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1.
Medicine (Baltimore) ; 100(6): e24690, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578603

RESUMO

ABSTRACT: Pediatric procedural sedation (PPS) is often performed outside of the operating room, and by various sub-specialty providers. There is no consistency in how pediatric emergency medicine (PEM) fellows are trained in PPS. The objective of this study was to survey PEM program directors (PDs) and PEM fellows about their current sedation teaching practices via a direct survey. While many fellowship programs train PEM fellows in PPS, we hypothesize that there is no consistent method of developing and measuring this skill.A 12-question survey was sent to PEM PDs directly via email. A separate 17-question survey was sent to current PEM fellows via their program coordinators by email. Each survey had multiple choice, yes-no and select-all program questions. Responses were collected in an online (REDCap) database and summarized as frequencies and percentages.Based on identifiable email, 67 programs were contacted, with a PD response rate of 46 (59%). Sixty-two program coordinators were contacted based on identifiable email with 78 fellow responses. We noted that 11/46 PD respondents offer a formal PPS rotation. Thirty programs report using propofol in the emergency department and 93% of PD respondents (28/30) actively train fellows in the use of propofol. Approximately 62% of PEM fellow respondents (48/78) report sedating without any attending oversight. Twenty-eight percent of PEM fellow respondents report using simulation as a component of their sedation training.PPS is a critical skill. However, there is a lack of consistency in both education and evaluation of competency in this area. An organized PPS rotation would improve PPS case exposure and PPS skills.


Assuntos
Anestesiologia/educação , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Medicina de Emergência Pediátrica/educação , Anestésicos Intravenosos/administração & dosagem , Anestésicos Intravenosos/uso terapêutico , Competência Clínica/estatística & dados numéricos , Gerenciamento de Dados , Educação de Pós-Graduação em Medicina/métodos , Escolaridade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Propofol/administração & dosagem , Propofol/uso terapêutico , Treinamento por Simulação/estatística & dados numéricos , Inquéritos e Questionários
2.
Medicine (Baltimore) ; 100(2): e23540, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466120

RESUMO

ABSTRACT: The independent plastic surgery pathway recruits candidates with 5 years of surgical training who are typically more advanced in research than their integrated counterparts. Research productivity helps to discriminate between applicants. However, no studies exist detailing the academic attributes of matched independent plastic surgery candidates.We performed a cohort study of 161 independent plastic surgery fellows from accredited residency programs from the 2015 to 2017 application cycles. We performed a bibliometric analysis utilizing Scopus, PubMed, and Google Scholar to identify research output measures at the time of application.The cohort was predominantly men (66%) with a median of 3 articles and a H-index of 1 at the time of application. Interestingly, 16% of successful candidates had no published articles at the time of application, and this did not change significantly over time (P = .0740). Although the H-index remained stable (R 0.13, P = .1095), the number of published journal articles per candidate significantly decreased over 3 consecutive application cycles (R -0.16, P = .0484). Analysis of article types demonstrated a significant increase in basic science articles (R 0.18, P = .0366) and a concurrent decrease in editorial-type publications (R = -0.18, P = .0374).Despite the decline in publication volume of matched independent plastic surgery fellows, the quality of their research portfolio has remained constant. Matched applicants appear to be shifting focus from faster-to-publish articles to longer but higher impact projects. In selecting a training route, applicants must weigh the highly competitive integrated path against the dwindling number of independent positions.


Assuntos
Pesquisa Biomédica/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Cirurgia Plástica/educação , Bibliometria , Pesquisa Biomédica/normas , Feminino , Médicos Graduados Estrangeiros/estatística & dados numéricos , Humanos , Masculino , Fatores de Tempo
3.
Am J Surg ; 221(1): 90-94, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32650977

RESUMO

BACKGROUND: Females comprise 1/3 of general surgery residents, 1/4 of surgical faculty and 10% of full professors. Inadequate sponsorship is one proposed mechanism for this decline. This study evaluated letters of recommendation (LOR) among applicants applying to a complex general surgical oncology (CGSO) fellowship. METHODS: Linguistic analysis of LOR for CGSO applicants was conducted. Demographics of authors and features of the LOR were extracted. Differences by gender of the applicant were analyzed. RESULTS: Among 340 letters, 67% were written for male and 33% written for female applicants. Males authored 84% of letters reviewed. Female authors used more grindstone adjectives than males (3.61 v 2.90). However, this difference was seen only among letters written for male applicants (3.82 v. 2.73). All other linguistic features were similar, aside from mention of physical appearance which was significantly more common in letters written about female applicants (4% v. 1%). CONCLUSIONS: Female authors write substantively different letters than males. Physical appearance is a small but important difference in letters for female applicants.


