Implementing a Full Time Equivalent-Supported Hematology/Oncology Fellowship Core Faculty Program May Improve Faculty Engagement in Education, Mentorship, and Recruitment

Background: The American Council of Graduate Medical Education (ACGME) requires every U.S. residency and fellowship training program to designate Core Faculty (CF) who participate in teaching and mentoring trainees. With increasing recognition of competing faculty responsibilities in academic medicine, many groups have recently recommended providing CF with salary support in exchange for their educational efforts, yet few programs have implemented such initiatives. During the 2020-2021 academic year (AY), the Hematology and Medical Oncology Fellowship Program at Yale School of Medicine created a CF program with 10% full time equivalent (FTE) support to 18 CF selected for their dedication to teaching and mentoring fellows. These CF were given responsibilities in participation in fellow conferences, fellow mentorship, and fellowship recruitment. Mentorship Committees (MC) were also launched during the 2020-2021 AY, with each first-year fellow assigned to a group of CF members for career planning and guidance throughout the AY. Methods: We performed a mixed-methods study to explore the impact of our FTE-supported CF program utilizing a combination of faculty and fellow survey data, free-text written comments, and data on faculty participation in educational activities. At the end of the 2020-2021 AY, an online survey utilizing the Qualtrics platform was sent via email to all 18 CF members and all 24 Hematology/Oncology fellows. All CF members and fellows were asked questions about the CF program, while only the CF members and the eight first-year fellows were asked questions regarding the MC. The surveys consisted of multiple choice and open-ended questions with free-text responses and were distributed from June-July 2021. Quantitative data was obtained regarding faculty attendance at the fellowship program's weekly New Patient conference and availability of faculty for fellowship recruitment interviews for both the 2019-2020 AY and the 2020-2021 AY. Results: A total of 14 (77.8%) CF members and 13 (54.2%) fellows responded to the survey. Among CF respondents, 11 (78.5%) reported that both their overall job satisfaction and sense of involvement in the fellowship program and its educational mission increased by either "a little" or "a lot" as a result of becoming a CF member. In free-text comments, positive aspects of being a CF member included "satisfaction in being an integral part of fellowship education," a "sense of commitment" to the educational mission of the fellowship program and improved "communication with colleagues and house staff." As a result of being a CF member, seven (21.1%) reported increased attendance at fellow conferences, nine (27.3%) devoted more time to mentoring and advising fellows, and seven (21.1%) increased their participation in fellowship recruitment compared to prior years. Five (15.5%) CF members felt that they had not appreciably changed their activities, but rather that they received much appreciated recognition and support for activities they were already engaged in prior to becoming a CF member. Among fellow respondents, six (46.2%) noted that following implementation of the CF program, faculty attendance at fellow educational conferences increased. One fellow praised the CF program for "identifying teachers who are very committed to educating fellows" and another commented "fantastic faculty and education overall". Three (37.5%) first year fellows responded to questions about MC, with all three indicating that the MC assisted "a little" or "a lot" in identifying or elucidating their career path. Thirty-eight (36.5%) faculty participated in New Patient conference in 2019-2020 vs. 50 (46.7%) in 2020-2021. Of faculty who were designated CF in 2020, 12 (75%) attended New Patient conference a median of 9 times in 2019-2020 vs. 18 (100%) a median of 20.5 times in 2020-2021. In terms of recruitment, 14 (87.5%) CF reported availability to interview a median of 2 times during 2019-2020 vs. 17 (94.4%) a median of 8.5 times during 2020-2021. Conclusions: Our FTE-supported CF program was viewed enthusiastically by fellows and participating faculty, resulting in increased faculty conference attendance, mentorship of trainees, and involvement in recruitment. MCs may hold promise in guiding career decisions for first year Hematology/Oncology fellows. Disclosures Podoltsev: CTI BioPharma: Honoraria; Bristol-Myers Squib: Honoraria; Celgene: Honoraria; Novartis: Honoraria; Incyte: Honoraria; Blueprint Medicines: Honoraria; Pfizer: Honoraria; PharmaEssentia: Honoraria.

Residency Education Redesign: The Interplay of Innovation and Standardization

Tensions have always existed between innovation and standardization in family medicine, due to the need for rapid responses to changing health issues while ensuring proficiency. For innovation in residency training to be successful, standardization of milestones and frameworks as well as outcomes of residency education are needed and must be clear and rely on measurable effectiveness standards. Standardization without innovation can cause educational stasis, failure to adapt to change, and/or lack of evidence-guided education. Here, we examine possible options for creating the right balance, review what the evidence shows, and make recommendations for the future, including (1) adoption and study of clear, actionable entrustable professional activities (EPAs) as educational standards for residency graduates; (2) core faculty be required to engage in faculty development that includes competency-based medical education using the EPA framework, advanced curriculum development, program evaluation, objective learner assessments aligned with individualized learning plans, and increased opportunities for program directors to gain additional training in the educational sciences; (3) 30% of protected time for core faculty to design, administer, and assess the educational program; (4) required participation in educational collaboratives that rigorously study innovation; (5) required scholarly work that supports program development both clinically and educationally. Taken together, these recommendations represent a vital interplay between cutting-edge innovation and thoughtful standardization using collaboration to graduate residents ready to provide optimal care in their communities, both now and into the future. All stakeholders in the discipline must undertake strategic and deliberate planning designed to adjust direct and indirect costs of residency training to support these recommendations.

