The Accreditation Council for Graduate Medical Education (ACGME) requires an annual evaluation of all ACGME-accredited residency and fellowship programs to assess program quality. The results of this evaluation must be used to improve the program. This manuscript describes a metric to be used in conducting ACGME-mandated annual program review of ACGME-accredited anesthesiology residencies and fellowships.
A variety of metrics to assess anesthesiology residency and fellowship programs are identified by the authors through literature review and considered for use in constructing a program "report card."
Metrics used to assess program quality include success in achieving American Board of Anesthesiology (ABA) certification, performance on the annual ABA/American Society of Anesthesiology In-Training Examination, performance on mock oral ABA certification examinations, trainee scholarly activities (publications and presentations), accreditation site visit and internal review results, ACGME and alumni survey results, National Resident Matching Program (NRMP) results, exit interview feedback, diversity data and extensive program/rotation/faculty/curriculum evaluations by trainees and faculty. The results are used to construct a "report card" that provides a high-level review of program performance and can be used in a continuous quality improvement process.
An annual program review is required to assess all ACGME-accredited residency and fellowship programs to monitor and improve program quality. We describe an annual review process based on metrics that can be used to focus attention on areas for improvement and track program performance year-to-year. A "report card" format is described as a high-level tool to track educational outcomes.
In 2007, our healthcare system established a clinical fellowship program in pathology informatics. In 2011, the program benchmarked its structure and operations against a 2009 white paper “Program requirements for fellowship education in the subspecialty of clinical informatics”, endorsed by the Board of the American Medical Informatics Association (AMIA) that described a proposal for a general clinical informatics fellowship program.
A group of program faculty members and fellows compared each of the proposed requirements in the white paper with the fellowship program's written charter and operations. The majority of white paper proposals aligned closely with the rules and activities in our program and comparison was straightforward. In some proposals, however, differences in terminology, approach, and philosophy made comparison less direct, and in those cases, the thinking of the group was recorded. After the initial evaluation, the remainder of the faculty reviewed the results and any disagreements were resolved.
The most important finding of the study was how closely the white paper proposals for a general clinical informatics fellowship program aligned with the reality of our existing pathology informatics fellowship. The program charter and operations of the program were judged to be concordant with the great majority of specific white paper proposals. However, there were some areas of discrepancy and the reasons for the discrepancies are discussed in the manuscript.
After the comparison, we conclude that the existing pathology informatics fellowship could easily meet all substantive proposals put forth in the 2009 clinical informatics program requirements white paper. There was also agreement on a number of philosophical issues, such as the advantages of multiple fellows, the need for core knowledge and skill sets, and the need to maintain clinical skills during informatics training. However, there were other issues, such as a requirement for a 2-year fellowship and for informatics fellowships to be done after primary board certification, that pathology should consider carefully as it moves toward a subspecialty status and board certification.
Pathology informatics fellowship; clinical informatics; clinical informatics fellowship; pathology informatics; pathology informatics teaching; clinical informatics teaching
The 2009-2010 American Association of Colleges of Pharmacy (AACP) Council of Faculties Faculty Affairs Committee reviewed published literature assessing the scope and outcomes of faculty development for tenure and promotion. Relevant articles were identified via a PubMed search, review of pharmacy education journals, and identification of position papers from major healthcare professions academic organizations. While programs intended to enhance faculty development were described by some healthcare professions, relatively little specific to pharmacy has been published and none of the healthcare professions have adequately evaluated the impact of various faculty-development programs on associated outcomes.
The paucity of published information strongly suggests a lack of outcomes-oriented faculty-development programs in colleges and schools of pharmacy. Substantial steps are required toward the development and scholarly evaluation of faculty-development programs. As these programs are developed and assessed, evaluations must encompass all faculty subgroups, including tenure- and nontenure track faculty members, volunteer faculty members, women, and underrepresented minorities. This paper proposes AACP, college and school, and department-level recommendations intended to ensure faculty success in achieving tenure and promotion.
faculty development; colleges and schools of pharmacy; tenure; promotion; outcomes
To compare the quantity of manuscripts published in journals by departments of pharmacy practice at schools and colleges of pharmacy in the United States for the years 2001-2003.
We utilized the Web of Science bibliographic database to identify publication citations for the years 2001 to 2003 which were then evaluated in a number of different ways. Faculty were identified via American Association of Colleges of Pharmacy rosters for 2000-2001, 2001-2002, and 2002-2003 academic years.
Rankings were done based on the number of publications per institution and average number of publications per faculty member at an institution. Upon linear regression analysis, a relationship exists between an institution’s faculty size and the total number of publications but not for tenure/nontenure-track faculty ratio. Rating highest in overall publication number did not guarantee high rankings in the average number of publications per faculty member at an institution assessment. Midwestern schools were responsible for more publications per institution than other regions. Many schools only generated minimal scholarship over this evaluative period.
