Adequacy of fellowship training: results of a survey of recently graduated fellows

National survey of infectious disease fellowship program directors: A call for subspecialized training in infection prevention and control and healthcare epidemiology

OBJECTIVE

The importance of infection prevention and control and healthcare epidemiology (IPC/HE) in healthcare facilities was highlighted during the COVID-19 pandemic. Infectious disease (ID) clinicians often hold leadership positions in IPC/HE teams; however, there is no standard for training or certification of ID physicians specializing in IPC/HE. We evaluated the current state of IPC/HE training in ID fellowship programs.

DESIGN

A national survey of ID fellowship program directors was conducted to assess current IPC/HE training components in programs and plans for expanded offerings.

SETTING AND PARTICIPANTS

All ID fellowship program directors in the United States and Puerto Rico.

METHODS

Surveys were distributed using Research Electronic Data Capture (REDCap) to program directors in March 2023, with 2 reminder emails; the survey closed after 4 weeks.

RESULTS

Of 166 program directors, 54 (32.5%) responded to the survey. Among respondent programs, 49 (90.7%) of 54 programs reported didactic training in IPC/HE averaging 4.4 hours over the course of the fellowship. Also, 18 (33.3%) of 54 reported a dedicated IPC/HE training track. Furthermore, 23 programs (42.6%) reported barriers to expanding training. There was support (n = 47, 87.0%) for formal IPC/HE certification from a professional society within the standard fellowship.

CONCLUSIONS

Despite the COVID-19 pandemic highlighting the need for ID medical doctors with IPC/HE expertise, formal training in ID fellowship remains limited. Most program directors support formalization of IPC/HE training by a professional organization. Creation of standardized advanced curriculums for ID fellowship training in IPC/HE could be considered by the Society of Healthcare Epidemiology of America (SHEA) to grow, retain, and enhance the IPC/HE physician workforce.

Training infectious diseases fellows for a new era of hospital epidemiology

Training programs for infectious diseases fellows pursuing a career in infection prevention and control and hospital epidemiology are grounded in mentorship and organizational experience. In this commentary, we propose a competency-based framework for creating structured learning for infectious diseases fellows pursuing hospital epidemiology and related fields.

A qualitative study of infectious diseases fellowships in Japan

OBJECTIVE

The purpose of this research is to elucidate the actual status of Infectious Diseases (ID) Fellowship programs in Japan to improve them further.

METHODS

We conducted qualitative interviews with infectious diseases fellows and his/her faculty consultants from 10 institutions providing ID Fellowships in Japan. We qualitatively analysed the data to delineate the actual status of each program and the fellowship program policies overall, and to identify measures for further improvement.

RESULTS

The interviews revealed that there are largely two kinds of ID fellowships; ID programs entirely devoting full time to infectious diseases, and programs that are subordinate concepts of other subspecialties, where only a portion of hours were devoted to ID. Some institutions did not even have an ID department. Time spent by the faculty consultants on fellows also varied among programs. The desire for improvement also varied among interviewees; some being happy with the current system while others demanded radical reform.

CONCLUSIONS

Even though there are many ID fellowship programs in Japan, the content, quality, and concepts apparently vary among programs. The perceptions by interviewees on the educational system differed, depending on the standpoints they have on ID physicians. There probably needs to be a coherency in the provision of ID fellowship programs so that fellows acquire competency in the subspecialty with sufficient expertise to act as independent ID specialists. Further studies are necessary for the improvement of ID subspecialty training in Japan.

Pediatric Infectious Diseases Fellowship Training in Healthcare Epidemiology A National Needs Assessment

Objective.

Pediatric infectious diseases (ID) fellows are required to receive training in hospital epidemiology and infection control and prevention. We sought to assess the current state of healthcare epidemiology training for fellows and to determine which topics are considered important by key stakeholders.

Participants.

US pediatric ID fellowship program directors and hospital epidemiologists.

Methods.

We conducted an anonymous Web-based survey in February 2012. We assessed the presence and content of curricula, perceived importance of specific topics, and barriers to career development.

Results.

Of 97 eligible participants, 76 (78%) completed the survey, representing 54 programs. Respondents were program directors (60%), hospital epidemiologists (25%), or both (15%). A total of 82% of programs with didactic curricula have infection control sessions, most commonly 1–2 hours in total duration. Of 17 identified topics, only 3 were covered by more than 50% of programs: isolation precautions (54%), central line-associated bloodstream infection (CLABSI; 53%), and hand hygiene (51%). Of the 76 respondents, 35% indicated that fellows participate in a dedicated infection control rotation. Six topics were considered very important by more than 75% of respondents: antimicrobial stewardship (94%), isolation precautions (93%), hand hygiene (90%), CLABSI (90%), surveillance for resistant bacteria (81%), and communicable disease exposure management (81%).

Conclusions.

