Burnout in Urological Education: An In-Depth Study of Residents and Fellows in the 2021 AUA Census.

PURPOSE: Our goal was to explore the current trends in burnout, career choice regret, and well-being needs among urology residents and fellows, with specific emphasis on identifying key factors associated with burnout. MATERIALS AND METHODS: The AUA Workforce Workgroup collaborated with the AUA Data Team to analyze data from the 2021 AUA Census, comprising a total of 243 residents and fellows. Key demographics, benefits and resources, career choice and debt, and burnout levels were analyzed, focusing on variables like gender, PGY (postgraduate year) level, debt burden, and personal health appointments. RESULTS: Overall, 48% of residents and 33% of fellows met criteria for professional burnout, with a higher incidence among PGY-2 residents (70%). Depersonalization was particularly notable, with 74% of residents reporting medium to high levels. Burnout was significantly associated with difficulty attending personal health appointments (52% vs 34%) and lack of access to on-call rooms (54% vs 36%). In contrast, having children during residency was associated with lower burnout levels (30.8% vs 49.1%). Meal plans were ranked as the most desired benefit (32%), followed by ability to attend health appointments during work hours (17%) and paid family leave (16%). Educational debt over $150,000 was carried by 53% of residents and 48% of fellows. Interestingly, burnout rates showed no statistically significant difference in response rates across genders, relationship status, amount of educational debt, presence of paid maternity or paternity leave, and type of childcare arrangements. CONCLUSIONS: Burnout remains a significant issue among urology trainees, with a complex interplay of factors like lack of personal time and provision of call rooms. The alarming rates of depersonalization and exhaustion highlight the urgency of implementing targeted interventions. Enhanced support systems, improved access to health care appointments, provision of call rooms, and debt management programs are recommended to alleviate the growing problem of professional burnout in the field of urology.

Trainee Involvement and ERCP Complications: A Systematic Review and Meta-Analysis.

BACKGROUND: Therapeutic endoscopy and gastroenterology fellows often participate in endoscopic retrograde cholangiopancreatography (ERCP) during their training period. However, it is generally feared that trainee involvement may increase ERCP-related complications, mainly because of the side-viewing nature of the endoscope and the higher risk of pancreatic duct cannulation. There is no concrete evidence to support this notion. This systematic review and meta-analysis aims to investigate the resultsof trainee participation on adverse events related to ERCP. METHODS: PubMed, EMBASE, Google Scholar, SCOPUS, and Web of Science databases were searched from inception to 31 May 2023 for studies evaluating the ERCP outcomes defined as success rates, procedure time, failed attempts, and adverse events with and without trainee participation. A random effect model was used to perform the meta-analysis, and heterogeneity was assessed using the I2 statistics. RESULTS: Seven studies were included in the final analysis, including 17,088 ERCPs. The pooled odds ratio (pOR) of success rate, incomplete/failed attempts in the trainee and no trainee groups were 0.466 (95% CI 0.13 to 1.66, I2 = 97.8%, p = 0.239) and 3.2 (95% CI 0.70 to 14.55), I2 = 98.5%, p = 0.134), respectively. The pOR of post-ERCP pancreatitis and bleeding in the trainee vs. no trainee groups was 0.97 (95% CI 0.76 to 1.23, I2 = 0%, p = 0.78) and 1.3 (95% CI 0.59 to 2.83, I2 = 49%, p = 0.54). The pOR of all adverse events in both groups was 1.028 (95% CI 0.917 to 1.152, I2 = 0%, p = 0.636). Surprisingly, the pooled std mean difference for the procedure time was 0.217 (95% - 0.093 to 0.05, I2 = 98.5%, p = 0.17). CONCLUSION: This meta-analysis comprising of 17,088 ERCPs in seven studies demonstrated comparable ERCP outcomes related to trainee participation regarding success rates, procedure time, and adverse events. Trainees' involvement in ERCP within a proper teaching setting appears safe and does not compromise the overall procedure's success.

