Subspecialty Choices Among Medicine-Pediatrics Graduates: Results From a Four-Year National Program Director Survey.

Background and objectives Dual-trained medicine-pediatrics physicians (med-peds) play an important role in the healthcare ecosystem. Little is known about the subspecialty choices of med-peds residency graduates. This study aims to characterize the subspecialty choices of med-peds residency graduates. Methods The Medicine-Pediatrics Program Directors Association (MPPDA) administers an annual survey to the program directors of all med-peds residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). This project represents aggregate survey data from 2020-2023. Results The number of program directors responding to the survey ranged from 80.8% (63/78) to 85.7% (66/77; mean response rate: 82.8%). About 465 of 1,245 (37%) graduates over the four years chose fellowship training, across 51 unique subspecialties. The top five selected pathways were: adult pulmonary and critical care 54 (11.6%), allergy and immunology 37 (7.9%), adult infectious diseases 30 (6.5%), adult cardiology 30 (6.5%), and pediatric cardiology 30 (6.5%). Conclusions Med-Peds residents pursue a diversity of subspecialty training and represent an important contribution to the subspecialty workforce. Improving combined subspecialty opportunities may increase participation by med-peds graduates and, in particular, may support the increasing need for pediatric subspecialists.

Referring wisely: knowing when and how to make subspecialty consultations in hospital medicine.

Subspecialty consultations are becoming highly prevalent in hospital medicine, due to an ageing population with multimorbid conditions and increasingly complex care needs, as well as medicolegal fears that lead to widespread defensive medical practices. Although timely subspecialty consultations in the appropriate clinical context have been found to improve clinical outcomes, there remains a significant proportion of specialty referrals in hospital medicine which are inappropriate, excessive, or do not add value to patient care. In this article, we sought to provide an overview of the common problems pertaining to excessive quantity and suboptimal quality of inpatient subspecialty consultations made in real-world practice and highlight their implications for healthcare financing and patient care. In addition, we discuss the underlying contributing factors that predispose to inappropriate use of the specialist referral system. Finally, we offer a practical, multitiered approach to help rationalize subspecialty consultations, through (i) a systematic model ('WISE' template) for individual referral-making, (ii) development of standardized healthcare institutional referral guidelines with routine clinical audits for quality control, (iii) adopting an integrated generalist care model, and (iv) incorporating training on effective referral-making in medical education.

Mapping the Locations of Medical Specialists in the Ministry of Health's Hospitals in Malaysia by Specialty, Subspecialty and Area of Interest.

Mapping the distribution of medical specialists in the Ministry of Health (MOH) Malaysia facilities is expected to be more complex as the demand for specialty and subspecialty services increases in the future. A more robust and definitive gap analysis is needed to facilitate planning and resource allocation. The Medical Development Division developed a master list of framework of specialties, subspecialties and areas of interest, and Specialist Database Module in the Medical Programme Information System (MPIS) as tools to facilitate mapping of services. Relational database of specialists' location, facilities, workload, population profile and other relevant parameters were developed to provide data visualisation in specific dashboard. Needs versus supply ratio is proposed as one of parameters to visualise specialised medical services distribution by geographical localities.

A Cross-Sectional Study of Gender-Specific Influences of Orthopedic Subspecialty Selection.

