Survey of Current Practices in Fellowship Orientation

Abstract

Background: The transition from medical resident to subspecialty fellow is a critical time period in fellowship training that has not been well described. The current practices of fellow orientation in pulmonary and critical care training programs are not known. Objectives: The aim of this study was to describe orientation practices for training programs in the United States. Methods: A 10-question survey was sent via e-mail to program directors of pulmonary/critical care fellowship programs identified on the American Thoracic Society (ATS) webpage of current programs. Results: Eighty-seven programs responded (61.7%), of which 86% had a formal orientation program. The mean time spent in fellow orientation was 5–10 h in didactic sessions and 0–5 h in wet labs. The most frequent didactic sessions were bronchoscopy in 69 programs (80.2%), pulmonary function testing in 63 programs (73.3%) and orientation to hospital services in 63 programs (73.3%). The most frequent use of wet labs was in bronchoscopy training in 60 programs (81.1%) and ventilators in 45 programs (60.8%). Simulators were used in 37 programs (43%). The majority reported that these areas were covered with on the job training, without a formal designated orientation. Conclusion: This survey demonstrated that early fellow training differs across programs in both time spent and clinical and procedural topics covered. An early, standardized approach to clinical and procedural training can assure appropriate exposure that cannot be guaranteed by on the job training. To provide justification for such an approach, clinical outcomes need to be correlated with training methods.

Developments in Simulation Bronchoscopy Training

“…Core curriculum training in many institutions includes a series of lectures and modular approach including a variety of technological media describing the procedure, its indications, complications and consenting [6][7][8][9]. For example, trainees may watch a video of a procedure or use a web-based e-learning module such as that available at British Thoracic Society (www.brit-thoracic.org.uk) or Essential Bronchoscopist (www.bronchoscopy.org) web sites [10][11][12].…”

Educating the Next Generation of Pulmonary Fellows in Transbronchial Needle Aspiration. Leading the Blind to See

“…Training in TBNA has remained a tenet of basic diagnostic bronchoscopy and cTBNA continues to be taught in the majority of PCCM fellowship programs (12), however surveys demonstrate that bronchoscopy education remains quite variable, including the instruction of TBNA (12)(13)(14). Surveys also indicate that cTBNA remains a poorly practiced procedure during and after fellowship (9,10,14,15).…”

Impact of an Intensive Cardiology Orientation Program on Confidence of New Fellows

“…Furthermore, when clinical responsibilities begin, it can be difficult for subspecialty trainees to attend introductory lectures, potentially making their transition more difficult and conceivably deleteriously affecting patient care. Thus, condensing these introductory lectures into a focused orientation program seems ideal (Lucarelli, Lucey, & Mastronarde, 2007). Although many training programs have orientations, including 50% (Merenstein & Preisach, 2002) to 90% (Brillman, Sklar, & Viccellio, 1995) of family practice and emergency medicine residencies, their curricula vary widely and their impact is largely unknown (Lucarelli et al, 2007).…”

“…Thus, condensing these introductory lectures into a focused orientation program seems ideal (Lucarelli, Lucey, & Mastronarde, 2007). Although many training programs have orientations, including 50% (Merenstein & Preisach, 2002) to 90% (Brillman, Sklar, & Viccellio, 1995) of family practice and emergency medicine residencies, their curricula vary widely and their impact is largely unknown (Lucarelli et al, 2007). Several small studies of specific orientation programs have been reported.…”