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Introduction Fellowship directors (FD) in sports medicine are distinguished leaders and mentors of trainees. There is little literature available regarding their demographics and unique factors and training that have allowed them to rise to their prominent positions. The goal of this study was to identify FDs' demographics, research output, and education with an emphasis on surveying the diversity in these leadership positions. Methods The Accreditation Council for Graduate Medical Education Public Accreditation Data System was used to identify all accredited and active orthopaedic sports medicine fellowship positions for 2019 to 2020. Primary data points for the FDs included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at the current institution, year of FD appointment, and H-index. Student t-tests were used to compare FDs who trained at their current institution versus those who did not. Significance was set at P Results The 87 active sports medicine fellowship programs surveyed were led by 86 FDs and 2 co-FDs. One (1.1%) FD was female, whereas 87 (98.9%) were male. The mean age of the 88 total FDs was 54.5 years (n = 81). FDs were predominantly White (n = 75, 85.2%), followed by Asian American (n = 6, 6.8%), African American (n = 3, 3.4%), Middle Eastern (n = 3, 3.4%), and then Hispanic/Latino (n = 1, 1.1%). Certain associations were observed between FDs' residency and fellowship and future leadership positions. The most frequently reported training locations were Hospital for Special Surgery (residency, N = 10) and the Steadman Clinic (Vail) (fellowship, N = 10). The mean H-index was 22.33 ± 16.88, and FDs leading the fellowship where they trained had significantly lower mean H-indices than FDs who were not (12.57 ± 12.57 versus 24.85 ± 17.56, respectively) (P = 0.02). Conclusion More diversity is possible among sports medicine FDs, who are prominent leaders. Moreover, certain programs are associated with producing a greater number of FDs.

Ultrasound-guided musculoskeletal and spasticity injections have become common procedures in physical medicine and rehabilitation practices, but there are currently no guidelines for teaching these procedures in residency and fellowship training programs. As part of a quality improvement initiative, the authors aimed to assess the educational value of a hands-on cadaver-based workshop for enhancing these skills in residents and fellows. Twenty-seven physical medicine and rehabilitation trainees in a single institution were asked to complete surveys before and after the workshop to assess self-perceived benefits. After the workshop, the overwhelming majority felt improvement in their overall knowledge of ultrasound-guided musculoskeletal (93%) and spasticity (78%) procedures. In addition, the workshop improved the level of comfort of trainees both in planning (70%) and performing (59%) the procedures independently. Improving these skills is especially important considering most trainees plan to incorporate ultrasound-guided musculoskeletal (81%) and spasticity (74%) procedures into their future practices. The framework for this workshop can serve as a template for other programs to incorporate into their own training.

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

Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions and mentored clinical experience. To assist with prioritisation of learning, we have organised relevant pathology and procedures as essential, desirable and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones and a sample objective structured clinical examination to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.

Over the last decade, use of laparoscopy for the treatment of colon cancer has been variable despite evidence of benefit, possibly reflecting surgeon expertise rather than other factors.The purpose of this study was to examine the spatial variation in the use of laparoscopy for colon cancer surgery and to determine what factors may influence use.This was a population-based retrospective analysis from April 2008 to March 2015.All Canadian provinces (excluding Quebec) were included.The study included all patients ≥18 years of age undergoing elective colectomy for colon cancer.The primary outcome was laparoscopy use rates. Predictors of use included patient and disease characteristics, year of surgery, rurality, hospital and surgeon volumes, and distance from a colorectal fellowship training center.A total of 34,725 patients were identified, and 42% underwent laparoscopic surgery. Significant spatial variations in laparoscopy use were identified, with 95% of high-use clusters located ≤100 km and 98% of low-use clusters located100 km from a colorectal fellowship center. There were no high-use clusters located around large academic centers without colorectal fellowships. At the individual level, patients living within 25 km and 26 to 100 km of a fellowship center were 2.6 and 1.6 times more likely to undergo laparoscopic surgery compared with those100 km away (95% CI, 2.47-2.79, p0.00; 95% CI, 1.53-1.71, p0.001). Surgeon and hospital volumes were associated with increased rates of laparoscopy use (p0.001).Data were obtained from an administrative database, and despite 85% to 95% published validity, they remain subject to misclassification, response, and measurement bias.Significant spatial variations in the use of laparoscopy for colon cancer surgery exist. After adjusting for patient and system factors, proximity to a colorectal fellowship training center remained a strong predictor of laparoscopy use. There remain regional variations in colon cancer treatment, with discrepancies in the surgical care offered to Canadian patients based solely on location. See Video Abstract at http://links.lww.com/DCR/B595.ANTECEDENTES:Durante la última década, la utilización de la laparoscopia para el tratamiento del cáncer de colon ha sido variable a pesar de la evidencia de beneficio; posiblemente reflejando la experiencia del cirujano, más que otros factores.OBJETIVO:Examinar la variación espacial en el uso de la laparoscopia para la cirugía del cáncer de colon y determinar qué factores pueden influir en la utilización.DISEÑO:Análisis retrospectivo poblacional de abril de 2008 a marzo de 2015.ENTORNO CLÍNICO:Todas las provincias canadienses (excepto Quebec).PACIENTES:Todos los pacientes18 años sometidos a colectomía electiva por cáncer de colon.PRINCIPALES MEDIDAS DE RESULTADO:El principal resultado fueron las tasas de utilización de laparoscopia. Los predictores de uso incluyeron las características del paciente y la enfermedad, el año de la cirugía, la ruralidad, los volúmenes de hospitales y cirujanos, y la distancia a un centro de formación de residentes colorectales.RESULTADOS:Se identificaron 34.725 pacientes, 42% fueron sometidos a cirugía laparoscópica. Se identificaron variaciones espaciales significativas en el uso de laparoscopia, con el 95% de los conglomerados de alto uso ubicados a100 km y el 98% de los conglomerados de bajo uso ubicados a100 km, desde un centro de residencia colorectal. No había grupos de alto uso ubicados alrededor de grandes centros académicos sin residentes colorrectales. A nivel individual, los pacientes que vivían dentro de los 25 km y 26-100 km de un centro de residentes tenían 2,6 y 1,6 veces más probabilidades de someterse a una cirugía laparoscópica, respectivamente, en comparación con aquellos a100 km de distancia (95% CI 2,47-2,79, p0,00; IC del 95% 1,53-1,71, p0,001). Los volúmenes de cirujanos y hospitales se asociaron con mayores tasas de utilización de laparoscopia (p0,001).LIMITACIONES:Los datos se obtuvieron de una base de datos administrativa y, a pesar de una validez publicada del 85-95%, siguen sujetos a errores de clasificación, respuesta y sesgo de medición.CONCLUSIONES:Existen variaciones espaciales significativas en el uso de la laparoscopia para la cirugía del cáncer de colon. Después de ajustar por factores del paciente y del sistema, la proximidad a un centro de formación de residentes colorectales siguió siendo un fuerte predictor del uso de laparoscopia. Sigue habiendo variaciones regionales en el tratamiento del cáncer de colon, con discrepancias en la atención quirúrgica ofrecida a los pacientes canadienses basadas únicamente en la ubicación. Consulte Video Resumen en http://links.lww.com/DCR/B595.

