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Fellowship Education in Interstitial Lung Disease. A National Survey of Program Directors and Trainees.

ABSTRACT: Background: Whether graduating pulmonary and critical care medicine (PCCM) fellows feel adequately trained in interstitial lung disease (ILD) remains unknown. In addition, there are no published data describing the current approach to educating trainees about ILD. Objective: To characterize the present state of ILD training during fellowship and to determine graduating PCCM fellows' perceived abilities to diagnose and manage ILD. Methods: We surveyed PCCM fellowship program directors nationwide and compared their perceptions of graduating fellows' abilities to diagnose, provide initial management to, and offer longitudinal care to patients with ILD using a series of unpaired t tests. We also inquired about existing practices for educating fellows about ILD. We then surveyed graduating PCCM fellows from 19 different preselected programs to assess comfort level with ILD in comparison with other core clinical domains. Results: Program director respondents (n = 74, 40% response rate) rated graduating fellows' abilities to establish specific ILD diagnoses and to provide initial management similarly (4.3 ± 0.8 on five-point Likert scale), whereas the ability to provide longitudinal expert care was rated significantly lower (3.8 ± 0.9, P = 0.001). Most respondents (n = 52, 70.3%) reported having dedicated outpatient ILD specialists with whom fellows could rotate, but only half required this rotation. In addition, very few (n = 17, 23.0%) reported that a majority of patients with suspected or newly diagnosed ILD were scheduled in fellow clinics, many of whom received subsequent longitudinal care from dedicated ILD specialists. Among 71 third-year fellow respondents, confidence in managing ILD was rated poorly (3.2 ± 1.0 on a five-point Likert scale) in contrast to more common diseases like chronic obstructive pulmonary disease (4.4 ± 0.7, P < 0.001) and asthma (4.2 ± 0.8, P < 0.001). Conclusion: Trainee exposure to ILD in both clinical and educational settings varied across PCCM fellowships nationwide. Fellows nearing graduation were significantly less confident in their ability to manage ILD compared with other more common pulmonary diseases.

SUBMITTER: Natalini JG

PROVIDER: S-EPMC8015767 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionDetermine the consistency, accessibility, and adequacy of parental leave policies for adult and pediatric medicine fellowship programs.MethodsWe administered a 40-question survey to fellowship program directors (PDs) and trainees in adult and pediatric cardiology, hematology/oncology, gastroenterology, and pulmonology/critical care fellowship programs in the United States. We used Chi-square tests to compare proportions for categorical variables and t-tests to compare means for continuous variables.ResultsA total of 190 PDs from 500 programs (38.0%) and 236 trainees from 142 programs (28.4%) responded. Most respondents did not believe that parental leave policies were accessible publicly (322/426; 75.6%), on password-protected intranet (343/426; 80.5%), or upon request (240/426; 56.3%). The PDs and trainees broadly felt that parental leave for fellows should be 5-10 weeks (156/426; 36.6%) or 11-15 weeks (165/426; 38.7%). A majority of PDs felt that there was no increased burden upon other fellows (122/190; 64.2%) or change in overall well-being (110/190; 57.9%). When asked about the biggest barrier to parental leave support, most PDs noted time constrains of fellowship (101/190; 53.1%) and the limited number of fellows (43/190; 22.6%). Trainees similarly selected the time constraints of training (88/236; 37.3%), but nearly one-fifth chose the culture in medicine (44/236; 18.6%). There were no statistically significant differences in answers based on the respondents' sex, specialty, or subspecialty.DiscussionParental leave policies are broadly in place, but did not feel these were readily accessible, standardized, or of optimum length. PDs and trainees noted several barriers that undermine support for better parental leave policies, including time constraints of fellowship, the limited number of fellows for coverage, and workplace culture. Standardization of parental leave policies is advisable to allow trainees to pursue fellowship training and care for their newborns without undermining their educational experiences.

Project description:BackgroundOrthopedic fellowship positions continue to be increasingly competitive, with most orthopedic residency graduates pursuing fellowship after completion of residency. Shoulder and elbow fellowship training represents an increasingly competitive and relatively smaller cohort of applicants than other subspecialties; there are only 29 programs with a total of 40 offered positions. The purpose of this survey is to identify and rank factors considered most important by shoulder and elbow fellowship directors when identifying potential fellowship candidates.MethodsA web-based survey was emailed to all 29 orthopedic shoulder and elbow fellowship directors recognized by American Shoulder and Elbow Surgeons. Demographic information was collected regarding program size, total number of applicants interviewed, and total number of applicants subsequently ranked. The survey also included a list of twelve applicant characteristics which each program director was asked to rank in a sequential order (most important to least). The median score of each factor was calculated, and a weighted score was applied to the top five (of twelve) categories selected by each program. Five points were given to the top-ranked factor. Four points were given to factors ranked 2nd, three points to factors ranked 3rd, two points to factors ranked 4th, and one point to factors ranked 5th. The weighted scores were then used to determine the most highly desired applicant characteristics.ResultsTwenty-two of 29 (76%) orthopedic shoulder and elbow fellowship programs responded to the survey. Fourteen of 22 (64%) programs interview 20 or fewer applicants each year. No programs ranked more than 25 applicants. Twelve of 22 (55%) of program directors rated the interview as the most important factor, whereas 6 of 22 (27%) selected letters of recommendation. Based on the weighted score calculation, interviews, letters of recommendation, and personal connections to the applicant/letter writers comprised the top three categories, respectively, and captured 193 of 330 (58%) of the total available points in the weighted score. Strength of shoulder/elbow experience in residency, ties to the geographical area, and comments made regarding technical competence scored among the lowest factors.ConclusionOrthopedic shoulder and elbow fellowship directors consistently ranked interviews, letters of recommendation, and personal connection to applicant/letter writer higher than other factors when ranking applicants. This information provides both program directors as well as applicants with important information to consider when navigating the shoulder and elbow fellowship application process.

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Fellowship Education in Interstitial Lung Disease. A National Survey of Program Directors and Trainees.

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