The relationship between residency programs and fellowships in the educational setting.

In 1981, the Advisory Council for Orthopaedic Education published a list of 175 orthopedic postgraduate fellowships. Since that time, several groups within orthopedics have discussed various methods for enhancing the educational nature of fellowships as they related to orthopedic residency programs. The orthopedic community as a whole has concurred about the concept of accrediting fellowships, ensuring a minimum standard educational quality, and keeping the growth of fellowships in some areas from adversely affecting the educational quality of a residency program. When fellowships are accredited, standards are created, such as the requirement that a fellowship must last at least one year, and depending on the area of specialization, include both research and clinical work. Certification and accreditation are separate issues. Certification is the process of credentialing individual physicians as specialists and is the responsibility of a specialty board. Accreditation is the process of identifying residency and fellowship programs that meet published educational standards and is the responsibility of the Accreditation Council for Graduate Medical Education and the corresponding Residency Review Committee. There is little question that the educational process that occurs during a fellowship can have a beneficial effect on the learning process of residents and vice versa.