Opportunities for Scholarly Activities During Subspecialty Education: A Scorecard for Pediatric Fellowship Programs

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• Appendix. Supplementary data
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In 2001, the American Board of Pediatrics (ABP) convened leaders from the various subspecialties, organizations, and other constituencies of pediatrics to discuss the nature and quality of the education of subspecialty residents (or fellows). An explicit purpose of this evaluation was to examine whether the education was properly aligned with the purpose of fellowship training, “to develop future academic pediatricians,” as stated in 1996 and reaffirmed in 2004 by the Federation of Pediatric Organizations.¹ Important questions were raised as to whether “the meaningful accomplishment in research” was the only or best means of achieving the goal of providing a foundation in critical thinking, which was judged to be an essential component of academic preparation; whether the work product that was required was an effective means for ensuring that the fellow had indeed accomplished something meaningful; and whether there was sufficient flexibility in the training to recognize the diverse roles of contemporary subspecialty pediatricians in academic settings.

It had become apparent that the determination of compliance with this requirement was nearly impossible to adjudicate at the level of the credentials committees of the various subboards, which judged achievement in this regard based on written material of highly variable quality. Furthermore, there was little way to ensure that the quality of individual research training was substantially supported at an institutional level through specified local commitments and supervision.

After an extended process during which new guidelines were developed, reviewed, and revised, a document was widely distributed in the summer of 2003, with the intent that these be put into effect by the summer of 2004.² There were a number of substantive changes that offered options for the educational experience of individual subspecialty fellows and necessitated organizational redesign of programs. Some of the most important components of the guidelines are as follows:

This last requirement offers an opportunity for training programs to gain systematic insight into the suitability and adequacy of their training resources, infrastructure support, operations, and individual trainee mentoring and supervision, through both internal and external review. However, at present, such a process may not be routine, and some programs may never have undergone such an evaluation. Traditionally, the respective subspecialty subboard of the ABP, aided by an evaluation from a program director, materials submitted by a candidate and formal testing, judged whether individuals fulfilled the spirit and requirements for clinical competence and research experience. The Residency Review Committee (RRC), on the other hand, evaluated whether the program had sufficient (ie, minimally acceptable) resources (faculty, patients, and institutional) and administrative structure to serve as an acceptable site for clinical education in the respective discipline. However, the RRC is not currently poised to examine either the array of opportunities for research or other scholarly activities in an individual program or the success of a program's graduates. Moreover, prospective subspecialty residents are not necessarily equipped to assess the opportunities and merits of programs and often judge the training milieu based on very limited information.

We believe that it is essential for programs to evaluate the quality of their educational resources on a regular basis. We have developed a voluntary “score card” that includes many of the elements necessary for assessing short-term opportunities and longer term success of a program (Table available online at www.us.elsevierhealth.com/jpeds). We have deliberately tried to put this in a relatively simple format that permits regular additions with a minimum amount of incremental work. We propose that this can serve as a template for a database with common elements for all training programs, and provide a history of each program.

Our score card has at least 3 main purposes: (1) to serve as a basis for self-assessment, (2) to serve as a guideline for formal evaluation by invited intramural or extramural reviewers, and (3) to serve as a means for candidates to assess the available educational opportunities, the experience and accomplishments of previous fellows in the programs of interest, and the differences among potential training programs. We are particularly concerned that potential candidates might not currently have access to this information to assist them in exploring educational opportunities to support their scholarly activities during fellowship, nor would they know what data were of most use toward this end. This tracking of information regarding continued scholarly activities for at least 10 years postfellowship should be the responsibility of the training program. Although this requires that programs maintain continued contact with former fellows, it is an important opportunity to gain understanding of the consequences of the training.

Important questions were raised whether “the meaningful accomplishment in research” was the only or best means to achieve the goal of providing a foundation in critical thinking.

Data regarding clinical education is of equal importance. However, the number and type of patients encountered, the variety of technical and cognitive experiences, and the faculty and institutional resources to support the education is already tracked by the regular RRC reviews of a program. Furthermore, there is no generic template that would readily apply to all subspecialties. Accordingly, we encourage interested applicants to request such information about the clinical education when considering a program and when comparing opportunities.

We fully recognize the potential problems inherent in voluntary reporting. Program directors could choose to not use this approach. There are no means to ensure that data are valid. However, if the reporting mechanism proves to be useful for applicants, they will request it from programs; the request and response will in turn help validate the data and may even refine or adapt the tool such that it is more useful. Just as there is an expectation that a product will be assessed by a consumer report, there could be the anticipation that a program will provide these data if the “consumer” (ie, the applicant) finds the information to be of value. Thus we offer this score card as a modest attempt to provide a tool that will be useful to program directors and potential fellows. For the benefit of the fellows, we have included a column to describe the purpose of the information related to previous fellows, even though in practice this might be deleted.

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Appendix. Supplementary data 

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References 

1. Federation of Pediatric Organizations policy statement, pediatric fellowship training . Pediatrics. 2004;114:295–296
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2. American Board of Pediatrics: Changes in Training Requirements for Subspeciality Certification. http://www.abp.org/RESIDENT/trchanges.htm
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