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ATS Best Practices for Fellowship Training Programs


Our training program employs novel and cutting edge educational methods to assess the competency of our fellows from the day they begin their fellowship until graduation. Traditionally fellows have begun clinical training and learned via a “see one: do one” educational method which has limitations. We created a novel month-long introduction to fellowship coined “Pulmonary Medical School” designed to establish minimal cognitive and procedural skills prior to beginning clinical rotations. A multimodality approach provides instruction in core clinical topics and procedures with assessment of basic competency in a low-stakes environment. Lectures and e-learning modules are used to review relevant basic physiology, core clinical topics in pulmonary and critical care medicine, and essential procedures. Technical skills and baseline procedural competencies are established through the use of simulators and cadaver laboratories (both with direct faculty supervision), and wet labs with static models. Finally, first-year fellows (F1) work in an “apprentice role” on each of the core clinical services where they shadow a senior fellow, performing all procedures and providing patient care with direct supervision and individual instruction from the faculty. 

Assessment of competency is achieved through the administration of written pre- and post-tests, direct observation of procedures in the simulator, cadaver and skills laboratories, and by designated faculty members who use structured competency assessment tools to evaluate fellows’ performance following the completion of a predetermined number procedures. Upon successful completion of all competency assessments, first-year fellows are then graduated to assume full patient care responsibilities on the clinical services.  As fellows progress in their training and achieve specific numbers of key procedures they undergo a formal assessment of competency to practice these procedures independently upon graduation.  

Our “Introduction to Research” month in January of the F1 year provides a similar opportunity to build key skills at a critical transition point in fellowship education. This curriculum is designed to build a firm foundation in skills necessary to pursue successful careers in academic medicine, to facilitate the selection of a primary research project and mentor, and to enhance the practice of self-directed learning. Didactic lectures and e-learning modules in research design and analysis, grantsmanship, Internal Review Board submissions, and scientific writing are coupled with a series of round table discussions with faculty of varying academic backgrounds who offer advice on successful mentoring. Finally, F1s participate in a mentor/fellow matching process which ensures that each fellow has identified a faculty mentor and research project for the next academic year. Each fellow is subsequently assigned to a research mentor panel with meetings at least quarterly to review their progress.
           
We have also developed a mentoring program for residents that begins with intern orientation.  A “Pulmonary/Critical Care Interest Group” offers quarterly gatherings and one-on-one meetings with the Program Director and Associate Program Director to guide residents toward a successful career in Pulmonary/Critical Care medicine including facilitating research experiences with our faculty This year, 6 residents will be attending the International Conference with our Division to present abstracts and oral presentations, and to see first-hand the numerous benefits of membership in a professional society (6 residents attended in 2011). 
           
Our Pulmonary/Critical Care fellowship training program has worked to develop formal curricula at key transitional points in fellowship education while also establishing clear milestones for achieving competencies prior to graduation. These best-teaching practices highlight the strength of the educational programming available at our institution, and illustrate some of the many reasons why we believe this training program is exceptional.