Trainee Insight into Pain Fellowship Programs: A Critical Evaluation of the Current Educational System by the APPD.

BACKGROUND: Since 1992, when the Accreditation Council of Graduate Medical Education (ACGME) acknowledged pain medicine as a subspecialty, the field has experienced significant growth in its number of programs, diversity of sponsoring specialties, treatment algorithms, and popularity among applicants. These shifts prompted changes to the educational model, overseen by program directors (PDs) and the ACGME. The pool of pain fellowship applicants also changed during that period. OBJECTIVES: This study aims to investigate trainees' reasons for applying to pain medicine fellowship programs as well as the applicants' specific expectations, interests, and motivations, thereby contributing to the remodeling and universal improvement of programs across the country. STUDY DESIGN: Online survey via SurveyMonkey. The online questionnaire targeted pain fellowship applicants in 2023 and current fellows in the US. METHODS: Our study was designed by board members of the Association of Pain Program Directors (APPD). The board disseminated a survey to those who applied to ACGME Pain Medicine fellowships in 2023 as well as to existing fellows. The survey was emailed to residency and fellowship PDs for dissemination to their trainees. The participants answered a 12-question survey on their reasons for pursuing pain medicine fellowships, expectations of and beyond those fellowships, and educational adjustments. RESULTS: There were 283 survey participants (80% applicants in residency training and 20% fellows). Participants ranked basic interventional procedures and a strong desire to learn advanced procedures as the most significant factors in pursuing a pain fellowship. Most trainees (70%) did not wish to pursue a 2-year fellowship, and 50% desired to go into private practice. LIMITATIONS: The relatively small number of respondents is a limitation that could introduce sampling error. Since most of the respondents were from the fields of physical medicine and rehabilitation (PM&R) and anesthesia, the use of convenience sampling reduced our ability to generalize the results to the wider community. Furthermore, approximately 80% of the trainees were residents, who might have had less experience in or knowledge of the survey's particulars than did the fellows. CONCLUSION: This survey demonstrated that procedural volume and diversity were important factors in trainees' decisions to apply to the field of pain medicine; however, extending the duration of a pain fellowship was not an option survey participants favored. Therefore, PDs and educational stakeholders in pain fellowship training need to develop creative strategies to maintain competitive applicants' interest while they adapt to our evolving field.

Recent Trends and Challenges in Employment for Emergency Medicine Trainees: A Survey of Graduating Residents' Perspectives.

OBJECTIVES: The landscape of the emergency medicine (EM) workforce has undergone significant changes recently, posing challenges for residents who are about to graduate from EM training programs. The objective of this study was to survey graduating residents' perceptions of the recent EM job market. METHODS: We conducted a cross-sectional survey study involving EM residents from programs in New York and New Jersey between August 2021 and November 2021. The survey consisted of 12 multiple-choice questions that focused on graduating EM residents' perceptions of the EM job market, its impact on their job search, and their interest in pursuing fellowship training. RESULTS: During the study period, 436 survey results were collected from 26 EM residency programs. Of the 418 respondents, 233 (56%) expressed their intention to start their job search earlier than their counterparts in previous years, as highlighted by the survey. Among respondents, 141 (76%) postgraduate year (PGY)-2, 139 (79%) PGY-3, and 47 (85%) PGY-4 residents anticipated a challenging job search. Nearly 90% of respondents believed that the coronavirus disease 2019 pandemic would affect both academic and nonacademic medical centers in terms of job openings. A total of 248 (59%) were interested in pursuing a fellowship after residency. Most residents preferred job opportunities on the East and West Coasts of the United States. CONCLUSIONS: The findings highlight the increasing competitiveness and challenges residents face in securing their first job, the declining interest in pursuing fellowships as residents progress in their training, and the geographic preferences for job opportunities.

OBGYN Hospitalist Fellowships: An Update on Fellowship Training in the United States.

