Diversity Differences Among Cardiovascular Fellowships Across Five Geographic Regions in the United States

Introduction Diversity and inclusion in cardiovascular fellowships are necessary for addressing the healthcare needs of diverse patient populations. However, regional disparities in the diversity of these programs persist, diminishing efforts to create a representative workforce. We observe the regional differences in the diversity of cardiovascular fellowship programs, focusing on gender, doctorate designation, and graduation within the United States (US) or other. We hypothesized that males, medical doctors (MD), and US graduates would be in majority across all regions. Methods Data for cardiovascular fellowships from the Fellowship and Residency Electronic Database Access (FREIDA) system for the matriculation year 2022-2023 was obtained to assess the representation of male vs female gender, MD vs osteopathic doctor (DO) designation, and US vs non-US graduate. We then compared these backgrounds to five defined regions (Midwest, Northeast, Southeast, Southwest, and West) in the United States to define representation for backgrounds across geographic areas. Statistical significance was determined by p<0.05 with the use of SAS Studio 3.8, version 9.4 (Cary, NC: SAS Institute, Inc.), and Wilson score for confidence intervals. Results We found significant disparities across all background factors for all regions. This includes that females, DOs, and non-US graduates were underrepresented among Midwest, Northeast, Southeast, Southwest, and West regions, and the p-value was <0.001 for all variations. Specifically for Midwest, the female frequency was 155 (23.81%; CI: 21, 27; p<0.001), DO frequency was 101 (15.51%; CI: 13, 19; p<0.001), and non-US graduate frequency was 206 (31.84%; CI: 28, 36; p<0.001). For Northeast, the female frequency was 231 (29.62; CI: 27, 33; p<0.001), DO frequency was 72 (9.22; CI: 7, 11; p<0.001), and non-US graduate frequency was 239 (30.68; CI 28, 34; p<0.001). For Southeast, the female frequency was 178 (25.99; CI: 23, 29; p<0.001), DO frequency was 67 (9.78; CI: 8, 12; p<0.001), and non-US graduate frequency 279 (41.46; CI: 38, 45; p<0.001). For Southwest, the female frequency was 74 (26.71; CI: 22, 32; p<0.001), DO frequency was 21 (7.58; CI 5, 11; p<0.001), and non-US graduate frequency was 110 (39.71; CI: 34,46; p<0.001). For West, the female frequency was 107 (31.75; CI 27, 37; p<0.001), DO frequency was 15 (4.45; CI: 3, 7; p<0.001), and non-US graduate frequency was 54 (16.07; CI: 13, 20; p<0.001). Conclusion We emphasize the regional disparities for females, DOs, and non-US graduates within cardiovascular fellowships in the past matriculation year. Understanding that we have not reached diversity goals allows for further reflection and implementation of targeted interventions and initiatives aimed at promoting equal opportunities for applicants. This is true for all regions of the United States. By addressing these disparities, fellowship programs can more effectively mirror the diverse patient populations they serve and foster a healthcare environment that is inclusive and accommodating. This, in turn, contributes to the overall enhancement of healthcare outcomes.

The Road Not Yet Traveled: Distinction in Critical Care Cardiology through the Advanced Heart Failure and Transplant Cardiology Training Pathway

As the acuity, complexity, and illness severity of patients admitted to cardiac intensive care units have increased, the need to recognize critical care cardiology (CCC) as a dedicated subspecialty in cardiovascular disease has received increasing support. Differing viewpoints exist regarding the optimal pathway for CCC training. Currently, all proposed CCC training pathways involve permutations of individual training years culminating in subspecialty certification across multiple disciplines; however, there are significant disadvantages to these training paradigms. We propose an innovative, pragmatic approach to CCC training through tailored subspecialty training in advanced heart failure and transplant cardiology (AHFTC), using elective time to enrich AHFTC training with skills and experiences necessary to become a highly skilled critical care cardiologist. The completion of this pathway would lead to completion of AHFTC training with a novel designation: distinction in critical care cardiology.

