Perceptions on Navigating ACGME-Accredited Addiction Psychiatry Fellowship Program Websites: A Thematic Analysis across a Race- and Gender-Diverse Pool of Potential Applicants

Abstract

Background: There is an alarming shortage of addiction psychiatrists in the United States. To promote interest in addiction psychiatry (ADP), it is essential to maximize resources available through ADP fellowship websites. The aim of this study was to investigate the perceived adequacy and accessibility of content on ADP fellowship websites and discover what further information is considered important among trainees interested in becoming addiction specialists. Methods: Three virtual focus groups were conducted between January and February 2021 among medical students and residents in diverse geographic regions. Participants were asked about the availability of information on ADP fellowship program websites and other material they would like to see available. Focus groups were recorded, with data transcribed and coded using NVivo 11 and Dedoose. A coding scheme was deductively developed based on the core research questions. Results: The majority of participants (N = 27) identified areas of dissatisfaction with the content currently available on ADP websites. The sample was highly representative of racial and ethnic minoritized trainees (n = 12) and genderqueer/non-binary participants (n = 3). Three major themes were identified and durable across all focus groups: lack of emphasis on diversity/health equity, lack of portrayal of everyday life and activities of fellows, and inadequate representation of curricula. Overwhelmingly, participants identified a dedication to health equity (for example, working with minoritized populations) as a key deciding factor in whether to apply to a particular ADP fellowship. Conclusions: ADP fellowship websites are perceived to have considerable variability in the amount and quality of information. Many do not appear to provide the full spectrum of content desired by diverse potential applicants, such as information regarding current fellows and community-centered initiatives. This is concerning, as it suggests ADP fellowships may be interfacing poorly with burgeoning leaders, especially those from race and gender minoritized backgrounds, neglecting potential opportunities to develop future addiction specialists.

Evaluating ACGME-Accredited Addiction Psychiatry Fellowship Online Content: A Critical Analysis of Addiction Psychiatry Fellowship Program Websites in the US

“…Similarly, trainees identified wanting to learn about harm reduction practices such as interaction with safe injection sites, 9 but we found most included no information about harm reduction strategies (4.3%). This may likely impact the recruitment of trainees from racial/ethnic minoritized backgrounds, as a previous study of racially diverse trainees interested in ADP, 9 noted a commitment to health equity, including learning about harm reduction, as a highly important factor in influencing their decision to apply to ADP fellowship programs. Providing health equity content is crucial, given the disproportionate number of patients from marginalized groups with addiction, and the dearth of racial/ethnic diversity amongst ADP fellows.…”

“…While there were many key points from our research, we did have some limitations. One major limitation was that the list of 42 criteria was informed heavily by the research team's prior study of a non-representative sample of trainees perceptions of the content and navigability of ADP websites 9 . The sample lacked generalizability due to the racial composition and geographical ties of participants, therefore it is possible that the criteria included in this study may not include a comprehensive set of factors that other trainees feel are important when deciding what ADP program content is salient.…”

“…9 The 42 criteria were factors that appeared to be salient, recurrent, and unique factors discussed by trainees during the focus groups. 9 All ADP fellowship program websites were evaluated by 2 authors (MA and AK). Presence or absence of each factor was recorded over a two-week period in October 2020.…”

“…Psychiatry residents have also identified concerns over the length of the fellowship training period, a lack of sufficient loan repayment options, a dearth of ADP fellowships in their current city of residence, and inadequate advertising as factors influencing their interest in ADP fellowships 8 . Further, a racially diverse sample of trainees interested in ADP indicated that the information available on ADP fellowship websites varied widely and was perceived to be inadequate in meeting the needs and interests of potential applicants 9 …”

“…While there is limited information on the utility of ADP fellowship websites in influencing applicant decisions, previous studies on related psychiatry subspecialties suggest that websites are an important component in the application decision-making process 7 . Consistent with most medical transitions, potential ADP fellowship applicants rely on electronic resources—specifically ADP fellowship program websites—when deciding the next steps of their training 9 , 19 . To better address the gap in trained addiction psychiatrists, it is important to understand the quality of information that is available online via ADP fellowship program websites, since these platforms serve as a primary source for residents and medical students interested in ADP fellowships.…”