Background: Per the American Academy of Orthopaedic Surgeons, 6.5% of practicing orthopedic surgeons are female and a majority subspecialize in pediatrics, hand, and foot and ankle surgery. The study purpose is to evaluate influences of orthopedic subspecialty selection, specifically factors such as perceived strength, lifestyle, and mentorship influence on subspecialty decisions and to identify if gender plays a role in these perceptions. Methods: An IRB approved cross-sectional study was conducted via email distribution of a REDCapTM survey to U.S. licensed orthopedic surgeons. Data regarding demographics, professional degree, training and current practice location, and perceptions regarding orthopedic surgery was obtained using Likert rating scales. Data was analyzed using descriptive statistics with two-tailed student's t-tests (α=0.05). Results: The survey yielded 282 responses (182 females and 100 males). Overall, the distribution of residents (28%), fellows (6%), and attendings (66%) correlates well with the prevalence of each respective physician category in the field of orthopedic surgery. The study demonstrated no difference in subspecialty choice based on mentorship, work-life-balance, career advancement, subspecialty culture, salary potential, family planning, or schedule. However, a statistically significant difference exists regarding stereotypes, perceived strength required, and perception of discrimination from pursuing a specific orthopedic subspecialty. 27% of females and 10% of males reported discouragement from any subspecialty (p<0.05). Adult reconstructive and oncology were most frequently discouraged. Women reported not choosing a subspecialty because of perceived physical demands more often than men (p<0.001). Women reported an increased use of adaptive strategies in the operating room (p<0.001). Women were also more likely to report feeling discouraged from pursuing a subspecialty due to their gender (p<0.001). Both men and women reported mentorship as the most influential factor in subspecialty selection. Conclusion: Women and men reported different factors were important in their decision of subspecialty. Women were more likely to be discouraged from a subspecialty and experience discrimination based on their perceived strength compared to male peers. Residents, fellows, and attending surgeons valued mentorship as the most influential in their subspeciality choice. This study suggests intrinsic and extrinsic influences that may differentially affect male and female orthopedic surgeons when they choose a subspecialty. Level of Evidence: III.

Factors that influence surgical decision-making for geriatric displaced femoral neck fractures: Bullet Health Analysis (BHA) I : Worldwide Orthopaedic Research Collaboration: Leveraging Big Data (WORLD) I.

PURPOSE: The management of geriatric femoral neck fractures, which includes options like hemiarthroplasty (HA), total hip arthroplasty (THA), and fixation, exhibits regional and healthcare setting variations. However, there is a lack of information on global variations in practice patterns and surgical decision factors for this injury. METHODS: Survey data were collected from April 2020 to June 2023 via Orthobullets Case Studies, a global clinical case collaboration platform hosted on a prominent orthopedic educational website. Collaboratively developed standardized polls, based on the best available evidence and a comprehensive, peer-reviewed, evidence-based item list, were used to capture surgeons' treatment preferences worldwide. Subsequent analyses explored preferences within subspecialties and practice settings. Multivariable regression analysis identified associations between subspecialty, practice type, the likelihood of choosing THA, and the preferred femoral fixation method. RESULTS: Our study encompassed 2595 respondents from 76 countries. Notably, 51.5% of participants (n = 1328; 51.5%, 95% CI 49.6-53.4%) leaned towards THA and 44.9% for HA, while 3.6% favoured surgical fixation. Respondents affiliated with academic institutions and large non-university-affiliated hospitals were 1.74 times more likely to favour THA, and arthroplasty specialists exhibited a 1.77-fold preference for THA. There was a 19-fold variation for cemented femoral fixation between the United Kingdom (UK) and USA with the UK favouring cemented fixation. CONCLUSION: Our study reveals a significant shift towards THA preference for managing geriatric femoral neck fractures, influenced by subspecialty and practice settings. We also observed a pronounced predominance of cement fixation in specific geographic locations. These findings highlight the evolving fracture management landscape, emphasizing the need for standardization and comprehensive understanding across diverse healthcare settings.

The Art and Science of Securing an Anaesthesiology Training Job: A Survey of the Key Factors in Two Australian Tertiary Hospitals.