Impact of Faculty and Programmatic Resources on the Proportion of Academic Doctoral Degrees in Professional Physical Therapist Education Programs

Objective The Commission on Accreditation in Physical Therapy Education has introduced a requirement that 50% of core faculty members in a physical therapist education program have an academic doctoral degree, which many programs are not currently meeting. Competition between programs for prestige and resources may explain the discrepancy of academic achievement among faculty despite accreditation standards. The purpose of this study was to identify faculty and program characteristics that are predictive of programs having a higher percentage of faculty with academic doctoral degrees. Methods Yearly accreditation data from 231 programs for a 10-year period were used in a fixed-effects panel analysis. Results For a 1 percentage point increase in the number of core faculty members, a program can expect a decline in academic doctoral degrees by 14% with all other variables held constant. For a 1% increase in either reported total cost or expenses per student, a program could expect a 7% decline in academic doctoral degrees with all other variables held constant. Programs that have been accredited for a longer period of time could expect to have proportionately more faculty members with academic doctoral degrees. Conclusions Programs may be increasing their core faculty size to allow faculty with academic doctoral degrees to focus on scholarly productivity. The percentage of faculty with academic doctoral degrees declines as programs increase tuition and expenditures, but this may be due to programs’ tendency to stratify individuals (including part-time core faculty) into teaching- and research-focused efforts to maximize their research prowess and status. Impact This study illuminates existing relationships between physical therapist faculty staffing, time spent in research versus teaching, and program finances. The results of this study should be used to inform higher education policy initiatives aimed to lower competitive pressures and the costs of professional education.

A Survey of Craniofacial Fellowships in North America: The Craniofacial Fellowship Experience Outside of the Operating Room

Residencies are governed by the Accreditation Council for Graduate Medical Education’s (ACGME) common program requirements to help ensure that residents are adequately trained to practice medicine independently. Fellowships either rely on ACGME accreditation for standardization, have developed their own specialty accreditation councils, or have no governing body to monitor programs, such as in craniofacial surgery. This study was designed to capture the clinical, educational, and scholarly experiences of craniofacial fellows to better understand the current craniofacial fellowship landscape. An anonymous online survey was sent to all North American craniofacial surgery fellowship program directors via email. The first question group focused on program characteristics: ACGME accreditation, core faculty, and patient population. The second question group focused on the fellow’s scholarly experience: educational meetings and research requirements. The third question group focused on the fellow’s non-operative experience: clinic participation and call experience. The fourth question group focused on the fellow’s international experience. A total of 22 of 31 programs directors (71%) responded to the survey. The majority of fellowship programs (95.5%) had an educational program of meetings. The majority of programs (82.8%) mandated clinic time for the fellows. Five programs (22.7%) had a fellow’s clinic. The majority of fellowship programs (95.5%) had research expectations for the fellow. Call type and frequency varied widely between fellowship programs. Less than half (47.6%) of programs had an international experience for the fellow. Three-fourths of fellows only interacted with subspecialties of the cleft and craniofacial multidisciplinary clinic during clinic time. A total of 16 fellowship programs (72.7%) were non-ACGME accredited. Despite rapid growth in craniofacial fellowships and a lack of current oversight as to content, programs provide a similar experience for fellows outside of the operating room. Areas for further discussion regarding standardizing programs may include international experiences and formal exposure to other disciplines within the cleft and craniofacial clinic.

How Well Do Core Faculty Understand The Emeregency Medicine Milestones?

Introduction: It is unclear how emergency medicine (EM) programs educate core faculty about the use of milestones in competency-based evaluations. We conducted a national survey to profile how programs educate core faculty regarding their use and to assess core faculty’s understanding of the milestones. Methods: Our survey tool was distributed over six months in 2017 via the Council of Emergency Medicine Residency Directors (CORD) listserv. Responses, which were de-identified, were solicited from program directors (PDs), assistant/associate program directors (APDs), and core faculty. A single response from a program was considered sufficient. Results: Our survey had a 69.7% response rate (n=140/201). 62.9% of programs reported educating core faculty about the EM Milestones via the distribution of physical or electronic media. Although 82.6% of respondents indicated that it was important for core faculty to understand how the EM Milestones are used in competency-based evaluations, respondents estimated that 48.6% of core faculty possess “fair or poor” understanding of the milestones. Furthermore, only 50.7% of respondents felt that the EM Milestones were a valuable tool. Conclusion: These data suggest there is sub-optimal understanding of the EM Milestones among core faculty and disagreement as to whether the milestones are a valuable tool.