Pediatric ID fellowship programs dedicate little time to didactic or experiential learning in healthcare epidemiology. There are a wide array of topics that the majority of programs do not cover, including several subjects that are considered to be very important by program directors and hospital epidemiologists. Creating a standardized pediatric infection control curriculum would likely benefit fellows in training.

Healthcare epidemiology practicum rotation for postgraduate physician trainees in medicine-infectious diseases

Practicum education in healthcare epidemiology and infection control (HEIC) for postgraduate physician trainees in infectious diseases is necessary to prepare them to be future participants and leaders in patient safety. Voss et al suggested that training in HEIC should be offered as a “common trunk” for physicians being trained in clinical microbiology or infectious diseases. A 1-month rotation has been recommended previously. A survey by Joiner et al indicated that only 50% of infectious diseases fellows found the infection control training adequate. The objective of this article is to report our 2-year experience with a 1-month practicum rotation we designed and implemented at our institution.

The setting is the Adult Infectious Diseases fellowship program at the University of Texas Southwestern Medical Center (UTSW), Dallas, Texas. The fellows have clinical rotations at the Parkland Health and Hospital System, UTSW University hospitals, North Texas Veterans Affairs Health Care System, and Children's Medical Center Dallas. The 2-year program recruits 7 fellows every 2 years. The 1-month core rotation was established in July 2011 and is ongoing. Fellows who completed the rotation during the period July 2011 to April 2013 are included in this study.

Surgical fellowship training in Canada: what is its current status and is improvement required?

This paper examines current issues concerning surgical fellowship training in Canada. Other than information from a few studies of fellowship training in North America, there are scant data on this subject in the literature. Little is known about the demographic characteristics of those who pursue fellowship training in Canada, what the experiences and expectations are of fellows and their supervisors with respect to the strengths and weaknesses of this level of training, or how this level of education fits in with Canadian undergraduate and postgraduate medical training. We summarize current knowledge about fellowship training in Canada as it pertains to demographic characteristics, finances, work hours, residency training, preparation for clinical and research work and satisfaction with training. Most information on surgical fellowship training comes from the United States. As such, we used information from American studies to supplement the Canadian data. Because a surgical fellowship experience in Canada may be different from that in the United States, we propose that Canadian surgical fellows and their supervisors should be surveyed to gain an understanding of such information. This knowledge could be used to improve surgical fellowship training in Canada.

A survey of current and past Pediatric Infectious Diseases fellows regarding training

BACKGROUND

The objectives of this study were to characterize the satisfaction of Pediatric Infectious Diseases fellows with their training and to understand how opinions about training have changed over time.

METHODS

Anonymous survey studies were conducted with questions designed to include areas related to the 6 ACGME core competencies. Surveys for current fellows were distributed by fellowship directors, while surveys for graduates were mailed to all individuals with Pediatric Infectious Diseases certification.

RESULTS

Response rates for current fellows and graduates were 50% and 52%, respectively. Most fellows (98%) and graduates (92%) perceived their overall training favorably. Training in most clinical care areas was rated favorably, however both groups perceived relative deficiencies in several areas. Current fellows rated their training in other competency areas (e.g., systems-based practice, research, and ethics) more favorably when compared to past graduates. Recent graduates perceived their training more favorably in many of these areas compared to past graduates.

CONCLUSIONS

Pediatric Infectious Diseases fellowship training is well regarded by the majority of current and past trainees. Views of current fellows reflect improved satisfaction with training in a variety of competency areas. Persistent deficiencies in clinical training likely reflect active barriers to education. Additional study is warranted to validate perceived deficiencies and to establish consensus on the importance of these areas to infectious diseases training.

Education of veterinary medical and other public health providers: linking interventions with health outcomes

A systematic literature review was performed to summarize the nature, implementation, outcomes, and long-term impacts of previously instituted interventions and programs aimed at educating veterinary public health providers. A logic model was developed to direct the literature search strategy, provide a framework for evaluating the relationship between veterinary public health professional education and their associated population health outcomes, and guide future training development and recommendations for the education of veterinary health professionals. Our literature review indicates that there is a relative lack of published literature that connects veterinary public health educational interventions to population health outcomes. Reasons for the lack of evidence to connect educational programs and population health outcomes include the evaluation of outcomes on a short-term rather than intermediate- or long-term basis, a lack of experimental studies, and infrequent grounding in population health or educational theory. Future intervention recommendations as suggested in the reviewed articles are also summarized.

MRI interpretation proficiency of musculoskeletal fellows in training

RATIONALE AND OBJECTIVES

The aim of this study was to evaluate the magnetic resonance imaging (MRI) interpretation proficiency of musculoskeletal fellows in training.

