A Qualitative Study of Internal Medicine Subspecialty Fellowship Program Directors’ Perspectives on Short-Term Hospitalist Employment Prior to Fellowship
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SUBMITTER: Crecelius T
PROVIDER: S-EPMC11234311 | biostudies-literature | 2024 Apr
REPOSITORIES: biostudies-literature
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Project description:BackgroundLittle is known about whether and how medical knowledge relates to interest in subspecialty fellowship training. The purpose of this study was to examine the relationships between residents' interest in subspecialty fellowship training and their knowledge of internal medicine (IM).MethodsA questionnaire was emailed to 48 categorical postgraduate-year (PGY) two and three residents at a New York university-affiliated IM residency program in 2007 using the Survey Monkey online survey instrument. Overall and content area-specific percentile scores from the IM in-training examination (IM-ITE) for the same year was used to determine objective knowledge.ResultsForty-five of 48 residents (response rate was 93.8%) completed the survey. Twenty-two (49%) were PG2 residents and 23(51%) were PGY3 residents. Sixty percent of respondents were male. Six (13%) residents were graduates of U.S. medical schools. Eight (18%) reported formal clinical training prior to starting internal medicine residency in the U.S. Of this latter group, 6 (75%) had training in IM and 6 (75) % reported a training length of 3 years or less. Thirty-seven of 45 (82%) residents had a subspecialty fellowship interest. Residents with a fellowship interest had a greater mean overall objective knowledge percentile score (56.44 vs. 31.67; p = 0.04) as well as greater mean percentile scores in all content areas of IM. The adjusted mean difference was statistically significant (p < 0.02) across three content areas.ConclusionsMore than half of surveyed residents indicated interest in pursuing a subspecialty fellowship. Fellowship interest appears positively associated with general medical knowledge in this study population. Further work is needed to explore motivation and study patterns among internal medicine residents.
| S-EPMC3038163 | biostudies-literature
Project description:IntroductionIn 2011, the Accreditation Council for Graduate Medical Education (ACGME) implemented new Common Program Requirements to regulate duty hours of resident physicians, with three goals: improved patient safety, quality of resident education and quality of life for trainees. We sought to assess Internal Medicine program director (IMPD) perceptions of the 2011 Common Program Requirements in July 2012, one year following implementation of the new standards.MethodsA cross-sectional study of all IMPDs at ACGME-accredited programs in the United States (N?=?381) was performed using a 32-question, self-administered survey. Contact information was identified for 323 IMPDs. Three individualized emails were sent to each director over a 6-week period, requesting participation in the survey. Outcomes measured included approval of duty hours regulations, as well as perceptions of changes in graduate medical education and patient care resulting from the revised ACGME standards.ResultsA total of 237 surveys were returned (73% response rate). More than half of the IMPDs (52%) reported "overall" approval of the 2011 duty hour regulations, with greater than 70% approval of all individual regulations except senior resident daily duty periods (49% approval) and 16-hour intern shifts (17% approval). Although a majority feel resident quality of life has improved (55%), most IMPDs believe that resident education (60%) is worse. A minority report that quality (8%) or safety (11%) of patient care has improved.ConclusionOne year after implementation of new ACGME duty hour requirements, IMPDs report overall approval of the standards, but strong disapproval of 16-hour shift limits for interns. Few program directors perceive that the duty hour restrictions have resulted in better care for patients or education of residents. Although resident quality of life seems improved, most IMPDs report that their own workload has increased. Based on these results, the intended benefits of duty hour regulations may not yet have been realized.