Background There is no specific formal guidance on what prospective trainees must focus on to secure an anaesthetic training position in Australia, and there is little in the literature to advise both applicants and their mentors. Method This study aims to ascertain the views of anaesthetic clinicians from two Australian tertiary referral hospitals on what they consider most important for selection. A paper-based survey was conducted at both hospitals across three groups, totalling 104 participants with a 100% response rate. Results The characteristics most agreed upon to be of at least some importance were clinical anaesthetic knowledge (98%, 102/104), teaching (95%, 99/104), basic science and courses (94%, 98/104), other critical care experience (93%, 97/104), and anaesthetic experience for more than six months (92%, 96/104). Of these, anaesthetic experience of greater than six months, non-anaesthetic critical care experience, and the completion of relevant courses were felt to be most important. Furthermore, good referee reports (95%, 99/104), especially those that come from anaesthetists (75%, 78/104) as well as having previous experience working in the institution applied to (88%, 92/104) were also seen as important factors. 'Non-technical' skills (40%, 42/104) were also regarded as an important factor, with immense competition for a few training positions (45%, 47/104) as the greatest barrier. When it came to selection, prevocational trainees consistently ranked the majority of criteria higher than accredited trainees or specialists. Conclusion This staff survey in two Australian hospitals has shed light on factors considered critical in securing an anaesthetic training position. It underscores the significance of clinical anaesthetic knowledge, basic science proficiency, and relevant critical care experience.

Preparing for Fellowship in Internal Medicine With a Focus on Pulmonary or Critical Care Medicine: Major Principles and New Realities.

In this article, the authors provide guidance for applicants to any subspecialty in the medical specialties matching program, with a particular focus on those seeking a match into a pulmonary or critical care medicine training program, or both. The preparation, application, interview, ranking, and match steps are used to discuss available literature that informs this process. Preparing a fellowship application is discussed in terms of personal career goals, and specific strategies are suggested that can help a candidate to assess a program's fit with those goals. In addition to review of recent data on virtual interviewing and interview questioning, the authors provide practical recommendations for candidates seeking to maximize their success in the current interview environment. Finally, key points about generating a rank order list are summarized. This resource will prove useful to any candidate pursuing medical subspecialty training in the current era.

Academic radiology department subspeciality organization & fellowship offerings: A hodgepodge.

INTRODUCTION: As opportunities for radiologists to subspecialize have increased, many avenues to organize Radiology department subspecialties exist. This study seeks to determine how academic U.S. Radiology departments structure themselves with respect to subspecialty divisions/sections, as there are no current standards for how Radiology departments are subdivided. Additionally, the extent of Radiology fellowships offered are assessed. The websites of academic U.S. Radiology departments, a highly influential source of information, were analyzed to perform this study. MATERIALS & METHODS: Radiology department websites of all allopathic U.S. medical schools (n = 148) were assessed for the following: presence/absence of Radiology department subdivisions, division/section labels, number of divisions/sections, division/section titles, presence/absence of Radiology fellowships, number of fellowships, and fellowships titles. RESULTS: 114/148 (77 %) medical schools had Radiology department websites. According to their respective websites, 66/114 (58 %) academic Radiology departments had subspecialty divisions/sections, whereas 48/114 (42 %) had no divisions/sections listed. Of the departments that had divisions/sections, the median number of divisions/sections per department was nine, and ranged from two to 14. Fellowships were offered at 82/114 (72 %) academic Radiology departments that had websites, and the median number was six, ranging from one to 13. CONCLUSION: There is marked heterogeneity of departmental organization across Radiology departments nationwide, likely due to the lack of current standards for how Radiology departments are subdivided into divisions/sections. Of the 77 % of medical schools that have Radiology department websites, only 58 % of departments listed divisions/sections, and 72 % posted fellowship offerings.

A Pilot Survey on the Perceptions of Pediatric Subspecialty Fellows and Program Directors on Virtual Compared with In-Person Interview Experiences.

Pediatric fellowship programs have conducted virtual interviews since the start of the COVID-19 pandemic in 2020. In this national survey of fellowship program directors and fellows interviewed in-person and virtually, fellowship program directors and fellows formed accurate impressions, regardless of format, but our data did not clearly support one interview format over another.

Designing the Future of Medical Education: The EPA Framework as a Catalyst to Inform Family Planning and Reproductive Health Fellowship Training Program in Ethiopia Medical Education: An Exploratory Sequential Mixed Method Study.