The Clinical Teaching Fellow role: exploring expectations and experiences.

BACKGROUND: Many UK junior doctors are now taking a year out of the traditional training pathway, usually before specialty training, and some choose to work as a clinical teaching fellow (CTF). CTFs primarily have responsibility for delivering hospital-based teaching to undergraduate medical students. Only a very small amount of literature is available regarding CTF posts, none of which has explored why doctors choose to undertake the role and their expectations of the job. This study aimed to explore the expectations and experiences of CTFs employed at NHS hospital Trusts in the West Midlands. METHODS: CTFs working in Trusts in the West Midlands region registered as students on the Education for Healthcare Professionals Post Graduate Certificate course at the University of Birmingham in August 2019 took part in a survey and a focus group. RESULTS: Twenty-eight CTFs participated in the survey and ten participated in the focus group. In the survey, participants reported choosing a CTF role due to an interest in teaching, wanting time out of training, and being unsure of which specialty to choose. Expectations for the year in post were directly related to reasons for choosing the role with participants expecting to develop teaching skills, and have a break from usual clinical work and rotations. The focus group identified five main themes relating to experiences starting their job, time pressures and challenges faced in post, how CTF jobs differed between Trusts, and future career plans. Broadly, participants reported enjoying their year in a post at a mid-year point but identified particular challenges such as difficulties in starting the role and facing time pressures in their day-to-day work. CONCLUSION: This study has provided a valuable insight into the CTF role and why doctors choose a CTF post and some of the challenges experienced, adding to the sparse amount of literature. Understanding post holders' experiences may contribute to optimisation of the role. Those employing CTFs should consider ensuring a formal handover process is in place between outgoing and incoming CTFs, having a lead person at their Trust responsible for evaluating changes suggested by CTFs, and the balance of contractual duties and personal development time.

A structured curriculum supporting biomedical trainees' transition into independent academic positions and early career success.

The United States government makes a substantial investment in biomedical training programs each year. However, for most trainees, these opportunities do not translate into career progression in academic research pathways. Only about one-fifth of postdoctoral fellows eventually secure a tenure-track faculty position, and even among these candidates, attrition is high. Although a number of factors govern career choices and career longevity, the transition from trainee to faculty is a challenging process and requires knowledge and skills that are not necessarily developed during a traditional university experience. Many postdoctoral fellows receive adequate training in research skills and scientific communication, but new faculty report not being sufficiently prepared for the job search process and for starting their labs. To address this critical training gap, the ITERT core (Interdisciplinary Translational Education and Research Training) and the Office of Postdoctoral Fellows at the University of Texas MD Anderson Cancer Center implemented a structured course for both postdoctoral fellows and senior PhD students to provide formalized training for successfully navigating academic positions in biomedical research. Here we report on the pilot Navigating Academic Careers course conducted in 2021-2022 for 30 PhD students and postdocs. The nine-module course was conducted over 13 weeks in 25.5 h instructional sessions. The key educational objectives included 1) navigating the job application and the interview/negotiation process, 2) hiring, leading, and mentoring lab personnel and program support staff, 3) project administration and financial stewardship, 4) managing time and work-life balance and 5) developing collaborations, branding, personalized niche, and networking. Survey-based analysis at the time of the course was used to capture the participants' assessment of the course content, organization, and delivery, with a follow-up survey conducted approximately 2 years post-course (2024) to evaluate longer-term impacts of the training. Initial in-course assessment revealed that 89.9% of respondents found the scope and instructional content appropriate, and 91.1% found the course relevant and applicable to their career needs. Longer-term post-course evaluation indicated that 80% of respondents applied the learnings of the course, that 80% reported feeling more confident in navigating an academic job search, and that 66.6% continued to report agreement with the course preparing them for their current role/ongoing job search, with 46.7% already securing jobs in academic research, including as independent faculty. The outcomes of this pilot course suggest that integrating this into the broader postdoctoral training curriculum can enhance both the transition and early-career success of talented scientists-in-training into working professionals in biomedical careers, as faculty and science-trained staff.