While many schools have pharmacy practice faculty that strongly contributed to the biomedical literature, other schools have not. Pharmacy practice faculty in the Midwest publish more journal manuscripts than faculty in other regions of the country. More pharmacy schools need to engage their faculty in scholarly endeavors by providing support and incentives.
Bibliometrics; Faculty; Pharmacy Schools; United States
Pediatric Rheumatology (PR) training in the US has existed since the 1970’s. In the early 1990’s, the training was formalized into a three year training program by the American College of Graduate Medical Education (ACGME) and American Board of Pediatrics (ABP). Programs have been evaluated every 5 years by the ACGME to remain credentialed and graduates had to pass a written exam to be certified. There has been no report yet that details not just what training fellows should receive in the 32 US PR training programs but what training the trainees are actually receiving.
After a literature search, a survey was constructed by the authors, then reviewed and revised with the help members of the Executive Committee of the Rheumatology Section of the American Academy of Pediatrics (AAP) using the Delphi technique. IRB approval was obtained from the AAP and Nationwide Children’s Hospital. The list of fellows was obtained from the ABP and the survey sent out to 81 current fellows or fellows just having finished. One repeat e-mail was sent out.
Forty-seven fellows returned the survey by e-mail (58%) with the majority being 3rd year fellows or fellows who had completed their training. The demographics were as expected with females > males and Caucasians> > non-Caucasians. Training appeared quite appropriate in the number of ½ day continuity clinics per week (1–2, 71%), number of patients per clinic (4–5, 60%), inpatient exposure (2–4 inpatients per week, 40%; 5 or greater, 33%), and weekday/weekend call. Fellows attended more didactic activities than required, had ample time for research (54% 21-60/hours per week), and had multiple teaching opportunities. Seventy-seven percent of the trainees presented abstracts at national meetings, 41% had publication. Disease exposure was excellent and joint injection experience sufficient.
Most US PR training programs as a whole provide an appropriate training by current ACGME, American College of Rheumatology (ACR), and ABP standards in: 1) number of continuity clinics; 2) sufficient on-call activities for weekday nights and weekends; 3) joint interdisciplinary conferences; 4) electives 5) didactic activities; 6) scholarly activities; and 7) exposure to diverse rheumatology diseases. Areas of concern were uniformity & standardization of training, need for a customized PR training curriculum, more mentorship, free electives, training in musculoskeletal ultrasound, need for a hands-on OSCE certification exam and more exposure to ACGME competencies.
There have been significant pressures on urology training in North America over the last decade due to both the constantly evolving skill set required and the external demands around delivery of urological care, particularly in Canada. We explore the attitudes and experience of Canadian urology residents toward their postgraduate decisions on fellowship opportunities.
The study consisted of a self-report questionnaire of 4 separate cohorts of graduating urology residents from 2008 to 2011. The first cohort graduating in 2008 and 2009 were sent surveys through SurveyMonkey.com after graduation from residency; those graduating in 2010 and 2011 were prospectively invited as a convenience sample attending a Queen’s Urology Examination Skills Training Program review course just prior to graduation. The survey included both open- and closed-ended questions, employing a 5-point Likert scale, and explored the attitudes and experience of fellowship choices. Likert scores for each question were reported as means ± standard deviation (SD). Descriptive and correlative statistics were used to analyze the responses. In addition, an agreement score was created for those responding with “strongly agree” and “agree” on the Likert scale.
A total of 104 surveys were administered, with 84 respondents (80.8% response rate). As a whole, 84.9% of respondents agreed that they pursued fellowships; oncology and minimally invasive urology were the most popular choices throughout the 4 years. Respondents stated that reasons for pursuing a fellowship included: interest in pursuing an academic career (mean 3.73± 1.1 (SD): agreement score 61.1%) as well as acquiring marketable skills to obtain an urology position (3.59 ± 1.3: 64.4%). Most agreed or strongly agreed (84.9%) that a reason for pursing a fellowship was an interest in focusing their practice to this sub-specialty area. In comparison, most graduates disagreed that a reason for pursuing a fellowship was that residency did not equip them with the necessary skills to practice urology (2.49 ± 1.2: 19%). Most (81.2%) of graduates agreed they knew enough about academic urology to know if it would be a suitable career choice for them versus 54.7% regarding community urology (p < 0.0001). Surprisingly, only 61.7% of residents agreed that they completed a community elective during training, and most felt they would have benefited from additional elective time in the community.