Assuntos
Correspondência como Assunto , Bolsas de Estudo/estatística & dados numéricos , Cirurgia Geral/estatística & dados numéricos , Candidatura a Emprego , Oncologia/estatística & dados numéricos , Seleção de Pessoal/estatística & dados numéricos , Feminino , Humanos , Masculino , Fatores Sexuais
4.
N Z Med J ; 133(1527): 15-25, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332325

RESUMO

AIM: This paper outlines the results of the Royal Australian and New Zealand College of Radiologists (RANZCR) Faculty of Radiation Oncology (FRO) 2018 workforce census. Here we report the responses of New Zealand radiation oncologists and trainees in order to understand characteristics of the New Zealand radiation oncology workforce. METHOD: The workforce census was conducted online during July-September 2018. Distribution was by Survey Monkey to all radiation oncologists (fellows, life members, educational affiliates, retired) and trainees on the RANZCR membership database, including members from Australia, New Zealand and Singapore. All responses were aggregated for analysis. This paper addresses only responses from New Zealand members. The census was designed to explore issues relevant to the New Zealand workforce, and questions from previous workforce censuses were repeated in order to monitor trends. RESULTS: The response rate for New Zealand radiation oncologists was 73.3% (44/60). The majority (67%) were male. The average age was 50.8 years. Three-fifths (59.5%) reported New Zealand ethnicity. One-third obtained their specialist qualifications outside of Australia and New Zealand. Most worked in the public sector only (63.4%), with only two in exclusive private practice. Most radiation oncologists attained a consultant post immediately on completion of training, but there were 26 who pursued an overseas fellowship. Most worked one full-time equivalent or greater (FTE), with 17.5% working less than 1.0 FTE. Radiation oncologists reported working a median of 50.0 hours per week, with half working over 10 hours above their contracted hours. Most time was spent on clinical duties with minimal time spent on research. Radiation oncologists reported seeing an average of 235 new patients per year (median: 230). Leadership positions were held by 21/43 respondents. Within 15 years, 55% of the current workforce reported an intention to retire, including 30% of those currently practising highly specialised brachytherapy. Females in the workforce were less likely to work fulltime and spent less time in research and management activities. All trainees reported full-time work, although 50% expressed a desire for part-time training. Half of the trainees reported working 6-10 hours on call, and 60% reported two or less hours of protected teaching per week. Despite this, 90% of trainees were satisfied with their career choice. CONCLUSIONS: Radiation oncology is a small specialty in New Zealand, with a significant reliance on overseas-trained specialists. The specialty continues to work significant overtime hours while time spent on research and non-clinical duties remains low. The growth in staffing between the 2014 and 2018 census has been low. Trainee numbers do not appear sufficient to meet the demand for replacing staff, due to retirements and the reduction of hours. Radiation intervention rates are low in New Zealand, but growth would be reliant on an expansion of the workforce beyond simply replacing staff losses. The radiation oncology workforce in New Zealand remains vulnerable, and careful consideration must be given to expansion and retention to ensure a viable workforce for the future.


Assuntos
Mão de Obra em Saúde/estatística & dados numéricos , Radio-Oncologistas/estatística & dados numéricos , Radioterapia (Especialidade)/educação , Radioterapia (Especialidade)/estatística & dados numéricos , Adulto , Braquiterapia/estatística & dados numéricos , Censos , Emprego/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Prática Privada/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Radio-Oncologistas/provisão & distribução , Aposentadoria/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
5.
Obstet Gynecol ; 136(5): 987-994, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33030868