MATERIALS AND METHODS

Between July 2003 and June 2007, 14 musculoskeletal fellows were independently tested with 20 MRI studies of the knee and shoulder at four separate time points during their fellowship years. Trends in true-positive and false-positive interpretation results were evaluated. Fellows who completed their residencies at the fellowship institution (internal fellows) were compared with those from other residencies (external fellows).

RESULTS

There was a significant improvement in proficiency between the initial and final (9-month) evaluations (P < .0001). At the initial evaluation, there was a mean of 52.8% (41.7 of 79) true-positive results (range, 32-51); at 9 months, there was a mean of 71.0% (56.1 of 79; range, 40-72). The number of false-positive results also declined during this time period from a mean of 8.1 (range, 2-13) at initial evaluation to 4.7 (range, 2-8) at 9 months (P < .001). External fellows had more incorrect diagnoses initially but showed greater improvement than internal fellows at 9 months.

CONCLUSION

Fellows continued to improve their MRI interpretation skills throughout the first 9 months of their fellowships. External fellows were slightly less proficient at the start of their fellowships but slightly more proficient at 9 months compared to internal fellows.

Postgraduate training in infectious diseases: investigating the current status in the international community

International collaboration and understanding is becoming increasingly important as we face a soaring number of emerging and re-emerging infectious diseases. Management of these conditions calls for a cohesive international effort, with contributions from many infectious disease specialists. To optimise collaborative efforts, an international understanding of training, capabilities, and skills would be valuable. An investigation of postgraduate training programmes in the infectious disease specialties around the world was done. 33 countries contributed information. 26 of these countries had established training programmes—one of which was changing its duration and research component; three were in the process of setting up programmes, two provided specialist training that had no official recognition, and two had no specialist training. In addition to promoting international understanding and collaboration, this article should catalyse a global assessment of postgraduate training programmes within the field of infectious diseases.

Les internes en anesthésie-réanimation — une enquête nationale

OBJECTIVE

We surveyed the residents in their first (R1) and fourth (R4, last) years of residency in anaesthesia and intensive care in France.

METHODS

The questionnaires mailed to each resident were designed to obtain personal data, motivation for specializing in anaesthesia and their opinion of their training.

RESULTS

The response rates were 48% for the R1 residents and 77% for the R4 residents. There were 40% females in this population and the R1 residents were 25 +/- 1 year old, 29 +/- 2 year-old for the R4 residents. Almost half (46%) of the R1 responders were married as were 74% of the R4 residents. They spent an average of 726 each year on books, computers and other educational items. Most (71%) had opted for anaesthesia after considering other medical specialties, but only 12% had considered surgery. Half (51%) were on a training program that was far away from their home. They thought highly of their training, with the clinical training being rated above the non-clinical component. About half of them had obtained specialized certificates (mainly additional certification in intensive care and antibiotic therapy) during their residency. Two thirds of those in R4 expected to work in a public hospital and about one third expected to work in intensive care. Money was an important factor in their choice of profession. A majority planned to remain in the area where they had graduated in anaesthesia after their residency. Finally, 96% declared that they would choose anaesthesia again if they had to do so.

CONCLUSION

French residents in anaesthesia are satisfied of their initial choice for anaesthesia and don't regret it at the end of their residency training.

The Effect of Board-Imposed Changes on Maternal-Fetal Medicine Fellowships

OBJECTIVE

A 1996 survey of Maternal-Fetal Medicine fellows revealed that there was cause for serious concern over fellow experience. In 1997, Maternal-Fetal Medicine fellowships underwent significant changes, including a lengthening of the program and more stringent requirements for protected research performance. We investigated whether the changes imposed in Maternal-Fetal Medicine fellowships in 1997 have improved fellow experience.

METHODS

Fellows were identified through the Society of Maternal-Fetal Medicine. An identical survey to a 1996 survey using the Likert scale, ordinal- and categorical-scale questions were used. The results of the 1996 survey were compared with the results of the 2000 survey. chi2, Mann-Whitney U test, Fisher exact test, and analysis of variance were used where appropriate.

RESULTS

Sixty-five of 100 fellows returned the survey (return rate, 65%). Overall, there has been improvement in many areas of fellow experience. Significant changes include an increase in research time (7 months versus 18 months; P <.001), number of research projects (2.9 versus 4.3 projects/fellow; P <.001), fellows rating research time as adequate (66.4% versus 85.6%; P=.003), fellows receiving grant training (20.2% versus 37.1%; P=.012), 2 or more research presentations (36.2% versus 47.1%; P=.028), pursuit of a postgraduate degree (5.7% versus 32.9%; P <.001), presence of a mentor (68.1% versus 80.8%; P=.049), and the rating of mentorship as strong (59.4% versus 77.9%; P=.039). Of concern, 24.3% of current fellows did not believe they would receive their full-protected research time.

CONCLUSION

The changes imposed in Maternal-Fetal Medicine fellowships in 1997 appear to have had a positive impact on fellows' experience, especially the ability to perform and present research.