Introduction: Entrustable Professional Activities (EPAs) are tasks or responsibilities within a specific field that can be given to a learner once they are competent to perform them independently. EPAs are being used in various specialty programs and serving as valuable tool to inform educational program. However, due to disparities in professional practice between different contexts, the automatic transfer of a set of core EPAs is not feasible. Hence, our study aims to develop an EPA framework to inform the Family Planning and Reproductive Health Fellowship Program in the local context of Ethiopia. Methods: We employed an exploratory mixed-method design, which involved the collection of qualitative data using the Nominal Group Technique and quantitative data through a nationwide survey in all residency training institutions across the country. Qualitative data analysis involved several steps, including compiling a list of tasks, removing duplicate tasks, reviewing EPAs using criteria and an equal rubric tool. For quantitative data analysis, descriptive statistics, validity index analysis, and intra-class correlation coefficients, were used. Results: Seven senior panelists were able to propose a total of 57 EPAs, with 17 remaining after qualitative data analysis. The panelist evaluated the relevance of each EPA in the second phase. As a result, 17 EPAs received a content validity index of >0.83, indicating satisfactory relevance. In the national survey, experts reached a high level of final agreement regarding the relevance and representativeness of all 17 EPAs (ICC = 0.815, 95% CI [0.0.756,0.865], p.0001). Conclusion: The final set of 17 end-of-training EPAs is valid, acceptable and representative of the discipline, and they can be used as a framework to inform Family planning and Reproductive Health Fellowship Program in Ethiopian medical education once these core EPA statements are described in sufficient detail. This can contribute to raise the quality of training and hence the quality of patient care.

Does hematology rotation impact the interest of internal medicine residents in considering hematology as a career?

BACKGROUND: The ongoing need for hematologists is not met in many parts of the world. The hematology rotation during internal medicine residency is an opportunity to attract more physicians to the hematology field. This study aimed to assess the impact of a hematology rotation on internal medicine residents' interest in considering a hematology career. METHODS: Internal medicine residents were invited to complete an anonymous questionnaire before and after a mandatory hematology rotation. Their interest in pursuing a hematology career was assessed by asking them to rate "Consider hematology as a career" on a 0 to 10 scale (0 = never, 10 = strongly agree). In addition, viewing the hematology workload as manageable, comfort in dealing with cancer and satisfaction with the hematologist lifestyle were assessed before and after the rotation. RESULTS: Sixty out of 62 IM residents completed the pre- and post-hematology rotation questionnaire (response rate 97%). 80% were in the age range of 25-29 years and 73% were males. Two-thirds were in the senior level (3rd and 4th year) of their residency program and 40% had a prior rotation in a hematology unit. Rating considering hematology as a career increased significantly from a median of 7 (IQR: 5-9) pre-rotation to 8.5 (IQR: 7-10) post-rotation (p = 0.0018). Subgroup analysis showed a significant increase in interest among subgroups except residents > 29 years of age, those with prior hematology rotation and junior residents (1st and 2nd year residency). The change in viewing hematology workload as manageable, comfort in dealing with cancer patients and perceiving the hematologist lifestyle as satisfactory were strongly positively correlated with the change in considering hematology as a career (p = 0.0014, < 0.0001 and < 0.0001; respectively). CONCLUSIONS: A hematology rotation is associated with an increase in the interest of internal medicine residents in considering hematology as a career. Further research is needed to Identify factors that may make hematology rotations an effective tool in attracting residents to the hematology field.

Body oncologic imaging subspecialty training a curriculum based on the experience in a tertiary cancer center.

PURPOSE: To describe the structure of a dedicated body oncologic imaging fellowship program. To summarize the numbers and types of cross-sectional imaging examinations reported by fellows. METHODS: The curriculum, training methods, and assessment measures utilized in the program were reviewed and described. An educational retrospective analysis was conducted. Data on the number of examinations interpreted by fellows, breakdown of modalities, and examinations by disease management team (DMT) were collected. RESULTS: A total of 38 fellows completed the fellowship program during the study period. The median number of examinations reported per fellow was 2296 [interquartile range: 2148 - 2534], encompassing all oncology-relevant imaging modalities: CT 721 [646-786], MRI 1158 [1016-1309], ultrasound 256 [209-320] and PET/CT 176 [130-202]. The breakdown of examinations by DMT revealed variations in imaging patterns, with MRIs most frequently interpreted for genitourinary, musculoskeletal, and hepatobiliary cancers, and CTs most commonly for general staging or assessment of nonspecific symptoms. CONCLUSION: This descriptive analysis may serve as a foundation for the development of similar fellowship programs and the advancement of body oncologic imaging. The volume and diversity of examinations reported by fellows highlights the comprehensive nature of body oncologic imaging.

