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Richard K, Chiel L, Kazmerski TM, Atteih S, Nelson B, Cohen R, Laguna TA, D'Anna R, Dahlberg S, Zecena M, Casey A. Virtual interviews and equity: The pediatric pulmonary fellow perspective. Pediatr Pulmonol 2024; 59:1731-1739. [PMID: 38546009 DOI: 10.1002/ppul.26983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 02/09/2024] [Accepted: 03/13/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND AND OBJECTIVES The SARS-CoV-2 pandemic shifted medical training programs to utilize virtual interviews (VIs) starting with the 2020 interview cycle. Fellowship interviews continue in the virtual format. It is unknown how this shift has affected equity for applicants as compared to in-person interviews. Equity in this study includes consideration of the opportunity for an applicant to accept, access, and conduct a VI. This study assessed pediatric pulmonary fellows' perception of equity associated with VIs and preferences for future cycles. METHODS An anonymous survey link was emailed to Pediatric Pulmonology Program Directors to disseminate to incoming and first-year pediatric pulmonary fellows who participated in the 2022-2023 and 2021-2022 VI seasons. Responses were summarized by frequency and percentages. Inductive coding was used to thematically analyze free-text responses. RESULTS Nearly 30% of eligible incoming and first-year pulmonary fellows (n = 35/119, 29.4%) completed the survey. Seventy-four percent felt that VIs reduce inequities as compared to in-person interviews. Sixty percent felt that VIs were the most equitable format, and 51% chose a VI as their preferred future format. Important practice considerations to promote equity for future VIs included providing applicants with instruction for the expected dress code, followed by providing applicants with virtual technology (91% and 89% of respondents ranked as at least "somewhat important," respectively). CONCLUSION VIs were perceived as a more equitable interview format by pediatric pulmonology fellows compared to in-person interviews in our study. To increase equity for VIs, program directors can consider additional adaptations such as providing standardized instruction for dress code and providing the required technology.
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Affiliation(s)
| | - Laura Chiel
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Traci M Kazmerski
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Center for Innovative Research on Gender Health Equity (CONVERGE), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Samar Atteih
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Ben Nelson
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, Massachusetts, USA
| | - Robyn Cohen
- Boston Medical Center, Boston, Massachusetts, USA
| | - Theresa A Laguna
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel D'Anna
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Magan Zecena
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alicia Casey
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Rai N, Chang A, Kass A, Berger S, Sein AS, De A. Impact of an Online Curriculum on Trainee Learning during a Pediatric Pulmonary Elective. ATS Sch 2024; 5:254-258. [PMID: 38957490 PMCID: PMC11215994 DOI: 10.34197/ats-scholar.2023-0119br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/26/2024] [Indexed: 07/04/2024] Open
Affiliation(s)
- Nooralam Rai
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; and
| | - Audrey Chang
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; and
| | - Alexandra Kass
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; and
| | - Sophie Berger
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Aubrie Swan Sein
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; and
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Boolchandani H, Chen L, Elder RW, Osborn R, Phatak UP, Puthenpura V, Sheares BJ, Tiyyagura G, Amster L, Lee S, Langhan ML. Identifying Gender and Racial Bias in Pediatric Fellowship Letters of Recommendation: Do Word Choices Influence Interview Decisions? J Pediatr 2024; 265:113843. [PMID: 37995931 DOI: 10.1016/j.jpeds.2023.113843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/09/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES To describe linguistic differences in letters of recommendation (LORs) for pediatric fellowship candidates based on applicant and letter writer demographics and to examine if these differences influenced the decision to interview a candidate for a fellowship position. STUDY DESIGN LORs for applicants to 8 pediatric subspecialty fellowships at a single academic center from the 2020 Match were analyzed in this cross-sectional study. Frequency of validated agentic and communal terms in each letter were determined by a language processing web application. Bias was determined as having a >5% surplus of agentic or communal terms. RESULTS We analyzed 1521 LORs from 409 applicants: 69% were women, 28% were under-represented minorities in medicine (URM), and 50% were invited to interview. Overall, 66% of LORs were agentic biased, 16% communal biased, and 19% neutral. There was no difference in bias in LORs by an applicant's gender (woman 67% agentic vs man 62% agentic; P = .058), race, or ethnicity (non-URM 65% agentic vs URM 67% agentic; P = .660). Despite a lower frequency of agentic terms in LORs for applicants invited for interviews, when accounting for other components of an application and applicant demographics, no significant association was made between language bias in LORs and fellowship interview status. CONCLUSIONS The frequency of agentic and communal terms in LORs for pediatric subspecialty fellowship candidates were not found to influence the decision to invite a candidate to interview. However, raising awareness of potential areas of bias within the pediatric fellowship selection process might lead to a more equitable and holistic approach to application review.