Preparing Hematology/Oncology Fellows for Success: Implementing an Annual Career Development and Research Retreat.

Multiple factors, including job satisfaction, personality traits, and training experiences, influence the career trajectory of hematology/oncology fellows. In an effort to expose hematology/oncology fellows to (1) the various careers in oncology, (2) a diverse group of speakers for future mentorship, and (3) research opportunities, and grant writing experience, we established an annual career development and research retreat. During the retreat, we engaged speakers who covered a range of career trajectories, including academic, private practice, industry, government, and administrative paths. We introduced clinicians and researchers with a track record of providing top-notch mentorship to fellows with aligning interests and detailed research opportunities and grant writing. The sessions were led by senior fellows, and we adopted an in-person and virtual hybrid model to allow speakers from various institutions to participate. Feedback from participants, as gathered through surveys, indicated positive responses: all respondents reported that this retreat was "extremely" or "very helpful," and a majority expressed their intent to pursue academic careers. The curriculum and structure of this retreat may help to inform the development of fellowship career development and research retreats at other institutions.

Skills, Not Just Knowledge: Infectious Diseases Fellows' Recommendations Regarding Antimicrobial Stewardship Training.

BACKGROUND: Antimicrobial stewardship (AS) is an important topic in infectious diseases (ID) training, yet many ID fellowships lack formal training, and little is known about fellows' learning preferences. METHODS: We conducted 24 in-depth interviews with ID fellows across the United States during 2018 and 2019 to explore their experiences with and preferences for AS education during fellowship. Interviews were transcribed, deidentified, and analyzed to identify themes. RESULTS: Fellows had variable exposure to AS before and during fellowship, which impacted their knowledge about and attitude toward stewardship as a career; however, all fellows expressed the importance of learning general stewardship principles during fellowship. Some fellows' training included mandatory stewardship lectures and/or rotations, but most fellows felt their primary stewardship learning occurred through informal experiences in the clinical setting, such as holding the antimicrobial approval pager. Fellows expressed a preference for a standardized, structured curriculum that included in-person practical, interactive discussions with multidisciplinary faculty along with the opportunity to practice and apply their skills; however, they emphasized that time needed to be set aside for those educational activities. Although they wanted to learn the evidence and rationale for stewardship recommendations, they especially wanted training in and feedback on how to communicate stewardship recommendations to other health professionals, particularly in the setting of conflict. CONCLUSIONS: ID fellows believe that standardized AS curricula should be included in their fellowship training, and they prefer structured, practical, and interactive learning experiences.

v-SYMPHONY career development series: A collaboration to enhance professional awareness for pediatric hematology oncology trainees.

BACKGROUND: A recent survey of pediatric hematology oncology (PHO) physicians identified that a majority believe fellows are struggling to find jobs that align with their goals. Career development for trainees has historically been home institution-specific, limiting fellows' exposures to career path possibilities. The "virtual-Symposium of Pediatric Hematology/Oncology of New York (v-SYMPHONY)" instituted a tristate Career Development Series for PHO trainees to better address their needs and increase awareness of the variety of PHO career opportunities. PROCEDURE: The v-SYMPHONY Career Development Series incorporated three sessions: (a) institutional perspective, (b) individual perspectives, and (c) nuts and bolts of job search. Pre- and post-series surveys were administered to participants to measure impact. RESULTS: Forty-one fellows registered for the series and completed a pre-survey. Over half (54%) were in their third or later year of fellowship. Careers with a clinical focus were the most commonly desired career path (59%). Most had received career development advice only from faculty within their institutions (90%). Post-surveys were completed by 11 PHO fellows. Overall, 100% of respondents reported benefiting from the career sessions and recommended the series should be repeated annually. Over 90% learned new information to prepare for the job search. CONCLUSIONS: The v-SYMPHONY Career Development Series for PHO fellows across multiple institutions was established and was extremely well received by its participants. PHO fellows agreed that these sessions were beneficial in helping prepare them for the job search process. An annual regional Career Development Series is feasible and is strongly suggested to support PHO fellows.

