Analysis of Performance Trends from 2010-2019 on the American Board of Internal Medicine Nephrology Certifying Exam.

BACKGROUND: The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. METHODS: This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. RESULTS: Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. CONCLUSIONS: Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

Impact of COVID-19 on Dermatology Residency.

COVID-19 has created challenges across medicine, including in medical education, with deeply rooted impacts in the dermatology residency experience. Its effects are both acute and chronic, including: shifts to virtual education and conferences, skewed clinical experiences, negatively impacted wellness, and uncertainty in the future. As educators and mentors, it is important to recognize and address these issues so that we may remain transparent, adaptable, and engaged as we continue to build a better tomorrow for our resident trainees.

Trends in Number of Women Speakers at the American Head and Neck Society Meetings, 2007-2019.

Importance: The number of female speakers at American Head and Neck Society (AHNS) conferences should ideally be consistent with the number of women entering head and neck surgery fellowships to ensure gender equity in the field. Yet the presence of women speakers at the annual AHNS meetings, which is specific to the field of head and neck cancer, endocrine and microvascular reconstructive surgery, has yet to be studied. Objective: To determine whether the proportion of female speakers at the AHNS has increased in a manner consistent with the numbers of women entering fellowships since 2007. Design, Setting, and Participants: This qualitative study assessed 13 final meeting programs from AHNS national/international conferences from 2007 to 2019. The number of male and female participants in different roles throughout the meeting were retrospectively tracked. Participants were male and female speakers at AHNS national/international conferences who took part in the roles of scientific session presenter, scientific session moderator, expert panelist, miscellaneous moderator, and named lecturers/keynote speaker. Gender of the speaker was determined by searching names on the internet and using available published pronouns. Main Outcomes and Measures: Number of speaking opportunities for men and women in different roles from 2007 to 2019 as well as number of men and women entering AHNS fellowships since 2007 and new active AHNS members since 2012. Results: In this qualitative study, from 2007 to 2019, 4059 speakers were identified. Of these speakers, 902 (22%) were women and 3157 (78%) were men. Overall, there was a strong correlation between increasing years and number of women speakers from 2007 to 2019 (ρ = 0.75; 95% CI, 0.72-0.78). There were 2096 invited speaking roles that excluded research presentations, of which 400 were offered to female participants (19.1%) across the study period. There were 131 different women that made up all 400 of the opportunities that were offered to women in the years surveyed. There was a strong correlation in the proportion of women as presenters for oral abstracts, expert panelists, and miscellaneous moderators between the years but no correlation in scientific session moderators and named lecturers/keynote speakers. Of the 45 named lecturers/keynote speakers in the programs tracked, only 2 were women. Conclusions and Relevance: In this study, from 2007 to 2019, the presence of women at ANHS has increased overall, reflecting the changing demographic characteristics of those entering in head and neck oncology and microvascular surgery fellowships. However, a strong disparity continues to exist for preeminent speaking opportunities.

Trends in cytopathology fellowship positions and vacancies over the past decade.

INTRODUCTION: Cytopathology is one of the most sought-after fellowships within pathology, with a lower fellowship vacancy rate compared with most other subspecialties. The Accreditation Council for Graduate Medical Education (ACGME) actively tracks annual program data for cytopathology fellowship programs, and evaluating this longitudinal data looking at trends in programs and positions over the past 10 years could provide insights into the future of cytopathology and its training programs. METHODS: Data obtained from the ACGME was examined in detail for all ACGME-accredited cytopathology fellowship programs over the past decade (2011-2021). Additional responses from program directors (PDs) from a 2021 American Society of Cytopathology (ASC) survey are also included. RESULTS: The total number of ACGME-approved cytopathology training programs and cytopathology fellowship positions remained relatively constant over the past 10 years, but the vacancy rate and number of programs with 1-2 unfilled spots has gradually but steadily risen over the past 6 years. In a 2021 ASC PD survey with 66% response rate, 53% of PDs reported having recruitment problems at least occasionally and 46% reported an increase in unexpected fellowship openings. CONCLUSIONS: Although the number of cytopathology positions has been relatively constant over the past decade, there has been a recent increase in cytopathology fellowship vacancies that may indicate changes in career choices or the job market, with fellows choosing jobs over additional fellowships, and potentially signal a growing shortage of fellowship-trained, Board-certified cytopathologists in the coming years.

