Scholarly activity training in pediatric pulmonology fellowship programs

Abstract

Background: Scholarly activity training is a required component of pediatric pulmonology fellowship programs. However, there are no data on resources and barriers to training and factors associated with fellow productivity.Methods: We surveyed US pediatric pulmonology fellowship program directors (FPDs) between March and October 2019. Our primary outcome was fellow productivity (>75% of fellows in the past 5 years had a manuscript accepted in a peerreviewed journal). Analyses included descriptive statistics, χ 2 and Fisher's exact tests for categorical values, and t-test or Wilcoxon rank-sum test for numerical values.Results: Sixty-one percent (33/54) of FPDs completed the survey. Seventy-nine percent reported that most fellows completed clinical, basic science, or translational research. However, only 21% reported that most fellows pursued research positions after graduation; academic clinical positions were more common. For 21%, lack of funding and competing clinical responsibilities were barriers to completing the scholarly activity. Only 39% had highly productive programs; those FPDs were more likely to be highly satisfied with fellow scholarly activity products (p = 0.049) and have >6 publications in the previous 3 years (p = 0.03). Fifty-two percent of FPDs believed that pediatric pulmonary training should be shortened to 2 years for those pursuing clinical or clinician-educator careers. Conclusions: Barriers to scholarly activity training in pediatric pulmonology programs threaten the pipeline of academic pediatric pulmonologists and physicianinvestigators. Aligning fellow scholarly activity and clinical training with the skills required in their postgraduate positions could optimize the utilization of limited resources and better support career development.

Recruitment into Pediatric Pulmonary Fellowship Programs: The Bigger the Better?

“…In subspecialty fellowship programs, programs with at least seven fellows and ⩽25% unfilled positions in the match were less likely to be perceived as financially insecure ( 8 ). Larger pediatric pulmonary fellowships are more likely to have a specific research curriculum and less likely to report a lack of expertise on the scholarly oversight committee ( 9 ). Qualitative studies would be useful to determine if these factors or others such as camaraderie and social interactions are most important.…”

“…Is the shift to large programs a problem? In larger pediatric pulmonology programs, fellows are more likely to pursue a position in research after graduation ( 9 ), which is important when considering the decrease in the number of physician scientists. Given the large expense associated with fellowship program administration and fellow salaries in the harsh financial climate of hospitals, perhaps it would be beneficial to share resources and centralize into fewer programs.…”

“…However, that ignores the importance of the joy and meaning in work that faculty at smaller programs may feel in training the next generation in their subspecialty, which is important in reducing burnout and enhancing engagement ( 10 ). Despite the differences in resources, there was no difference between large and small pediatric pulmonology programs with regard to scholarly productivity measured by peer-reviewed publications or grant applications, and, in fact, small programs were more likely to have >75% of their fellows present their work at a national or international meeting ( 9 ). The potential of worsening the disparity in access to care between states by centralizing training into a few metropolitan areas is important; however, that association needs to be further studied.…”