RESUMO

OBJECTIVE: To assess whether a pediatric and adolescent gynecology electronic learning (eLearning) module improves knowledge and clinical performance among obstetrics and gynecology residents. METHODS: We conducted a multi-institutional, single-blinded, randomized controlled trial across four university programs; three had pediatric and adolescent gynecology rotations, and two had pediatric and adolescent gynecology fellowship-trained faculty. Applying permutated block randomization, residents were randomized to no intervention or completion of a validated eLearning module on prepubertal bleeding. All residents subsequently completed a pediatric and adolescent gynecology-related knowledge assessment that queried understanding of prepubertal bleeding and an objective structured clinical examination that assessed history collection, performance of a prepubertal genital examination, vaginal culture, and vaginoscopy for a pediatric patient. Objective structured clinical examinations were videotaped and reviewed by two faculty, blinded to randomization group; interrater reliability score was 97%. We calculated descriptive frequencies and compared randomization groups using χ analyses and Fisher exact tests for categorical variables, and median tests for continuous variables; a value of P<.05 was considered significant. RESULTS: From July 2018 to June 2019, we invited 115 residents to participate; 97 (83%) completed both objective structured clinical examination and follow-up knowledge assessments. Most were female (91%) and the majority reported limited pediatric and adolescent gynecology didactic or clinical experience, with 36% reporting prior didactics on prepubertal vaginal bleeding and 33% reporting prior exposure to the prepubertal genital examination. Forty-five participants (46%) were randomized to the module and groups were similar across training levels. Residents assigned to the module scored significantly higher on the knowledge assessment (4/5 vs 2/5, P<.001) and objective structured clinical examination (13/16 vs 7/16, P<.001) and were more likely to avoid a speculum in the examination of a pediatric patient (95.6% vs 57.7%, P<.001). CONCLUSION: Our pediatric and adolescent gynecology eLearning module resulted in improved short-term resident knowledge and simulated clinical skills among obstetrics and gynecology residents. Applying this learning technique in other programs may help address deficiencies in pediatric and adolescent gynecology education and training.


Assuntos
Competência Clínica/estatística & dados numéricos , Ginecologia/educação , Internato e Residência/estatística & dados numéricos , Pediatria/educação , Treinamento por Simulação/métodos , Adolescente , Adulto , Criança , Currículo , Avaliação Educacional , Bolsas de Estudo/métodos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Ginecologia/métodos , Humanos , Internato e Residência/métodos , Pediatria/métodos , Reprodutibilidade dos Testes , Método Simples-Cego
7.
Anesth Analg ; 131(4): 1201-1209, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925341

RESUMO

BACKGROUND: The critical question of racial and gender diversity in pediatric anesthesia training programs has not been previously explored. The primary objective of this study was to evaluate trends by race/ethnicity and gender in pediatric anesthesiology fellowship training programs in the United States for the years 2000 to 2018. METHODS: Demographic data on pediatric anesthesiology fellows and anesthesiology residents were obtained from the self-reported data collected for the Journal of the American Medical Association's annual report on Graduate Medical Education for the years 2000 to 2018. Diversity was assessed by calculating the proportions of trainees per year by gender and racial/ethnic groups in pediatric anesthesiology fellowship and anesthesiology residency programs. Logistic regression equations were developed to estimate the annual growth rate of each racial/ethnic groups. RESULTS: The number of pediatric anesthesiology fellows increased from 57 trainees in 2000-2001 to 202 in 2017-2018 at an average rate of 9 fellows per year (95% confidence interval [CI], 8-10). These increases were primarily due to white trainees (54.4%-63.4%) as the proportions of black (7.0%-4.5%), Asian (26.3%-21.3%), and other minority (12.3%-10.9%) trainees have remained low. The number of anesthesiology residents increased from 3950 trainees in 2000-2001 to 5940 in 2017-2018 at an average rate of 99 residents per year (95% CI, 88-111). Within all anesthesiology trainees, these increases were due to white trainees (55.7%-61.3%) as the proportion of black (5.0%-6.0%), Asian (25.8%-24.1%), and other minority trainees (8.2%-8.5%) has remained fairly constant over the time period. Despite the overall lower proportion of female anesthesiology residents (range: 27.0%-37.5%), a steady increase in the number of women in pediatric anesthesiology fellowship programs has reversed the gender imbalance in this population as of 2010. CONCLUSIONS: While historic gains have been made in gender diversity in pediatric anesthesiology, there is persistent underrepresentation of black and Hispanic trainees in pediatric anesthesiology. It appears that their low numbers in anesthesiology residency programs (the reservoir) may be partly responsible. Efforts to increase ethnic/racial diversity in pediatric anesthesiology fellowship and anesthesiology residency training programs are urgently needed.