Lessons learned from regional training of paediatric nephrology fellows in Africa.

BACKGROUND: Access to care for children with kidney disease is limited in less well-resourced regions of the world and paediatric nephrology (PN) workforce development with good practical skills is critical. METHODS: Retrospective review of a PN training program and trainee feedback from 1999 to 2021, based at Red Cross War Memorial Children's Hospital (RCWMCH), University of Cape Town. RESULTS: A regionally appropriate 1-2-year training program enrolled 38 fellows with an initial 100% return rate to their country of origin. Program funding included fellowships from the International Pediatric Nephrology Association (IPNA), International Society of Nephrology (ISN), International Society of Peritoneal Dialysis (ISPD), and the African Paediatric Fellowship Program (APFP). Fellows were trained on both in- and out-patient management of infants and children with kidney disorders. "Hands-on skills" training included examination, diagnosis and management skills, practical insertion of peritoneal dialysis catheters for management of acute kidney injury and kidney biopsies. Of 16 trainees who completed > 1 year of training, 14 (88%) successfully completed subspecialty exams and 9 (56%) completed a master's degree with a research component. PN fellows reported that their training was appropriate and enabled them to make a difference in their respective communities. CONCLUSIONS: This training program has successfully equipped African physicians with the requisite knowledge and skills to provide PN services in resource-constrained areas for children with kidney disease. The provision of funding from multiple organizations committed to paediatric kidney disease has contributed to the success of the program, along with the fellows' commitment to build PN healthcare capacity in Africa. A higher resolution version of the Graphical abstract is available as Supplementary information.

Learning Clinical Reasoning: The Experience of Postgraduate Psychiatry Trainee Doctors in Qatar.

Phenomenon: As a core competency in medical education, clinical reasoning is a pillar for reducing medical errors and promoting patient safety. Clinical reasoning is a complex phenomenon studied through the lens of multiple theories. Although cognitive psychology theories transformed our understanding of clinical reasoning, the theories fell short of explaining the variations in clinical reasoning influenced by contextual factors. Social cognitive theories propose a dynamic relationship between learners' cognitive process and their social and physical environments. This dynamic relationship highlights the essential role of formal and informal learning environments for learning clinical reasoning. Approach: My research aimed to explore the personal experience of learning clinical reasoning in a sample of postgraduate psychiatry trainee doctors using cognitive psychology and social cognitive theories. A stratified convenience sample of seven psychiatry trainee doctors working in the Mental Health Services in Qatar completed semi-structured interviews in 2020. I analyzed the data manually using theoretical thematic analysis. Findings: I identified three overarching themes with multiple subthemes. The first theme was the hierarchical cultural impact on perceived learning opportunities and learning behavior. The first theme had two subthemes that explored the relationship with team members and the expected hierarchy roles. The second theme was the impact of emotions on the learning and execution of clinical reasoning.The second theme had three subthemes that explored the personal approach to managing emotions related to perceived self-efficacy and professional image. The third theme was characteristics of learning environments and their role in learning clinical reasoning. The last theme included three subthemes that explored stressful, autonomous, and interactive environments. Insights: The results accentuate the complexity of clinical reasoning. Trainees' experience of learning clinical reasoning was influenced by factors not controlled for in the curricula. These factors constitute a hidden curriculum with a significant influence on learning. Our local postgraduate training programmes will benefit from addressing the points raised in this study for effective and culturally sensitive clinical reasoning learning.

The Clinical Teaching Fellow role: views of the Heads of Academy in the West Midlands.