| S-EPMC4175662 | biostudies-literature
Project description:BackgroundTo increase diversity and inclusion in graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) issued a revision to their Common Program Requirements during the 2019-2020 academic year mandating that all residency programs must have policies and practices to achieve appropriate diversity among trainees and faculty.ObjectiveTo explore the perspectives of internal medicine program directors (PDs) and associate program directors (APDs) on the ACGME diversity standard.DesignQualitative study of internal medicine residency program leadership from academic and community programs across the USA.ParticipantsCurrent PDs (n = 12) and APDs (n = 8) of accredited US internal medicine residency programs.ApproachWe conducted semi-structured, in-depth qualitative interviews. Data was analyzed using the constant comparative method to extract recurrent themes.Key resultsThree main themes, described by participants, were identified: (1) internal medicine PDs and APDs had limited knowledge of the new Common Program Requirement relating to diversity; (2) program leaders expressed concern that the diversity standard reaches beyond the PDs' scope of influence and lack of institutional commitment to the successful implementation of diversity standards; (3) participants described narrow view of diversity and inclusion efforts focusing on recruitment strategies during the interview season.ConclusionsOur findings of lack of familiarity with the new diversity standards, and limited institutional investment in diversity and inclusion efforts raise a concern about successful implementation across GME programs. Nevertheless, our finding suggests that structured implementation in the form of education, guideposts, and financial allocation can alleviate some of the concerns of program leadership in meeting the new ACGME diversity standard in a meaningful way.
| S-EPMC8390633 | biostudies-literature
Project description:Due to the COVID-19 pandemic, most graduate medical education (GME) training programs conducted virtual interviews for prospective trainees during the 2020-2021 application cycle. Many internal medicine (IM) subspecialty fellowship programs hosted virtual interviews for the first time with little published data to guide best practices.To evaluate how IM subspecialty fellowship applicants perceived the virtual interview day experience.We designed a 38-item questionnaire that was sent via email to applicants in eight IM subspecialty programs at a single tertiary academic medical center (University of California, San Francisco) from September-November, 2020.Seventy-five applicants completed the survey (75/244, 30.7%), including applicants from all eight fellowship programs. Most survey respondents agreed that the length of the virtual interview day (mean = 6.4 hours) was long enough to gather the information they needed (n = 65, 86.7%) and short enough to prevent fatigue (n = 55, 73.3%). Almost all survey respondents agreed that they could adequately assess the clinical experience (n = 71, 97.3%), research opportunities (n = 72, 98.6%), and program culture (n = 68, 93.2%). Of the respondents who attended a virtual educational conference, most agreed it helped to provide a sense of the program's educational culture (n = 20, 66.7%). Areas for improvement were identified, with some survey respondents reporting that the virtual interview day was too long (n = 11) or that they would have preferred to meet more fellows (n = 10).Survey respondents indicated that the virtual interview was an adequate format to learn about fellowship programs. These findings can inform future virtual interviews for GME training programs.
| S-EPMC8253192 | biostudies-literature
Project description:Background: Fellowship directors are assumed to be distinguished in orthopedics, but the traits and training that have enabled them to achieve their leadership positions have not been assessed. Purpose: We sought to identify common demographics, research output, and educational trends of fellowship directors in orthopedics, with an emphasis on racial, ethnic, and gender diversity. Methods: We conducted a literature review to identify published studies on fellowship directors in orthopedic surgery and found 4 cross-sectional studies of fellowship directors in spine, arthroplasty, pediatrics, and sports medicine subspecialties. Another 4 accredited orthopedic subspecialties and their fellowship directors were identified using the American College of Graduate Medical Education Public Accreditation Data System for 2020-2021 and national fellowship directories. Data endpoints included race/ethnicity, age, sex, residency and fellowship training institutions, year of fellowship completion, year of hire at current institution, year of fellowship directors appointment, and h-index. The demographics and educational backgrounds for listed fellowship directors were collected from curricula vitae (CVs). Results: Of the 537 fellowship directors identified among 8 orthopedic subspecialties, the average age was 52.9 ± 2.2 years, 5.6% (N = 30) were women, 79.1% (N = 406) were white, 12.5% (N = 64) were Asian American, 3.7% (N = 19) were African American, 2.9% (N = 15) were Middle Eastern, and 1.7% (N = 9) were Hispanic/Latino. Oncology 20% (N = 4) had the highest percentage of female fellowship directors; 37.6% (N = 202) of fellowship directors were at the same institution they trained at for residency or fellowship. Their average h-index was 18.6 ± 3.7. Conclusion: This study of fellowship directors in orthopedics found that they have a high research output and a high level of institutional familiarity. We identified a need for greater diversity in these leadership positions in both gender and race/ethnicity.