Assuntos
Anestesiologia/educação , Grupos Étnicos/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Pediatria/educação , Sexismo/estatística & dados numéricos , Adulto , Afro-Americanos , Americanos Asiáticos , Criança , Estudos de Coortes , Educação de Pós-Graduação em Medicina , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Grupos Minoritários , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos , Adulto Jovem
8.
Plast Reconstr Surg ; 146(2): 217e-220e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740601

RESUMO

BACKGROUND: The gender disparity between the number of female and male chairs and program directors has been previously established. The aim of this study was to determine whether any differences in objective credentials existed between male and female plastic surgery department chairs/division chiefs and program directors. METHODS: Information about each plastic surgery program director and chair/chief was extracted from the websites of all institutions affiliated with a plastic surgery residency program. For each individual, information about the length of their career, number of fellowships completed, and number of publications was recorded. The two-tailed t test was used to compare differences between male and female chairs and program directors. RESULTS: A total of 99 chairs were recorded, of which nine (9.1 percent) were female. Of the 99 program directors, 13 (13.1 percent) were female. There was no difference in the number of years in practice or number of fellowships between men and women for either position. On average, male chairs had significantly fewer publications than female chairs (71.9 versus 128; p < 0.05). There was no significant difference in the number of publications between male and female program directors. Compared to program directors, chairs had significantly more years in practice and numbers of publications, which held true for both men and women. CONCLUSIONS: Women are not only underrepresented in the department chair and program director positions, but also possess higher qualifications that may reflect differences in standards for promotion and appointment. Additional research is needed to elucidate the reasons behind the observed differences in qualifications.


Assuntos
Docentes de Medicina/organização & administração , Internato e Residência/organização & administração , Seleção de Pessoal/ética , Sexismo , Cirurgia Plástica/organização & administração , Docentes de Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/ética , Internato e Residência/estatística & dados numéricos , Liderança , Masculino , Publicações/estatística & dados numéricos , Cirurgia Plástica/ética , Cirurgia Plástica/estatística & dados numéricos
9.
BMC Public Health ; 20(1): 1030, 2020 Jun 29.
Artigo em Inglês | MEDLINE | ID: mdl-32600381

RESUMO

BACKGROUND: Since its inception in 2009, the Consortium for Advanced Research Training in Africa (CARTA) program has focused on strengthening the capacity of nine African universities and four research centres to produce skilled researchers and scholars able to improve public and population health on the continent. This study describes the alignment between CARTA-supported doctoral topics and publications with the priorities articulated by the African public and population health research agenda. METHODS: We reviewed the output from CARTA PhD fellows between 2011 and 2018 to establish the volume and scope of the publications, and the degree to which the research focus coincided with the SDGs, World Bank, and African Development Bank research priority areas. We identified nine key priority areas into which the topics were classified. RESULTS: In total, 140 CARTA fellows published 806 articles in peer-reviewed journals over the 8 years up to 2018. All the publications considered in this paper had authors affiliated with African universities, 90% of the publications had an African university first author and 41% of the papers have CARTA fellows as the first author. The publications are available in over 6300 online versions and have been cited in over 5500 other publications. About 69% of the published papers addressed the nine African public and population health research agenda and SDG priority areas. Infectious diseases topped the list of publications (26.8%), followed by the health system and policy research (17.6%), maternal and child health (14.7%), sexual and reproductive health (14.3%). CONCLUSIONS: Investments by CARTA in supporting doctoral studies provides fellows with sufficient training and skills to publish their research in fields of public and population health. The number of publications is understandably uneven across Africa's public and population priority areas. Even while low in number, fellows are publishing in areas such as non-communicable disease, health financing, neglected tropical diseases and environmental health. Violence and injury is perhaps underrepresented. There is need to keep developing research capacity in partner institutions with low research output by training more PhDs in such institutions and by facilitating enabling environments for research.


Assuntos
Educação Profissional em Saúde Pública/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Editoração/estatística & dados numéricos , Pesquisadores/educação , África , Humanos , Universidades
11.
Am J Ophthalmol ; 218: 261-267, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32574772

