Fellowship training: a qualitative study of scope and purpose across one department of medicine

Abstract

BackgroundFellowship training follows certification in a primary specialty or subspecialty and focusses on distinct and advanced clinical and/or academic skills. This phase of medical education is growing in prevalence, but has been an “invisible phase of postgraduate training” lacking standards for education and accreditation, as well as funding. We aimed to explore fellowship programs and examine the reasons to host and participate in fellowship training, seeking to inform the future development of fellowship education.MethodsDuring the 2013–14 academic year, we conducted interviews and focus groups to examine the current status of fellowship training from the perspectives of division heads, fellowship directors and current fellows at the Department of Medicine, University of Ottawa, Canada. Descriptive statistics were used to depict the prevailing status of fellowship training. A process of data reduction, data analysis and conclusions/verifications was performed to analyse the quantitative data.ResultsWe interviewed 16 division heads (94%), 15 fellowship directors (63%) and 8 fellows (21%). We identified three distinct types of fellowships. Individualized fellowships focus on the career goals of the trainee and/or the recruitment goals of the division. Clinical fellowships focus on the attainment of clinical expertise over and above the competencies of residency. Research fellowships focus on research productivity. Participants identified a variety of reasons to offer fellowships: improve academic productivity; improve clinical productivity; share/develop enhanced clinical expertise; recruit future faculty members/attain an academic position; enhance the reputation of the division/department/trainee; and enhance the scholarly environment.ConclusionsFellowships serve a variety of purposes which benefit both individual trainees as well as the academic enterprise. Fellowships can be categorized within a distinct taxonomy: individualized; clinical; and research. Each type of fellowship may serve a variety of purposes, and each may need distinct support and resources. Further research is needed to catalogue the operational requirements for hosting and undertaking fellowship training, and establish recommendations for educational and administrative policy and processes in this new phase of postgraduate education.

Impact of Geriatric Emergency Fellowship Training on the careers of Emergency Physicians

“…The questions were developed by the authors who have expertise in survey question design corresponding to the surveying emergency medicine guideline [12]. We reviewed and adapted the survey from previous studies evaluating fellowship graduates' current work, responsibility in the ED and beyond, grants and publications, satisfaction in post-training career path, and work-life balance [13][14][15][16]. Our final survey had 36 questions (see appendix A) to assess the GEM fellows' experience within the fellowship and their careers since graduating.…”

Benefits of developing graduate medical education programs in community health systems

“…Fellowships can bolster the reputation of an institution by producing highly skilled and specialized individuals, while providing a self-sustaining source of difficult-to-recruit specialists to the community. [64] Fellows add to the staffing of the department, expanding the capacity of a potentially limited resource either through enhanced access or ability to create new clinical offerings. The presence of fellows allows for an expansion of the teaching and research capacity of the division, as well.…”

How Strong Is the Duty to Treat in a Pandemic? Ethics in Practice: Point‐Counterpoint

“…First, the primary responsibility of a fellow is to become a competent provider in their specialty to allow them to care for future patients in their specialty. 9 To ask the fellow to serve outside their specialty is asking them to neglect their primary responsibility and has downstream ramifications by decreasing educational opportunities in their field and potentially decreasing their competence level when they care for future patients. Second, and perhaps more important, the way that fellows are compensated is primarily through the education that they receive, as their future (higher) earnings are almost entirely dependent on their specialized training.…”