Leveraging Doctor of Nursing Practice Scholarship to Meet Organizational Leaders' Expectations.

Background: The Doctor of Nursing Practice (DNP) degree prepares nurses for engagement in practice scholarship to improve health outcomes at multiple system levels. Organizational leaders' and employers' perceptions and expectations of DNP-prepared nurses require further study. Objective: To explore the perception of organizational leaders regarding expectations and engagement of DNP-prepared nurses in practice scholarship activities. Methods: Guided by the Actualized DNP Model, a cross-sectional design was used to survey organizational leaders (N = 87) regarding DNP-prepared nurses' engagement in practice scholarship. Results: Findings indicate that 92% (n = 80) of participants believed practice scholarship should be an expectation of DNP-prepared nurses serving in a variety of roles. Of the 77 respondents to the scholarship engagement questions, 97.4% (n = 75) reported that DNP-prepared nurses engaged in one or more practice scholarship activities over the past year. Conclusions: Aligning DNP practice scholarship competencies, as outlined in the American Association of Colleges of Nursing 2021 Essentials, with organizational needs, expectations, and provision of sufficient time to support these scholarship activities is needed. Implications for Nursing: Opportunities exist for DNP-prepared nurses to articulate and demonstrate their value by conducting practice scholarship through innovative advanced nursing roles to realize organizational goals. Organizational support is necessary for practice scholarship activities to transform DNP education.

Impact of a Regional Pediatric Hematology/Oncology Fellowship Program in Guatemala.

PURPOSE: This study aimed to describe and assess the regional experience of a pediatric hematology/oncology fellowship program based in Guatemala. METHODS: The Unidad Nacional de Oncología Pediátrica (UNOP) in Guatemala City, Guatemala, is the only hospital in Central America dedicated exclusively to childhood and adolescent cancer. To address the regional need for specialists, a fellowship program in pediatric hematology/oncology was launched in 2003. The UNOP fellowship program comprises 3 years of training. Although the program is based at UNOP, it also includes rotations locally and internationally to enhance clinical exposure. The curriculum is based on international standards to cover clinical expertise, research, professionalism, communication, and health advocacy. Trainees are selected according to country or facility-level need for pediatric hematologists/oncologists, with a plan for them to be hired immediately after completing their training. RESULTS: Forty physicians from 10 countries in Latin America have completed training. In addition, there are currently 13 fellows from five countries in training. Of the graduates, 39 (98%) are now practicing in pediatric hematology/oncology in Latin America. Moreover, many of them have leadership positions within their institutions and participate in research, advocacy, and policy making. Graduates from the UNOP program contribute to institutions by providing care for an increasing number of patients with pediatric cancer. The UNOP program is the first pediatric hematology/oncology fellowship program in the world to be accredited by Accreditation Council for Graduate Medical Education-International, an international body accrediting clinical training programs. CONCLUSION: The UNOP program has trained specialists to increase the available care for children with cancer in Latin America. This regional approach to specialist training can maximize resources and serve as a model for other programs and regions.

A novel global safe surgery mentorship program using a multidisciplinary team approach.

BACKGROUND: The global surgery movement aims to provide equitable surgical care in low- and middle-income countries (LMICs) and attempts to address a wide range of issues around the lack of access and poor-quality. In response, the Lifebox McCaskey Safe Surgery Fellowship was established in Ethiopia to train a multidisciplinary team of healthcare professionals. We conducted this study to evaluate the outcome of this training program. METHODS: A qualitative study was conducted to evaluate the implementations and outcomes of the first three cohorts of the McCaskey Fellowship. Interviews with fellows, mentors, and program staff reveal valuable insights into the program's strengths and challenges. RESULTS: Key findings include positive feedback on the program's curriculum highlighting its multidisciplinary nature. Challenges were noted in maintaining schedules, communication with healthcare facilities, and budget constraints, suggesting the need for improved program management. The fellowship's impact was evident in altering participants' perceptions of teamwork and enhancing their research and leadership skills. Fellows initiated quality improvement projects impacting surgical practices positively. However, challenges, such as hospital resistance and the COVID-19 pandemic, affected program implementation. CONCLUSION: Despite various challenges, the program's unique approach combining multidisciplinary training and local mentorship proves promising. It fosters a culture of teamwork, equips participants with essential skills, and encourages fellows to become advocates for safe surgery. As surgical quality champions emerge from this fellowship, there is optimism for lasting positive impacts on surgical care in LMICs.

Training Future Surgeon Leaders in Environmental Stewardship: A Review of a Decade of the Health Care Sustainability Fellowship.