| S-EPMC9837408 | biostudies-literature
Project description:BackgroundWhile 26% of US adults are disabled, only 3.1 to 9.3% of practicing physicians report having a disability. Ableism within medical training and practice diminishes physician diversity and wellbeing and contributes to healthcare disparities.ObjectiveExplore physician barriers to disability equity and inclusion by examining internal medicine (IM) program directors' (PD) perspectives about recruiting and accommodating residents with disabilities (RWD).DesignQualitative study involving semi-structured virtual interviews (conducted December 2022-September 2023; analyzed through December 2023).ParticipantsPDs were recruited via email. Purposive sampling captured program diversity in size, location, and affiliations. Convenience sampling ensured PD diversity by gender, race/ethnicity, and age.ApproachCoders analyzed thematic and discursive content of interview transcripts to characterize PD perspectives about RWDs and accommodations.Key resultsOf the 15 programs represented, 4 had ≤ 49 and 8 had ≥ 100 total residents. Three were community-based; the rest had academic affiliations. On average, PDs had 17 (SD 8.2) years in practice. Most (11/15) identified as White race; 8/15 as female; and none as disabled. PDs characterized disability as a source of grit and empathy but also as an intrinsic deficit. They worried RWDs could have unpredictable absences and clinical incompetencies. Perceived accommodation challenges included inexperience, workload distribution, information asymmetry about accommodation needs or options, barriers to disclosure (e.g., discrimination concerns), and insufficient accommodation advertising. Perceived facilitators included advanced planning; clear, publicized processes; and access to expertise (e.g., occupational health, ombudsmen).ConclusionsPDs held contradictory views of RWDs. PD insights revealed opportunities to alleviate PD-RWD information asymmetry in recruitment/accommodation processes, which could help align needs and improve representation and inclusion.
| S-EPMC11780235 | biostudies-literature
Project description:BackgroundThe care of patients with HIV is increasingly focused on outpatient chronic disease management. It is not known to what extent internal medicine residents in the US are currently being trained in or encouraged to provide primary care for this population of patients.ObjectiveTo survey internal medicine residency program directors about their attitudes regarding training in outpatient HIV care and current program practices.DesignProgram directors were surveyed first by email. Non-responding programs were mailed up to two copies of the survey.SubjectsAll internal medicine residency program directors in the US.Main measuresProgram director attitudes and residency descriptions.Key resultsOf the 372 program directors surveyed, 230 responded (61.8 %). Forty-two percent of program directors agreed that it is important to train residents to be primary care providers for patients with HIV. Teaching outpatient-based HIV curricula was a priority for 45.1%, and 56.5% reported that exposing residents to outpatient HIV clinical care was a high priority. Only 46.5% of programs offer a dedicated rotation in outpatient HIV care, and 50.5% of programs have curricula in place to teach about outpatient HIV care. Only 18.8% of program directors believed their graduates had the skills to be primary providers for patients with HIV, and 70.6% reported that residents interested in providing care for patients with HIV pursued ID fellowships. The strongest reasons cited for limited HIV training during residency were beliefs that patients with HIV prefer to be seen and receive better care in ID clinics compared to general medicine clinics.ConclusionsWith a looming HIV workforce shortage, we believe that internal medicine programs should create educational experiences that will provide their residents with the skills and knowledge necessary to meet the healthcare needs of this population.
