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Silvestre J, Nagpal A. A 10-year analysis of application and match rates for pain medicine training in the United States. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:374-379. [PMID: 38613846 DOI: 10.1093/pm/pnae026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/31/2024] [Accepted: 02/16/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE We analyzed application and match rates for pain medicine training in the United States and hypothesized that there would be (1) greater growth in the number of training positions than applicants, (2) higher match rates among US allopathic graduates relative to non-US allopathic graduates, and (3) greater number of unfilled training positions over time. DESIGN Retrospective, cross-sectional study of all applicants for pain medicine training in the United States. METHOD National Resident Matching Program data were obtained over a ten-year period (2014-2023). Match rates and applicant-to-position ratios were calculated and compared over time with linear regression. Comparisons were made with chi-square tests. RESULTS Growth in the number of annual training positions (261-377, 44% increase) exceeded growth in the number of interested applicants (398-415, 4% increase) (P < .001). Annual applicant-to-training position ratios decreased (1.5-1.1, P < .001). The representation of US allopathic graduates among incoming pain medicine fellows decreased over the study period (73%-58%, P < .001) while US osteopathic graduates increased (9%-28%, P < .001).Match rates increased for both US allopathic graduates (71%-91%, P < .001) and non-US allopathic graduates (51%-81%, P < .001). From 2018 to 2023, US allopathic graduates (79%) had higher match rates than US osteopathic graduates (60%, P < .001) and international medical graduates (57%, P < .001). More available annual training positions went unfilled over the study period (2%-5%, P = .006). CONCLUSIONS Stagnant annual applicant volume and increasing number of available training positions have led to increasing match rates for pain medicine fellowship training. Fewer US allopathic graduates are pursuing pain medicine training. The increasing percentage of unfilled training positions warrants ongoing surveillance.
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Affiliation(s)
- Jason Silvestre
- Perelman School of Medicine, Philadelphia, PA 19104, United States
| | - Ameet Nagpal
- Medical University of South Carolina, Charleston, SC 29425, United States
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Occhigrossi F, Carpenedo R, Leoni MLG, Varrassi G, Chinè E, Cascella M. Delphi-Based Expert Consensus Statements for the Management of Percutaneous Radiofrequency Neurotomy in the Treatment of Lumbar Facet Joint Syndrome. Pain Ther 2023; 12:863-877. [PMID: 37103732 PMCID: PMC10199975 DOI: 10.1007/s40122-023-00512-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/31/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION A modified Delphi strategy was implemented for obtaining recommendations that could be useful in the management of percutaneous radiofrequency treatment of lumbar facet joint syndrome, as the literature on the argument was poor in quality. METHODS An Italian research team conducted a comprehensive literature search, defined the investigation topics (diagnosis, treatment, and outcome evaluation), and developed an explorative semi-structured questionnaire. They also selected the members of the panel. After an online meeting with the participants, the board developed a structured questionnaire of 15 closed statements (round 1). A five-point Likert scale was used and the cut-off for consensus was established at a minimum of 70% of the number of respondents (level of agreement ≥ 4, agree or strongly agree). The statements without consensus were rephrased (round 2). RESULTS Forty-one clinicians were included in the panel and responded in both rounds. After the first round, consensus (≥ 70%) was obtained in 9 out of 15 statements. In the second round, only one out of six statements reached the threshold. The lack of consensus was observed for statements concerning the use of imaging for a diagnosis [54%, median 4, interquartile range (IQR) 3-5], number of diagnostic blocks (37%, median 4, IQR 2-4), bilateral denervation (59%, median 4, IQR 2-4), technique and number of lesions (66%, median 4, IQR 3-5), and strategy after denervation failure (68%, median 4, IQR 3-4). CONCLUSION Results of the Delphi investigations suggest that there is a need to define standardized protocols to address this clinical problem. This step is essential for designing high-quality studies and filling current gaps in scientific evidence.