Urology residents graduating from Canadian programs pursue postgraduate training to enhance their surgical skill set and to achieve marketability, but also to facilitate a potential academic career. Responses from the trainees suggest that exposure to community practice appears suboptimal and may be an area of focus for programs to aid in career counselling and professional development.
Objectives. To examine trends in the numbers of women and underrepresented minority (URM) pharmacy faculty members over the last 20 years, and determine factors influencing women faculty members’ pursuit and retention of an academic pharmacy career.
Methods. Twenty-year trends in women and URM pharmacy faculty representation were examined. Women faculty members from 9 public colleges and schools of pharmacy were surveyed regarding demographics, job satisfaction, and their academic pharmacy career, and relationships between demographics and satisfaction were analyzed.
Results. The number of women faculty members more than doubled between 1989 and 2009 (from 20.7% to 45.5%), while the number of URM pharmacy faculty members increased only slightly over the same time period. One hundred fifteen women faculty members completed the survey instrument and indicated they were generally satisfied with their jobs. The academic rank of professor, being a nonpharmacy practice faculty member, being tenured/tenure track, and having children were associated with significantly lower satisfaction with fringe benefits. Women faculty members who were tempted to leave academia for other pharmacy sectors had significantly lower salary satisfaction and overall job satisfaction, and were more likely to indicate their expectations of academia did not match their experiences (p<0.05).
Conclusions. The significant increase in the number of women pharmacy faculty members over the last 20 years may be due to the increased number of female pharmacy graduates and to women faculty members’ satisfaction with their careers. Lessons learned through this multi-institutional study and review may be applicable to initiatives to improve recruitment and retention of URM pharmacy faculty members.
underrepresented minority faculty members; women faculty members; recruitment; retention; diversity
We desired information from the recent, current, and future matched hand surgery fellows regarding their residency training, number of interviews, position matched, cost of interviewing, influences, opinions on future hand training models, and post-fellowship job information.
Institutional review board approval was obtained from our institution to submit an online survey. An email was sent to the coordinators of all US Hand Fellowships to be forwarded to their fellows with graduation years 2011, 2012, and 2013, as well as directly to the fellows if their email addresses were provided. Data on the application process, relative importance of program attributes, and opinions regarding optimal training of a hand surgeon were collected. Statistical analysis was performed with respect to the training background and graduation year of the respondent.
The survey was completed by 137 hand surgery fellows. Seventy-one percent of the survey responders were from an orthopedic residency background, 20 % from plastic, and 7 % from general surgery. Forty-four percent of all of the respondents matched into their first choice. The type of operative cases performed by the current fellows was most often selected as very important when making their rank list. Seventy-seven percent of the respondents reflected their personal preference in fellowship model to be a 1-year fellowship program.
The field of hand surgery is unique in that it has residents from multiple training backgrounds who all apply to one fellowship. The current fellowship model allows for diversity of training and the possibility of obtaining a second fellowship if desired.
Electronic supplementary material
The online version of this article (doi:10.1007/s11552-013-9504-y) contains supplementary material, which is available to authorized users.
Fellowship; Hand; Residency; Survey; Training
Ethnic diversity among physicians may be linked to improved access and quality of care for minorities. Academic medical institutions are challenged to increase representation of ethnic minorities among health professionals.
To explore the perceptions of physician faculty regarding the following: (1) the institution's cultural diversity climate and (2) facilitators and barriers to success and professional satisfaction in academic medicine within this context.
Qualitative study using focus groups and semi-structured interviews.
Nontenured physicians in the tenure track at the Johns Hopkins University School of Medicine.
Focus groups and interviews were audio-taped, transcribed verbatim, and reviewed for thematic content in a 3-stage independent review/adjudication process.
Study participants included 29 faculty representing 9 clinical departments, 4 career tracks, and 4 ethnic groups. In defining cultural diversity, faculty noted visible (race/ethnicity, foreign-born status, gender) and invisible (religion, sexual orientation) dimensions. They believe visible dimensions provoke bias and cumulative advantages or disadvantages in the workplace. Minority and foreign-born faculty report ethnicity-based disparities in recruitment and subtle manifestations of bias in the promotion process. Minority and majority faculty agree that ethnic differences in prior educational opportunities lead to disparities in exposure to career options, and qualifications for and subsequent recruitment to training programs and faculty positions. Minority faculty also describe structural barriers (poor retention efforts, lack of mentorship) that hinder their success and professional satisfaction after recruitment. To effectively manage the diversity climate, our faculty recommended 4 strategies for improving the psychological climate and structural diversity of the institution.
