship's end.

NEXT STEPS

This novel fellowship was well received and effective in teaching community organizing to health professionals concerned about climate change. Future studies are needed to assess longer-term effects of the fellowship.

Everything in Moderation: How to Lead Scholarly Sessions at Academic and Scientific Meetings

Presenters share emerging scholarship at scientific meetings as oral or poster presentations. While there is ample direction for presenters, moderators, who are overarching content experts that lead the sessions, also need guidance.1,2 The approach to moderating an academic session presented below enables presenters and audiences to engage in meaningful discourse and moderators to keep abreast of the latest developments in their academic areas.

Body oncologic imaging subspecialty training a curriculum based on the experience in a tertiary cancer center

PURPOSE

To describe the structure of a dedicated body oncologic imaging fellowship program. To summarize the numbers and types of cross-sectional imaging examinations reported by fellows.

METHODS

The curriculum, training methods, and assessment measures utilized in the program were reviewed and described. An educational retrospective analysis was conducted. Data on the number of examinations interpreted by fellows, breakdown of modalities, and examinations by disease management team (DMT) were collected.

RESULTS

A total of 38 fellows completed the fellowship program during the study period. The median number of examinations reported per fellow was 2296 [interquartile range: 2148 - 2534], encompassing all oncology-relevant imaging modalities: CT 721 [646-786], MRI 1158 [1016-1309], ultrasound 256 [209-320] and PET/CT 176 [130-202]. The breakdown of examinations by DMT revealed variations in imaging patterns, with MRIs most frequently interpreted for genitourinary, musculoskeletal, and hepatobiliary cancers, and CTs most commonly for general staging or assessment of nonspecific symptoms.

CONCLUSION

This descriptive analysis may serve as a foundation for the development of similar fellowship programs and the advancement of body oncologic imaging. The volume and diversity of examinations reported by fellows highlights the comprehensive nature of body oncologic imaging.

Factors Influencing Physical Medicine and Rehabilitation Trainee Research Engagement

ABSTRACT

Research engagement during physical medicine and rehabilitation residency and fellowship training is essential for advancing evidence-based medicine and fostering the development of clinician-scientists. Current Accreditation Council for Graduate Medical Education guidelines regarding research requirements during physical medicine and rehabilitation training are ambiguous, and it is unknown whether physical medicine and rehabilitation trainees receive adequate support to pursue research at the level they desire. This anonymous survey study aimed to identify perceived barriers and facilitators to research engagement among US physical medicine and rehabilitation residents and fellows. Our findings suggest that physical medicine and rehabilitation trainees value research engagement. However, research productivity during physical medicine and rehabilitation residency is limited, with many trainees reporting inadequate support and time to participate in research in a meaningful way. Additional support from residency and fellowship programs, including protected time for research, as well as research-specific education and mentorship should be considered to enhance physical medicine and rehabilitation trainee research engagement.

The Society of Thoracic Surgeons Looking to the Future Scholarship Program: A 15-Year Review

BACKGROUND

It has been postulated that a possible barrier to pursuing cardiothoracic surgery is a lack of exposure and mentorship during training. In 2006, The Society of Thoracic Surgeons began the Looking to the Future Scholarship to expand interest in the field. Undecided trainees with limited exposure were prioritized in the selection process. This report summarizes the career outcomes of general surgery resident and medical student recipients.

METHODS

Scholarship recipients and nonrecipients (control) were queried in a Google search. The percentage of those who were cardiothoracic surgeons or in cardiothoracic training (%CTS) was calculated, as well as the percentage of female surgeons in cardiothoracic surgery.

RESULTS

From 2006 to 2021, there were 669 awardees. The %CTS was 63.7% for resident recipients and 31.4% for students, respectively. There was no significant difference in %CTS between resident and student recipients compared to nonrecipients. Notably, the percentage of female cardiothoracic surgeons was significantly greater for both resident and student recipients.

CONCLUSIONS

The majority of resident recipients are now in cardiothoracic surgery, comparable to nonrecipients. While there was no significant difference between the percentage of recipients and non-recipients in cardiothoracic surgery, these groups differed substantially as nonrecipients had greater exposure and commitment to the field at the time of application.