Curriculum and Competency Guidelines for the Advanced Care Practitioner in Infectious Disease.

Background: Changes in the health care delivery system have altered the way internal medicine (IM) is practiced, with inclusion of subspecialty advanced care practitioners (ACPs) as vital members of the health care team. Methods: ACPs are provided the clinical settings and educational resources within an academic center to become competent in recognizing and managing common and complicated infectious diseases (ID). The ID ACP will be given progressive responsibility with expectations for achievement of milestones as they develop into competent practitioners. We seek to ensure quality, cost-effective, and comprehensive patient-centered care on the ID service in the inpatient and ambulatory settings in compliance with national standards and scope of practice recommendations and regulations. Results: In recognition of the expanding role of ACPs, we developed a curriculum and guidelines in the subspecialty of ID. Conclusions: Our proposal greatly adds to the available literature for ACPs to provide the full spectrum of ID practice.

Ophthalmic exam and ophthalmology residents' subspecialty preference.

AIM: To evaluate residents' perceptions and attitudes toward the various aspects of a comprehensive ophthalmic examination, and to determine if these factors correlate with their choices for fellowship and future career plans. METHODS: This is a cross-sectional study. A questionnaire on the perception of the ophthalmic exam was sent via SurveyMonkey to ophthalmology residents throughout Israel. Eighty of them (one-half of all ophthalmology residents in 2019) completed it. The first part related to how they perceived each component of the ophthalmic evaluation. The second part related to their future fellowship plans. The Chi-squared test was used to compare categorical variables and Student's t-test and One-way ANOVA were used to compare continuous variables. Multivariate logistic regression analysis was applied as needed to detect interactions between variables and to exclude confounder effects. RESULTS: Slit-lamp examination of the anterior and posterior segments ranked as the most likeable aspects, whereas gonioscopy, ocular motility examination and visual acuity assessment were least likeable. Anterior segment and retina subspecialties were the ones most sought after. Forty-nine respondents (61.3%) noted a direct correlation between their preferred parts of comprehensive ophthalmic evaluations and their choice of subspecialty. Perceptions of selected components of those evaluations were significantly associated with responders' intentions to pursue anterior segment, retina, or oculoplastic fellowships (P<0.05). CONCLUSION: Perspectives of residents toward the ophthalmic examination, and most specifically its individual components, play an important role in their choice of subspecialty training.

Body CT examinations in oncologic patients: the impact of subspecialty radiology on radiation exposure in the clinical practice. A quality care study.