Background A significant proportion of glioblastoma (GBM) patients are considered for repeat resection, but evidence regarding best management remains elusive. Our aim was to measure the degree of clinical uncertainty regarding reoperation for patients with recurrent GBM. Methods We first performed a systematic review of agreement studies examining the question of repeat resection for recurrent GBM. An electronic portfolio of 37 pathologically confirmed recurrent GBM patients including pertinent magnetic resonance images and clinical information was assembled. To measure clinical uncertainty, 26 neurosurgeons from various countries, training backgrounds, and years' experience were asked to select best management (repeat surgery, other nonsurgical management, or conservative), confidence in recommended management, and whether they would include the patient in a randomized trial comparing surgery with nonsurgical options. Agreement was evaluated using κ statistics. Results The literature review did not reveal previous agreement studies examining the question. In our study, agreement regarding best management of recurrent GBM was slight, even when management options were dichotomized (repeat surgery vs. other options; κ=0.198 [95% confidence interval: 0.133-0.276]). Country of practice, years' experience, and training background did not change results. Disagreement and clinical uncertainty were more pronounced within clinicians with (κ=0.167 [0.055-0.314]) than clinicians without neuro-oncology fellowship training (κ=0.601 [0.556-0.646]). A majority (51%) of responders were willing to include the patient in a randomized trial comparing repeat surgery with nonsurgical alternatives in 26/37 (69%) of cases. Conclusion There is sufficient uncertainty and equipoise regarding the question of reoperation for patients with recurrent glioblastoma to support the need for a randomized controlled trial.

Background Linton A. Whitaker is a pioneer of craniofacial surgery. He served as chief of plastic surgery at the Children's Hospital of Philadelphia and University of Pennsylvania and director of the craniofacial training program. Herein, the authors reflect on his legacy by studying the accomplishments of his trainees. Methods Dr Whitaker's trainees who completed (a) craniofacial fellowship training while he was director of the program or (b) residency training while he was chief were identified. Curricula vitae were reviewed. Variables analyzed included geographic locations, practice types, academic leadership positions, scholarly work, and bibliometric data. Results Between 1980 and 2011, 34 surgeons completed craniofacial fellowship training under Dr Whitaker, and 11 completed plastic surgery training under his chairmanship and subsequent craniofacial fellowship. The majority had active craniofacial practices after training (83.3%) and practice in an academic setting (78.0%). Most settled in the northeast (31.1%) and south (31.1%) but across 24 states nationally. Overall, the mean ± SD number of publications was 76 ± 81 (range, 2-339); book chapters, 23 ± 29 (0-135); H-index, 18 ± 12 (1-45); and grants, 13 ± 16 (0-66). Of those who pursued academia, 53.1% were promoted to full professor, 46.9% had a program director role, 75.0% directed a craniofacial program, and 53.1% achieved the rank of chief/chair. Conclusions Equally important to Dr Whitaker's clinical contributions in plastic and craniofacial surgery is the development and success of his trainees who will undoubtedly continue the legacy of training the next generation of craniofacial surgeon leaders.

Background The transradial access (TRA) is rapidly gaining popularity for neuroendovascular procedures as there is strong evidence for its benefits compared to the traditional transfemoral access (TFA). However, the transition to TRA bears some challenges including optimization of the interventional suite set-up and workflow as well as its impact on fellowship training. Objective To compare the learning curves of TFA and TRA for diagnostic cerebral angiograms in neuroendovascular fellowship training. Methods We prospectively collected diagnostic angiogram procedural data on the performance of 2 neuroendovascular fellows with no prior endovascular experience who trained at our institution from July 2018 until June 2019. Metrics for operator proficiency were minutes of fluoroscopy time, procedure time, and volume of contrast used. Results A total of 293 diagnostic angiograms were included in the analysis. Of those, 57.7% were TRA and 42.3% were TFA. The median contrast dose was 60 cc, and the median radiation dose was 14 000 μGy. The overall complication rate was 1.4% consisting of 2 groin hematomas, 1 wrist hematoma, and 1 access-site infection using TFA. The crossover rate to TFA was 2.1%. Proficiency was achieved after 60 femoral and 95 radial cases based on fluoroscopy time, 52 femoral and 77 radial cases based on procedure time, and 53 femoral and 64 radial cases based on contrast volume. Conclusion Our study demonstrates that the use of TRA can be safely incorporated into neuroendovascular training without causing an increase in complications or significantly prolonging procedure time or contrast use.