Soliciting input from faculty provides tangible ideas regarding interventions to improve an institution's diversity climate.
cultural diversity; academic medicine; ethnic minorities; recruitment; promotion
The Accreditation Council for Graduate Medical Education requires fellows in many specialties to demonstrate attainment of 6 core competencies, yet relatively few validated assessment tools currently exist. We present our initial experience with the design and implementation of a standardized patient (SP) exercise during gastroenterology fellowship that facilitates appraisal of all core clinical competencies.
Fellows evaluated an SP trained to portray an individual referred for evaluation of abnormal liver tests. The encounters were independently graded by the SP and a faculty preceptor for patient care, professionalism, and interpersonal and communication skills using quantitative checklist tools. Trainees' consultation notes were scored using predefined key elements (medical knowledge) and subjected to a coding audit (systems-based practice). Practice-based learning and improvement was addressed via verbal feedback from the SP and self-assessment of the videotaped encounter.
Six trainees completed the exercise. Second-year fellows received significantly higher scores in medical knowledge (55.0 ± 4.2 [standard deviation], P = .05) and patient care skills (19.5 ± 0.7, P = .04) by a faculty evaluator as compared with first-year trainees (46.2 ± 2.3 and 14.7 ± 1.5, respectively). Scores correlated by Spearman rank (0.82, P = .03) with the results of the Gastroenterology Training Examination. Ratings of the fellows by the SP did not differ by level of training, nor did they correlate with faculty scores. Fellows viewed the exercise favorably, with most indicating they would alter their practice based on the experience.
An SP exercise is an efficient and effective tool for assessing core clinical competencies during fellowship training.
The Department of Veterans Affairs (VA) instituted the VA Women’s Health Fellowship (VAWHF) Program in 1994, to accommodate the health needs of increasing numbers of female veterans and to develop academic leaders in women’s health. Despite the longevity of the program, it has never been formally evaluated.
To describe the training environments of VAWHFs and career outcomes of female graduates.
DESIGN AND PARTICIPANTS
Cross-sectional web-based surveys of current program directors (2010–2011) and VAWHF graduates (1995–2011).
Responses were received from six of seven program directors (86 %) and 42 of 74 graduates (57 %). The mean age of graduates was 41.2 years, and mean time since graduation was 8.5 years. Of the graduates, 97 % were female, 74 % trained in internal medicine, and 64 % obtained an advanced degree. Those with an advanced degree were more likely than those without an advanced degree to pursue an academic career (82 % vs. 60 %; P < 0.01). Of the female graduates, 76 % practice clinical women’s health and spend up to 66 % of their time devoted to women’s health issues. Thirty percent have held a VA faculty position. Seventy–nine percent remain in academics, with 39 % in the tenure stream. Overall, 94 % had given national presentations, 88 % had received grant funding, 79 % had published in peer-reviewed journals, 64 % had developed or evaluated curricula, 51 % had received awards for teaching or research, and 49 % had held major leadership positions. At 11 or more years after graduation, 33 % of the female graduates in academics had been promoted to the rank of associate professor and 33 % to the rank of full professor.
The VAWHF Program has been successful in training academic leaders in women’s health. Finding ways to retain graduates in the VA system would ensure continued clinical, educational, and research success for the VA women veteran’s healthcare program.
VA women’s health; fellowship; academic productivity; female leadership; women in academic medicine
To describe the teaching and evaluation modalities utilized by pediatric critical care medicine (PCCM) training programs in the areas of professionalism and communication.
Cross sectional national survey.
PCCM fellowship programs.
PCCM program directors.
Measurements and Main Results
Survey response rate was 67% of program directors in the United States, representing educators for 73% of current PCCM fellows. Respondents had a median of 4 years experience, with a median of 7 fellows and 12 teaching faculty in his/her program. Faculty role modeling or direct observation with feedback were the most common modalities used to teach communication. However, 6 of the 8 (75%) required elements of communication evaluated were not specifically taught by all programs. Faculty role modeling was the most commonly utilized technique to teach professionalism in 44% of the content areas evaluated, and didactics were the technique utilized in 44% of other professionalism content areas. Thirteen of the 16 required elements of professionalism (81%) were not taught by all programs. Evaluations by members of the healthcare team were used for assessment for both competencies. The use of a specific teaching technique was not related to program size, program director experience, or training in medical education.
A wide range of techniques are currently utilized within PCCM to teach communication and professionalism, but there are a number of required elements that are not specifically taught by fellowship programs. These areas of deficiency represent opportunities for future investigation and improved education in the important competencies of communication and professionalism.
communication; professionalism; graduate medical education; fellowship training; evaluation; competency; pediatric
Throughout North America, increasing emphasis is being placed on surgical fellowships. Surgical educators and trainees have raised concerns that the escalating focus on fellowships may threaten the educational mission of more novice trainees. Our objective was to collect opinions from multiple perspectives (faculty, fellows and residents) regarding fellowship structure, fellow selection and the impact of clinical fellowships on urology resident training.
