Abstract
Objectives Neonatal-perinatal medicine (NPM) fellowship programs in the United States support
>800 learners annually. Understanding variations in the programmatic structure, challenges,
and needs is essential to optimize the educational environment and ensure the specialty's
future.
Study Design NPM fellowship program directors (PDs) and associate program directors (APDs) were
invited to complete an electronic survey on their program administration, recruitment,
clinical training, assessment methods, scholarly program, and career pathways. Each
participant identified individual programmatic strengths, challenges, opportunities,
and threats to the field.
Results Representatives from 59 NPM fellowships provided data (response rate 59/96 = 61%).
In total, 30% of PDs received less than the Accreditation Council for Graduate Medical
Education -recommended protected time for administrative duties, and 44% of APDs received
no protected time. Fellow clinical service assignments varied widely from 13 to 18
months and 90 to 175 call nights over 3 years. Recruitment practices varied across
programs; 59% of respondents raised concerns over the pipeline of applicants. Conflicts
between fellows and advanced practice providers were identified by 61% of responders.
Programs varied in their scholarly offerings, with 44% of NPM fellowships interested
in adding broader research opportunities.
Conclusion NPM fellowship leaders identified a need for improved programmatic support, enhanced
measures to assess competency, opportunities to strengthen scholarly programs, shared
curricular resources, and strategies to balance education with clinical demands. PDs
and APDs identified threats to the future of NPM training programs including the diminishing
pipeline of applicants into neonatology, challenges with clinical exposure and competence,
inadequate support for the educational mission, issues supporting high-quality scholarship,
and fewer graduates pursuing physician-investigator pathways. National organizations
and academic institutions should take action to address these challenges so that fellowships
can optimally prepare graduates to meet their patients' needs.
Key Points
-
Numerous challenges exist for current program directors in NPM including balancing
clinical work with scholarly activities, accurately assessing competency, optimizing
the culture of the learning environment, and ensuring that fellows are adequately
prepared for a range of postgraduate positions.
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Significant variation exists across NPM fellowship programs in clinical service/calls
assigned over 3 years of fellowship training, as well as opportunities to pursue scholarly
activities across a variety of areas.
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Challenges exist related to ensuring an adequate number of future applicants into
the specialty, including those from backgrounds traditionally underrepresented in
medicine, as well as those seeking to pursue careers as physician-investigators.
Keywords
neonatal-perinatal medicine - fellowship - program director - medical education