OBJECTIVE: Since the inception of Ken Lee Memorial Fellowship (KLMF) in 2013, our institution has achieved 10 years of trainee led sustainability projects. The ability of health care organizations to drive sustainability depends on organizational and human capacity. This qualitative study presents the first decade of sustainability fellows' projects, the challenges associated with implementing them, and the environmental and cost impact of these initiatives. DESIGN, SETTING, PARTICIPANTS: All residents in the General Surgery residency program at the Cleveland Clinic, a quaternary hospital, regardless of postgraduate year (PGY) level, are invited to apply for the KLMF program with a short project proposal. One fellow is selected per year. Each project since the program's inception was reviewed qualitatively, relying on data derived from observation, interview of prior fellows, and supervising staff, and analysis of documentation from the annual fellow presentation and abstract, Grand Rounds recording, and fellowship leadership. RESULTS: A targeted approach by each sustainability fellow is encouraged, with the following action cycle for change implementation throughout the 1-year fellowship: identification and discovery of an issue, collaborative planning of an intervention, implementation of the intervention, and evaluation. Projects range from water and waste reduction to education of surgical staff, with positive implications for environmental stewardship in our hospital. However, multiple barriers to completing, scaling, and maintaining sustainability initiatives remain, as demonstrated by challenges faced by our Ken Lee Fellows. CONCLUSIONS: Our goal is that this intensive educational experience within the framework of a graduate medical education curriculum will ensure future generations of surgeons who are thoughtful leaders in environmental stewardship.

Defining the passage of wisdom: A taxonomy of supervision for RANZCP trainees and Fellows.

OBJECTIVE: Trainees and Fellows of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) work in complex interpersonal and organisational environments. Engagement in supervision can be a helpful way for trainees and Fellows to achieve interpersonal, professional, and organisational success. Supervision comes in many forms depending on the stage and state of one's career. An awareness of different supervision models is relevant to trainees' understanding of what is expected of them and their supervisors in their work and educational contexts. This paper explores the taxonomy of supervision models available to RANZCP trainees and Fellows in Australia and New Zealand. CONCLUSION: Supervision is a heterogeneous concept with multiple aims, outcomes, and processes that change with ones' stage of career.

Impact of Fellow Participation During Colonoscopy on Adenoma Detection Rates.

BACKGROUND: An endoscopist's adenoma detection rate (ADR) is inversely related to interval colorectal cancer risk and cancer mortality. Previous studies evaluating the impact of gastroenterology fellow participation in colonoscopy on ADR have generated conflicting results. AIMS: We aimed to determine the impact of fellow participation, duration of fellowship training, and physician sex on ADR and advanced ADR (AADR). METHODS: We retrospectively analyzed average-risk patients undergoing screening colonoscopy at Veterans Affairs New York Harbor Healthcare System Brooklyn Campus and Kings County Hospital Center. Review of colonoscopy and pathology reports were performed to obtain adenoma-specific details, including the presence of advanced adenoma and adenoma location (right vs. left colon). RESULTS: There were 893 colonoscopies performed by attending only and 502 performed with fellow participation. Fellow participation improved overall ADR (44.6% vs. 35.4%, p < 0.001), right-sided ADR (34.1% vs. 25.2%, p < 0.001), and AADR (15.3% vs. 8.3%, p < 0.001); however, these findings were institution-specific. Year of fellowship training did not impact overall ADR or overall AADR, but did significantly improve right-sided AADR (p-value for trend 0.03). Female attending physicians were associated with increased ADR (47.1% vs. 37.0%, p = 0.0037). Fellow sex did not impact ADR. CONCLUSIONS: Fellow participation in colonoscopy improved overall ADR and AADR, and female attending physicians were associated with improved ADR. Year of fellowship training did not impact overall ADR or AADR.

All Nursing Is Global Nursing.

Editor's note: Sigma Theta Tau International Honor Society of Nursing is a global organization focused on leadership and scholarship, with more than 135,000 members from over 100 countries. This first article in a series highlights why global nursing should matter to U.S. nurses and offers an overview of organizations within the global nursing community.

Leadership skills curriculum development for residents and fellows: A needs-assessment.

BACKGROUND: Non-technical skills (NTS) curricula have demonstrated success in surgical residencies. The purpose of this study is to examine the need for a structured leadership curriculum at our institution. METHODS: A needs-assessment survey analyzing the importance of leadership domains, previously validated by Kazley et al. was delivered to 240 general surgery staff. Respondent groups were broken down into: Attendings, Residents, and Multi-Disciplinary. Statistical analyses were conducted using Cronbach's Alpha (α = 0.9259) and Fisher's exact test (pre-set p-value = 0.05). The importance of each competency was compared among groups and importance was defined as >75% important and very important responses. RESULTS: Nineteen of 33 competencies were important for all groups, including 3 with 100% importance: interpersonal communication, team-work, and problem-solving. Several competencies showed statistically significant differences among groups. CONCLUSION: A diverse range of surgery staff agreed that 19 leadership domains are important to teach residents, with some variance among respondent groups.

