HomeProfessionalsCareer DevelopmentFellowsInnovations in Fellowship Education2015 ▶ Variability in Structure of University Pulmonary/Critical Care Fellowships and Retention of Fellows in Academic Medicine
Variability in Structure of University Pulmonary/Critical Care Fellowships and Retention of Fellows in Academic Medicine

University of South Carolina
Charleston, SC

Program Director: Nicholas Pastis, MD
Program Type: Pulmonary and Critical Care Medicine
Abstract Authors: Nandita Nadig, MD, Allison Vanderbilt, MD, Dee Ford, MD, Lynn Schnapp, MD, Nicholas J Pastis, MD

The past decade has witnessed tremendous change in graduate medical education based on mandates by the Accreditation Council for Graduate Medical Education (ACGME).Despite ACGME guidelines, individual fellowship programs are challenged to find a format which meets the ACGME requirements, grooms fellows to be trusted clinicians, and encourages them to enter academic careers. While requirements exist for program structure and for amounts of training time, there can be significant leeway in how programs achieve these requirements. Little is known about this variability or the implications of different training strategies on the retention of fellows in academic medicine. This study was undertaken as part of an internal effort to evaluate and revise the program structure of the pulmonary and critical care (PCCM) fellowship at the Medical University of South Carolina (MUSC). We conducted a survey of 40 US PCCM program directors at major academic centers to use as a guide for tailoring the structure of our program with the goal of enhancing retention of fellows into academic medicine.

A 30-item survey was developed through rigorous internal review and was administered via email to select (40) programs that were in similar structure to MUSC. The survey questions defined variations in the training structure (clinical, research, educational) of PCCM programs and identified factors associated with retaining fellows in academic medicine. Descriptive statistics, cronbach’s alpha, correlations, and repeated measures analysis of variance (ANOVA) were calculated. All data was analyzed in SPSS 21.0.

Twenty-one fellowship directors out of the 40 (52% response rate) completed the survey. Program directors reported that within the past 5 years, 38% of their fellows remained in academic medicine and 20% remained in academics with significant research focus. The Pearson’s correlation revealed a statistically significant relationship between the percent of fellows who obtained a master’s degree and the percent of fellows who graduated and remained in academics (rs = .559, p < .008). The survey also revealed statistically significant relationships between scholarly requirements (grant proposals, peer reviewed original research projects) and the percent of fellows who graduated and remained in academics. Based on these results, the internal program structure at MUSC was substantially revised to increase the focus on research and grant funding opportunities. Revisions included offering clinician scientist training for two of the five third year fellows committed to pursuing grant funding opportunities. This change has led to a fourth year of fellowship for research and a Master’s of Science in Clinical Research (MSCR) during that time for those two fellows. Previously, only 1 fellow in the past 10 years achieved grant funding and pursued a fourth year with a MSCR. In addition to these changes, the fellow conferences were modified to provide feedback via the biannual research work-in-progress conference and the institution of regular research mentorship committee meetings.

This survey offers some insights that may be useful to fellowship program directors desiring to increase retention of fellows in academic medicine. In particular, advanced education in research was associated with academic retention. We will be prospectively evaluating whether enhanced research curriculum (research training, mentorship and regular peer/faculty feedback) leads to increased retention of fellows in academic careers.


Last Reviewed: July 2016