Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut.
Am J Perinatol. 2024 May;41(S 01):e163-e173. doi: 10.1055/a-1850-3929. Epub 2022 May 12.
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.
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.
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.
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.
· 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.. · 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.. · 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..
美国的新生儿围产医学（NPM）研究员课程每年支持超过 800 名学员。了解课程结构、挑战和需求的差异对于优化教育环境和确保该专业的未来至关重要。
NPM 研究员课程主任（PD）和副课程主任（APD）受邀完成了一份关于他们的课程管理、招生、临床培训、评估方法、学术项目和职业发展途径的电子调查。每位参与者都确定了各自课程计划的优势、挑战、机遇和对该领域的威胁。
59 个 NPM 研究员课程的代表提供了数据（应答率为 59/96=61%）。总的来说，30%的 PD 获得的行政职责保护时间少于研究生医学教育认证委员会推荐的时间，44%的 APD 没有获得保护时间。研究员的临床服务分配在 3 年的时间里从 13 到 18 个月和 90 到 175 个夜班不等，差异很大。招生实践在各个课程之间存在差异；59%的受访者对申请人的数量表示担忧。61%的应答者表示研究员和高级执业人员之间存在冲突。课程在学术课程的设置上存在差异，44%的 NPM 研究员希望增加更广泛的研究机会。
NPM 研究员课程的领导者确定需要改善课程计划的支持、加强评估能力的措施、加强学术项目的机会、共享课程资源以及平衡教育与临床需求的策略。PD 和 APD 确定了 NPM 培训计划未来面临的威胁，包括进入新生儿科的申请人数量减少、临床暴露和能力的挑战、对教育使命的支持不足、支持高质量学术的问题以及追求医师研究员职业道路的毕业生减少。国家组织和学术机构应采取行动应对这些挑战，以便研究员课程能够最佳地培养毕业生满足患者的需求。
目前 NPM 的课程主任面临着许多挑战，包括平衡临床工作与学术活动、准确评估能力、优化学习环境文化以及确保研究员为各种研究生职位做好充分准备。
在 NPM 研究员课程中，3 年研究员培训期间的临床服务/呼叫分配以及从事各种学术活动的机会存在显著差异。
确保未来有足够数量的申请人进入该专业，包括那些来自医学传统上代表性不足的背景的人，以及那些寻求从事医师研究员职业的人，存在挑战。