BACKGROUND: Increasingly junior doctors are taking a year out of the traditional training pathway, and some opt to spend a year in a clinical teaching fellow (CTF) post. The CTF post mainly involves delivering hospital-based teaching to undergraduate medical students. In NHS hospital Trusts in the West Midlands, Heads of Academy (HoAs) have oversight of medical education at each Trust and therefore have responsibility for employing and directing the work of CTFs. Currently, only limited literature exists about the CTF role and exploring this from the point of view of different stakeholders in medical education is important in terms of contributing towards development of the role. This study aimed to explore the views of HoAs in the West Midlands region regarding CTFs employed at their Trusts. METHODS: All HoAs at the NHS Trust/teaching hospitals associated with the University of Birmingham were invited to take part in an in-depth interview about CTFs at their Trusts. Interviews were held via Zoom recorded using Zoom's recording functionality. Interview transcripts were then coded and analysed using thematic analysis. RESULTS: Seven out of 11 HoAs participated in an interview. Seven themes were identified: CTF duties/Job role, Relationship with students, Benefits of having CTFs, Challenges associated with CTFs, Popularity of the role, What Trust offers CTFs, and Future of the role. Primarily it was felt that having CTFs at their Trust was beneficial in terms of the amount of teaching they provide for medical students. The HoAs were keen to ensure the CTF posts were of maximum benefit to both the post holders and to the Trusts where they were based. The CTF role is one that they felt would continue and develop in the future. CONCLUSION: This study has provided the first insight into the CTF role from the point of view of senior doctors with responsibility for delivery of undergraduate medical education. The consistency and reliability of teaching provided by the CTFs was identified as a key benefit of the role. Future work exploring the role from the point of view of post holders themselves would be beneficial to contribute to development of the role.

Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice.

BACKGROUND: The purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency. METHODS: Anesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016-2017, 2017-2018, and 2018-2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology. RESULTS: A total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes - workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists' value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles. CONCLUSIONS: Anesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.

Evaluation of the Infectious Diseases Society of America's Core Antimicrobial Stewardship Curriculum for Infectious Diseases Fellows.

BACKGROUND: Antimicrobial stewardship (AS) programs are required by Centers for Medicare and Medicaid Services and should ideally have infectious diseases (ID) physician involvement; however, only 50% of ID fellowship programs have formal AS curricula. The Infectious Diseases Society of America (IDSA) formed a workgroup to develop a core AS curriculum for ID fellows. Here we study its impact. METHODS: ID program directors and fellows in 56 fellowship programs were surveyed regarding the content and effectiveness of their AS training before and after implementation of the IDSA curriculum. Fellows' knowledge was assessed using multiple-choice questions. Fellows completing their first year of fellowship were surveyed before curriculum implementation ("pre-curriculum") and compared to first-year fellows who complete the curriculum the following year ("post-curriculum"). RESULTS: Forty-nine (88%) program directors and 105 (67%) fellows completed the pre-curriculum surveys; 35 (64%) program directors and 79 (50%) fellows completed the post-curriculum surveys. Prior to IDSA curriculum implementation, only 51% of programs had a "formal" curriculum. After implementation, satisfaction with AS training increased among program directors (16% to 68%) and fellows (51% to 68%). Fellows' confidence increased in 7/10 AS content areas. Knowledge scores improved from a mean of 4.6 to 5.1 correct answers of 9 questions (P = .028). The major hurdle to curriculum implementation was time, both for formal teaching and for e-learning. CONCLUSIONS: Effective AS training is a critical component of ID fellowship training. The IDSA Core AS Curriculum can enhance AS training, increase fellow confidence, and improve overall satisfaction of fellows and program directors.

Adherence to international guidelines for the management of Helicobacter pylori infection among gastroenterologists and gastroenterology fellows in Italy: A Survey of the Italian Federation of Digestive Diseases - FISMAD.