PURPOSE To report female representation within the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) at all levels of career achievement over 50 years. METHODS Data were extrapolated from published ASOPRS directories and the 50th anniversary booklet. Fellowship, membership, leadership, and awards data were evaluated over 5 decades. Comparisons were made between the first and second 25 years, proportions of early and late career achievements, and time to career progression between males and females. RESULTS During the first decade, 5.6% of ASOPRS fellows were female (n = 2), which rose to 6.6% (n = 8), 17.6% (n = 32), 22.4% (n = 35), and 39.4% (n = 97) in the second, third, fourth, and fifth decades, respectively. These patterns were echoed in ASOPRS membership. When comparing the first half (1969-1994) to the second half (1995-2018), fellowship (10.5% vs. 30.0%, p < 0.001), membership (8.0% vs. 30.3%, p < 0.001), early career awards (5.6% vs. 28.9%, p = 0.047), program directorship (0.0% vs. 15.7%, p = 0.017), and executive committee female representation (4.5% vs. 16.8%, p < 0.001) increased significantly. However, females were proportionally underrepresented as program directors (p = 0.003), late career award winners (p = 0.001), executive committee members (p < 0.001), and presidents (p = 0.020). Among those reaching leadership positions, females took longer than males to become program directors by a median of 4 years (p = 0.025). CONCLUSIONS There has been a steady increase in female representation in ASOPRS fellowship training and membership. While significant progress has been made, growth in female leadership and award recognition is still needed.

Background Institutional academic productivity remains an influential factor in an applicant's selection of fellowship training. This study aimed to determine the quality and quantity of research in the United States orthopaedic sports medicine fellowship programs and identify those with highest productivity. Methods The Arthroscopy Association of North America Fellowship Directory was used to evaluate 88 fellowships in the United States. Publication data and Hirschberg indices (h-index) were collected from the Scopus database. Subanalysis was performed based on the number of publications and mean h-index. Results Total number of publications per faculty member ranged from 0 to 866, with a median of 20. The median h-index per faculty member was 9. The number of fellows was correlated with a higher mean average h-index of faculty members (P = 0.05). The five programs with the highest number of publications included Hospital for Special Surgery, Rush University, University of Pittsburgh Medical Center, Mayo Clinic in Rochester, and Boston Children's Hospital. Conclusions Most academic productivity in sports medicine is produced by a relatively small number of fellowship programs in the United States. Of interest, the number of fellows or faculty does not affect significantly the quality or quantity of research productivity at top institutions.

INTRODUCTION AND OBJECTIVE:Post graduate fellowships involve a spectrum of training opportunities that include reproductive and sexual medicine. Herein we seek to develop metrics defining the outco...

OBJECTIVE To assess contemporary trends in the National Institutes of Health (NIH) Career Development (K) Awards within the Departments of Surgery and its impact on the likelihood of achieving independent R01 grants. BACKGROUND The NIH provides K-type Career Development Awards to nurture young clinicians toward a productive academic career, thereby maintaining a pipeline of physician-scientists. However, the impact of K awards on career trajectory of surgeons remains unclear. METHODS The NIH grant data was queried for all new K08/K23 grants awarded to Departments of Surgery (1999-2019). Principal Investigators' data and grant-related information was obtained. RESULTS The NIH awarded 298 K08/23 surgical grants ($41,893,170) over the last 2 decades. Median budget increased from $116,370 to $167,508 (P

BACKGROUND Routine use of chest X-ray (CXR) in pediatric patients presenting with their first episode of wheezing was recommended by many authors. Although recent studies conclude that a CXR is not routinely indicated in these children, there continues to be reports of overuse. OBJECTIVE To examine the attitudes of practicing physicians in ordering CXRs in pediatric patients presenting with their first episode of wheezing to an emergency department (ED) and the factors that influence this practice by surveying ED physicians. METHODS A survey targeting pediatric emergency medicine (PEM) and general emergency medicine attending physicians was distributed electronically to the nearly 3000 members of the PEM Brown listserve and the Pediatric Section of American College of Emergency Physicians listserve. The 14-item survey included closed ended and free text questions to assess the respondent's demographic characteristics, their belief and current practice of obtaining a CXR in pediatric patients presenting with their first episode of wheezing. Data were analyzed using descriptive statistics and χ test. RESULTS Of the 537 attending physicians who participated, their primary residency training was: 42% pediatrics, 54% emergency medicine, and 4% other. Seventy-two percent of participating physicians supervise residents, 54% were board-eligible or -certified in PEM. Thirty percent (95% confidence interval [CI], 26-34) of participants indicated that they would always obtain a CXR in pediatric patients presenting with their first episode of wheezing. Eighty-one percent (95% CI, 75-87) of those who always obtain a CXR believe that it is the standard of care. Of the 376 physicians who do not always obtain a CXR, 18% (95% CI, 15-23) always obtain a CXR under certain age (2 weeks to 12 years, median of 1 year). Physicians who report a primary residency in pediatrics, who supervise residents, who were board-eligible or -certified in PEM, and who were practicing for greater than 5 years were less likely to obtain a CXR (P < 0.001, P < 0.001, P < 0.001, P = 0.001). CONCLUSIONS In our study, a significant number of practicing ED physicians routinely obtain a CXR in children with their first episode of wheezing presenting to the ED. The factors influencing this practice are primary residency training, fellowship training, resident supervision, and years of independent practice. This identifies a target audience that would benefit from education to decrease the overuse of CXRs in children with wheezing.

