Exercise-induced bronchoconstriction (EIB) is described by transient narrowing of the airways after exercise. It occurs in approximately 10% of the general population, while athletes may show a higher prevalence, especially in cold weather and ice rink athletes. Diagnosis of EIB is often made on the basis of self-reported symptoms without objective lung function tests, however, the presence of EIB can not be accurately determined on the basis of symptoms and may be under-, over-, or misdiagnosed. The goal of this review is to describe other clinical entities that mimic asthma or EIB symptoms and can be confused with EIB.

PurposeEntrustable professional activities (EPAs) are one approach to competencybased medical education (CBME), and 7 EPAs have been developed that address content relevant for all pediatric subspecialties. However, it is not known what level of supervision fellowship program directors (FPDs) deem necessary for graduation. The Subspecialty Pediatrics Investigator Network (SPIN) investigated FPD perceptions of the minimum level of supervision required for a trainee to successfully graduate.

Background: There is concern that inadequate recruitment of new subspecialty trainees to replace the aging physician population will lead to significant workforce issues in pediatric pulmonology. The factors leading trainees to pursue a fellowship in pediatric pulmonology are unclear. Objective: To gain a better understanding of the decision-making process surrounding the choice to pursue a pediatric pulmonary fellowship and to provide informed recommendations to increase recruitment of new trainees. Methods: Informed by the Social Cognitive Career Theory, eight focus groups were held with pediatric residents and fellows attending the 2019 American Thoracic Society International Conference. Questions focused on personal background, learning experiences, self-efficacy and outcome expectations, interests, and goals. Transcripts were analyzed by conventional content analysis. Results: Fifty-six residents and fellows representing 42 different institutions participated. Responses resulted in seven major themes: 1 ) attractive aspects of pediatric pulmonology draw trainees to the field, 2 ) exposure to the breadth and scope of the field is limited, 3 ) mentorship is key, 4 ) decisions surrounding fellowship selection occur early in the second year, 5 ) trainees want flexibility in length and structure of fellowship, 6 ) financial considerations are not the driving factor in decision-making, and 7 ) there are inherent aspects of pulmonology that trainees may not enjoy. Conclusion: A lack of broad exposure to pediatric pulmonology during residency results in false perceptions of the field and is a deterrent to recruitment. Improving faculty engagement, guaranteeing broad and early exposure to the field, and creating learning experiences aimed at raising self-efficacy may improve recruitment and ultimately improve the pediatric pulmonary workforce.

BACKGROUND AND OBJECTIVES:The educational requirements for pediatric fellows include at least 12 months of scholarly activity and generation of a work product. Yet there lacks detailed guidance on how programs can best integrate scholarly activity training into fellowships. Our objectives were to understand the resources and barriers to training and identify factors associated with productivity. METHODS:We surveyed pediatric fellowship program directors (FPDs) nationally in 2019. Data analysis included descriptive statistics, x 2 and Fisher's exact tests, and multivariable modeling to identify factors associated with high productivity (.75% of fellows in the past 5 years had an article from their fellowship accepted).RESULTS: A total of 499 of 770 FPDs responded (65%). A total of 174 programs (35%) were highly productive. The most frequent major barriers were a lack of funding for fellows to conduct scholarship (21%, n = 105) and lack of sufficient divisional faculty mentorship (16%, n = 79). The median number of months for scholarship with reduced clinical obligations scholarship was 17. A total of 40% (n = 202) of FPDs believed training should be shortened to 2 years for clinically oriented fellows. Programs with a T32 and a FPD with .5 publications in the past 3 years were twice as likely to be productive. Not endorsing lack of adequate Scholarship Oversight Committee expertise and a research curriculum as barriers was associated with increased productivity (odds ratio = 1.83-1.65).CONCLUSIONS: Despite significant protected fellow research time, most fellows do not publish. Ensuring a program culture of research may provide the support needed to take projects to publication. The fellowship community may consider reevaluating the fellowship duration, particularly for those pursing nonresearch focused careers.WHAT'S KNOWN ON THIS SUBJECT: Engagement in scholarly activities is an entrustable professional activity of pediatric subspecialists. Its importance is reflected in the training requirements for pediatric fellows. However, there lacks detailed guidance for fellowship programs on how to train fellows effectively in scholarly activity. WHAT THIS STUDY ADDS:In this national survey of pediatric fellowship program directors, we assess resources for and barriers to fellow scholarly activity training and factors associated with productivity. Productivity was associated with having a productive director, training grants, mentorship, and adequate core curriculum.

No abstract