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Affiliation(s)
- Henna Boolchandani
- Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Laura Chen
- Section of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Robert W Elder
- Section of Pediatric Cardiology, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Rachel Osborn
- Section of Pediatric Hospital Medicine, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Uma P Phatak
- Section of Pediatric Gastroenterology and Hepatology, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Vidya Puthenpura
- Section of Pediatric Hematology and Oncology, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Beverley J Sheares
- Section of Pediatric Pulmonology, Allergy, Immunology, and Sleep Medicine, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | - Gunjan Tiyyagura
- Section of Pediatric Emergency Medicine, Department of Pediatrics at Yale University School of Medicine, New Haven, CT
| | | | - Seohyuk Lee
- Yale University School of Medicine, New Haven, CT
| | - Melissa L Langhan
- Section of Pediatric Emergency Medicine, Department of Pediatrics at Yale University School of Medicine, New Haven, CT.
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Noah TL, Boyer D, Davis SD, Vinci RJ, Oermann CM. Child Health and the Pediatric Pulmonology Workforce: 2020-2040. Pediatrics 2024; 153:e2023063678Q. [PMID: 38300006 DOI: 10.1542/peds.2023-063678q] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
There is concern as to whether the supply of pediatric pulmonology (PULM) subspecialists will be adequate to meet future demand. As part of an American Board of Pediatrics (ABP) Foundation-sponsored supplement investigating the future of the pediatric subspecialty workforce, this article assesses the current PULM clinical workforce and estimates the clinical workforce supply in the United States through 2040. The current workforce was assessed using ABP certification and Maintenance of Certification data, and a workforce supply model evaluating population growth, clinical effort, and geographic trends was developed after incorporating ABP data. Findings demonstrate that the number of pediatric pulmonologists has gradually increased over the past decade, and the ratio of subspecialists to children is likely to increase another 20% to 40% over the next 2 decades, although absolute numbers remain small. Geographic variation in access will persist in some regions. The proportion of women in the discipline has increased, but the proportion of pediatric pulmonologists from underrepresented in medicine backgrounds still lags behind the general population. Based on current trends, the PULM clinical workforce appears equipped to meet both population growth and the modest increase in demand for clinical services speculated to occur because of changes in the subspecialty's clinical portfolio. However, several factors could inhibit growth, and geographic maldistribution may continue to impact care access. Efforts to address variation in access and demographic diversity in the field are warranted. This article concludes by discussing the training, clinical practice, policy, and future workforce research implications of the data presented.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Debra Boyer
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Stephanie D Davis
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert J Vinci
- Department of Pediatrics, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christopher M Oermann
- University of Missouri-Kansas City School of Medicine; Children's Mercy Kansas City, Kansas City, Missouri
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Singh A, Khan E. Punching above your weight class: How a small pediatric pulmonology fellowship program implemented Kern's model and developed an entrustable professional activities-based program. Pediatr Pulmonol 2023; 58:3337-3341. [PMID: 37401885 DOI: 10.1002/ppul.26581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Alvin Singh
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Erin Khan
- Division of Allergy, Immunology, Pulmonary and Sleep Medicine, Children's Mercy-Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
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Stephenson N, Forno E, Laguna TA, Lovinsky-Desir S, Moore PE, Sheares BJ, Kazmerski TM, Udoko MN, Lypson ML, Harding LRW, Wilkes DS, Adair DJ, Afolabi F, Balasubramaniam V, Ale GJB, Castner LM, Ghera P, Heras A, Jordan K, Ly NP, Martinez-Fernandez TM, Mishra PE, Narang I, Palla JB, Rivera-Sanchez YM, Tapia IE, Toprak D, Torres-Silva CA, Cohen RT. Diversity, Equity, and Inclusion in the Pediatric Pulmonary Workforce: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2023; 20:1373-1388. [PMID: 37772940 PMCID: PMC10559131 DOI: 10.1513/annalsats.202306-583st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
Despite growing recognition of the need for increased diversity among students, trainees, and faculty in health care, the medical workforce still lacks adequate representation from groups historically underrepresented in medicine (URiM). The subspecialty field of pediatric pulmonology is no exception. Although there have been efforts to address issues of diversity, equity, and inclusion (DEI) in our own field, gaps persist. To address these gaps, the members of the Diversity, Equity, and Inclusion Advisory Group (DEI-AG) of the American Thoracic Society Pediatrics Assembly created and distributed a Needs Assessment Survey in the United States and Canada to better understand the racial and ethnic demographics of the pediatric pulmonary workforce and to learn more about successes, gaps, and opportunities to enhance how we recruit, train, and retain a diverse workforce. The DEI-AG leadership cochairs convened a workshop to review the findings of the DEI Needs Assessment Survey and to develop strategies to improve the recruitment and retention of URiM fellows and faculty. This Official ATS Workshop Report aims to identify barriers and opportunities for recruitment, training, and career development within the field of pediatric pulmonology. Additionally, we offer useful strategies and resources to improve the recruitment of URiM residents, the mentorship of trainees and junior faculty, and the career development of URiM faculty in academic centers. This Workshop Report is an important first deliverable by the DEI-AG. We hope that this work, originating from within the Pediatrics Assembly, will serve as a model for other Assemblies, disciplines across the ATS, and other fields in Pediatrics.