Data-Based Self-awareness as the Foundation for Effective Leadership.

The AONL Nurse Executive Fellowship supports nurses who are new to an executive role in developing critical executive competencies. Participants engage in an in-depth specialized assessment process to help them understand themselves and the impact on their leadership. Learnings from the 1st 2 cohorts of fellowship participants provide insight into challenges faced by new executives and how self-awareness can improve performance to address those challenges.

Trends in Leadership at Pediatric Orthopaedic Fellowships.

BACKGROUND: Pediatric orthopaedic fellowship directors (FDs) have a valuable impact on the education of trainees and future leaders in the field. There is currently no research on the characteristics of pediatric orthopaedic FDs. METHODS: Programs were identified using the Pediatric Orthopaedic Society of North America fellowship directory. Operative, nonoperative, and specialty programs were included. Data was collected through Qualtrics survey, e-mail, telephone, and online searches. Variables included demographics (age, sex, race/ethnicity), Hirsch index (h-index) as a measure of research productivity, graduate education, residency and fellowship training, years of hire at current institution and as FD, and leadership roles. RESULTS: Fifty-five FDs were identified. The majority (49/55, 89%) were male and 77% (27/35) were Caucasian. The mean age at survey was 51.1±8.2 years. The mean h-index was 17.2. Older age correlated with higher h-index (r=0.48, P=0.0002). The average duration from fellowship graduation to FD appointment was 9.6±6.7 and 6.9±6.1 years from institutional hire. Sixteen FDs (29%) had additional graduate level degrees. Almost all (52/55, 95%) FDs completed orthopaedic surgery residencies and all graduated fellowship training. Twenty-nine percent (16/55) completed more than 1 fellowship. Most FDs (51/55, 93%) completed a fellowship in pediatric orthopaedic surgery. Ten FDs (18%) completed pediatric orthopaedic surgery fellowships that included spine-specific training. One-third of all current FDs were fellowship-trained at either Boston Children's Hospital (9/55, 16%) or Texas Scottish Rite Hospital for Children (9/55, 16%). CONCLUSIONS: Pediatric orthopaedic FDs are typically early-career to mid-career when appointed, with a strong research background. Nearly a third completed additional graduate degrees or multiple fellowships. Although male dominated, there are more female FDs leading pediatric orthopaedic programs compared with adult reconstruction, trauma, and spine fellowships. As fellowships continue to grow and diversify, this research will provide a baseline to determine changes in FD leadership.

Resident Outcomes and Perspectives Over 2 Years of a New Scholarship Curriculum.

BACKGROUND AND OBJECTIVES: Scholarship is recognized as a challenge in many family medicine residency programs. Among evaluations of scholarship curricula, few describe resident experiences of such interventions. To bridge this gap in knowledge, we measured resident confidence, satisfaction, and participation before and after implementing a new scholarship curriculum. METHODS: The redesigned curriculum included a structured project timeline, resident research in progress meetings, faculty mentorship, scholarly skills workshops, and mentored journal clubs. We conducted a curriculum evaluation via surveys of residents prior to implementation and after years 1 and 2, measuring satisfaction with the scholarly environment and opportunities, and confidence and participation in specific scholarly activities using Likert scales from 1 (least confidence) to 5. RESULTS: Compared to baseline (n=28), after 2 years (n=27) of the curriculum, residents reported increased mean confidence in critical appraisal of scientific articles (2.6±1.1 to 3.3±0.7, P=.007), carrying out a scholarly project (2.5±0.8 to 3.4±1.0, P=.005), and writing an abstract (3.0±0.8 to 3.8±0.7, P=.002). As compared to the first year, more residents in the second year participated in quality improvement projects (7.1% vs 29.6%, P=.031) and wrote conference abstracts (10.7% vs 37.0%, P=.022). Over the same period, those very satisfied with the scholarly environment increased from 0 (0%) to 8 (29.6%, P=.017). The June 2020 survey identified increased interest in scholarship because of the antiracism movement (51.9%) and COVID-19 pandemic (40.7%). CONCLUSIONS: Implementation of a redesigned scholarship curriculum was associated with increases in family medicine resident scholarship confidence and satisfaction.

Perceptions and lessons from web-based interviews for the reproductive endocrinology and infertility fellowship application cycle.