Due to improved outcomes in clinical care, patient safety, and education, demand for OBGYN hospitalists is increasing. As a result, an OBGYN hospitalist fellowship was developed to train future leaders in OBGYN hospital medicine. This article is a discussion regarding the landscape of OBGYN hospitalist fellowships across the country. Utilizing information from program-specific Web sites, as well as discussions with past and present fellowship directors, this article summarizes key differences and similarities across programs, as well as reviews important considerations for those hoping to start a fellowship at their own institution.

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.

A Targeted Clinical Reasoning Remediation Program for Residents and Fellows in Need.

Background There is no standardized, widely accepted process for individualized clinical reasoning remediation. Objective We describe a novel, targeted assessment and coaching process that allows for individualized intervention for residents and fellows struggling with clinical reasoning. Methods Residents and fellows at the University of Virginia with performance concerns are referred to COACH (Committee on Achieving Competence Through Help) and assessed by a remediation expert. A subset is referred to a clinical reasoning remediation coach who performs an additional assessment and cocreates an individualized remediation plan. Following remediation, residents and fellows are reassessed by their respective programs. We report the frequency of struggle, remediation time invested, and academic outcomes. Results From 2017 to 2022, 114 residents and fellows referred to COACH met inclusion criteria, of which 38 (33%) had a deficiency in clinical reasoning. Targeted assessment revealed the following microskill deficits: hypothesis generation (16 of 38, 42%); data gathering (6 of 38, 16%); problem representation (7 of 38, 18%); hypothesis refinement (3 of 38, 8%); and management (6 of 38, 16%). Remediation required a mean of nearly 23 hours per trainee. Of the 38 trainees, 33 (87%) are in good standing at the time of writing. Conclusions Our unique program offers a feasible, targeted approach to clinical reasoning remediation based on our current understanding of the clinical reasoning process. Early hypothesis generation was the most common microskill deficit identified.

Perspectives of US Medical Residency and Fellowship Applicants on No-Stakes Campus Visits.

Background Virtual interviews may limit an applicant's ability to ascertain the culture of a training program. No-stakes campus visits (NSCVs) have been offered but their value is unknown. Objective The purpose of our study was to determine factors that influence applicants' rank lists and determine barriers to and perceptions of NSCVs and their impact on applicants' final rank lists. Methods All interviewed applicants of graduate medical education (GME) programs who agreed to participate in the study were emailed a survey after the 2023 National Resident Matching Program Match. The survey contained sections on demographics, perspectives on factors affecting ranking decisions, and perceptions of NSCVs. Results Of 796 applicants, 183 (22.9%) who interviewed at 16 different Mayo Clinic GME programs responded to the survey. Of 131 respondents who answered whether they accepted an NSCV offer, 39 (29.8%) accepted. Of 35 respondents who answered whether they thought attending NSCVs impacted their rank, 19 (54.3%) were either uncertain or said yes. Of 34 respondents who answered whether the NSCV influenced their ranking of the program, 16 (47.1%) said their rank did not change, 12 (35.3%) said they ranked the program higher, and 5 (14.7%) said they ranked the program lower. For respondents who did not attend NSCVs, financial burden and lack of time were primary reasons. Conclusions NSCVs are perceived positively by most respondents. Many either believed they influenced their position on the program's rank list or were unsure. Most respondents said NSCVs either improved or did not change their ranking of the program.

Building Research Capacity: A Case Study of a Registered Practical Nurse's Research Fellowship.

A research fellowship geared toward registered practical nurses was designed to support the nurse's knowledge development in practice-based research. In this paper, we describe a six-month fellowship experience, which comprised research education, application and mentorship. Through the implementation of the research fellowship, we identified six components necessary for success, which include program infrastructure, application of training and leadership development. The research fellowship framework can support nurse leaders in the professional development of their nursing staff through building research capacity. Our fellowship description can also help guide the implementation of similar initiatives at other acute care sites.

Fellows of the American Medical Informatics Association (FAMIA): Looking Back and Looking Ahead.