We anonymously surveyed 52 members of a major academic urology training program (University of Toronto) with established fellowship training programs for their opinions regarding fellowship structure, fellow selection, and the impact on resident training and education.
The overall response rate was 88%. We identified significant differences of opinion among faculty, fellows and residents regarding fellowship structure, fellow selection and the impact on resident education. Specifically, faculty and fellows supported the addition of more fellows, felt that certain complex cases should be designated as “fellow cases” and that residents' research opportunities were not restricted. Residents felt that fellows “steal” operative cases, that performing operations with the fellow is not equivalent to performing operations with faculty alone and that fellowship candidates should perform an operation with division faculty as part of the application process. There was agreement that fellowship programs add value to residents' overall education, that fellows should participate in the call schedule and that fellows' role in the operating room needs to be better defined with respect to case volume and selection. Proficiency in technical skills, clinical knowledge, teaching and teamwork were cited as the most attractive characteristics of an effective clinical fellow.
Residency and fellowship program directors must clearly define the role of the fellow and outline the limits of surgical practice, establish clear and consistent guidelines outlining responsibilities (operative, clinical and on-call), and open lines of communication to ensure that all opinions are recognized and addressed. Finally, they must select fellows with proficient technical skills, clinical knowledge, teaching ability and work ethic to ensure that they focus on “specialized” training.
The aim of the study was to assess the methodology and content of nutrition education during gastroenterology fellowship training and the variability among the different programs.
A survey questionnaire was completed by 43 fellowship training directors of 62 active programs affiliated to NASPGHAN, including sites in the United States, Canada and Mexico. The data were examined for patterns in teaching methodology and coverage of specific nutrition topics based on Level 1 training in nutrition, which is the minimum requirement according to published NASPGHAN fellowship training guidelines.
The majority of the teaching was conducted by MD degree faculty (61%), and most of the education was provided through clinical care experiences. Only 31% of Level 1 nutrition topics were consistently covered by more than 80% of programs, and coverage did not correlate with the size of the programs. Competency in nutrition training was primarily assessed through questions to individuals or groups of fellows (77 and 65%, respectively). Program directors cited a lack of faculty interested in nutrition and a high workload as common obstacles for teaching.
The methodology of nutrition education during gastroenterology fellowship training is for the most part unstructured and inconsistent among the different programs. The minimum Level 1 requirements are not consistently covered. The development of core curriculums and learning modules may be beneficial in improving nutrition education.
Pediatric gastroenterology fellowship; Fellowship training; nutrition education
Objective. To describe the education, training, and academic experiences of newly hired faculty members at US colleges and schools of pharmacy during the 2012-2013 academic year.
Methods. A survey regarding education, training, and academic experiences was conducted of all first-time faculty members at US colleges and schools of pharmacy hired during the 2012-2013 academic year.
Results. Pharmacy practice faculty members accounted for the majority (68.2%) of new hires. Ambulatory care was the most common pharmacy specialty position (29.8%). Most new faculty members had a doctor of pharmacy (PharmD) as their terminal degree (74.8%), and 88.3% of pharmacy practice faculty members completed a residency. Of new faculty members who responded to the survey, 102 (67.5%) had at least 3 prior academic teaching, precepting, or research experiences.
Conclusion. New faculty members were hired most frequently for clinical faculty positions at the assistant professor level and most frequently in the specialty of ambulatory care. Prior academic experience included precepting pharmacy students, facilitating small discussions, and guest lecturing.
faculty member; pharmacy education; training; hiring; survey
Willis Cohoon Campbell was born in Jackson, Mississippi in 1880. He received his undergraduate training in his home state and medical training at the University of Virginia, Charlottesville, where he graduated in 1924 . After serving a two-year internship, he went into private practice in Memphis, Tennessee. As with other prominent orthopaedic surgeons (Ryerson among them), he visited medical centers in Europe, particularly London and Vienna. He evidently then spent some time in postgraduate work in New York City prior to returning to private practice in Memphis. (Most formal residencies were not established until the 1930s coincident with the formation of the American Board of Orthopaedic Surgery in 1934, although many doctors took “postgraduate” work following one or two years of internship in general medicine or surgery.) In 1910, he was asked to organize a Department of Orthopaedic Surgery at the University of Tennessee Medical School as the first Professor of Orthopaedics, a post he held until his death.