Components of an Updated Disaster Medicine Curriculum Included in Emergency Medicine Residency and Emergency Medical Services Fellowship in the United States

INTRODUCTION

Disaster medicine (DM) is a unique field that has undergone significant development as disaster events become increasingly complicated to respond to. However, DM is not recognized by the American Board of Medical Specialties (ABMS) or Accreditation Committee of Graduate Medical Education (ACGME), and therefore lacks board certification. Furthermore, prior studies have shown that there is unique body of DM knowledge not being addressed in emergency medicine (EM) residency or Emergency Medical Services (EMS) fellowship, resulting in fundamental DM topics not being covered amongst graduate medical education (GME) programs most prepared to produce DM physicians. A recently published DM core curriculum addresses this knowledge gap and seeks to promote standardization of DM training.

STUDY OBJECTIVE

The objective of this study is to analyze EM residency and EMS fellowship curricula for the inclusion of DM major curriculum topics and subtopics, using the most recently published DM core curriculum as a control.

METHODS

Both EM residency and EMS fellowship curricula were analyzed for inclusion of DM curriculum topics and subtopics, using the DM curriculum recommendations published by Wexler, et al as a control. A major curriculum topic was deemed covered if at least one related subtopic was described in the curricula. The included and excluded DM topics and subtopics were analyzed using descriptive statistics.

RESULTS

While all the DM major curriculum topics were covered by either EM residency or EMS fellowship, EMS fellowship covered more major curriculum topics (14/15; 93%) than EM residency (12/15; 80%) and EMS fellowship covered more DM curriculum subtopics (58/153; 38%) than EM residency (24/153; 16%). Combined, EM residency and EMS fellowship covered 65 out of 153 (42%) of the DM curriculum subtopics.

CONCLUSION

Although this study finds that all the DM major curriculum topics will be covered in EM residency followed by EMS fellowship, over one-half of the subtopics are not covered by either program (16% and 38%, respectively) or both programs combined (42%). Increasingly relevant subtopics, such as climate change, droughts, and flooding, are amongst those not covered by either curriculum. Even amongst the DM topics included in GME curricula, an emphasis on themes such as mass treatment, preparedness, and mitigation is likely under-represented. Accreditation from ACGME for DM fellowship would further promote uniform implementation of the updated core curriculum and ensure optimal training of disaster-ready physicians.

Who Are the Mentors of the Future Endourologist? An Analysis of Endourological Society Program Directors

Introduction: Surgical training programs are pivotal in shaping skilled and compassionate surgeons, with mentors playing a crucial role in instilling clinical competence and essential attributes. This study aims to describe the characteristics of the program directors of Endourological Society-accredited fellowship programs. Methodology: The Endourological Society's website was used to identify program directors. The following data points were extracted: year of graduation from medical school, year of completing residency, if they had attended fellowship training or held additional degrees such as (PhD, MS, MBA, MSc, etc.), and number of publications on Scopus. Descriptive statistics were used to analyze the data. Results: A total of 84 fellowship programs and 115 program directors were identified. Geographically, 77.4% (n = 65) were in North America, 8.3% (n = 7) in Asia, 8.3% (n = 7) in the Middle East, 3.6% (n = 3) in Europe, and 2.4% (n = 2) in South America. Of the 115 program directors, 94.8% were male, and only 5.2% were female. Program directors graduated medical school with a median year of 1998 (1966-2015). Eighty percent attended fellowship programs, and 19.1% held additional degrees (PhD, MS, MBA, MSc, etc.). The median number of publications was 79 (4-1963), with a median citation of 1607 (1-43,565). The median H-index was 23 (range: 1-110). Conclusion: Most program directors of Endourological Society-accredited fellowship programs are fellowship-trained and a notable number held a second degree. However, a pronounced gender disparity is observed, with limited female representation among program directors. This assessment contributes valuable insights into the urology and endourology mentorship, emphasizing the need for broader diversity and inclusivity in leadership roles.

