Recommended Protected Time for Pediatric Fellowship Program Directors: A Needs Assessment Survey

Changes, Challenges, and Variations in Neonatal-Perinatal Medicine Fellowship: A View from the Program Directors

OBJECTIVES

Neonatal-perinatal medicine (NPM) fellowship programs in the United States support >800 learners annually. Understanding variations in the programmatic structure, challenges, and needs is essential to optimize the educational environment and ensure the specialty's future.

STUDY DESIGN

NPM fellowship program directors (PDs) and associate program directors (APDs) were invited to complete an electronic survey on their program administration, recruitment, clinical training, assessment methods, scholarly program, and career pathways. Each participant identified individual programmatic strengths, challenges, opportunities, and threats to the field.

RESULTS

Representatives from 59 NPM fellowships provided data (response rate 59/96 = 61%). In total, 30% of PDs received less than the Accreditation Council for Graduate Medical Education -recommended protected time for administrative duties, and 44% of APDs received no protected time. Fellow clinical service assignments varied widely from 13 to 18 months and 90 to 175 call nights over 3 years. Recruitment practices varied across programs; 59% of respondents raised concerns over the pipeline of applicants. Conflicts between fellows and advanced practice providers were identified by 61% of responders. Programs varied in their scholarly offerings, with 44% of NPM fellowships interested in adding broader research opportunities.

CONCLUSION

NPM fellowship leaders identified a need for improved programmatic support, enhanced measures to assess competency, opportunities to strengthen scholarly programs, shared curricular resources, and strategies to balance education with clinical demands. PDs and APDs identified threats to the future of NPM training programs including the diminishing pipeline of applicants into neonatology, challenges with clinical exposure and competence, inadequate support for the educational mission, issues supporting high-quality scholarship, and fewer graduates pursuing physician-investigator pathways. National organizations and academic institutions should take action to address these challenges so that fellowships can optimally prepare graduates to meet their patients' needs.

KEY POINTS

· Numerous challenges exist for current program directors in NPM including balancing clinical work with scholarly activities, accurately assessing competency, optimizing the culture of the learning environment, and ensuring that fellows are adequately prepared for a range of postgraduate positions.. · Significant variation exists across NPM fellowship programs in clinical service/calls assigned over 3 years of fellowship training, as well as opportunities to pursue scholarly activities across a variety of areas.. · Challenges exist related to ensuring an adequate number of future applicants into the specialty, including those from backgrounds traditionally underrepresented in medicine, as well as those seeking to pursue careers as physician-investigators..

Nephrology Program Director Protected Time for Program Administration in the United States

BACKGROUND AND OBJECTIVES

The Accreditation Council for Graduate Medical Education (ACGME) required that program directors receive 10-20 h/wk of protected time for program administration (including didactic teaching). In July 2022, this was reduced for all internal medicine subspecialties on the basis of program size, with 8 h/wk required for programs with fewer than seven fellows, the majority of nephrology programs.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

We surveyed all 151 US adult nephrology program directors (ACGME Public List of Programs 2021-2022) to determine how much protected time they receive, how much they think is necessary, and the division of their professional time. The anonymous 20-question online survey was administered from March 31 to April 30, 2022. The analysis was descriptive.

RESULTS

Response rate was 66% (99 of 151). Geographic distribution and approved fellow positions were similar to programs nationally; 59% had fewer than seven approved positions. Median protected time was 10 h/wk (interquartile range, 5-10), with 8 h/wk (interquartile range, 5-10) for those with fewer than seven positions. Program directors estimated needing 12 h/wk (interquartile range, 10-16) to effectively administer programs, including those with fewer than seven positions, a median 5 h/wk (interquartile range, 0-7) more than received. Of program directors reporting <10 h/wk for program administration, 62% provided >20 hours of direct patient care. Thirty-nine percent had no protected time for core faculty. Fellow recruitment (68%) was the most time-consuming task, and didactic teaching (80%) was the most professionally rewarding.

CONCLUSIONS

Approximately half of the nephrology programs surveyed were not in compliance with the ACGME-stipulated 10-h/wk minimum protected time for the 2021-2022 training year. Program directors estimated a median of 12 h/wk are needed to effectively manage programs.

A balancing act: The Supervisor of Training role in anaesthesia education

In this qualitative study, we report how Supervisors of Training, educational supervisors overseeing the learning of anaesthesia trainees, experience their role in practice. Using purposive sampling, we interviewed Supervisors of Training from across Australia and New Zealand. The interviews began by asking ‘what do you see as your role as a Supervisor of Training?’ then explored the response in detail. Following the technique of thematic analysis, inductive analysis occurred as data were collected until we generated a thematic structure sufficient to address our research question after 19 interviews. In the first three of the four identified themes, Supervisors of Training perceived themselves as the fulcrum of the learning environment, ‘the something in between’. These three themes were: guiding and assessing trainees; identifying, supporting, and adjudicating trainee underperformance; and mediating trainees’ relationship with the hospital. Participants perceived themselves as a broker between trainees, their colleagues, their hospital, the Australian and New Zealand College of Anaesthetists and the community to varying degrees at different times. Negotiating these competing responsibilities required Supervisors of Training to manage multiple different relationships and entailed significant emotional work. Our fourth theme, scarcity, described the imbalance between these demands and the time and resources available. The complexity of the Supervisor of Training role and the tensions between these competing demands is underappreciated. Our findings would support strategies to mitigate the administrative load and share the decision-making burden of the role and to enhance the capability of Supervisors of Training by requiring formal training for the role.

Research during Pediatric Residency Training: A Nationwide Study in Japan

Introduction

Training in scholarship is an essential component of postgraduate education. Previous studies worldwide on the research activities of pediatric residents were questionnaires targeting program directors or surveys conducted in a limited number of institutions; however, no nationwide studies have been conducted. The objective of this study was to describe the research activities of pediatric residents.

Methods

We conducted a nationwide cross-sectional study during 2015 and 2016 in Japan. Study data were collected from each resident's logbook submitted to the board examination office and compared by the type of institution, namely, university, children's, or community hospital.

Results

Of 1,718 eligible participants, 1,500 participated in this study. Overall, 499 (33.3%) residents trained at national/public university hospitals, 371 (24.7%) at private university hospitals, 140 (9.3%) at children's hospitals, and 490 (32.7%) at community hospitals. Although 1,361 (90.7%) residents gave at least one presentation at an academic conference during their residency, only 235 (15.7%) residents published one or more articles in a peer-reviewed academic medical journal. The proportion of residents who gave at least one presentation (p=0.03) and published at least one study (p<0.01) differed significantly among the types of institutions. Residents at community hospitals gave fewer presentations at conferences (odds ratio [OR] 0.56; 95% confidence interval [95% CI] 0.36-0.87) and published fewer peer-reviewed articles (OR 0.53; 95% CI 0.37-0.76) than residents at national/public university hospitals.

Conclusions

This is apparently the first nationwide study demonstrating that the research activities of pediatric residents consisted mostly of presentations at academic conferences, but also that most residents had not published their research. There was a marked variation in residents' academic activities by institution type.