In addition to forming a department for the university, Campbell helped establish one of the first hospitals for crippled children in the south, then the Willis Cohoon Campbell Clinic in 1920 , and finally in 1923 the Hospital for Crippled Adults. The Campbell clinic provided postgraduate training, meeting the requirements of the American Board for the Certification of Specialists. Dr. Campbell, while not one of the original nine board members of the American Board of Orthopaedic Surgery, was influential in establishing the Board in 1934. According to Wickstrom , a “...persistent rumor, repeatedly denied, held that Henderson (Melvin) and Campbell were the primary movers behind the establishment of both the American Academy of Orthopaedic surgeons and the American Board in Orthopaedic Surgery; their actions were said to be a retaliatory response to their rejection by the orthopaedic establishment ‘in the East.’” Be that as it may, Dr. Campbell served as President of a number of professional organizations . He published many papers and three monographs, including the classic “Operative Orthopaedics” , which has gone through 10 editions, was the standard textbook for orthopaedic surgeons for decades and remains one of the most widely read references. Dr. Campbell was widely known as a kind, courteous man .
The article reproduced here describes arthroplasty of the elbow to restore motion to ankylosed joints . In this article Campbell recognized some of the described resection arthroplasties (usually with interposition of various materials) left the elbow unstable and weak. He advocated creating a “double flap” of the triceps aponeurosis and underlying periosteum and suturing that to the anterior capsule of the elbow after resecting bone. This, he suggested, allowed functional motion within 6 months in the two cases he described. Interestingly, in his “Operative Orthopaedics” published in 1939, he recommends covering the exposed bony surfaces with fascia lata, and does not describe attaching the flap of the triceps to the anterior capsule, but rather suggests attaching “at a lower point than its former attachment to permit free play of the joint in flexion” .
Willis Cohoon Campbell, MD is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress, 1983.
Calandruccio RA. The history of the Campbell Clinic. Clin Orthop Relat Res. 2000:157–170.Campbell WC. Arthroplasty of the elbow. Ann Surg. 1922;76:615–623.Campbell WC. Operative Orthopedics. Saint Louis: CV Mosby Co; 1939.Wickstrom JK. Fifty years of the American Board of Orthopaedic Surgery: 1934. Clin Orthop Relat Res. 1990;257:3–10.Willis Cohoon Campbell 1880–1941. J Bone Joint Surg Am. 1941;23:716–717.
A large volume of literature has documented racial disparities in the delivery of cardiovascular care in the United States and that decreased access to procedures and undertreatment lead to worse outcomes. A lack of diversity among physicians is considered to be a major contributor. The fellowship training program in cardiovascular medicine at The Ohio State University Medical Center had never trained a fellow from a minority group underrepresented in medicine (URM) before 2007.
In 2005, the fellowship made it a priority to recruit and match URM candidates in an effort to address the community's lack of diversity and disparities in cardiovascular care.
Program leaders revised the recruitment process, making diversity a high priority. Faculty met with members of diverse residency programs during visits to other institutions, the focus of interview day was changed to highlight mentorship, additional targeted postinterview communications reached out to highly competitive applicants, and a regular mentoring program was constructed to allow meaningful interaction with URM faculty and fellows.
Since these changes were implemented, the program has successfully matched a URM fellow for 5 consecutive years. Such candidates currently make up 4 of 16 total trainees (25%) in the fellowship in cardiovascular medicine.
The cardiovascular medicine fellowship training program at The Ohio State University was able to revise recruitment to attract competitive URM applicants as part of a concerted effort. Other educational programs facing similar challenges may be able to learn from the university's experiences.
Background and Aims
The Gastroenterology Core Curriculum requires training in women’s digestive disorders; however, requirements do not necessarily produce knowledge and competence. Our study goals were: (1) to compare perceptions of education, fellow-reported levels of competence, and attitudes towards training in women’s gastrointestinal (GI) health issues during fellowship between gastroenterology fellows and program directors, and (2) to determine the barriers for meeting training requirements.
A national survey assessing four domains of training was conducted. All GI program directors in the United States (n = 153) and a random sample of gastroenterology fellows (n = 769) were mailed surveys. Mixed effects linear modeling was used to estimate all mean scores and to assess differences between the groups. Cronbach’s alpha was used to assess the consistency of the measures which make up the means.
Responses were received from 61% of program directors and 31% of fellows. Mean scores in perceived didactic education, clinical experiences, and competence in women’s GI health were low and significantly differed between the groups (P < 0.0001). Fellows’ attitudes towards women’s GI health issues were more positive compared to program directors’ (P = 0.004). Barriers to training were: continuity clinic at a Veteran’s Administration hospital, low number of pregnant patients treated, low number of referrals from obstetrics and gynecology, and lack of faculty interest in women’s health.
(1) Fellows more so than program directors perceive training in women’s GI health issues to be low. (2) Program directors more so than fellows rate fellows to be competent in women’s GI health. (3) Multiple barriers to women’s health training exist.