STUDY DESIGN Cross-sectional study. OBJECTIVE To illustrate demographic trends among spine fellowship leaders (FLs). SUMMARY OF BACKGROUND DATA No previous study in the orthopedic literature has analyzed the demographic characteristics or past surgical training of FL in an orthopedic sub-specialty. We attempt to illustrate demographic trends among spine fellowship leadership including fellowship directors (FDs) and co-fellowship directors (co-FDs). We also highlight the institutions that have trained these leaders at various levels. METHODS Our search for FDs was constructed from the 2018 to 2019 North American Spine Surgery (NASS) Fellowship Directory. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. RESULTS We identified 103 FLs consisting of 67 FDs, 19 co-FDs, and another 16 individuals with a synonymous leadership title. 96.1% (99) of the leadership consisted of males while 3.9% (4) were female. The mean age was 52.9 years old and the mean h-index of the FLs was 23.8. FLs were trained in orthopedic surgery (n = 89), neurosurgery (n = 13), or combined orthopedic surgery and neurosurgery training (n = 1). The top fellowships programs producing future FLs were: Case Western Reserve University, Cleveland (n = 10), Washington University, St. Louis (n = 9), and Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia (n = 7). CONCLUSION Spine surgery fellowship directors are more likely to have graduated from certain residency and fellowship programs. This finding could be a result of the training provided by these centers or the institution's predilection to select applicants that are more likely to later seek academic leadership roles post-training. LEVEL OF EVIDENCE 4.

INTRODUCTION The simulation fellowship training community has commenced efforts toward the development of core curricular elements for healthcare simulation fellowships but has not deployed the same effort to create evaluation strategies to monitor fellows' progress. The authors present a current view of simulation fellowship assessment strategies, their relative validity evidence using Kane's theoretical framework, and consider new approaches for defining expertise after training. METHODS Fellowship directors in North America were surveyed to identify what competencies are being used by the simulation fellowship community to monitor fellows' progress. A follow-up survey was sent to further clarify which tools with published validity evidence were being applied by current programs. RESULTS Of the 61 programs contacted, 44 (72.1%) responded and completed the first survey. Of the 44 programs, 32 (72.7%) reported using some formal assessment of their fellows. The most commonly assessed skill was debriefing. Twenty-three (37.7%) of the 61 programs contacted responded to the secondary survey. These reported that the most common published tool used was the Debriefing Assessment for Simulation in Healthcare, with only a few other tools mentioned. CONCLUSIONS There is a paucity of tools with published validity evidence being used to monitor a fellow's progression. The authors agree that further research needs to focus on creating validated assessment tools to assist in refining fellowship training.

Introduction.Residencies and fellowships have been developed to train physical therapists (PTs) toward advanced expertise while emphasizing patient outcomes, evidence-based care, and advancing practice. Research evaluating the impact of PT residency or fellowship training, its value, and/or benefits

Introduction:We investigated factors that helped recent fellows achieve a successful match and sought to understand the influences in pursuing a career in pediatric urology. Selecting to co...

Background The skin hook is a valuable instrument used in the practice of dermatologic surgery. However, because of numerous factors, the degree of its use varies extensively. Objective The purpose of this study was to examine practice trends among dermatologic surgeons regarding the use of skin hooks, as well as analyze factors influencing their use. Methods A survey comprising 14 questions was distributed to members of the American College of Mohs Surgery and the American Society for Dermatologic Surgery. Results were recorded, and statistical analysis was conducted using the 2-sample z-test to compare 2 population proportions. Results Five hundred seventy-one responses were received, with comments. 85.1% of respondents reported using skin hooks. Their use was further characterized as minimal (20.7%), moderate (29.0%), and extensive (35.4%). The utilization of skin hooks was additionally categorized based on age, gender, fellowship training, number of years in practice, practice setting, and history of experience/observance of a sharps exposure. Only the presence or absence of fellowship training demonstrated a statistically significant difference in the use of skin hooks. Conclusion Skin hooks are highly used tools among dermatologic surgeons. Their use requires appropriate training and experience, and care must be taken to minimize risk of exposure.

Introduction: Training in the acquisition and interpretation of echocardiograms is integral to cardiovascular disease fellowship training. The American Society of Echocardiography recommends 150 transthoracic echo (TTE) scans and 300 interpretations for level 2 training. Hypothesis: The COVID-19 pandemic led to the temporary restructuring of many fellowship programs. At our institution, fellows not involved in essential clinical rotations served in a backup capacity or were re-assigned with the onset of the Massachusetts stay-at-home advisory on March 15, 2020. A one-hour mid-day Zoom TTE reading session was offered when fellows were available. We hypothesized that these restrictions would impact fellow education in TTE scanning and interpretation volumes. Methods: We examined the number of TTE performed or interpreted by F1 and F2 fellows between July 2017 and June 2020 as recorded in our echo lab electronic database. Results: In the 21 months prior to the onset of the COVID-19 pandemic, 45 + 1 TTE scans/wk were performed by fellows which was reduced to 9 + 3 scans/wk (-80%, p Conclusions: By recognizing that there has already been an impact on echo education, fellowship programs will need to optimize fellow exposure and instruction in echocardiography so as to maintain adequate training volumes.