| S-EPMC2917660 | biostudies-literature
Project description:BACKGROUND: The benefits of mentoring residents have been studied, but there is no research about mentoring new program directors. Program directors' responsibilities have become increasingly complicated, and they may not be adequately prepared for their role at the time of appointment without the benefit of mentoring that is specific to their new role. OBJECTIVE: To assess whether nephrology subspecialty program directors were specifically mentored and whether they felt prepared for the educational and administrative aspects of this role. METHODS: We conducted an electronic needs assessment survey of the nephrology subspecialty program directors through the American Society of Nephrology listserv for program directors. RESULTS: The survey response rate was 42% (58 of 139). Of the respondents, 58% did not feel adequately prepared when they first became subspecialty program directors, and only 32% reported having formal or informal mentoring for the role. Individuals who had served as associate program directors (34%) were more likely to report mentoring than those who had not (P = .02). Eighty percent of respondents reported that mentoring from another nephrology program director would have been beneficial during their first several years. CONCLUSIONS: This appears to be the first study specifically evaluating mentoring experiences relevant to the role of nephrology program director. As a result of this survey, the American Society of Nephrology Training Program Director Executive Committee recognized the need to provide opportunities for mentoring new nephrology program directors and formed a New Training Program Director Training and Mentoring Work Group to recommend initiatives for mentoring and training new program directors. Further investigation is needed to assess whether mentoring benefits subspecialty program directors and whether these findings can be generalized to other specialties and subspecialties.
| S-EPMC2930312 | biostudies-other
Project description:Abstract Objective To compare in-person and virtual breast fellowship interview experiences from the perspective of fellowship program directors (PDs) and applicants. Methods Three separate voluntary, anonymous, e-mail delivered surveys were developed for PDs, in-person interview applicants in 2019–2020, and virtual interview applicants in 2020–2021. PD and applicant survey responses regarding the two interview cycles were compared. Results The response rate was 56% (53/95) for PDs, 19% (23/123) for in-person applicants, and 38% (49/129) for virtual applicants. PDs reported significantly lower cost for virtual compared to in-person interviews (P < 0.001). They reported no significant difference in number of applications received, number of applicants interviewed, applicant pool geographic regions, number of interview days offered, or format of interviews. Most PDs (31/53, 58%) felt the virtual format still allowed them to get to know the applicants well. Cost was significantly higher for in-person compared to virtual applicants (P < 0.001). More in-person applicants (11/23, 48%) listed cost as a barrier compared to virtual applicants (7/49, 14%) (P = 0.002). Virtual and in-person applicants reported a similar number of program applications, but virtual applicants completed more interviews (P = 0.012). Both groups preferred scheduled time to speak with the current fellows and a one-on-one interview format with two to four faculty members. Most applicants (36/49, 73%) felt the virtual format still allowed them to get to know each program well. Conclusion Virtual interviews provide a reasonable alternative to in-person interviews for breast imaging fellowship applicants, with decreased cost being the main advantage.
| S-EPMC9129215 | biostudies-literature
Project description:ObjectivePediatric emergency medicine (PEM) fellowship directors can interview candidates from either pediatric or EM residency programs. Currently, most candidates are pediatricians; however, because emergency physicians have attributes that could benefit PEM, our goal was to investigate facilitators and barriers to training more of them to become PEM physicians.MethodsWe surveyed U.S. PEM fellowship program directors (PDs) about their program's recruitment practices: Do they recruit only pediatricians or mostly pediatricians with an occasional emergency physician or do they actively recruit both? We solicited volunteers from each recruitment group for interviews. These were recorded, transcribed, and thematically coded using summative content analysis. Comments were cataloged into themes that were philosophical or logistic in nature and those that might facilitate (drivers) or serve as barriers (restrainers) to the inclusion of emergency physicians in PEM.ResultsWe received 50 of 86 (58%) survey responses, 29 (34%) of whom volunteered for interviews. The 17 volunteers we selected for interviews generated 13 themes that fell into the four major theme categories: four philosophical drivers, three logistic drivers, two philosophical restrainers, and four logistic restrainers. Program groups differed with regard to the inclusion of emergency physicians. Most limiting were the impact of variable program length and the implicit belief that pediatricians are best suited to treat children. Most beneficial is the recognized value of EM graduates to the field of PEM.ConclusionsWhile PDs acknowledged a growing need for PEM physicians, particularly in community hospitals, and that emergency physicians would contribute to PEM, they also identified the logistical burden of including them in programs primarily designed for pediatricians. This burden involves maintaining separate curricula for EM graduates and finding emergency physician faculty to serve as mentors. PDs also expressed a desire for resources to guide the integration of more emergency physicians into their programs.
| S-EPMC11656375 | biostudies-literature