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Affiliation(s)
| | | | - Matteo Luigi Giuseppe Leoni
- Unit of Interventional and Surgical Pain Management, Guglielmo da Saliceto Hospital, Via Taverna 49, 29121 Piacenza, Italy
| | | | - Elisabetta Chinè
- Unit of Pain Therapy, Polyclinic of Tor Vergata, 00133 Rome, Italy
| | - Marco Cascella
- Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G, Pascale, 80100 Naples, Italy
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Dutta D, Ibrahim H, Cofrancesco J, Archuleta S, Stadler DJ. The Gendered Work/Role of Program Directors in International Graduate Medical Education. QUALITATIVE HEALTH RESEARCH 2023; 33:154-164. [PMID: 36527203 DOI: 10.1177/10497323221145832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Healthcare organizations offer numerous clinical and academic leadership pathways for physicians, among which the position of program director (PD) is considered to be a prominent educational leadership role. As PDs are instrumental in the recruitment and training of the next generations of physicians, PD gender distribution can affect the present and future of a medical specialty. This study offers a dialectical perspective in understanding how international PDs negotiate gendered understanding of their work/role by using the framework of Relational Dialectics Theory 2.0. Thirty-three interviews of PDs from Qatar, Singapore, and the United Arab Emirates were conducted and, using contrapuntal analysis, the competing discourses of meanings of gender in the PD work/role were examined. Competing discourses where structural, cultural, and professional meanings of gender were interrogated revealed inherent multiple meanings of how gender is understood in PD work/roles. In making sense of these meanings of gender, PDs express dilemmas of traditional gender binaries of masculine/feminine work/role meanings to explain the term in different ways in their everyday organizational and cultural struggles. The findings have implications for PD recruitment and retention in teaching hospitals.
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Affiliation(s)
- Debalina Dutta
- School of Communication, Journalism and Marketing, 6420Massey University, New Zealand
| | - Halah Ibrahim
- Department of Medicine Khalifa of Medicine and Health Sciences, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates
| | - Joseph Cofrancesco
- Johns Hopkins Institute for Excellence in Education Professor of MedicineJohns Hopkins University School of Medicine Institute for Excellence in Education, Baltimore, MD, USA
- Johns Hopkins Institute for Excellence in Education Professor of MedicineJohns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophia Archuleta
- Department of Medicine, Yong Loo Lin School of Medicine, 37580National University of Singapore, Singapore
- Division of Infectious Diseases, National University Health System, Singapore
| | - Dora J Stadler
- 8395Walter Reed National Military Medical Center, Uniformed Services University, Bethesda, MD, USA
- Weill Cornell Medicine-Qatar, Doha, Qatar
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D’Souza RS, Pilitsis JG, Langford BJ, Orhurhu V, Hussain N, Hoffmann CM, Anitescu M, Vanterpool S, Ali R, Patel K, Moeschler SM. Speaker Gender Representation at the North American Neuromodulation Society Annual Meeting (2017-2021): Have We Made Progress in Closing the Gender Gap? J Pain Res 2022; 15:3423-3432. [PMID: 36320224 PMCID: PMC9618239 DOI: 10.2147/jpr.s380152] [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: 06/27/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022] Open
Abstract
Background Speaker gender representation at medical conferences is a significant site of gender disparity. Our primary objective was to quantify the proportion of female speakers and compare plenary session opportunities by gender at the North American Neuromodulation Society (NANS) Annual Conference. Methods Data from the 2017-2021 NANS Annual Conference presentations were abstracted. Primary outcomes included gender composition of speaker slots, gender composition of individual speakers, and comparison of plenary speaker slots by gender. Secondary outcomes included comparisons of session size, age, professional degree, and number of presentations per speaker based on gender. Results Gender composition of annual speaker slots was (% slots presented by women): 2017:14.6%; 2018:20.5%; 2019:23.5%; 2020:21.0%; 2021:41.4%. Annual gender composition of individual speakers was (% women): 2017:18.7%; 2018:20.6%; 2019:24.6%; 2020:24.9%; 2021:33.8%. Of all speaker slots, the percentage of plenary slots did not differ based on gender, with 11.4% presented by female speakers versus 11.2% presented by male speakers (OR 1.0, 95% CI 0.7-1.5, P=0.893). Compared to male speaker slots, there was an association of lower age (43.9±5.6 vs 50.8±8.9, P<0.001), lower odds of holding a single doctorate degree (OR 0.3, 95% CI 0.2-0.5, P<0.001), and lower odds of holding a dual MD/PhD or DO/PhD degree (OR 0.3, 95% CI 0.1-0.5, P<0.001) in female speaker slots. Compared to male speakers, there was an association of higher number of presentations per female speaker at the 2021 NANS Annual Meeting (2.48±1.60 vs 1.79±1.30, P=0.008). Conclusion Although the volume of female speaker slots and individual speakers trailed behind their male counterparts, female speaker representation steadily increased at each subsequent annual NANS meeting. We identified no difference in plenary session slots based on gender.