Women’s health; Gastroenterology fellowship; Training guidelines
Around the world, health professionals and program managers are leading and managing public and private health organizations with little or no formal management and leadership training and experience.
To describe an innovative 2-year, long-term apprenticeship Fellowship training program implemented by Makerere University School of Public Health (MakSPH) to strengthen capacity for leadership and management of HIV/AIDS programs in Uganda.
The program, which began in 2002, is a 2-year, full-time, non-degree Fellowship. It is open to Ugandan nationals with postgraduate training in health-related disciplines. Enrolled Fellows are attached to host institutions implementing HIV/AIDS programs and placed under the supervision of host institution and academic mentors. Fellows spend 75% of their apprenticeship at the host institutions while the remaining 25% is dedicated to didactic short courses conducted at MakSPH to enhance their knowledge base.
Overall, 77 Fellows have been enrolled since 2002. Of the 57 Fellows who were admitted between 2002 and 2008, 94.7% (54) completed the Fellowship successfully and 50 (92.3%) are employed in senior leadership and management positions in Uganda and internationally. Eighty-eight percent of those employed (44/54) work in institutions registered in Uganda, indicating a high level of in-country retention. Nineteen of the 20 Fellows who were admitted between 2009 and 2010 are still undergoing training. A total of 67 institutions have hosted Fellows since 2002. The host institutions have benefited through staff training and technical expertise from the Fellows as well as through grant support to Fellows to develop and implement innovative pilot projects. The success of the program hinges on support from mentors, stakeholder involvement, and the hands-on approach employed in training.
The Fellowship Program offers a unique opportunity for hands-on training in HIV/AIDS program leadership and management for both Fellows and host institutions.
building capacity; HIV/AIDS; program leadership; management; mentored Fellowship; Uganda
Introduction: Eligible residents during their fourth postgraduate year (PGY-4) of emergency medicine (EM) residency training who seek specialty board certification in emergency medicine may take the American Osteopathic Board of Emergency Medicine (AOBEM) Part 1 Board Certifying Examination (AOBEM Part 1). All residents enrolled in an osteopathic EM residency training program are required to take the EM Resident In-service Examination (RISE) annually. Our aim was to correlate resident performance on the RISE with performance on the AOBEM Part 1. The study group consisted of osteopathic EM residents in their PGY-4 year of training who took both examinations during that same year.
Methods: We examined data from 2009 to 2012 from the National Board of Osteopathic Medical Examiners (NBOME). The NBOME grades and performs statistical analyses on both the RISE and the AOBEM Part 1. We used the RISE exam scores, as reported by percentile rank, and compared them to both the score on the AOBEM Part 1 and the dichotomous outcome of passing or failing. A receiver operating characteristic (ROC) curve was generated to depict the relationship.
Results: We studied a total of 409 residents over the 4-year period. The RISE percentile score correlated strongly with the AOBEM Part 1 score for residents who took both exams in the same year (r=0.61, 95% confidence interval [CI] 0.54 to 0.66). Pass percentage on the AOBEM Part 1 increased by resident percent decile on the RISE from 0% in the bottom decile to 100% in the top decile. ROC analysis also showed that the best cutoff for determining pass or fail on the AOBEM Part 1 was a 65th percentile score on the RISE.
Conclusion: We have shown there is a strong correlation between a resident's percentile score on the RISE during their PGY-4 year of residency training and first-time success on the AOBEM Part 1 taken during the same year. This information may be useful for osteopathic EM residents as an indicator as to how well prepared they are for the AOBEM Part 1 Board Certifying Examination.
Journal advertising is one of the main sources of medicines information to doctors. Despite the availability of regulations and controls of drug promotion worldwide, information on medicines provided in journal advertising has been criticized in several studies for being of poor quality. However, no attempt has been made to systematically summarise this body of research. We designed this systematic review to assess all studies that have examined the quality of pharmaceutical advertisements for prescription products in medical and pharmacy journals.
Methods and Findings
Studies were identified via searching electronic databases, web library, search engine and reviewing citations (1950 – February 2006). Only articles published in English and examined the quality of information included in pharmaceutical advertisements for prescription products in medical or pharmacy journals were included. For each eligible article, a researcher independently extracted the data on the study methodology and outcomes. The data were then reviewed by a second researcher. Any disagreements were resolved by consensus. The data were analysed descriptively. The final analysis included 24 articles. The studies reviewed advertisements from 26 countries. The number of journals surveyed in each study ranged from four to 24 journals. Several outcome measures were examined including references and claims provided in advertisements, availability of product information, adherence to codes or guidelines and presentation of risk results. The majority of studies employed a convenience-sampling method. Brand name, generic name and indications were usually provided. Journal articles were commonly cited to support pharmaceutical claims. Less than 67% of the claims were supported by a systematic review, a meta-analysis or a randomised control trial. Studies that assessed misleading claims had at least one advertisement with a misleading claim. Two studies found that less than 28% of claims were unambiguous clinical claims. Most advertisements with quantitative information provided risk results as relative risk reduction. Studies were conducted in 26 countries only and then the generalizability of the results is limited.