PURPOSES: The primary objective of this retrospective study was to assess whether the CT dose delivered to oncologic patients was different in a subspecialty radiology department, compared to a general radiology department. The secondary explorative objective was to assess whether the objective image quality of CT examinations was different in the two settings. MATERIALS AND METHODS: Chest and abdomen CT scans performed for oncologic indications were selected from a general radiology department and a subspecialty radiology department. By using a radiation dose management platform, we extracted and compared CT dose index (CTDIvol) and dose length product (DLP) both for each phase and for the entire CT exams. For objective image quality evaluation, we calculated the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) at the level of the liver and of the aorta. A P-value < 0.05 was considered significant. RESULTS: A total of 7098 CT examinations were included. CTDIvol was evaluated in 12,804 phases; DLP in 10,713 phases and in 6714 examinations. The CTDIvol and DLP overall were significantly lower in the subspecialty radiology department compared to the general radiology department CTDI median (IQR) 5.19 (3.91-7.00) and 5.51 (4.17-7.72), DLP median and IQR of 490.0 (342.4-710.6) and 503.4 (359.9-728.8), p < 0.001 and p = 0.01, respectively. The objective image quality showed no significant difference in the general and subspecialty radiology departments, with median and IQR of 4.03 (2.82-5.51) and 3.84 (3.09-4.94) for SNRLiv (p = 0.58); 4.81 (2.70-7.62) and 4.34 (3.05-6.25) for SNRAo (p = 0.30); 0.83 (0.20-1.89) and 1.00 (0.35-1.57) for CNRLiv (p = 0.99); 2.23 (0.09-3.83) and 1.01 (0.15-2.84) for CNRAo (p = 0.24) with SNRLiv (p = 0.58), SNRAo (p = 0.30), CNRLiv (p = 0.99) and CNRAo (p = 0.24). CONCLUSION: In a subspecialty radiology department, CT protocols are optimized compared to a general radiology department leading to lower doses to oncologic patients without significant objective image quality degradation.

A Comparison of Otolaryngology Residency Applicants Over Time and to Other Surgical Applicants.

Objective: Understand how otolaryngology residency applicant characteristics have changed over time and compare them to those of other surgical subspecialties. Study Design: Retrospective analysis of academic, extracurricular, and application data in the Texas Seeking Transparency in Application to Residency databases. Setting: Applicants to otolaryngology, neurological surgery, ophthalmology, plastic surgery, urology, and orthopedic surgery applicants from 2019 to 2023. Methods: Kruskal-Wallis, Wilcoxon rank sum, Fischer's exact, and Mann-Whitney U tests were used to compare temporal, match-based, and subspecialty differences in applicant characteristics. Results: Across 4 match cycles and 541 otolaryngology applicants, significant differences were found in the average number of honored clerkships per applicant (P = 0.044), the percentage of matched applicants (P = 0.017), and the average number of research experiences (P < 0.001), peer-revied publications (P = 0.002), applied programs (P < 0.001), and interviews received (P = 0.041). Relative to their unmatched counterparts, matched applicants frequently received more interviews, belonged to higher academic quartiles, and were more likely to belong to academic honor societies (all P < 0.05). Matched applicants exhibited significant differences in the number of research experiences (P = 0.002), peer-reviewed publications (P = 0.004), and applied programs across cycles (P < 0.001). Relative to applicants from other surgical subspecialties, otolaryngology applicants exhibited high amounts of extracurricular involvement, were on par in terms of research output, and received a low proportion of interviews despite applying to a high number of programs. Conclusion: Matching into otolaryngology has become increasingly competitive and is as competitive as peer surgical subspecialties. Strong academic performance, judicious program signaling, increased research involvement, and holistic factors like letters of recommendation may help applicants successfully match.

Interspecialty Opioid Prescribing Patterns in Ophthalmology Following Declaration of a Public Health Emergency.

Purpose: Previous literature has investigated opioid prescription trends in ophthalmology at large, however, little has been done looking at differences between subspecialties. We evaluate if significant trends exist among subspecialties in opioid prescribing patterns. This study aims to illuminate potential over-usage of opioids in ophthalmology that could compromise patient quality of life. Methods: Medicare data and "National Plan and Provider Enumeration System (NPPES) Downloadable File" were queried for cases of ophthalmologists with nonsuppressed opioid prescription data from 2014 to 2019. Ophthalmologists with no subspecialty code or missing regional, gender, degree, or graduation information were excluded. Chi-squared analysis, analysis of variance, t-tests, and multivariate logistic regression were utilized. Results: Five thousand one hundred forty-three physician records were included in analysis, 450 of which were by cornea subspecialists. Most cornea cases were male, graduated before 2005, and practiced in the South. All subspecialties had a significantly increased likelihood of making opioid claims and higher prescription rates compared with cornea (P < 0.050) besides glaucoma (P = 0.357). Only oculoplastics had significantly increased likelihood of greater total supply of opioids compared with cornea (odds ratio [OR] = 22.195, 95% confidence interval [CI] = 12.209-40.350, P < 0.001), while pediatrics (OR = 4.036, 95% CI = 1.377-11.831, P = 0.011) and neuro-ophthalmology (OR = 4.158, 95% CI = 1.237-13.975, P = 0.021) in addition to oculoplastics (OR = 64.380, 95% CI = 26.306-157.560, P < 0.001) were predicted to have significantly greater opioid beneficiaries. Males, the South/Midwest, and graduating before 2005, all were generally associated with increased likelihood of greater total opioid claims, supply, beneficiaries, and prescription rate (P < 0.050). Conclusion: Subspecialty, demographic, chronological, and regional trends exist for opioid prescribing patterns in ophthalmology.