RESUMO

PURPOSE: To describe applicant characteristics and outcomes associated with the ophthalmology fellowship match. DESIGN: Retrospective case-control study. METHODS: This study took place in San Francisco and matched data for ophthalmology fellowship applicants in the USA. The study population was registrants for the 2010-2017 ophthalmology fellowship match cycles. The match rate took place during the 8-year study period. Applicant characteristics were stratified by match status and factors associated with matching to ophthalmology fellowship positions. RESULTS: Between 2010 and 2017, most applicants (2,558/3,471; 73.7%) were matched into ophthalmology fellowship programs. No difference over time in the proportion of applicants that matched for fellowship was identified (P = .41). On average, ophthalmology residents who were matched into fellowships had higher step 1 (difference: 9; 99% confidence interval [CI]: 6.8-10.9; P < .001), step 2 (difference: 9.5; 99% CI: 7-12; P < .001), and step 3 (difference: 7.4; 99% CI: 5-9.7; P <.001) scores than those who did not match. Applicants who matched also had a greater number of application distributions (difference: 9.6; 99% CI: 7.9-11.2; P < .001), and ranked programs on the match list (difference: 6.2; 99% CI: 5.8-6.7; P < .001). Among applicants who matched, 15% matched at the same institute, 29% matched in the same state, and 45% matched in the same region. On multivariable analysis, factors associated with an increased likelihood of matching into an ophthalmology fellowship program included graduates from the US versus graduates from non-US residency programs (odds ratio [OR]: 2.09; 99% CI: 1.27-3.44; P <.001), increasing percentage of applications ranked (number of ranked programs and/or number of applications distributed) (OR: 1.02; 99% CI: 1.02-1.03; P < .001) as well as having ranked more programs (OR: 1.24; 99% CI: 1.17-1.31; P < .001). Medical graduate status outside of the US (OR: 0.58; 99% CI: 0.36-0.93; P < .001) was associated with decreased odds of matching for fellowship. CONCLUSIONS: From 2010 to 2017, approximately three-quarters of residents applying for an ophthalmology fellowship position matched. Factors associated with increased likelihood of matching included the applicant's graduating from a U.S. residency, graduating from a U.S. medical school, ranking more programs, and having a higher percentage of applications ranked (number of programs ranked by applicant and/or number of applications distributed). The information gained from this study may help applicants as they consider applying to fellowship programs.


Assuntos
Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Oftalmologia/educação , Estudos de Casos e Controles , Bases de Dados Factuais , Feminino , Humanos , Masculino , Estudos Retrospectivos , São Francisco , Critérios de Admissão Escolar
12.
J Trauma Acute Care Surg ; 88(5): 629-635, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32320176

RESUMO

BACKGROUND: Interest in acute care surgery (ACS) has increased over the past 10 years as demonstrated by the linear increase in fellowship applicants to the different fellowships leading to ACS careers. It is unclear why interest has increased, whether various fellowship pathways attract different applicants or whether fellowship choice correlates with practice patterns after graduation. METHODS: An online survey was distributed to individuals previously registered with the Surgical critical care and Acute care surgery Fellowship Application Service. Fellowship program directors were also asked to forward the survey to current and former fellows to increase the response rate. Data collected included demographics, clinical interests and motivations, publications, and postfellowship practice patterns. Fisher's exact and Pearson's χ were used to determine significance. RESULTS: Trauma surgery was the primary clinical interest for all fellowship types (n = 273). Fellowship type had no impact on academic productivity or practice patterns. Most fellows would repeat their own fellowship. The 2-year American Association for the Surgery of Trauma-approved fellowship was nearly uniformly reported as the preferred choice among those who would perform a different fellowship. Career motivations were similar across fellowships and over time though recent trainees were more likely to consider predictability of schedule a significant factor in career choice. Respondents reported graduated progression to full responsibility, further exposure to trauma care and additional operative technical training as benefits of a second fellowship year. CONCLUSION: American Association for the Surgery of Trauma-approved 2-year fellows appear to be the most satisfied with their fellowship choice. No differences were noted in academic productivity or practice between fellowships. Future research should focus on variability in trauma training and operative experience during residency and in practice to better inform how a second fellowship year would improve training for ACS careers. LEVEL OF EVIDENCE: Descriptive, mixed methods, Level IV.


Assuntos
Escolha da Profissão , Cuidados Críticos , Bolsas de Estudo/tendências , Cirurgia Geral/educação , Internato e Residência/tendências , Adulto , Idoso , Competência Clínica , Bolsas de Estudo/estatística & dados numéricos , Feminino , Cirurgia Geral/métodos , Cirurgia Geral/estatística & dados numéricos , Humanos , Internato e Residência/normas , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
13.
J Grad Med Educ ; 12(2): 162-167, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322349