Background While minimally invasive thoracic surgery (MIS) has increased nationwide over the years, most patients undergoing lung and esophageal resections still undergo an open approach. We performed a national survey to analyze factors associated with a propensity to perform MIS after completing a cardiothoracic training program. Materials and methods Cardiothoracic surgery trainees in 2 or 3-year programs from 2010 to 2016 were sent an online survey regarding the numbers and types of cases performed during training and current practice patterns as attending surgeons. Comfort level with MIS was also assessed. Responses were recorded and analyzed using SPSS. Results One hundred thirty-six trainees responded, with a mean of 121 lobectomies (30-250) and 40 esophagectomies (8-110) performed during training. Mean minimally invasive lobectomy and esophagectomy rates during training were 53% and 30% respectively. A greater ratio of MIS procedures performed during training correlated with a higher rate performed as an attending (lobectomies, p = 0.04; esophagectomies, p = 0.01) and a greater comfort level with performing these procedures (lobectomies, p = 0.01 and esophagectomies, p, Highlights • Trainees who perform more minimally invasive procedures as trainees are more likely to do so as attendings. • Trainees who perform many open lobectomies do not necessarily convert to minimally invasive approaches as attendings. • Trainees who perform many esophagectomies are less likely to convert as attendings.

Background Many aspire to leadership in academic plastic surgery yet there is no well-documented pathway. Methods Information regarding plastic surgery residencies and program directors was obtained from the American Medical Association's FREIDA database. The division chief or department chair (academic head) of every academic plastic surgery program was identified. One Internet-based survey was distributed to academic heads; another, to program directors. Results Ninety academic heads were identified, 35 of whom also serve as program director. Sixty-seven unique program directors were identified. There was a 51 percent academic head response rate and a 65 percent program director response rate. Academic plastic surgery is overwhelmingly administered by midcareer men. The average program director was appointed at age 45 and has served for 7 years. She or he was trained through the independent track, completed additional training in hand surgery, and is a full professor. She or he publishes two or three peer-reviewed manuscripts per year and spends 9 hours per week in administration. The average academic head was appointed at age 45 and has held the position for 12 years. She or he was trained in the independent model, completed fellowship training, and is a full professor. She or he publishes five peer-reviewed manuscripts per year and spends 12 hours per week involved in administration. Conclusions Program directors and academic heads serve nonoverlapping roles. Few program directors will advance to the role of academic head. Successful applicants to the program director position often serve as an associate program director and are seen as motivated resident educators. In contrast, those faculty members selected for the academic head role are academically accomplished administrators with business acumen.

Background The field of pediatric orthopaedic surgery is evolving with a reported increase in the number of pediatric orthopaedic fellows being trained as well as an increase in the number of fellows completing additional fellowship training in another subspecialty. The purpose of this study was to examine the historic trends of trainees seeking multiple fellowships within pediatric orthopaedics over an 11-year period using the database of the American Board of Orthopaedic Surgery (ABOS). Methods We queried the ABOS database for fellowship choice of applicants for the ABOS part II oral examination with the self-declared subspecialty of pediatric orthopaedics during the years of 2005 to 2015. Descriptive analysis was performed to determine the percentage of applicants who completed >1 fellowship, and the type of subspecialty fellowship completed. χ analysis was used to compare the proportion of multiple fellowship trainees between years. Results From 2005 to 2015, 310 applicants for ABOS part II pediatric subspecialty examination had completed a fellowship in pediatric orthopaedic surgery, with that number increasing from 14 to 43/y over that span. Forty-five trainees (15%) completed 48 additional fellowships over that decade, with 2 recent trainees completing multiple additional fellowships. The most common additional fellowships were sports (n=22, 46%), hand (n=8, 17%), and spine (n=7, 15%). The rate of additional fellowship training increased over 5-fold from 5% in the first 3 years of the study to 28% in the last 2 years of the study (P=0.001). Conclusions The proportion of trainees completing additional subspecialty fellowships in addition to pediatric orthopaedics has risen over the past decade. The precise cause and effect of such change is uncertain and likely multifactorial. Reexamination of our classic training paradigms may be warranted in light of these trends. Level of evidence Level III.

BACKGROUND Transitioning to competency-based surgical training will require consensus regarding the scope of plastic surgery and expectations of operative ability for graduating residents. Identifying surgical procedures experts deemed most important in preparing graduates for independent practice (i.e., "core" procedures), and those that are less important or deemed more appropriate for fellowship training (i.e., "noncore" procedures), will focus instructional and assessment efforts. METHODS Canadian plastic surgery program directors, the Canadian Society of Plastic Surgeons Executive Committee, and peer-nominated experts participated in an online, multiround, modified Delphi consensus exercise. Over three rounds, panelists were asked to sort 288 procedural competencies into five predetermined categories within core and noncore procedures, reflecting increasing expectations of ability. Eighty percent agreement was chosen to indicate consensus. RESULTS Two hundred eighty-eight procedures spanning 13 domains were identified. Invitations were sent to 49 experts; 37 responded (75.5 percent), and 31 participated (83.8 percent of respondents). Procedures reaching 80 percent consensus increased from 101 (35 percent) during round 1, to 159 (55 percent) in round 2, and to 199 (69 percent) in round 3. The domain "burns" had the highest rate of agreement, whereas "lower extremity" had the lowest agreement. Final consensus categories included 154 core, essential; 23 core, nonessential; three noncore, experience; and 19 noncore, fellowship. CONCLUSIONS This study provides clarity regarding which procedures plastic surgery experts deem most important for preparing graduates for independent practice. The list represents a snapshot of expert opinion regarding the current training environment. As our specialty grows and changes, this information will need to be periodically revisited.

Postgraduate training, otherwise termed residency or fellowship training, for nurse practitioners is a growing trend. Many new graduates are seeking intensive and immersive clinical experiences supported by evidence-based didactic learning directly related to their clinical experience. This article describes current trends and evidence supporting fellowship training.