OBJECTIVE: To evaluate the experience and perceptions of reproductive endocrinology and infertility fellowship applicants and program directors (PDs) regarding the current and future use of web-based interviews (WBIs). DESIGN: Cross-sectional study. SETTING: Nationwide cohort. PATIENT(S): Reproductive endocrinology and infertility fellowship applicants and PDs participating in the 2020 application cycle. INTERVENTION(S): Anonymous survey sent to applicants and PDs. MAIN OUTCOME MEASURE(S): Descriptive study evaluating the experience and satisfaction of applicants and PDs with WBIs. RESULT(S): Forty-six percent of applicants and eligible PDs responded to our survey. Most applicants and PDs responded that WBIs were adequate for conveying a sense of a program's strengths, faculty, diversity, clinical training, and research opportunities, but less than half responded that WBIs were adequate in providing a sense of the program's clinical site and facilities. After WBIs, both applicants (73%) and PDs (86%) were able to rank with confidence. The cost of WBIs was significantly lower for both applicants (median: $100) and programs (median: $100) than the costs previously reported for in-person interviews. The applicants interviewed at more programs than they would have if the interviews were on-site, and Zoom was the highest rated platform used. Most applicants and PDs responded that WBIs were an adequate substitute, and that they should continue after the coronavirus disease 2019 pandemic. Furthermore, most of the PDs were planning to continue to use WBIs in some capacity. CONCLUSION(S): Both applicants and PDs had favorable experiences with and perceptions of WBIs, and most endorse the continued use of this interview modality. The findings of this study can help guide and optimize future WBI practices.

Surgical subspecialists in West Africa: Workforce size, training opportunities, and contributing factors.

BACKGROUND: The global burden of disease treatable by surgical subspecialists remains an outstanding area of need, and yet little is known about the subspecialist workforce worldwide, especially in sub-Saharan Africa. This study aims to quantify the subspecialty surgical workforce and number of subspecialty training programs in West Africa and to identify socioeconomic factors predicting the number of subspecialists in West African countries. METHODS: West African subspecialists and accredited fellowship training programs in 17 West African countries were quantified using membership data from the West African College of Surgeons and compared with publicly available workforce data from the United States, the United Kingdom, and East, Central, and Southern Africa. Spearman's coefficients were calculated to identify socioeconomic predictors of subspecialist surgical workforce. RESULTS: Of 2,181 surgeons, 712 (32.6%) were surgical subspecialists. Three (18%) of 17 West African countries had greater than 11 subspecialists. There were 174 subspecialty training programs in the region, though 13 countries (76%) had no programs. The number of subspecialists correlated most strongly with the number of subspecialty training programs (rS = 0.68, P = .003) but also correlated significantly with gross population and number of medical schools (rS = 0.50-0.52, P ≤ .05). CONCLUSION: Subspecialist surgeons represent one third of surgeons in West Africa, though most countries have fewer than 12 providers. The number of subspecialists is significantly correlated with the number of subspecialty training programs, and yet many West African countries lack accredited programs. These results suggest that investing in training programs is the most valuable potential strategy to address the shortage of surgical subspecialists in West Africa.

Post-residency medical education fellowships: a scoping review.

The authors conducted a scoping review to investigate the structure, content, and potential impact of post-residency medical education fellowships. The authors searched eight databases to identify English-language articles describing longitudinal, post-residency medical fellowships that both focused on medical education and described the structure and content of the curriculum. The authors summarized the findings of each article and, for those articles that included a program evaluation, assessed the potential impact of the program via the Kirkpatrick's Four-Level Training Evaluation Model and the Medical Education Research Study Quality Instrument. Nine articles, describing a total of ten post-residency medical education fellowships, met inclusion criteria. Half of the programs were dedicated medical education fellowships and half were medical education tracks within a subspecialty fellowship. The content and educational strategies varied, with no two programs having the same curriculum. Most programs most focused on teaching skills, adult learning theory, curricular development, and medical education research/scholarship. Most programs used project-based learning, workshops, and faculty mentorship as educational strategies. Six of the articles included an evaluation of their program(s), all of which suggested positive changes, at least at the level of fellow behavior (Kirkpatrick level 3), and designs limited the strength of any conclusions drawn. This scoping review highlights the variation among medical education fellowships and the need for common curricular components, as well as program evaluation, across and within these fellowships. Additional assessment at higher levels of trainee outcomes will help guide the creation and revision of medical education fellowships, and inform the development of a core curriculum shared across programs. Such a core curriculum could then serve as the foundation for a certification program, by which a medical educator's expertise could be recognized, thus elevating medical education to the stature it deserves within the academic mission.