RESUMO

Background: Parenting issues can affect physicians' choice of specialty or subspecialty, as well as their selection of individual training programs, because of the distinctive challenges facing residents and fellows with children. Specific information about how residents perceive these challenges is limited. Objective: We sought to better understand the challenges associated with parenting during residency and fellowship training in order to inform policy and research. Methods: In 2017, a voluntary online questionnaire was distributed to all 2214 Partners HealthCare graduate medical education trainees across 285 training programs. The survey queried attitudes of and about trainees with children and assessed needs and experiences related to parental leave, lactation, and childcare. Responses were compared between subgroups, including gender, surgical versus nonsurgical specialty, parental status, and whether the respondent was planning to become a parent. Results: A total of 578 trainees (26%) responded to the questionnaire. Of these, 195 (34%) became parents during training. An additional 298 (52%) planned to become parents during training. Respondents overwhelmingly agreed that their institution should support trainees with children (95%) and that doing so is important for trainee wellness (98%). However, 25% felt that trainees with children burden trainees without children. Childcare access, affordability, and availability for sufficient hours were identified as key challenges, along with issues related to parental leave, lactation facilities, and effect on peers. Conclusions: This survey highlights trainees' perspectives about parenting during their clinical training, signaling parental leave, lactation facilities, and childcare access and affordability as particular challenges and potential targets for future interventions.


Assuntos
Bolsas de Estudo/organização & administração , Internato e Residência/organização & administração , Poder Familiar , Adulto , Atitude do Pessoal de Saúde , Cuidado da Criança/economia , Cuidado da Criança/estatística & dados numéricos , Pré-Escolar , Educação de Pós-Graduação em Medicina , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Lactente , Internato e Residência/estatística & dados numéricos , Lactação , Masculino , Massachusetts , Determinação de Necessidades de Cuidados de Saúde , Licença Parental/estatística & dados numéricos , Gravidez , Inquéritos e Questionários
14.
J Grad Med Educ ; 12(2): 212-216, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322356

RESUMO

Background: Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. Objective: We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. Methods: We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. Results: Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. Conclusions: Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties.


Assuntos
Escolha da Profissão , Tomada de Decisões , Medicina Interna/educação , Internato e Residência/estatística & dados numéricos , Estudos de Coortes , Educação de Pós-Graduação em Medicina , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários , Fatores de Tempo
15.
J Grad Med Educ ; 12(2): 217-220, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32322357

RESUMO

Background: International medical graduates (IMGs) form a significant portion of the physician workforce in the United States and are vital in filling training slots due to a shortage of American medical graduates. Most often, IMGs require visa sponsorship, which must be solidified before applying for a residency or fellowship. Objective: We examined the association of H-1B visa sponsorship on retention of physician trainees within the state of Ohio. Methods: This was a single institutional study that examined all visa-sponsored residency and fellowship graduates who entered fully licensed clinical practice between 2006 and 2015. Practice location was ascertained immediately upon completion of training and at follow-up to determine which visa group (H-1B or J-1) were more likely to initially practice in Ohio after graduation and remain within the state. Results: Of 103 visa-sponsored residency and fellowship graduates, 42 were H-1B sponsored and 61 were J-1-sponsored. Fifty-two percent (22) of H-1B visa-sponsored trainees and 31% (19) of J-1 visa-sponsored trainees were retained in Ohio after graduation. At follow-up, 40% (17) of H-1B and 26% (16) of J-1 visa holders remained in the state. Conclusions: H-1B visa-sponsored trainees were more likely than those with J-1 visas to practice in the state of Ohio after graduation. Regardless of visa status, graduates tended not to change their geographical location over time.


Assuntos
Bolsas de Estudo/estatística & dados numéricos , Médicos Graduados Estrangeiros/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/estatística & dados numéricos , Emigração e Imigração/legislação & jurisprudência , Humanos , Ohio , Médicos/provisão & distribução
16.
J Shoulder Elbow Surg ; 29(7): e269-e278, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32336604