The Clinical Anatomy Fellowship: Revolutionizing curricular experiences for faculty and students

Fellows completing the Clinical Anatomy Fellowship at Kansas City University assist Anatomy faculty in the Gross Anatomy laboratory, complete robust research projects, and support other departments. The program's positive impact on participants has been reported; however, the impact on individuals interfacing with Fellows has not been investigated. A follow-up, survey-based (Likert scale, multiple-choice, open-ended) study was conducted to evaluate faculty, staff, and student perceptions of the program. Ninety-five percent of surveyed faculty and staff (n = 22) perceived the Fellows as beneficial to students, faculty, and the university (p < 0.05) by acting as role models (95%) and mentors (90%), contributing to educational processes (90%), and reducing faculty work burden (81%) (p < 0.05). Student responses (n = 95) were also positive: 97% perceived interactions with Fellows as beneficial (p < 0.05). A passion for Anatomy (mean, 4.6; p < 0.05) and the opportunity to increase competitiveness for residency (mean, 4.5; p < 0.05) were the most important factors driving interest in the Fellowship (Cronbach's alpha, 0.766). In contrast, diverting a year from the school's curriculum (mean, 4.4; p < 0.05) and delaying clinical experiences (mean, 4.3; p < 0.05) were the most important deterrents (Cronbach's alpha, 0.505). Additionally, the financial investment required by the program is lower than that associated with hiring full-time faculty. Analysis comparing employment of Fellows versus associate-level faculty identified annual net savings of $370,000. Not only does the Fellowship augment faculty and student experiences at the university, but it also allows for substantial cost savings. Collectively, these data are evidence for other health professional institutions to consider adopting a similar program.

European fellowship training opportunities for hepato-pancreato-biliary surgery: an international survey of fellows and program directors

BACKGROUND

There are no established training pathways for hepato-pancreato-biliary (HPB) surgery in Europe. This study aims to overview the current status of fellowship training from both fellows' and institutions' perspectives.

METHODS

A web-based snapshot survey was distributed to all members of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) to reach for former fellows and program directors of European HPB surgery fellowships held between 2013 and 2023.

RESULTS

A total of 37 fellows and 13 program directors replied describing 32 different programs in 13 European countries. The median (range) age at fellowship start was 34 (30-45 years). Fellowship duration was most commonly one (36 %) or two (40 %) years. Fellowships were funded in 70 % and fellows were required to learn a new language in 27 %. Most fellows performed between none and 10 pancreatic (68 %), major (67 %) and minor (60 %) liver resections as 1st surgeon, while the number of operations performed as 1st assistant were more heterogeneous. Program directors estimated a higher number of operations performed by fellows as first surgeons. The percentage of procedures performed minimally invasively did not exceed 10 %.

CONCLUSION

There is substantial heterogeneity between HPB fellowship programs in Europe. A wider standardization of clinical curriculum, including minimally invasive surgery, is desirable.

Growing Novice Nurses to Perianesthesia Care: Formation of a Post-Anesthesia Care Unit (PACU) Fellowship

PURPOSE

To provide a proof of concept of a structured, replicable perianesthesia fellowship program for nurses with less than 2 years of experience and new graduate nurses.

DESIGN

An immersive learning experience was implemented as a pilot quality improvement project using the Plan-Do-Study-Act method.

METHODS

This 24-week fellowship program used blended learning approaches and the Tiered Skill Acquisition Model (TSAM) to develop foundational Post Anesthesia Care Unit (PACU) skills. Nurse Fellows (4) acquired knowledge in stages, with each week in the program reinforcing and building upon the prior week's learnings. Settings included an initial 10 weeks in the ambulatory PACU, then the acute care PACU (weeks 11-20), and the final 4 weeks were spent in the primary unit where the Fellow would transition into a PACU Staff RN. Through each phase, the Professional Practice Department's Clinical Mentor Nurse promoted preceptor development, facilitated learning experiences and provided bimonthly evaluations of the Nurse Fellow's progress via our institution's clinical rounding tool. We used the Nursing Anxiety and Self-Confidence Associated with Clinical Decision Making (NASC-CDM) scale to assess novice nurses' anxiety and self-confidence associated with making clinical decisions at designated intervals.