BACKGROUND: Information on the management of Helicobacter (H.) pylori infection by gastroenterologists and gastroenterology fellows are scarce. We aimed to assess practice of gastroenterologists and gastroenterology fellows and their adherence to guidelines for diagnosis and treatment of H. pylori infection in Italy. MATERIALS AND METHODS: All gastroenterologists and gastroenterology fellows attending the National Congress of Digestive Diseases - FISMAD were invited to fill-in an on-line questionnaire. The questionnaire included questions on the diagnosis and treatment of H. pylori infection. RESULTS: A total of 279 gastroenterologists and 61 gastroenterology fellows participated to the study. The 13 C-urea breath test was the most preferred method among gastroenterologists and fellows for the diagnosis of H. pylori infection (40.4% and 57.6%, respectively) and the confirmation of eradication (61.3% and 70%, respectively). Sequential therapy was the most preferred first-line treatment of H. pylori for both gastroenterologists and gastroenterology fellows (31.8% and 44%, respectively), followed by bismuth quadruple therapy (31% and 27.6%, respectively) and clarithromycin triple therapy (26.8% and 22.4%, respectively). Only 30% of gastroenterologists and 38.5% of fellows used the clarithromycin triple therapy for the recommended duration of 14 days. Bismuth quadruple therapy was the most preferred second-line therapy for both gastroenterologists and fellows. The majority of gastroenterologists and fellows would prefer an empirical therapy at third line (72.6% and 62.5%, respectively) and a susceptibility-guided therapy at fourth line (46.7% and 71.4%, respectively). CONCLUSIONS: Practices of gastroenterologists and gastroenterology fellows are in line with guidelines' recommendations, apart for the first-line treatment of H. pylori infection. Targeted educational interventions to improve adherence to guidelines are needed.

The Effect of Supervision and Out-of-Hours Surgery on the Outcomes of Primary Macula-On Retinal Detachments Operated by Vitreoretinal Fellows: A Review of 435 Surgeries.

PURPOSE: During bank holidays and weekends (BHWE), many primary macula-on retinal detachments (RD) across the United Kingdom are performed unsupervised out-of-hours by experienced vitreoretinal (VR) fellows. We aimed to determine whether first-year (F1) and second-year (F2) fellows could safely operate out-of-hours independently with remote supervision on primary macula-on RDs. METHODS: This is a retrospective consecutive series of 435 patients attending the Birmingham and Midlands Eye Centre from January 2017 to July 2020. We evaluated (i) 6-month re-detachment rate and (ii) visual outcomes of F1, F2, and consultants during office hours and BHWE as well as the effects of supervision versus non-supervision. RESULTS: For the re-detachment rate, no difference was found between surgeon grade (p = 0.821), whether supervised (p = 1.000), whether BHWE (p = 1.000), unsupervised BHWE and supervised mid-week (p = 0.757), and unsupervised F1 and F2 (p = 1.000), with non-significance maintained on multivariate regression. No difference was detected in the level of supervision (15.7%) between fellow grades during BHWE (p = 0.761) or mid-week (p = 0.295) or between surgeon grade and logMAR letters gained pre-postoperatively (p = 0.834). CONCLUSION: Safe VR services can be provided by experienced VR fellows during office hours, BHWE, supervised, or unsupervised, with similar primary success and visual outcomes to consultants in this patient subgroup. Initial intensive supervision and feedback and a gradual increase in independence is fundamental for VR fellows to gain confidence and become safe independent surgeons.

Understanding Distribution of Gender and Race across Consultation Liaison Psychiatry in USA.