RESUMO

BACKGROUND: The incidence of various open shoulder procedures has changed over time. In addition, various fellowships provide overlapping training in open shoulder surgery. There is a lack of information regarding the relationship between surgeon training and open shoulder procedure type and incidence in early career orthopedic surgeons. METHODS: The American Board of Orthopaedic Surgery Part-II database was queried from 2002 to 2016 for reported open shoulder procedures. The procedures were categorized as follows: arthroplasty, revision arthroplasty, open instability, trauma, and open rotator cuff. We evaluated procedure trends as well as their relationship to surgeon fellowship categorized by Sports, Shoulder/Elbow, Hand, Trauma, and "Other" fellowship as well as no fellowship training. We additionally evaluated complication data as it related to procedure, fellowship category, and volume. RESULTS: Over the 2002-2016 study period, there were increasing cases of arthroplasty, revision arthroplasty, and trauma (P < .001). There were decreasing cases in open instability and open rotator cuff (P < .001). Those with Sports training reported the largest overall share of open shoulder cases. Those with Shoulder/Elbow training reported an increasing overall share of arthroplasty cases and higher per candidate case numbers. The percentage of early career orthopedic surgeons reporting 5 or more arthroplasty cases was highest among Shoulder/Elbow candidates (P < .001). Across all procedures, those without fellowship training were least likely to report a complication (odds ratio [OR], 0.76; 95% confidence interval, 0.67-0.86; P < .001). Shoulder/Elbow candidates were least likely to report an arthroplasty complication (OR, 0.84, P = .03) as was any surgeon reporting 5 or more arthroplasty cases (OR, 0.81; 95% confidence interval, 0.70-0.94; P = .006). CONCLUSION: The type and incidence of open shoulder surgery procedures continues to change. Among early career surgeons, those with more specific shoulder training are now performing the majority of arthroplasty-related procedures, and early career volume inversely correlates with complications.


Assuntos
Procedimentos Ortopédicos/tendências , Cirurgiões Ortopédicos/tendências , Ortopedia/tendências , Articulação do Ombro/cirurgia , Artroplastia/estatística & dados numéricos , Competência Clínica , Bases de Dados Factuais , Bolsas de Estudo/estatística & dados numéricos , Humanos , Instabilidade Articular/cirurgia , Cirurgiões Ortopédicos/educação , Cirurgiões Ortopédicos/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Reoperação/estatística & dados numéricos , Lesões do Manguito Rotador/cirurgia , Estados Unidos
17.
World Neurosurg ; 139: e373-e382, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32305615

RESUMO

OBJECTIVE: The process of fellowship selection remains unclear and heterogeneous among subspecialties in neurosurgery. We surveyed neurosurgical residents applying for subspecialty fellowships about their experiences to evaluate the process and find areas for improvement. METHODS: We distributed an online, nationwide survey to 153 U.S. neurosurgical residents (postgraduate years 5-7) identified via the American Association of Neurological Surgeons resident database. RESULTS: Sixty-nine residents responded to the survey, representing a variety of subspecialties. Most residents applied for 2-5 programs (45%) and completed 2-5 interviews (45%). The primary methods of finding fellowships were via word of mouth (68%) and faculty mentors (67%), followed by Web sites and reaching out to fellowship directors (54%) and online database searching (46%). Although many residents applied for fellowships in postgraduate year 5 of training (39%), there was significant variability in times for interviews and offer letters. Most residents accepted their first offer (75%). Most respondents (93%) believed that national neurosurgical societies should help improve the fellowship application process, with reasons including a common application and due dates (29%), fellowship database with program details (29%), and improved coordination of interviews (23%). Regarding a nationalized match system, residents were roughly split among opposed (38.6%), neutral (26.3%), and supportive (35.1%). CONCLUSIONS: These survey results suggested that the neurosurgical fellowship application process could be improved by a common application, public listing of programs, standardized dates for application, and improved coordination of interviews. Residents are generally supportive of having an improved organization of the match and/or a national fellowship match.


Assuntos
Bolsas de Estudo/estatística & dados numéricos , Neurocirurgia/educação , Atitude do Pessoal de Saúde , Educação de Pós-Graduação em Medicina , Humanos , Internato e Residência , Mentores , Seleção de Pessoal , Inquéritos e Questionários , Estados Unidos
18.
PLoS One ; 15(4): e0231135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32302321

RESUMO

When allocating resources, people often diversify across categories even when those categories are arbitrary, such that allocations differ when identical sets of options are partitioned differently ("partition dependence"). The first goal of the present work (Experiment 1) was to replicate an experiment by Fox and colleagues in which graduate students exhibited partition dependence when asked how university financial aid should be allocated across arbitrarily partitioned income brackets. Our sample consisted of community members at a liberal arts college where financial aid practices have been recent topics of debate. Because stronger intrinsic preferences can reduce partition dependence, these participants might display little partition dependence with financial aid allocations. Alternatively, a demonstration of strong partition dependence in this population would emphasize the robustness of the effect. The second goal was to extend a "high transparency" modification to the present task context (Experiment 2) in which participants were shown both possible income partitions and randomly assigned themselves to one, to determine whether partition dependence in this paradigm would be reduced by revealing the study design (and the arbitrariness of income categories). Participants demonstrated clear partition dependence in both experiments. Results demonstrate the robustness of partition dependence in this context.