FINDINGS

All Nurse Fellows completed the program and remained in PACU positions 2 years post-fellowship. They reported discomfort and increased stress transitioning to different PACUs; however, they later indicated reduced anxiety and greater confidence in clinical decision-making, as noted in subsequent evaluations of the NASC-CDM scale.

CONCLUSIONS

Perianesthesia fellowship programs incorporating blended learning, skill reinforcement, and formal mentoring on a primary PACU unit build confidence and competence in the novice nurse, making this once-excluded population of nurses a viable option for recruitment directly into the PACU environment.

Getting the Most Out of Your Medical Education Survey: 11 Tips From the Association of Pediatric Program Directors Research and Scholarship Learning Community

OBJECTIVE

Surveys in medical education are commonplace. However, survey studies often lack scientific rigor. Well-designed surveys can ensure improved response rates and higher likelihood of dissemination. The purpose of this paper is to provide guidance for investigators planning to survey pediatric residency leaders METHODS: We examined the Association of Pediatric Program Directors Research and Scholarship Learning Community (APPD-RSLC) submissions, acceptances, and outcomes between 2015 and 2020. Additionally, we performed a literature review of survey design methods with the help of a research librarian. We established a list of tips and settled on the 11 included here by group discussion and consensus.

CONCLUSION

These 11 tips provide specific recommendations for successful design of medical education surveys distributed by the APPD based on experience from current and former leaders of the RSLC and literature review in survey design and implementation.

Pediatric Residency Graduates' Characteristics, Career Choice, and Satisfaction by Race and Ethnicity, 2011-2022

OBJECTIVE

Learning more about resident characteristics, career choices, job search experiences, and satisfaction for different racial and ethnic backgrounds can inform needs and approaches to diversifying the physician workforce.

METHODS

We analyzed survey data collected from national random samples of pediatric residents graduating from 2011 to 2022. We used chi-square linear association to examine trends in reported race and ethnicity and multivariable logistic regression to estimate associations of race and ethnicity with graduates' characteristics including debt, career choice, job search experience, and satisfaction with specialty choice and report predicted percentage values (PV).

RESULTS

Adjusted response rate was 53.7% (6392/11,900); 59.7% of respondents identified as white, 20.6% Asian, 10.5% Hispanic/Latino/Spanish, 5.6% Black/African American, and 3.6% Other. These percentages were unchanged across years. Black graduates were more likely than white graduates to identify as female (PV = 81.7 [95% CI = 77.7-85.8] and 73.4 [95% CI = 72.0-74.9], P < .00) and report educational debt >$200,000 (PV = 63.1 [95% CI = 57.2-68.9] and 51.2 [95% CI = 49.3-53.0], P < .00). Black and Hispanic graduates were least likely to be entering subspecialty fellowships. Black, Asian, and Other graduates were more likely than white residents to report job search difficulty. Among residents starting full-time general pediatrics positions, half or more of all race and ethnicity groups reported starting salaries of >$175,000 without significant differences. Nearly all would choose pediatrics again.

CONCLUSIONS

Few strides have been made over the past decade in diversifying pediatrics. Trainees from minoritized racial and ethnic backgrounds may require support via educational debt relief, mentoring, and social support to overcome barriers and ensure their success.

Practical Guide to Qualitative Research in Surgical Education

This Guide to Statistics and Methods provides an overview of the selection and application of qualitative research in surgical education.

Defining Practice Readiness in Pediatric Surgery Fellowship: A Qualitative Analysis

INTRODUCTION

While competency-based training is at the forefront of educational innovation in General Surgery, Pediatric Surgery training programs should not wait for downstream changes. There is currently no consensus on what it means for a pediatric surgery fellow to be "practice-ready". In this study, we aimed to provide a framework for better defining competency and practice readiness in a way that can support the Milestones system and allow for improved assessment of pediatric surgery fellows.