BACKGROUND: Over the past 30 years, the American Medical Informatics Association (AMIA) has played a pivotal role in fostering a collaborative community for professionals in biomedical and health informatics. As an interdisciplinary association, AMIA brings together individuals with clinical, research, and computer expertise and emphasizes the use of data to enhance biomedical research and clinical work. The need for a recognition program within AMIA, acknowledging applied informatics skills by members, led to the establishment of the Fellows of AMIA (FAMIA) Recognition Program in 2018. OBJECTIVES: To outline the evolution of the FAMIA program and shed light on its origins, development, and impact. This report explores factors that led to the establishment of FAMIA, considerations affecting its development, and the objectives FAMIA seeks to achieve within the broader context of AMIA. METHODS: The development of FAMIA is examined through a historical lens, encompassing key milestones, discussions, and decisions that shaped the program. Insights into the formation of FAMIA were gathered through discussions within AMIA membership and leadership, including proposals, board-level discussions, and the involvement of key stakeholders. Additionally, the report outlines criteria for FAMIA eligibility and the pathways available for recognition, namely the Certification Pathway and the Long-Term Experience Pathway. RESULTS: The FAMIA program has inducted five classes, totaling 602 fellows. An overview of disciplines, roles, and application pathways for FAMIA members is provided. A comparative analysis with other fellow recognition programs in related fields showcases the unique features and contributions of FAMIA in acknowledging applied informatics. CONCLUSION: Now in its sixth year, FAMIA acknowledges the growing influence of applied informatics within health information professionals, recognizing individuals with experience, training, and a commitment to the highest level of applied informatics and the science associated with it.

Survey of Hematology/Oncology Program Leaders on Equity and Global Health Opportunities for Fellows.

PURPOSE: The study assesses the current state of global oncology (GO)/hematology training opportunities in US fellowship programs. METHODS: We developed a comprehensive survey of 64-Likert multiple-choice and open-ended questions. The survey was electronically distributed to fellowship program leaders at Accreditation Council for Graduate Medical Education-accredited adult hematology/oncology fellowships. Program directors received three reminders after which survey was sent to assistant program directors or division heads for programs not represented. RESULTS: A total of 171 programs were eligible for the survey. We received 42 (24.6%) responses; 40 were included in the analysis, and two were excluded for declined consent and incomplete responses. The programs include large academic (81.6%) and community hospitals (10.5%). Of the respondents, 18 (48.6%) reported offering some opportunities for global health training, and half reported interest among current fellows. Most programs (29, 82.9%) had three or fewer faculty engaged in GO research. Institutional training grants were available in 15 (39.5%) programs, of which six (40%) allowed for global health research. Of the 18 programs offering global health training activities, most (15, 83.3%) report less than a quarter of their trainees currently participate in GO experiences. The most commonly perceived barriers to GO opportunities include competing priorities (85.3%) and lack of faculty mentors with GO-related experience (82.4%). Conversely, the most commonly perceived facilitators include established partnerships outside the United States (97.0%) and dedicated institutional funding (93.9%). CONCLUSION: Our survey demonstrates that although there is significant interest among fellowship trainees, a minority of the fellowship programs offer GO opportunities. Providing GO opportunities would require programs to establish partnerships with institutions outside the United States and to have systematic approaches of addressing other barriers, including enhancing funding and mentorship.

Including the Sustainable Development Goals in Nursing Scholarship.

A call to action.

The GIBACHT fellowship: a multilateral initiative for strengthening capacity in biosafety and biosecurity towards pandemic preparedness.

The German Biosecurity Programme was launched in 2013 with the aim to support partner countries overcome biological threats including natural outbreaks or the intentional misuse of highly pathogenic agents. As part of this programme, this paper describes the development and implementation of a multilateral biosafety and biosecurity training initiative, called 'Global Partnership Initiated Biosecurity Academia for Controlling Health Threats' (GIBACHT). To achieve its objectives, GIBACHT implemented a blended-learning approach with self-directed, distance-based learning phases and three training-of-trainer workshops. The programme follows Kirkpatrick's model of learning to guarantee sustainable effects of improved knowledge and skills. One hundred nine fellows from 26 countries have been trained in seven cohorts. Many GIBACHT alumni have established additional biosafety/biosecurity trainings in their home countries. The knowledge exchange is strengthened by the implementation of a Moodle-based alumni network. GIBACHT has the potential to contribute to strengthening the capacities of partner countries in Africa, the Middle East, and South and Central Asia to respond and build resilience to biological threats.