Assuntos
Comportamento de Escolha , Alocação de Recursos , Adolescente , Adulto , Connecticut , Bolsas de Estudo/economia , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Renda/estatística & dados numéricos , Masculino , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Universidades/economia , Universidades/estatística & dados numéricos , Adulto Jovem
19.
J Shoulder Elbow Surg ; 29(4): 655-659, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32197760

RESUMO

BACKGROUND: The purpose of this study was to perform a cross-sectional analysis of diversity among academic shoulder and elbow surgeons in the United States. METHODS: US shoulder and elbow surgeons who participated in shoulder and elbow fellowship and/or orthopedic surgery resident education as of November 2018 were included. Demographic data (age, gender, race), practice setting, years in practice, academic rank, and leadership roles were collected through publicly available databases and professional profiles. Descriptive statistics were performed and findings were compared between different racial and gender groups. Statistical significance was set at P <.05. RESULTS: A total of 186 orthopedic shoulder and elbow surgeons were identified as participating in shoulder and elbow fellowship and/or orthopedic surgery residency education. Overall, 83.9% were white, 14.5% were Asian, 1.1% were Hispanic, 0.5% were an other race, and 0% were African American. In addition, 94.6% of surgeons were male, whereas 5.4% were female. Further, 64.5% of all surgeons had been in practice for >10 years, and 39.2% worked in an urban setting. Less than half (40.3%) of the surgeons practicing primarily at academic institutions held a professor rank. White surgeons had a significantly greater time in practice vs. nonwhite surgeons (mean 18.8 vs. 12.6 years, P < .01) and were more likely to hold a professor rank (44.0% vs. 21.7%, P = .04). CONCLUSION: Racial and gender diversity among US shoulder and elbow surgeons who participate in fellowship and residency education is lacking. Hispanic, African American, and female surgeons are underrepresented. Efforts should be made to identify the reasons for these deficiencies and address them to further advance the field of orthopedic shoulder and elbow surgery.


Assuntos
Diversidade Cultural , Cotovelo/cirurgia , Docentes de Medicina/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Ombro/cirurgia , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Feminino , Humanos , Masculino , Ortopedia/educação , Distribuição por Sexo , Estados Unidos
20.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32001489

RESUMO

BACKGROUND: Interest in global health (GH) among pediatric residents continues to grow. GH opportunities in pediatric fellowship programs in the United States are poorly described. We aimed to evaluate GH offerings among accredited general and subspecialty pediatric fellowship programs and identify implementation barriers. METHODS: This was a cross-sectional study by pediatric GH educators from the Association of Pediatric Program Directors Global Health Learning Community and the American Board of Pediatrics Global Health Task Force. Fellowship program directors and GH educators at accredited US pediatric fellowship programs were surveyed. Data were analyzed by using descriptive and comparative statistics. RESULTS: Data were obtained from 473 of 819 (57.8%) fellowship programs, representing 111 institutions. Nearly half (47.4%) offered GH opportunities as GH electives only (44.2%) or GH tracks and/or fellowships (3.2%) (GHT/Fs). Pretravel preparation and supervision were variable. Programs offering GH opportunities, compared to those without, were more likely to report that GH training improves fellow education (81.9% vs 38.3%; P < .001) and recruitment (76.8% vs 35.9%; P < .001). Since 2005, 10 programs with GHT/Fs have graduated 46 fellows, most of whom are working in GH. Of those with GHT/Fs, 71% believe national accreditation of GH fellowships would define minimum programmatic standards; 64% believe it would improve recruitment and legitimize GH as a subspecialty. CONCLUSIONS: GH experiences are prevalent in accredited US pediatric fellowship programs, and programs offering GH perceive that these opportunities improve fellow education and recruitment. Responses suggest that standards for GH opportunities during fellowship would be useful, particularly regarding pretravel preparation and mentorship for trainees.


Assuntos
Bolsas de Estudo , Saúde Global/educação , Pediatria/educação , Canadá , Estudos Transversais , Bolsas de Estudo/estatística & dados numéricos , Humanos , Tutoria/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Estados Unidos
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