The United States of America (USA) has a culturally and ethnically diverse population. Various gender and racial minorities in the healthcare system are not represented adequately when compared to their ratios in the general population. This study reviewed the gender and racial distribution and its temporal trends among fellows in Consultation-Liaison Psychiatry (CLP) within the USA. A retrospective analysis was performed to evaluate the gender and race of fellows in CLP fellowship programs in the USA from 2007 to 2019. Data was retrieved from publicly available Accreditation Council for Graduate Medical Education (ACGME) Resource Books. According to ACGME data, races were categorized as White (non-Hispanic), Asian/Pacific Islander, Hispanic, Black (non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was self-reported as male, female, and not reported. Among fellows in CLP, the White (Non-Hispanic) race remained the most represented and increased by 7.3% from 2011 to 2019, with an 18.6% increase in relative change. In contrast, the Asian/Pacific Islander, African American/Black (Non-Hispanic), and others decreased by 6.2%, 4.0%, and 4.6%, respectively. Gender distribution trends showed an increase in male representation with a relative increase of 14.7% and an absolute increase of 5.5%. Similar trends were seen in female representation with a relative and absolute increase of 5.2% and 2.8%, respectively. However, women remained the most represented throughout the period. Considering the ongoing globalization & rapidly evolving US demographics, it is crucial to analyze the gender and racial disparities within psychiatry. Racial concordance and a diversified culturally competent physician workforce is imperative for the effective delivery of mental health services.

Gender and Racial Trends among Geriatric Psychiatry Fellows in the USA: A Call to Action.

OBJECTIVE: The United States (USA) is a culturally and ethnically diverse country with an estimated 5.6 to 8 million elderly population living with psychiatric and substance use disorders and a dwindling geriatric psychiatry workforce. In this study, we explored the gender and racial trends in USA geriatrics psychiatry fellowship programs from 2007-20, and forecasted the 2030 geriatric psychiatry workforce to identify the gaps and provide recommendations. METHOD: This retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) data included trainees in geriatric psychiatry fellowship programs in the USA from 2007-20. Races were classified as White (Non-Hispanic), Asian/Pacific Islander, Hispanic, Black (Non-Hispanic), Native American/Alaskan, Others, and Unknown. Gender was categorized as Male, Female, and Not Reported. RESULTS: Amongst the geriatric psychiatry fellowship trainees, there was an overall decrease in the representation of all races from 2011-20. There was a relative decrease of 16%, 8.6% and 2.3% for White (Non-Hispanic), Asian/Pacific Islander, and Black (Non-Hispanics) respectively whereas the Hispanic and Native American/Alaskan trainees remained unchanged. Women relatively increased 28.4% from 2007-20 while men relatively decreased 27.1%. Our projections suggest that without changes in the current health professional recruitment trends and the shortage of geriatric psychiatrists will persist with a shortfall of 1,080 (9.7%) by 2030. CONCLUSION: There are critical gaps in racial and gender representation in geriatric psychiatry fellowship programs in the USA. An inclusive workforce is required to address diverse communities and bridge gaps in physician workforce gender and racial disparities.

Gender and Racial Disparity among Addiction Psychiatry Fellows in the United States.

The United States (US) has a culturally diverse population. However, the percentage of underrepresented minorities (URMs) and women in healthcare does not fully reflect their current and future demographics. Our objective was to explore and forecast the gender and racial trends in the US addiction psychiatry fellowship programs. A retrospective analysis was performed using data from Accreditation Council for Graduate Medical Education (ACGME) Resource Books which encompassed US addiction psychiatry fellows from 2007 to 2020. Simple linear and multiple regression were used to predict the 2030 addiction psychiatry workforce. White (Non-Hispanic) and Asian/Pacific Islander had a relative change of -2.8% and -26.1% from 2011 to 2020, respectively. Black (non-Hispanic) had a relative change of + 5.2%. Hispanic and Native American/Alaskan had no relative change during this time. From 2007 to 2020, women's representation relatively decreased by 10.9%. Statistically, these dynamic trends of the addiction psychiatry workforce will continue to exist in 2030. Women and URM addiction psychiatrists play an effective role in addressing substance use disorders (SUD). Unfortunately, the current gender and racial disparities in addiction psychiatry will exist in the future. Understanding the continued gender and racial bias in addiction psychiatry fellowships and devising appropriate recommendations can help mitigate the existing disparities.