Background Limited research has evaluated the relative citation ratio (RCR), a novel measure of research productivity. Accordingly, there remains a minimal understanding of its practical value relative to established metrics such as the h-index. Here, we examined correlations between the mean and weighted RCR scores and the h-index and explore the influence of academic rank, career duration, PhD acquisition, and fellowship training on these metrics. Methods Data regarding the academic rank (e.g. assistant professor, associate professor, professor, or “other”), career duration, degrees, fellowship training, and research yield were collected for 1018 academic ophthalmologists practicing in the southern United States of America. The iCite and Scopus databases were utilized to quantify research yield via calculations of mean and weighted RCR, and h-index, respectively. Results Significant correlations were observed between the h-index and the mean (ρ = 0.62, P, Highlights • The relative citation ratio (RCR) is a novel NIH-supported research metric. • Advanced academic rank and PhD acquisition is associated with increased RCR and h-index. • The h-index is poorer at delineating differences due to career duration. • Overall, the RCR is a more representative measure of research productivity.

The optimization of surgical care for traumatic vascular injuries has come under scrutiny. Important questions regarding the impact of endovascular techniques, as well as residency and fellowship training paradigms on the preparedness of acute care, trauma and vascular surgeons have been raised. Inter-specialty collaboration is critical to address these issues.

PURPOSE To report on the evolution of simulation-based training (SBT) by identifying the composition and infrastructure of existing simulation fellowship programs, describing the current training practices, disclosing existing program barriers, and highlighting opportunities for standardization. METHOD Investigators conducted a cross-sectional survey study among English-speaking simulation fellowship program directors (September 2014-September 2015). They identified fellowships through academic/institutional Web sites, peer-reviewed literature, Web-based search engines, and snowball sampling. They invited programs to participate in the Web-based questionnaire via e-mail and follow-up telephone calls. RESULTS Forty-nine programs met the inclusion criteria. Of these, 32 (65%) responded to the survey. Most programs were based in the United States, but others were from Canada, England, and Australia. Over half of the programs started in or after 2010. Across all 32 programs, 186 fellows had graduated since 1998. Fellows and directors were primarily departmentally funded; programs were primarily affiliated with hospitals and/or medical schools, many of which had sponsoring centers accredited by governing bodies. Fellows were typically medical trainees; directors were typically physicians. The majority of programs (over 90%) covered four core objectives, and all endorsed similar educational outcomes. Respondents identified no significant universal barriers to program success. Most directors (18/28 [64%]) advocated standardized fellowship guidelines on a national level. CONCLUSIONS Paralleling the fast growth and integration of SBT, fellowship training opportunities have grown rapidly in the United States, Canada, and beyond. This study highlights potential areas for standardization and accreditation of simulation fellowships which would allow measurable competencies in graduates.

Orthopaedic surgery fellowship provides an opportunity to further develop skills in a particular subspecialty. However, the condensed time frame, complex skill acquisition, and clinical demands require efficient and effective learning techniques to achieve mastery. As with any advanced task, success during fellowship training can be achieved with active participation and a goal-directed approach. Skill acquisition can be successfully achieved by following a framework that includes preparation, execution, and reflection for every surgical case.

The American Medical Society for Sports Medicine (AMSSM) recognizes a need to provide direction and continually enhance the quality of sports medicine fellowship training programs. This document was developed to be an educational resource for sports medicine physicians who teach in a 1-year primary care sports medicine fellowship training program. It is meant to provide high standards and targets for fellowship training programs that choose to reassess their curriculum and seek to make improvements.

All 36 physicians board-certified in both anesthesiology and clinical informatics as of January 1, 2016, were surveyed via e-mail, with 26 responding. Although most (25/26) generally expressed satisfaction with the clinical informatics boards, and view informatics expertise as important to anesthesiology, most (24/26) thought it unlikely or highly unlikely that substantial numbers of anesthesiology residents would pursue clinical informatics fellowships. Anesthesiologists wishing to qualify for the clinical informatics board examination under the practice pathway need to devote a substantive amount of worktime to informatics. There currently are options outside of formal fellowship training to acquire the knowledge to pass.

James A. Arrighi, MD, FACC, Chair Lisa A. Mendes, MD, FACC, Co-Chair Jesse E. Adams III, MD, FACC John E. Brush Jr, MD, FACC[#][1] G. William Dec Jr, MD, FACC Ali Denktas, MD, FACC Susan Fernandes, LPD, PA-C Rosario Freeman, MD, MS, FACC[#][1] Rebecca T. Hahn, MD, FACC Jonathan L.

INTRODUCTION AND OBJECTIVES:Urinary incontinence is a prevalent condition that is becoming recognized in more women regardless of the presence of traditional risk factors. Female Pelvic Medicine & Reconstructive Surgery (FPMRS) is a subspecialty of urologists and gynecologists with expertise in the management of pelvic floor disorders, including refractory incontinence. We hypothesized that patients hospitalized after incontinence procedures would have different characteristics based on the level of training of their surgeon. FPMRS surgeons may treat more complex patients in metropolitan areas, and this may be associated with higher costs and length of hospitalization.METHODS:New York State Statewide Planning and Research Cooperative System (SPARCS) inpatient de-identified datasets were queried for women who underwent genitourinary incontinence procedures from 2009 to 2016. Descriptive statistics using chi-square tests were performed to compare FPMRS-trained surgeons to non-FPMRS surgeons. Age, race, leng...

This article is the last in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated on program completion. This article focuses on the many career paths as educators, researchers, advocates, innovators, consultants, administrators, and leaders available to pediatric emergency medicine physicians, in both clinical and nonclinical realms, and how fellows and junior faculty can enrich and prolong their careers through diversification.