Ten Year Trends in Minimally Invasive Surgery Fellowship.

BACKGROUND: Minimally Invasive Surgery (MIS) is one of the more recently established surgical fellowships, with many candidates applying due to a perception of inadequate exposure to advanced MIS during residency. The desire for advanced training should be reflected in increased competitiveness for fellowship positions. The aim of this study is to determine the desirability of MIS fellowships over time through review of national application data. METHODS: We reviewed the fellowship match statistics obtained from The Fellowship Council, the organizing body behind the MIS fellowship match. Data from January 1, 2008 - December 31, 2019 were included. We compared match rates to other specialties using the National Resident Matching Program, a nonprofit organization established for US residency and some fellowship programs. RESULTS: In the period of 2008 to 2019, the number of certified MIS fellowship programs increased from 124 to 141. While this program expansion was associated with a 19% increase in available positions, the number of applications increased 36%. As a result, the number of positions filled increased from 83% to 97%, but the match rate among US applicants fell from 82% to 71% during this interval. In comparison, the match rates for pediatric surgery, surgical oncology, vascular surgery, and surgical critical care fellowships remained largely unchanged, most recently 50%, 56%, 99%, and 100% respectively. CONCLUSION: Over the last decade, US residents have shown an increased interest in pursuing MIS fellowship positions. As a consequence, the match process for MIS fellowships is becoming increasingly competitive.

The impact of COVID-19 on REI fellowship educational experience.

PURPOSE: To assess perceived deficiencies of reproductive endocrinology and infertility (REI) fellow education due to changes in care secondary to COVID-19. METHODS: This is a cross-sectional study performed in an academic setting. A survey was generated and administered to REI fellows and attendings practicing in programs across the United States. Descriptive statistics were used to quantify results regarding clinical volume, academic responsibilities, clinical safety, and fellowship education. RESULTS: The survey response rate was 23%. Eighty-four percent of respondents self-identified as fellows, and 16% identified as program directors or other REI academic instructors. Overall, the survey responses confirmed that the COVID-19 pandemic tremendously affected clinical volume, with 91% of participants reporting their clinical volume decreased by at least half. Although 67% of attendings believed that the changes related to COVID-19 have or will have significantly affected the clinical skills of fellows, 66% of fellows did not believe that their clinical training had been significantly impacted. Sixty-seven percent of fellows and 78% of attendings do not believe that changes related to COVID-19 will affect the ability of fellows to practice independently. CONCLUSION: Even though most attendings surveyed believed that the changes related to COVID-19 would affect the clinical skills of fellows, the cessation of clinical and research activities was short-lived, likely tempering the overall effect on clinical training. Overall, most respondents did not believe that the pandemic significantly affected fellow education.

Assessing Trends in Fellowship Training Among Otolaryngology Residents: A National Survey Study.

OBJECTIVE: To summarize trends in otolaryngology fellowship applications, fellowships selected, and reasons for pursuing a fellowship. STUDY DESIGN: One-page anonymous questionnaire. SETTING: A survey was completed by examinees at the conclusion of their American Board of Otolaryngology-Head and Neck Surgery oral examination from 2011 to 2019. METHODS: Data included age, gender, fellowship type, reasons for doing a fellowship, and type of practice that examinees will enter. Spearman correlation and Pearson chi-square tests were completed. RESULTS: Over the 8-year study, 58% of the 2243 responding examinees did fellowships. The most frequently chosen fellowship was facial plastic surgery (25%), followed by pediatric otolaryngology (21%), head and neck surgery (19%), rhinology (13%), laryngology (9%), and neurotology (8%). The 2 most common reasons for doing a fellowship were desire for additional expertise beyond residency training (35%) and intellectual appeal (30%). Over the study period, the number of residents choosing to do a fellowship increased from 45.6% in 2011 to 61.5% in 2019, with a positive correlation between year and number of residents (r = 0.73, P = .036). When the data were stratified by gender, there were statistically significant differences in fellowship selection (P < .001), notably with women selecting pediatric otolaryngology at a higher frequency than men (30.9% vs 15.8%). CONCLUSION: There is a statistically significant increasing trend of otolaryngology residents who choose to undergo further training in fellowship. These data from a large, long-term study will be valuable in planning for training and workforce needs in the future.