Prevalence and Etiology of Burnout in a Community-Based Graduate Medical Education System: A Mixed-Methods Study

Background and Objectives: Burnout rates among American physicians and trainees are high. The objectives of this study were: (1) to compare burnout rates among residents and faculty members of the graduate medical education (GME) programs sponsored by the University of Kansas School of Medicine-Wichita (KUSM-W) to previously published data, and (2) to evaluate the physicians’ feedback on perceived causes and activities to promote wellness. Methods: Between April and May 2017, we surveyed 439 residents and core faculty members from 13 residency programs sponsored by the KUSM-W. The survey included the Abbreviated Maslach Burnout Inventory, two open-ended questions, and demographic questions. The authors used Kruskal-Wallis and Fisher exact tests to analyze the quantitative data, and an immersion-crystallization approach to analyze the open-ended data. Results: Forty-three percent of all respondents met the criteria for burnout, and the overall response rate was 50%. When compared with core faculty members, rates of burnout among residents were higher (51% vs 31%, P<.05). The immersion-crystallization approach revealed five interconnected themes as possible causes of burnout among physicians: work-life imbalance, system issues, poor morale, difficult patient populations, and unrealistic expectations. Promotion of healthy and mindfulness activities; enhanced program leadership; and administration, program, and system modification were identified as activities/resources that can promote wellness among physicians. Conclusions: The findings show that burnout is prevalent among physicians within GME. Wellness and burnout prevention should be addressed at the beginning of medical training and longitudinally. Potential intervention should include activities that allow physicians to thrive in the health care environment.

The Prevalence of Faculty Physician Burnout in Military Graduate Medical Education Training Programs: A Cross-Sectional Study of Academic Physicians in the United States Department of Defense

Introduction In military populations, physician burnout has potential to adversely affect medical readiness to deploy in support of joint operations. Burnout among Graduate Medical Education (GME) faculty may further threaten the welfare of the medical force given the central role these officers have in training and developing junior physicians. The primary aim of this investigation was to estimate the prevalence of burnout among faculty physicians in United States (US) Army, Navy, and Air Force GME programs. Materials and Methods We conducted a cross-sectional study of faculty physicians at US military GME training programs between January 2018 and July 2018. Through direct coordination with Designated Institutional Officials, we administered the Maslach Burnout Inventory Health Services Survey (MBI-HSS) via online web link to faculty physicians listed in Accreditation Data System at each sponsoring institution. In addition to the MBI-HSS, we collected demographic data and queried physicians about common occupational stressors in order to assist institutional leaders with identifying at-risk physicians and developing future interventions to address burnout. Results Sixteen of 21 institutions that currently sponsor military GME programs agreed to distribute the MBI-HSS survey to core faculty. We received completed assessments from 622 of the 1,769 (35.1%) reported physician core faculty at these institutions. Of the 622 physician respondents, 162 demonstrated high levels of emotional exhaustion and depersonalization for an estimated 26% prevalence of burnout. We identified only one independent risk factor for burnout: increasing numbers of deployments (OR 1.38, 95% CI 1.07–1.77). Physicians in our cohort who reported a desire to stay beyond their initial active duty service obligation were less likely to be classified with burnout (OR 0.45, 95% CI 0.26–0.77). The most common drivers of occupational distress were cumbersome bureaucratic tasks, insufficient administrative support, and overemphasis on productivity metrics. Conclusions We estimate that 26% of physician faculty in military GME programs are experiencing burnout. No specialty, branch of service, or specific demographic was immune to burnout in our sample. Institutional leaders in the MHS should take action to address physician burnout and consider using our prevalence estimate to assess effectiveness of future interventions.

Zayyat, Elias (1935--)

The painter Elias Zayyat (born Damascus, Syria, 1935) has played a leading role in developing a Syrian modern art pedagogy and analysis of Syrian visual culture—particularly traditions of icon painting. He first learned painting as a teenager in the studio of Michel Kurché in Damascus, followed by fellowship study at the Academy of Fine Arts in Sofia, Bulgaria (1956–1960) and a final year at the Faculty of Fine Arts in Cairo, Egypt. Upon his return to Syria, Zayyat took an assistant teaching position at the new College of Fine Arts in Damascus, where he worked with the core faculty to overhaul and update the curriculum to an international standard of open experimentation. He became involved in the Group of Ten in 1970, which was dedicated to encouraging the development of art outside the official ministry framework in Syria. His own art is influenced by religious and popular iconography and often makes use of allegory to express the social, economic, and political plight of Syrians. Zayyat has also worked as a restorer of icons as well as completing new icon commissions. In this work, he seeks to employ a modern visual style and to develop distinctively Syrian features.