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Affiliation(s)
- Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA,Correspondence: Ryan S D’Souza, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA, Email
| | - Julie G Pilitsis
- Department of Clinical Neurosciences, Florida Atlantic University, Boca Raton, FL, USA
| | - Brendan J Langford
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Vwaire Orhurhu
- Department of Pain Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nasir Hussain
- Department of Anesthesiology, Beth Israel Deaconess Medical Center, Boston, MA, USA,Department of Anesthesiology, The Ohio State University, Columbus, OH, USA
| | - Chelsey M Hoffmann
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Magdalena Anitescu
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL, USA
| | | | - Rushna Ali
- Division of Neurosurgery, Spectrum Health, Grand Rapids, MI, USA
| | - Kiran Patel
- Department of Anesthesiology, New York University Langone Medical Center, New York City, NY, USA
| | - Susan M Moeschler
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
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Mattson LM, Rosario-Concepcion RA, Hurdle MFB, Pagan-Rosado RD, Clapp AD, Maynard JR. Gender Diversity in Primary Care Sports Medicine Leadership. Curr Sports Med Rep 2022; 21:303-308. [PMID: 35946849 DOI: 10.1249/jsr.0000000000000979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Diversity, equity, and inclusion have been recognized as important drivers of excellence and innovation in the physician workforce. Given the historical underrepresentation of women in medicine, gender diversity is of interest. In this cross-sectional study, we sought to quantify leadership representation of female physicians in primary care sports medicine settings, including primary care sports medicine fellowship programs, select sports medicine societies, and select sports medicine-related scientific journals. Data were collected by querying the corresponding web site for each fellowship program, society, and journal and analyzed in a descriptive manner. Results showed that fewer female physicians hold primary care sports medicine leadership roles than men do. This work establishes a baseline for female representation in primary care sports medicine leadership; efforts should continue to increase the presence of women in leadership positions.
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Affiliation(s)
- Laura M Mattson
- Primary Care Sports Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science
| | | | | | - Robert D Pagan-Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Adrianna D Clapp
- Department of Family Medicine, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science
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Tieppo Francio V, Gill B, Hagedorn JM, Pagan Rosado R, Pritzlaff S, Furnish T, Kohan L, Sayed D. Factors involved in applicant interview selection and ranking for chronic pain medicine fellowship. Reg Anesth Pain Med 2022; 47:rapm-2022-103538. [PMID: 35760514 PMCID: PMC9411898 DOI: 10.1136/rapm-2022-103538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/16/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Applicants to chronic pain medicine fellowship programs often express confusion regarding the importance of various selection criteria. This study sought to elucidate program directors' considerations in applicant selection for fellowship interviews and ranking and to correlate these criteria with match statistics to provide a guide for prospective candidates. METHODS An electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited chronic pain fellowship directors. The importance of various applicant characteristics were evaluated and compared with recent match data. RESULTS Fifty-seven program directors completed the survey. The most important factors involved in applicant interview selection were perceived commitment to the specialty, letters of recommendation from pain faculty, scholarly activities, and leadership experiences. Although completion of a pain rotation was valued highly, experience with procedures was of relatively low importance. There was no preference if rotations were completed within the responders' department. Variability was noted when considering internal applicants or the applicant's geographic location. When citing main factors in ranking applicants, interpersonal skills, interview impression and applicant's fit within the institution were highly ranked by most responders. DISCUSSION Assessment of an applicant's commitment to chronic pain is challenging. Most responders prioritize the applicant's commitment to chronic pain as a specialty, scholarly activity, participation in chronic pain rotations, pain-related conferences and letters of recommendation from pain faculty. Chronic pain medicine fellowship candidates should establish a progressive pattern of genuine interest and involvement within the specialty during residency training to optimize their fellowship match potential.