Predictors of Subspecialty Appointment Scheduling and Completion for Patients Referred From a Pediatric Primary Care Clinic.

Failure to complete subspecialty referrals decreases access to subspecialty care and may endanger patient safety. We conducted a retrospective analysis of new patient referrals made to the 14 most common referral departments at Boston Children's Hospital from January 1 to December 31, 2017. The sample included 2031 patient referrals. The mean wait time between referral and appointment date was 39.6 days. In all, 87% of referrals were scheduled and 84% of scheduled appointments attended, thus 73% of the original referrals were completed. In multivariate analysis, younger age, medical complexity, being a non-English speaker, and referral to a surgical subspecialty were associated with a higher likelihood of referral completion. Black and Hispanic/Latino race/ethnicity, living in a Census tract with Social Vulnerability Index (SVI) ≥ 90th percentile, and longer wait times were associated with a lower likelihood of appointment attendance. Future interventions should consider both health care system factors such as appointment wait times and community-level barriers to referral completion.

Medical Knowledge Acquisition during a Pandemic: Pediatric Subspecialty in-Training Examination and Board Certification Exam Passing Rate.

OBJECTIVE: The COVID-19 pandemic resulted in training programs restructuring their curricula. Fellowship programs are required to monitor each fellow's training progress through a combination of formal evaluations, competency tracking, and measures of knowledge acquisition. The American Board of Pediatrics administers subspecialty in-training examinations (SITE) to pediatric fellowship trainees annually and board certification exams at the completion of the fellowship. The objective of this study was to compare SITE scores and certification exam passing rates before and during the pandemic. METHODS: In this retrospective observational study, we collected summative data on SITE scores and certification exam passing rates for all pediatric subspecialties from 2018 to 2022. Trends over time were assessed using analysis of variance (ANOVA) analysis to test for trends across years within one group and t-test analysis to compare groups before and during the pandemic. RESULTS: Data were obtained from 14 pediatric subspecialties. Comparing prepandemic to pandemic scores, Infectious Diseases, Cardiology, and Critical Care Medicine saw statistically significant decreases in SITE scores. Conversely, Child Abuse and Emergency Medicine saw increases in SITE scores. Emergency Medicine saw a statistically significant increase in certification exam passing rates, while Gastroenterology and Pulmonology saw decreases in exam passing rates. CONCLUSIONS: The COVID-19 pandemic resulted in restructuring didactics and clinical care based on the needs of the hospital. There were also societal changes affecting patients and trainees. Subspecialty programs with declining scores and certification exam passing rates may need to assess their educational and clinical programs and adapt to the needs of trainees' learning edges.

Reflections on the construction of sub-specialty high-quality of orthopedic nursing under the background of new era in China / 中国实用护理杂志

In accordance with the overall requirements of promoting the construction of high-quality medical institutions and high-quality nursing in the new era, this paper considers and summarizes the direction of the development and construction of the quality of orthopedic nursing subspecialty, that is, the quality standards of orthopedic nursing subspecialty should be formulated based on evidence-based evidence, the process quality management should be strengthened, the information support should be strengthened, and the actual situation of China's aging population should be focused on the needs of key groups. Thus, the quality of orthopedic subspecialty nursing service can be improved comprehensively.