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Esther CR, Rama JA, Nelson BA. Pediatric Pulmonary Fellowship Program Size Effect on Recruitment and Workforce Distribution. ATS Sch 2023; 4:311-319. [PMID: 37795123 PMCID: PMC10547028 DOI: 10.34197/ats-scholar.2022-0117oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/04/2023] [Indexed: 10/06/2023] Open
Abstract
Background Concerns about the pediatric pulmonology workforce suggest a need to improve fellowship recruitment. Program size is related to the financial health and recruitment success of pediatric subspecialty education programs, but there are few data on how program size impacts recruitment and workforce in pediatric pulmonology. Objective Assess the impact of program size in pediatric pulmonology through examination of the distribution of applicants matching into pediatric pulmonology training programs over time and relationships to workforce distribution. Methods Data from the National Residency Match Program from 2010 to 2022 were extracted from published documents. Positions offered, positioned filled, and match rates were calculated for each appointment year. Statewide statistics for the number of fellows matched were analyzed relative to the number of pediatric pulmonologists per capita using data from the American Board of Pediatrics. Results From 2010 to 2018, the size and distribution of programs in pediatric pulmonology were stable, with most fellows (82.4%) matching into programs with one or two positions per cycle. Starting in 2019, programs offering three or more positions steadily increased in number and aggregate positions offered. This change was associated with an increase in total filled positions (38.9 ± 7.3 in 2010-2018 vs. 50.5 ± 8.7 in 2019-2022; P < 0.03) and an increased fraction who matched into larger programs (17.6% in 2010-2018 vs. 36.9% in 2019-2022; P < 0.001). Among states with fellowship programs, the number of fellows matched over the past 5 years correlated with the number of practicing pediatric pulmonologists per capita (r = 0.78; P < 0.001). Conclusion The period 2019-2022 saw a marked shift of pediatric pulmonary trainees matching into a relatively small number of larger programs. This shift was associated with overall growth in the number of trainees but may have implications on geographical distribution of practicing pediatric pulmonologists.
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Affiliation(s)
- Charles R. Esther
- Department of Pediatric Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer A. Rama
- Department of Pediatric Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas; and
| | - Benjamin A. Nelson
- Department of Pediatric Pulmonology, Mass General Hospital for Children, Boston, Massachusetts
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Garattini SK, Valent F, Minisini AM, Riosa C, Favaretti C, Regattin L, Fasola G. Analysis of workload generated in the two years following first consultation by each new cancer patient: studying the past to plan the future of cancer care. BMC Health Serv Res 2022; 22:1184. [PMID: 36131286 PMCID: PMC9494889 DOI: 10.1186/s12913-022-08573-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Prevalence of cancer patients is dramatically increasing. We aimed at quantifying the oncology workload generated by each new cancer patient in the two years following first consultation. METHODS In this record-based retrospective study, we retrieved data of all newly diagnosed patients treated at the Oncology Department of Udine Academic Hospital between 01.01.2012 and 31.12.2017. We calculated mean number and standard deviation of the activity type generated by each new cancer patient during the following 2 years. RESULTS Seven thousand four hundred fifty-two cancer patients generated a total of 85,338 clinical episodes. The two-years mean number of oncology episodes generated was 11.31 (i.e., for every 1,000 new cancer patients, 11,310 oncology activities are generated overall in the following two-year lapse). Patients with advanced disease generated the highest workload (24.3; SD 18.8) with a statistically significant difference compared to adjuvant and follow-up patients (p < 0.001). The workload generated in the period 0-6 and 0-12 months was significantly higher than in the following months (p < 0.001) and it was also higher for patients initially designated to treatment (p < 0.001). CONCLUSION This is the first study reporting on the mean oncology workload generated during the 2 years following first consultation. Workload is the highest for patient with advanced disease, especially in the first months and in patients in active treatment. A detailed analysis of workloads in oncology is feasible and could be crucial for planning a sustainable framework for cancer care in the next future.
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Affiliation(s)
- SK. Garattini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD 33100 Italy
| | - F. Valent
- Institute of Hygiene and Clinical Epidemiology, Academic Hospital of Udine ASUFC, 33100 Udine, UD Italy
| | - AM. Minisini
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD 33100 Italy
| | - C. Riosa
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD 33100 Italy
| | - C. Favaretti
- Center for Leadership in Medicine, Catholic University of Sacred Heart, 000168 Rome, RO Italy
| | - L. Regattin
- Medical Director, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD 33100 Italy
| | - G. Fasola
- Department of Oncology, Academic Hospital of Udine ASUFC, Piazzale Santa Maria della Misericordia 15, Udine, UD 33100 Italy
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