Background The American Council of Graduate Medical Education, which oversees much of postgraduate medical education in the United States, has championed the concept of "milestones," standard levels of achievement keyed to particular time points, to assess trainee performance during residency. Objective To develop a milestones document for the American Society for Dermatologic Surgery (ASDS) Cosmetic Dermatologic Surgery (CDS) fellowship program. Methods An ad hoc milestone drafting committee was convened that included members of the ASDS Accreditation Work Group and program directors of ASDS-approved Cosmetic Dermatologic Surgery (CDC) fellowship training programs. Draft milestones were circulated through email in multiple rounds until consensus was achieved. Results Thirteen milestones were developed in the 6 Accreditation Council for Graduate Medical Education (ACGME) competency areas, with 8 of these being patient-care milestones. Additional instructions for milestone administration more specific to the CDS fellowship than general ACGME instructions were also approved. Implementation of semiannual milestones was scheduled for the fellowship class entering in July 2018. Conclusion Milestones are now available for CDS fellowship directors to implement in combination with other tools for fellow evaluation.

This article is the sixth in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article provides a broad overview of administering and supervising a PEM fellowship program. It explores 3 topics: the principles of program administration, committee management, and recommendations for minimum time allocated for PEM fellowship program directors to administer their programs.

This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the skills beyond clinical training required of pediatric emergency medicine physicians including teaching, leadership, teamwork, and communication.

Article, see p 101 Congenital heart disease (CHD) is the most common of all congenital defects, affecting nearly 1% of live births. Creative operative and catheter-based interventions have facilitated survival to adulthood with nearly all defects, setting the stage for a rapidly growing population of adolescents and adults with CHD. Although the field of adult CHD (ACHD) remains in its infancy, it is important to acknowledge the tremendous achievements in the United States and abroad over the last decades. ACHD publications have increased almost exponentially (Figure). The first American College of Cardiology/American Heart Association joint guidelines on the diagnosis and management of ACHD were published in 20081 with a revision anticipated soon; subspecialty status in cardiology was granted by the American Board of Medical Specialties in 2012 with the first qualifying examination offered in the fall of 2015, and the first class of American Council for Graduate Medical Education–approved fellowship training begins July 2016. Multicenter and multinational research collaborations have formed, including the Alliance for Adult Research in Congenital Cardiology, as have patient/provider collaborative organizations such as the Adult Congenital Heart Association and the International Society of Adult Congenital Heart Disease. Funding for research has also improved, led by the US Department of Defense, the American Heart Association, and the National Heart, Lung, and Blood Institute. Figure. Trends in adult congenital heart disease (ACHD). PubMed cited articles directly relating to adults with CHD over 4-year intervals since 1980 ( blue ) and the estimated number of ACHD patients (from program survey by the Adult Congenital Heart Association and the International Society of Adult Congenital Heart Disease) seen at programs in the United States that self-report as providing specialized care to adults with congenital disease ( red ) during 4 different years since 2005. Despite tremendous progress, obstacles to the appropriate and sustained growth of …

Introduction We examined trends in the mentorship and career choices of women urologists. Methods An anonymous electronic survey was distributed to 1,563 women urologists in January 2015. Descriptive data are presented as the percent and mean. Results Of the 1,563 emails sent 365 surveys were completed for a 23% response rate. Practicing women urologists were most likely to be in academic practice (85 of 218 or 39%) or group practice (96 of 218 or 44%). Of 215 women urologists 108 (almost 45%) held a traditional academic rank of professor, associate professor or assistant professor. Of practicing female urologists 52% had completed fellowship training. In the early 1990s a traditional academic rank was held by 22% to 31% of women compared to 44.6% in the current study. Fellowship trained women urologists were more likely to hold a traditional academic rank (p Conclusions Women urologists have a high rate of fellowship training and more women are attaining academic rank and pursuing academics. Mentoring in urological training is improving. However, there is a continued need for women urologists to ascend to leadership positions in training programs and urological societies to more accurately reflect the changing membership of urologists as a group.

This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the clinical aspects of fellowship training including the impact of the clinical environment, modalities for teaching and evaluation, and threats and opportunities in clinical education.

This article is the second in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine (PEM) fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article describes the development of PEM entrustable professional activities (EPAs) and the relationship of these EPAs with existing taxonomies of assessment and learning within PEM fellowship. It summarizes the field in concepts that can be taught and assessed, packaging the PEM subspecialty into EPAs.

Objective: To survey US-trained graduating neurology residents who are American Academy of Neurology members, in an effort to trend perceived quality and completeness of graduate neurology education. Methods: An electronic survey was sent to all American Academy of Neurology members graduating from US neurology residency programs in the Spring of 2014. Results: Of 805 eligible respondents, 24% completed the survey. Ninety-three percent of adult neurology residents and 56% of child neurology residents reported plans to pursue fellowship training after residency. Respondents reported a desire for additional training in neurocritical care, neuro-oncology, neuromuscular diseases, botulinum toxin injection, and nerve blocks. There remains a clear deficit in business training of neurology residents, although there was notable improvement in knowledge of coding and office management compared to previous surveys. Discussion: Although there are still areas of perceived weakness in neurology training, graduating neurology residents feel generally well prepared for their chosen careers. However, most still pursue fellowship training for reasons that are little understood. In addition to certain subspecialties and procedures, practice management remains deficient in neurology training and is a point of future insecurity for most residents. Future curriculum changes should consider resident-reported gaps in knowledge, with careful consideration of improving business training.

