Characteristics of Designated Institutional Officials and Sponsoring Institutions of ACGME-Accredited Training Programs

Priority Competencies for Designated Education Officers in the Veterans Health Administration

INTRODUCTION

Designated Education Officers (DEOs) at Veteran Health Administration (VHA) hospitals are senior educational leaders tasked with oversight of all clinical training at a particular facility. They prioritize dozens of tasks and responsibilities each day, from educational policy and strategy to staff management, financial planning, onboarding of trainees, and facility planning and management. Clarifying priority competencies for the role can help executives recruit, appoint, and evaluate capable personnel and promote effective, efficient performance.

MATERIALS AND METHODS

Using a federally developed method of competency analysis, researchers consulted a panel of subject-matter experts to identify priority competencies for DEOs, using data from a 2013 study that operationalizes competencies for more than 200 federal jobs.

RESULTS

The research identified 25 primary competencies within 6 leadership domains. Five of the primary competencies cut across all leadership domains.

CONCLUSIONS

Veteran Health Administration subject-matter experts in educational leadership say the identified competencies are urgently needed, critical for effective leadership, and valuable for distinguishing superior DEO performance. The competencies are relevant to VHA and perhaps other senior academic leaders who develop health professions education programs, oversee clinical training, and manage educational change. In military training facilities, attending to these competencies can help Designated Institutional Officials responsible for graduate medical education become more credible partners to other hospital leaders and contribute to becoming a high reliability organization. Executives identifying, recruiting, and appointing VHA DEOs and Designated Institutional Officials at military training facilities should consider these competencies when assessing candidates.

Speaker Gender Representation at the North American Neuromodulation Society Annual Meeting (2017-2021): Have We Made Progress in Closing the Gender Gap?

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.

An International Survey on the Practice of Lumbar Radiofrequency Ablation for Management of Zygapophyseal (Facet)-Mediated Low Back Pain

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.

Sex Disparity Persists in Pain Medicine: A Cross-Sectional Study of Chairpersons Within ACGME-Accredited Chronic Pain Fellowship Programs in the United States

OBJECTIVE

To compare the representation of female and male chairpersons and evaluate their respective demographic, academic, and program-related characteristics in academic chronic pain institutions.

METHODS

We identified all chronic pain fellowship programs that are accredited by the Accreditation Council for Graduate Medical Education (ACGME) on April 19, 2021. We queried institutional websites or contacted programs directly to identify the respective departmental/divisional program chairperson. We abstracted data on program chairpersons from public databases and performed statistical comparisons of demographic, academic, and program-related characteristics between female and male program chairpersons.

RESULTS

Of the 111 ACGME-accredited chronic pain fellowship programs, we identified the current chairperson at 87 programs (78.4%). There were 17 female chairpersons (19.5%) and 70 male chairpersons (80.5%). A higher proportion of female chairpersons reported an academic rank of assistant professor compared with male chairpersons (35.3% vs 11.4%, P = .027). Male chairpersons published more peer-reviewed articles compared with female chairpersons (median 32.0 vs 10.0 publications, P = .001). Concordantly, male chairpersons achieved a higher H-index score compared with female chairpersons (median 10.0 vs 3.0, P = .001). No differences were identified in other academic or program-related characteristics.

CONCLUSION

This cross-sectional study illuminates important details on sex-related differences in the chronic pain program chair role. Women chairpersons are underrepresented, have fewer peer-reviewed publications, and achieved a lower H-index score compared with male chairpersons. Establishing these baseline associations provides a reference for future studies to evaluate changes over time.

Gender Representation in Fellowship Program Director Positions in ACGME-Accredited Chronic Pain and Acute Pain Fellowship Programs

OBJECTIVE

We quantified the representation of female program directors (PDs) and assessed their respective demographics, academic metrics, and program-related characteristics in chronic pain and acute pain medicine fellowship programs accredited by the Accreditation Council for Graduate Medical Education (ACGME).

METHODS

We identified chronic and acute pain PDs on the ACGME website on November 15, 2020. We abstracted data from public databases and performed comparisons of demographics, academic metrics, and program-related characteristics between female and male PDs.

RESULTS

We identified 111 chronic pain programs and 35 acute pain programs. Overall, there were 35 (31.5%) chronic pain programs with a female PD and 76 (68.5%) chronic pain programs with a male PD. Female chronic pain PDs published fewer peer-reviewed articles (4.0 publications, interquartile range [IQR] = 2.0-12.0) compared with male chronic pain PDs (9.0 publications, IQR = 4.0-27.0; P = 0.050), although there was no difference in the H-index score (3.0 vs 4.0 publications, respectively; P = 0.062) or senior academic rank status (57.1% vs 50.0%, respectively; P = 0.543). There were 10 (28.6%) acute pain programs with a female PD and 25 (71.4%) acute pain programs with a male PD. Similar to the chronic pain cohort, there was no difference in senior academic rank status based on gender in acute pain PDs (50.0% vs 24.0%, respectively; P = 0.227).

CONCLUSION

Our study highlights gender differences in the PD role in ACGME-accredited chronic and acute pain fellowships. Female PDs remain underrepresented and have fewer peer-reviewed publications. Senior academic rank status was similar across genders, contradicting the current evidence in academic medicine.