Evidence from this review indicates that low quality of journal advertising is a global issue. As information provided in journal advertising has the potential to change doctors' prescribing behaviour, ongoing efforts to increase education about drug promotion are crucial. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines.
The Accreditation Council of Graduate Medical Education’s (ACGME) Data Accreditation System indicates 124 of 152 orthopaedic surgery residency program directors have 5 or fewer years of tenure. The qualifications and responsibilities of the position based on the requirements of orthopaedic surgery residency programs, the institutions that support them, and the ACGME Outcome Project have evolved the role of the program coordinator from clerical to managerial. To fill the void of information on the coordinators’ expanding roles and responsibilities, the 2006 Association of Residency Coordinators in Orthopaedic Surgery (ARCOS) Career survey was designed and distributed to 152 program coordinators in the United States. We had a 39.5% response rate for the survey, which indicated a high level of day-to-day managerial oversight of all aspects of the residency program; additional responsibilities for other department or division functions for fellows, rotating medical students, continuing medical education of the faculty; and miscellaneous business functions. Although there has been expansion of the role of the program coordinator, challenges exist in job congruence and position reclassification. We believe use of professional groups such as ARCOS and certification of program coordinators should be supported and encouraged.
To determine the relationship and impact of student-faculty ratio on scholarship of pharmacy faculty members.
The number and rank of faculty members, pharmacy program characteristics, and faculty productivity data were collected to determine the impact of student-faculty ratio on faculty scholarship.
Faculty scholarship was not predicted by student-faculty ratio. Factors impacting positively on faculty productivity included National Institutes of Health funding; presence of clinical associate professors, instructors, and lecturers; and programs located in public universities.
Faculty productivity is not related to the student-faculty ratio, wherein more faculty members and fewer students equates to increased scholarship. However, public universities may have different infrastructures which are associated with greater academic productivity compared to private institutions. Additionally, utilizing instructors and clinical or nontenure-track faculty members can significantly increase scholarship among faculty members.
pharmacy faculty; scholarship; student-faculty ratio; productivity
Objective. To determine the perceptions of junior pharmacy faculty members with US doctor of pharmacy (PharmD) degrees regarding their exposure to residency, fellowship, and graduate school training options in pharmacy school. Perceptions of exposure to career options and research were also sought.
Methods. A mixed-mode survey instrument was developed and sent to assistant professors at US colleges and schools of pharmacy.
Results. Usable responses were received from 735 pharmacy faculty members. Faculty members perceived decreased exposure to and awareness of fellowship and graduate education training as compared to residency training. Awareness of and exposure to academic careers and research-related fields was low from a faculty recruitment perspective.
Conclusions. Ensuring adequate exposure of pharmacy students to career paths and postgraduate training opportunities could increase the number of PharmD graduates who choose academic careers or other pharmacy careers resulting from postgraduate training.
pharmacy faculty members; residency programs; fellowships; graduate education; careers
Acquiring a faculty position in academia is extremely competitive and now typically requires more than just solid research skills and knowledge of one’s field. Recruiting institutions currently desire new faculty that can teach effectively, but few postdoctoral positions provide any training in teaching methods. Fellowships in Research and Science Teaching (FIRST) is a successful postdoctoral training program funded by the National Institutes of Health (NIH) providing training in both research and teaching methodology. The FIRST program provides fellows with outstanding interdisciplinary biomedical research training in fields such as neuroscience. The postdoctoral research experience is integrated with a teaching program which includes a How to Teach course, instruction in classroom technology and course development and mentored teaching. During their mentored teaching experiences, fellows are encouraged to explore innovative teaching methodologies and to perform science teaching research to improve classroom learning. FIRST fellows teaching neuroscience to undergraduates have observed that many of these students have difficulty with the topic of neuroscience. Therefore, we investigated the effects of interactive teaching methods for this topic. We tested two interactive teaching methodologies to determine if they would improve learning and retention of this information when compared with standard lectures. The interactive methods for teaching action potentials increased understanding and retention. Therefore, FIRST provides excellent teaching training, partly by enhancing the ability of fellows to integrate innovative teaching methods into their instruction. This training in turn provides fellows that matriculate from this program more of the characteristics that hiring institutions desire in their new faculty.
action potential; postdoctoral fellowship; interactive teaching; pedagogy; neuroscience; mentoring