A content and quality evaluation of ACGME-accredited reproductive endocrinology and infertility fellowship program webpages.

PURPOSE: To analyze the content of websites of ACGME-accredited REI fellowship programs in the USA and to determine whether there are differences in content across geographic regions. METHODS: All ACGME-accredited REI fellowship websites active as of September 2020 were evaluated and reviewed using 20 criteria in the following nine domains: program overview, contact information, application information, curriculum, current fellows, research, alumni, faculty, and fellowship benefits. Website content was compared across geographic regions (Northeast, Midwest, South, and West) of the USA. Analyses were completed using chi-squared univariate tests with p < 0.05 considered statistically significant. RESULTS: Out of the 49 accredited REI fellowship programs, 45 (92%) had a dedicated website. The most commonly available information included a program description (88%), clinical sites (84%), and application requirements (78%). Programs less commonly shared information regarding research requirements and didactics (65% for each). Current fellows were featured in 55% of websites with their pictures displayed in 41% and ongoing research in 20%. Salary and alumni information were included in only 14% and 12% of sites, respectively. When comparing content by geographic region, programs in the South had less information regarding application requirements (p < 0.001), interview dates (p = 0.03), and clinical sites (p = 0.04) compared to all other regions. CONCLUSIONS: REI fellowship websites have significant variability in content available to applicants, and many are lacking information about core fellowship requirements. An informative and well-constructed website has the potential to improve perception of a graduate program.

Fellowship in Immediate Medical Care examination: applicability to the Defence Medical Services.

The Fellowship in Immediate Medical Care (FIMC) is the highest level of formal qualification available for pre-hospital practitioners, aiming to test the knowledge, technical and non-technical skills of those providing specialist Pre-Hospital Emergency Care (PHEC). The FIMC is a multiprofessional examination with the potential to support continuous quality improvement of the PHEC that the Defence Medical Services (DMS) can offer to our patients now and in the future. The aim of this article is to inform the readership about the evolution of the FIMC examination and its applicability to military clinicians (and their civilian counterparts). A secondary aim is to inform those who are preparing for the examination.

The Impact of the Global SARS-CoV-2 (COVID-19) Pandemic on Neuroanesthesiology Fellowship Programs Worldwide and the Potential Future Role for ICPNT Accreditation.

BACKGROUND: The COVID-19 pandemic is an international crisis placing tremendous strain on medical systems around the world. Like other specialties, neuroanesthesiology has been adversely affected and training programs have had to quickly adapt to the constantly changing environment. METHODS: An email-based survey was used to evaluate the effects of the pandemic on clinical workflow, clinical training, education, and trainee well-being. The impact of the International Council on Perioperative Neuroscience Training (ICPNT) accreditation was also assessed. RESULTS: Responses were received from 14 program directors (88% response rate) in 10 countries and from 36 fellows in these programs. Clinical training was adversely affected because of the cancellation of elective neurosurgery and other changes in case workflow, the introduction of modified airway and other protocols, and redeployment of trainees to other sites. To address educational demands, most programs utilized online platforms to organize clinical discussions, journal clubs, and provide safety training modules. Several initiatives were introduced to support trainee well-being during the pandemic. Feelings of isolation and despair among trainees varied from 2 to 8 (on a scale of 1 to 10). Fellows all reported concerns that their clinical training had been adversely affected by the coronavirus disease 2019 (COVID-19) pandemic because of decreased exposure to elective subspecialty cases and limited opportunities to complete workplace-based assessments and training portfolio requirements. Cancellation of examination preparation courses and delayed examinations were cited as common sources of stress. Programs accredited by the ICPNT reported that international networking and collaboration was beneficial to reduce feelings of isolation during the pandemic. CONCLUSION: Neuroanesthesia fellowship training program directors introduced innovative ways to maintain clinical training, educational activity and trainee well-being during the COVID-19 pandemic.