The Financial Implications of Being a Female Fellow: Does Another Year Help Close the Gap?

In 2018, the American College of Foot and Ankle Surgeons Compensation and Benefits Survey illustrated a wage gap between male and female doctors of podiatric medicine in the United States. The purpose of the present study was to assess if an additional year of fellowship training closes that gap. To calculate the net present value, weighted mean general income data from female doctors of podiatric medicine with and without fellowship training was obtained. Demographic and clinical income data (based on 2080 hours) for 17 female graduates from 14 American College of Foot and Ankle Surgeons recognized fellowship programs was collected using an anonymous online survey. Income from general payments was collected from manual searches of Open Source Payments. Socioeconomic data from the 2018 American College of Foot and Ankle Surgeons compensation and benefits survey was used to calculate the net present value of the nonfellowship trained doctors of podiatric medicine for comparison. Overall, the net present value of female doctors of podiatric medicine with and without fellowship training was $1.91 million and $2.4 million, respectively. The comparative net present value and cumulative net income difference over 30 years for female doctors of podiatric medicine with and without fellowships was -$492,159.00 and -$820,000.00, respectively. The mean comparative income difference for fellowship trained female doctors of podiatric medicine annually was as follows: clinical (-$26,082.00) and general (+$1101.54). Based on the data, with consideration to the limitations of the study, the financial implications of fellowship on the gender wage gap is currently unclear. Additional research is warranted.

Investing in the Future: A Role for Professional Societies to Prepare the Next Generation of Healthcare Leaders Through Curriculum Development and Dissemination.

Professional societies serve many functions that benefit constituents; however, few professional societies have undertaken the development and dissemination of formal, national curricula to train the future workforce while simultaneously addressing significant healthcare needs. The Infectious Diseases Society of America (IDSA) has developed 2 curricula for the specific purpose of training the next generation of clinicians to ensure the future infectious diseases (ID) workforce is optimally trained to lead antimicrobial stewardship programs and equipped to meet the challenges of multidrug resistance, patient safety, and healthcare quality improvement. A core curriculum was developed to provide a foundation in antimicrobial stewardship for all ID fellows, regardless of career path. An advanced curriculum was developed for ID fellows specifically pursuing a career in antimicrobial stewardship. Both curricula will be broadly available in the summer of 2021 through the IDSA website.

Impact of the early COVID-19 pandemic on Breast Surgical Oncology fellow education.

INTRODUCTION: The early COVID-19 pandemic rapidly transformed healthcare and medical education. We sought to evaluate the professional and personal impact of the pandemic on 2019-2020 Breast Surgical Oncology (BSO) fellows in Society of Surgical Oncology approved programs to capture the experience and direct future changes. METHODS: From July 15, 2020 to August 4, 2020 a survey was administered to the American Society of Breast Surgeons' fellow members. The survey assessed the impact of the pandemic on clinical experience, education/research opportunities, personal health/well-being, and future career. Responses were collected and aggregated to quantify the collective experience of respondents. RESULTS: Twenty-eight of fifty-seven (54%) eligible fellows responded. Twenty-one (75%) indicated the clinical experience changed. Twenty-seven (96%) reported less time spent caring for ambulatory breast patients and sixteen (57%) reported the same/more time spent in the operating room. Fourteen (50%) stated their future job was impacted and eight (29%) delayed general surgery board examinations. Stress was increased in 26 (93%). Personal health was unaffected in 20 (71%), and 3 (10%) quarantined for COVID-19 exposure/infection. CONCLUSION: The COVID-19 pandemic altered the clinical experience of BSO fellows; however, the operative experience was generally unaffected. The creation of frameworks and support mechanisms to mitigate potential challenges for fellows and fellowship programs in the ongoing pandemic and other times of national crisis should be considered.