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Affiliation(s)
- Vinicius Tieppo Francio
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Benjamin Gill
- Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, Missouri, USA
| | | | - Robert Pagan Rosado
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott Pritzlaff
- Department of Anesthesiology and Pain Medicine, University of California Davis, Davis, California, USA
| | - Timothy Furnish
- Department of Anesthesiology, UC San Diego, San Diego, California, USA
| | - Lynn Kohan
- Divsion of Pain Medicine/Department of Anesthesia, University of Virginia, Charlottesville, Virginia, USA
| | - Dawood Sayed
- Department of Anesthesiology, The University of Kansas Medical Center, Kansas City, Kansas, USA
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Abd-Elsayed A, Azeem N, Chopra P, D’Souza RS, Sayed D, Deer T. An International Survey on the Practice of Lumbar Radiofrequency Ablation for Management of Zygapophyseal (Facet)-Mediated Low Back Pain. J Pain Res 2022; 15:1083-1090. [PMID: 35444461 PMCID: PMC9015042 DOI: 10.2147/jpr.s354506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
Objective The objective of this study was to survey current clinical practice related to lumbar radiofrequency (RFA) for the treatment of zygapophyseal (facet)-mediated low back pain. Methods Survey questions regarding the clinical practice of lumbar RFA were created and piloted by the American Society of Pain and Neuroscience (ASPN) leadership. After revision for clarity, health-care professionals worldwide who hold membership status within the ASPN Society and who offer lumbar RFA in their clinical practice were recruited to participate in this online survey. All responses were tabulated and summarized descriptively. Results A total of 329 participants responded in the survey. Most participants specialized in anesthesiology (68.4%) and physical medicine and rehabilitation (21.8%) and had been practicing pain management for more than five years (70.5%). Of physician respondents, 27.5% did not complete an Accreditation Council for Graduate Medical Education (ACGME)-accredited pain medicine fellowship and 16.5% were not board-certified in pain medicine. The majority of providers (69.7%) reported that they perform two diagnostic medial branch blocks prior to proceeding with lumbar RFA. Bupivacaine 0.5% was the most common medication utilized for both the first (37.4%) and second (37.1%) diagnostic blocks. There were 32.6% of total respondents who reported not utilizing contrast dye when performing diagnostic blocks. The vast majority of providers (91.4%) reported using conventional RFA for lumbar medial branch neurotomy. Conclusion This survey study provides a summary of the application of lumbar RFA for the treatment of axial low back pain in the real-world setting. We highlight a significant portion of providers who perform lumbar RFA yet do not have pain fellowship training at an ACGME-accredited institution or do not maintain current pain medicine board certification. We also report deviations from standard practice, specifically the type of local anesthetic used for comparative diagnostic blocks and the omission of contrast injection during diagnostic blocks.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Nomen Azeem
- Florida Spine & Pain Specialists, Tampa, FL, USA
| | | | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Rochester, MN, USA
| | - Dawood Sayed
- Department of Pain Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- The Spine and Nerve Centers, Charleston, WV, USA
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