METHODS

For this exploratory qualitative study, we developed an interview guide with nine questions focused on how faculty recognize competency and advance autonomy among pediatric surgery fellows. Demographic information was collected using an anonymous online survey platform. We iteratively reviewed data from each interview to ensure adequate information power was achieved to answer the research question. We used inductive reasoning and thematic analysis to determine appropriate codes. Additionally, the Dreyfus model was used as a framework to guide interpretation and contextualize the responses. Through this method, we generated common themes.

RESULTS

A total of 19 pediatric surgeons were interviewed. We identified four major themes from 127 codes that practicing pediatric surgeons associate with practice-readiness of a fellow: skill-based competency, the recognition and benefits of struggle, developing expertise and facilitating autonomy, and difficulties in variability of evaluation. While variability in evaluation is not typically included in the concept of practice readiness, assessment and evaluation were described by study participants as essential aspects of how practicing pediatric surgeons perceive practice readiness and competency in pediatric surgery fellows. Competency was further divided into interpersonal versus technical skills. Sub-themes within struggle included personal and professional struggle, benefits of struggle and how to identify and assist those who are struggling. Autonomy was commonly stated as variable based on the attending.

CONCLUSION

Our analysis yielded several themes associated with practice readiness of pediatric surgery fellows. We aim to further refine our list of themes using the Dreyfus Model as our interpretive framework and establish consensus amongst the community of pediatric surgeons in order to define competency and key elements that make a fellow practice-ready. Further work will then focus on establishing assessment metrics and educational interventions directed at achieving such key elements.

Five Years of the Musculoskeletal Radiology Fellowship Match: Trends and Perspectives

RATIONALE AND OBJECTIVES

The 2023 Match marks 5 years since the Musculoskeletal (MSK) Radiology Fellowship Match first took place in June 2019. The objective of this study is to analyze trends in the MSK Match over its 5-year course.

MATERIALS AND METHODS

Data from the National Resident Matching Program were evaluated for the number of applicants, medical school type of matched applicants, number of programs, and number of positions. Programs were grouped according to geographic region, program size, and ACGME accreditation status. These data were plotted to look for trends over time and by program characteristics.

RESULTS

There has been little variation in the number of eligible programs registering for the Match (range 80-83). The number of available positions has had a wider variation (range 204-218), and the number of applicants preferring MSK has varied from 156 to 178. The gap between positions and applicants has resulted in a percentage of positions filled that has ranged from 70.9% to 82.4%. Program size is positively correlated with Match rates, with 100% of programs with five or more positions filling ≥ 50% in 4 out of 5 years.

CONCLUSION

The variable numbers of fellowship positions and applicants have resulted in variable success of the Match by all metrics. Maintaining or increasing the number of applicants is the most critical factor for ongoing Match success.

Fellowship-trained physicians who let their geriatric medicine certification lapse: A national survey

BACKGROUND

Only 62.6% of fellowship-trained and American Board of Internal Medicine (ABIM)-certified geriatricians maintain their specialty certification in geriatric medicine, the lowest rate among all internal medicine subspecialties and the only subspecialty in which physicians maintain their internal medicine certification at higher rates than their specialty certification. This study aims to better understand underlying issues related to the low rate of maintaining geriatric medicine certification in order to inform geriatric workforce development strategies.

METHODS

Eighteen-item online survey of internists who completed a geriatric medicine fellowship, earned initial ABIM certification in geriatric medicine between 1999 and 2009, and maintained certification in internal medicine (and/or another specialty but not geriatric medicine). Survey domains: demographics, issues related to maintaining geriatric medicine certification, professional identity, and current professional duties.

RESULTS

153/723 eligible completed surveys (21.5% response). Top reasons for not maintaining geriatric medicine certification were time (56%), cost of maintenance of certification (MOC) (45%), low Medicare reimbursement for geriatricians' work (32%), and no employer requirement to maintain geriatric medicine certification (31%). Though not maintaining geriatric medicine certification, 68% reported engaging in professional activities related to geriatric medicine. Reflecting on career decisions, 56% would again complete geriatric medicine fellowship, 21% would not, and 23% were unsure. 54% considered recertifying in geriatric medicine. 49% reported flexible MOC assessment options would increase likelihood of maintaining certification.