Examining the Influence of a General Surgery Resident's Transplant Experience on Their Pursuit of Transplant Surgery Fellowship.

BACKGROUND: Transplant surgery has historically been a less desirable fellowship among general surgery graduates. Limited work has been done to understand factors associated with residents' interest in transplantation. Using a multi-institutional cohort, we examined how the resident experience on transplant surgery may influence their decision to pursue transplant fellowship. METHODS: Individual demographics, program characteristics, and transplant-specific case logs were collected for graduates from 2010 to 2020 at 20 general surgery residency programs within the US Resident OPerative Experience (ROPE) Consortium. Residents who pursued transplant surgery fellowship were compared to those who went directly into practice or pursued a non-transplant fellowship. RESULTS: Among 1342 general surgery graduates, 52 (3.9%) pursued abdominal transplant fellowship. These residents completed more transplant (22 vs. 9), liver (14 vs. 9), pancreas (15 vs. 11), and vascular access operations (38 vs. 30) compared to residents who did not pursue transplant fellowship (all p < 0.05). Multivariable logistic regression found that residents underrepresented in medicine were three times more likely (95% CI 1.54-6.58, p < 0.01) and residents at a program co-located with a transplant fellowship six times more likely (95% CI 1.95-18.18, p < 0.01) to pursue transplant fellowship. Additionally, a resident's increasing total transplant operative volume was associated with an increased likelihood of pursuing a transplant fellowship (OR = 1.12, 95% CI 1.09-1.14, p < 0.01). CONCLUSION: The findings from this multi-institutional study demonstrate that increased exposure to transplant operations and interaction within a transplant training program is associated with a resident's pursuit of transplant surgery fellowship. Efforts to increase operative exposure, case participation, and mentorship may optimize the resident experience and promote the transplant surgery pipeline.

A Qualitative Study of Internal Medicine Subspecialty Fellowship Program Directors' Perspectives on Short-Term Hospitalist Employment Prior to Fellowship.

Background Some internal medicine (IM) residents pursuing subspecialty training choose short-term hospitalist employment prior to fellowship, or "pre-fellowship hospitalist years." Residency and fellowship program directors (PDs) advise residents on this decision, but PD experience with fellows pursuing pre-fellowship hospitalist years and the impact on fellowship applications is unknown. Objective We aimed to explore perceptions of fellowship PDs regarding experience with fellows who pursued pre-fellowship hospitalist years, including perceived effects on how such years affect fellowship application candidacy. Methods A purposive sample of 20 fellowship PDs in the most highly competitive and commonly selected IM fellowships (cardiology, pulmonology/critical care medicine, hematology/oncology, gastroenterology) from 5 academic institutions were approached for participation in fall 2021. Interviews included semi-structured questions about pre-fellowship hospitalist employment. Utilizing rapid qualitative analysis, interview transcripts were summarized and reviewed to identify themes and subthemes describing fellowship PDs' perspectives of pre-fellowship hospitalist years. Results Sixteen fellowship PDs (80%) participated. PDs identified 4 major themes as important for trainees considering pre-fellowship hospitalist years: (1) Explain the "Why"-why the year was pursued; (2) Characteristics of the Hospitalist Position-what type of employment; (3) The Challenges-potential concerns faced with pre-fellowship hospitalist years; and (4) Describe the "What"-the experience's contribution to resident professional development. Conclusions Fellowship PDs in 4 competitive IM subspecialities placed a strong emphasis on explaining a clear, logical reason for seeking short-term hospitalist employment prior to fellowship, describing how it fits into the overall career trajectory, and selecting activities that demonstrate continued commitment to the subspecialty.