Succeeding in Aging Research During the Pandemic: Strategies for Fellows and Junior Faculty.

Fellows and junior faculty conducting aging research have encountered substantial new challenges during the COVID-19 pandemic. They report that they have been uncertain how and whether to modify existing research studies, have faced difficulties with job searches, and have struggled to balance competing pressures including greater clinical obligations and increased responsibilities at home. Many have also wondered if they should shift gears and make COVID-19 the focus of their research. We asked a group of accomplished scientists and mentors to grapple with these concerns and to share their thoughts with readers of this journal.

Current Trends in Compensation for Fellowship in Minimally Invasive Gynecologic Surgery Graduates: A 6-Year Follow-Up.

STUDY OBJECTIVE: To present updated information regarding compensation patterns for Fellowship in Minimally Invasive Gynecologic Surgery (FMIGS)-graduated physicians in the United States beginning practice during the last 10 years, focusing on the variables that have an impact on differences in salary, including gender, fellowship duration, geographic region, practice setting, and practice mix. DESIGN: An online survey was sent to FMIGS graduates between March 15, 2019 and April 12, 2019. Information on physicians' demographics, compensation (on the basis of location, practice model, productivity benchmarks, academic rank, and years in practice), and attitudes toward fairness in compensation was collected. SETTING: Online survey. PARTICIPANTS: FMIGS graduates practicing in the United States. INTERVENTION: E-mail survey. MEASUREMENTS AND MAIN RESULTS: We surveyed 298 US FMIGS surgeons who had graduated during the last 10 years (2009-2018). The response rate was 48.7%. Most of the respondents were women (69%). Most of the graduates (84.8%) completed 2- or 3-year fellowship programs. After adjustment for inflation, the median starting salary for the first postfellowship job was $252 074 ($223 986-$279 983) (Table 1). The median time spent in the first job was 2.6 years, and the median total salary at the current year rose to $278 379.4 ($241 437-$350 976). The median salary for respondents entering a second postfellowship job started at $280 945 ($261 409-$329 603). Significantly lower compensation was reported for female FMIGS graduates in their initial postfellowship jobs and was consistently lower than for that of men over time. Most FMIGS graduates (59.7%) reported feeling inadequately compensated for their level of specialization. CONCLUSION: A trend toward higher self-reported salaries is noted for FMIGS graduates in recent years, with significant differences in compensation between men and women. Among obstetrics and gynecology subspecialists, FMIGS graduates earn significantly less than other fellowship-trained physicians, with median salaries that are lower than those of generalist obstetrics and gynecology physicians.

Good practices in harnessing social media for scholarly discourse, knowledge translation, and education.

INTRODUCTION: There still remains a gap between those who conduct science and those who engage in educating others about health sciences through various forms of social media. Few empirical studies have sought to define useful practices for engaging in social media for academic use in the health professions. Given the increasing importance of these platforms, we sought to define good practices and potential pitfalls with help of those respected for their work in this new field. METHODS: We conducted a qualitative study, guided by constructivist grounded theory principles, of 17 emerging experts in the field of academic social media. We engaged in a snowball sampling technique and conducted a series of semi-structured interviews. The analytic team consisted of a diverse group of researchers with a range of experience in social media. RESULTS: Understanding the strengths of various platforms was deemed to be of critical importance across all the participants. Key to building online engagement were the following: 1) Culture-building strategies; 2) Tailoring the message; 3) Responsiveness; and 4) Heeding rules of online engagement. Several points of caution were noted within our participants' interviews. These were grouped into caveat emptor and the need for critical appraisal, and common pitfalls when broadcasting one's self. DISCUSSION: Our participants were able to share a number of key practices that are central to developing and sharing educational content via social media. The findings from the study may guide future practitioners seeking to enter the space. These good practices support professionals for effective engagement and knowledge translation without being harmed.