CONCLUSIONS

The value proposition of geriatric medicine certification needs strengthening. Geriatric medicine leaders must develop strategies and tactics to reduce attrition of geriatricians by enhancing the value of geriatric medicine expertise to key stakeholders.

Voices of Silence: Experiences in Disseminating Scholarship as a Global South Researcher

Issue: There is an unspoken requirement that medical education researchers living in the Global South must disseminate their work using dominant frames constructed by individuals living in the Global North. As such, the published literature in our field is dominated by researchers whose work primarily benefits the Western world, casting the rest of what is published as localized and unhelpful knowledge. In this article, we use Audre Lorde's conception of the Master's house as a metaphor to narrate the experiences of two South African medical education researchers trying to disseminate their work into North American venues. In addition to narrating these stories, we describe the personal and professional consequences they experienced as a result of their efforts. Evidence: For researchers working outside of the Global North, entering the Master's formidable house is daunting, and there is no clear pathway in. These narratives illustrate how reviewers and editorial staff act as gatekeepers, continuously shaping ideas about what it means to do acceptable research, and who is allowed to disseminate it within the field. These narratives also show that those who have been rejected by these gatekeepers are often conflicted about their position within the larger field of medical education. Implications: To begin to address this issue, we have made several suggestions for the research community to consider. First, medical education research journals need to create spaces for researchers publishing from the Global South. One suggestion is for journals to create a submission type that is dedicated to researchers working outside of North America. Second, journals should also include more Global South editors and reviewers to help with knowledge translation when articles are submitted from outside North America. If our collective goal is to improve the training of physicians and the health outcomes of humanity, then we need to renovate the Master's house and begin to break down the barriers that separate us from truly building together.

Family Planning Experiences and Challenges of Mohs Fellowship Trainees

BACKGROUND

There is a paucity of literature describing family planning challenges faced by Mohs fellows.

OBJECTIVE

To characterize perceptions about and experiences with family planning, fertility, lactation, and parental leave and identify ways to support parental health and family planning for Mohs fellows.

MATERIALS AND METHODS

A voluntary, anonymous survey was distributed to Mohs surgeons who recently completed fellowship.

RESULTS

In total, 116 Mohs surgeons completed the survey. Their mean age was 34.5 years old, and more were female ( n = 81, 69.8%) than male ( n = 35, 30.2%). Most had children before completion of their Mohs training ( n = 73, 62.9%). The most significant barrier to having children during fellowship was "loss of education or training time." Over 20% ( n = 23) of respondents or their partner had experienced infertility. Half of the 20 respondents ( n = 10) who breastfed or pumped did not have a convenient place to do so.

CONCLUSION

This study elucidates trainee perceptions and gaps in parental support for Mohs fellowship trainees. In addition, barriers to implementing a universal family planning policy in Mohs surgery are discussed.

Lack of standardization and faculty development in pediatric colonoscopy: A qualitative study

A standard curriculum for pediatric colonoscopy training has neither been required nor universally implemented in North American fellowship programs. This qualitative study assessed the needs of colonoscopy training in pediatric gastroenterology to determine the standardized components of procedural teaching. Focus groups with pediatric gastroenterology attendings, fellows, procedural nurses, and interviews with advanced endoscopists, all practicing at a single institution, were conducted between March and June 2018. Data were analyzed using thematic analysis principles. Four themes emerged: (1) lack of standardization of colonoscopy performance, (2) lack of professional development of procedure teaching skills, (3) need for teaching behaviors that promote learner's performance, and (4) barriers to effective teaching and learning. A conceptual framework was created for developing a standardized "train-the-trainer" curriculum. Our needs assessment supports expansion of efforts to make this comprehensive training available to all pediatric gastroenterologists involved in procedure teaching.

Practical Guide to Machine Learning and Artificial Intelligence in Surgical Education Research

This Guide to Statistics and Methods gives an overview of artificial intelligence techniques and tools in surgical education research.