Burnout and Well-Being Among Cardiology Fellowship Program Directors

OBJECTIVES

The third annual Cardiovascular Diseases (CV) Fellowship Program Directors (PDs) Survey sought to understand burnout and well-being among CV fellowship PDs.

BACKGROUND

Physician burnout is a common phenomenon. Data on burnout among cardiologists, specifically CV PDs, remain limited.

METHODS

The survey contained 8 questions examining satisfaction, stress, and burnout among CV fellowship PDs. Burnout was defined based on the self-reported presence of ≥1 symptom of burnout, constant feelings of burnout, or complete burnout.

RESULTS

Survey response rate was 57%. Most respondents were men (78%) and 54% represented university-based programs. Eighty percent reported satisfaction with their current job as PD, and 96% identified interactions with fellows as a driver of their satisfaction. Forty-five percent reported feeling a great deal of stress from their job. Stress was higher among women PDs, early-career PDs, and PDs of larger and university-based programs. Twenty-one percent reported some symptoms of burnout, and only 36% reported enjoyment without stress or burnout. Rates of enjoyment without stress or burnout were higher among men and late-career PDs, PDs of smaller programs, and PDs of community-based programs. Seventeen percent of PDs reported a high likelihood of resigning in the next year, of which the most common reason was the tasks of PDs were becoming overwhelming.

CONCLUSIONS

Most CV fellowship PDs are satisfied with their position, but stress and burnout remain common. Women PDs, early-career PDs, and PDs of larger, university-based programs demonstrate more adverse markers of well-being. Opportunities exist to support CV fellowship PDs in their critical role.

Improving Practice Guideline Adherence Through Peer Feedback: Impact of an Ambulatory Cardiology Curriculum

PROBLEM

Graduate medical trainees must be prepared to practice in a quality-driven system that values adherence to and documentation of evidence-based care. Few validated approaches exist to teach these skills. Our objective was to develop, implement, and evaluate an ambulatory practice improvement curriculum capitalizing on peer feedback aimed at improving cardiology fellow guideline knowledge, adherence, and chart documentation.

INTERVENTION

Four outpatient topics were reviewed in dedicated 1-hour sessions: stable ischemic heart disease, heart failure, atrial fibrillation, and aortic valvular disease. Each session began with peer review, critique, and guideline adherence discussion of deidentified outpatient fellow clinic charts, followed by discussion of clinical guidelines. The open discussion of real clinic notes provided a forum for peer feedback exchange. Before each session and after the final session, participants completed a multiple-choice knowledge assessment and self-assessment of comfort with the guidelines. To evaluate the potential effect on patient care, random clinic chart audits were conducted before and after the curriculum using a chart scoring system.

CONTEXT

Although the format is broadly applicable, the specific curriculum content was designed for a cardiology fellowship cohort in a large academic medical center. It was organized and implemented by 2 cardiology fellows under the direction and supervision of program directors. The curriculum was implemented during prescheduled noon conference hours. The intention was to carry forward this ambulatory curriculum in subsequent years and to use the first 4 sessions to study its potential successes and opportunities for improvement.

OUTCOME

All 22 general cardiology fellows attended at least two sessions (M = 3.1). Knowledge test scores rose from 52.6% to 73.0% (20.4% increase, p < .001), 95% confidence interval (CI) [13.6%, 27.2%]. Self-reported guidelines knowledge improved by 15.1% (p = .002), 95% CI [6.2%, 24.0%], and self-reported documentation improved by 12.5% (p = .008), 95% CI [3.8%, 21.7%]. Chart audit scores improved by 17.8% (p < .001), 95% CI [10.6%, 25.0%], driven in part by 16.4% improvement in adherence to Class I therapies (p = .001).

LESSONS LEARNED

A targeted curriculum combining peer chart review, feedback, and guideline discussion was associated with significant improvement in fellows' knowledge and adherence to evidence-based therapies. Peer assessment and group-based education and feedback can be leveraged to improve trainee education and impact patient care.