OBJECTIVE The aim of this study was to characterize distinguishing features among gynecology, urology, and combined female pelvic medicine and reconstructive surgery (FPMRS) fellowship programs and practices. METHODS A 32-item Web-based survey was sent to fellowship directors of FPMRS programs accredited by the Accreditation Council for Graduate Medical Education. The survey assessed the structure of the fellowship, as well as the degree to which gynecology and urology are integrated into the fellowship training. In addition to descriptive statistics, Fisher exact test and Mann-Whitney U test were used for statistical analysis. RESULTS Forty-one program directors (PDs) completed the survey for a 76% response rate. Of the respondents, 78% were gynecologists, and 22% were urologists. Sixty-five percent of the respondents considered their program gynecology based, 7.5% considered their program urology based, 22.5% considered their program fully integrated (urology and gynecology equal sharing), and 5% have separate tracks for urology fellows and gynecology fellows. Sixty-one percent of the programs accept both urology and gynecology fellows in their fellowship programs. Approximately two thirds of the PDs are happy with the fellowship model at their institution, whereas the remaining one third would like greater integration of gynecology and urology in fellowship training. Almost 90% of the respondents felt that there were benefits to an integrated program. The top benefits were reported as more exchange of information, better relationships, more comprehensive training, exposure to different treatment approaches, and improved care for women. For those PDs who desire a more integrated program, the top barriers listed were departmental competition/politics, lack of formally trained urology faculty, and expense. CONCLUSIONS There are several FPMRS fellowship models. A significant proportion of PDs would like a more integrated fellowship program, and an overwhelming majority note benefits for themselves and their fellows that result from increased contact with a diverse FPMRS faculty.

INTRODUCTION More than 90% of orthopaedic surgery graduates pursue fellowship training after residency. Previous investigations have examined factors considered important by orthopaedic sports medicine and hand surgery fellowship program directors (PDs). This study sought to identify which factors orthopaedic trauma fellowship PDs deem most important when evaluating applicants. METHODS A web-based survey was sent to all 59 orthopaedic trauma fellowship PDs. PDs were given a list of 12 factors, which they ranked in order of importance. A weighted score for each factor was calculated. PDs could also write-in additional factors they considered important when ranking applicants. RESULTS The overall response rate was 83% (49/59 PDs). Forty-five percent of responding PDs listed the interview as the most important factor when ranking applicants. Other factors considered most important included letters of recommendation, personal connections to the applicant and/or letter writers, and the applicant's background in trauma. Results of the weighted score calculation again identified the interview as the most important factor when ranking applicants, followed by letters of recommendation, personal connections to the applicant/letter writers, the applicant's residency program, strength of the applicant's background in trauma, and research experience. DISCUSSION Orthopaedic trauma fellowship PDs consider the interview, letters of recommendation, and personal connections to the applicant/letter writers to be the most important factors when ranking fellowship applicants.

Background The number of orthopaedic residency graduates pursuing additional subspecialty training has increased along with the percentage of advertised jobs requiring fellowship. As such, the implications of fellowship training on job availability and marketability may impact their choice of subspecialty. The purpose of this study was to evaluate job availability in the United States for general orthopaedics and orthopaedic subspecialties. Methods Job advertisements in 2019 were reviewed from the career center databases of the Journal of Bone and Joint Surgery, American Academy of Orthopaedic Surgeons, as well as of individual subspecialty societies. Job listings were cross referenced to identify unique jobs within the United States, which were categorized by the orthopaedic training required, practice type, and location. To assess job availability, a ratio of fellows to job listings was calculated based on the number of matched candidates for nine subspecialty fellowships and the number of residency graduates entering general practice in 2019. Results A total of 466 unique job listings were identified with 114 generalist and 352 subspecialist positions. The subspecialties with the lowest number of fellows per advertised job were foot and ankle (1.1), adult reconstruction (2.0), and trauma (2.1). The subspecialties with the highest number of fellows per advertised job were sports medicine (6.3), shoulder and elbow (5.8), and oncology (5.7). Job availability for general orthopaedics was higher than for any subspecialty. The highest percentage of positions advertised were hospital employed jobs compared with private practice and academic positions. Conclusions Job availability for fellowship graduates varies notably based on orthopaedic subspecialty. At this time, generalists and subspecialists trained in foot and ankle, adult reconstruction, and trauma seem to be in greatest demand. The reason for the differences in demand is likely multifactorial. Our findings should be considered by orthopaedic residents pursuing fellowship training in addition to weighing both personal interest and financial considerations in their subspecialty choice.

Objective The management of injured children is a required element of pediatric emergency medicine (PEM) fellowship training. Given the relatively infrequent exposure of trainees to major trauma, it is important to understand how programs train fellows and assess their competency in pediatric trauma. Methods An online survey was sent to 84 PEM fellowship program directors (PDs). Program directors were asked to describe their program's characteristics, the degree of fellow independence, educational techniques used to train fellows in trauma, and their expectation of fellows' competency in 14 core trauma-related skills upon graduation. Program directors were classified as having high expectations if they anticipated that graduating fellows could perform 12 trauma skills or more independently. Results Fifty-nine programs (70%) responded. Although most programs (55, 93%) identified as pediatric trauma centers, fellows at the majority of programs (41, 69%) spent some or all of their trauma experience at an outside hospital. Only a minority of programs (17, 29%) allowed fellows to lead pediatric trauma resuscitations as independent attendings without precepting. Programs used over a dozen different educational methods to varying degrees. Less than half of programs (28, 47%) used a formal trauma curriculum. Whereas 33 PDs (56%) had high expectations, only 9 (15%) expected fellows to be able to perform all 14 skills. Conclusions There is considerable variability in how PEM fellows are trained to care for injured children. Most PDs do not realistically expect fellows to be able to perform all recommended trauma skills after graduation. Our findings highlight the need for further research and efforts to standardize the training of PEM fellows in pediatric trauma.