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Does Current Nephrology Fellowship Training Affect Uti-lization of Peritoneal Dialysis in the United States?  [PDF]
Nand K. Wadhwa, Catherine R. Messina, Nasser M. Hebah
Open Journal of Nephrology (OJNeph) , 2013, DOI: 10.4236/ojneph.2013.32019
Abstract:

Background: The 2010 US Renal Data System annual report revealed that peritoneal dialysis is used by only 7% of end-stage renal disease patients on chronic dialysis vs. hemodialysis which is used by 93% of such patients, despite documented benefits of peritoneal dialysis over hemodialysis in these cases. Purpose: We examined whether education of nephrology fellows contributed to underutilization of peritoneal dialysis in the US. Methods: Self-report questionnaires were administered electronically to nephrology fellowship training program directors, October 2010-March 2011 (55% response). Results: Median number of training faculty and patients/fellow were significantly lower for peritoneal-dialysis vs. hemodialysis training. Hours of didactic teaching for fellows over their 2-year training period were significantly lower for peritoneal dialysis vs. hemodialysis. Peritoneal dialysis training was 20% of total training vs. 80% for hemodialysis. Most program directors (87%) believed lack of trained faculty in peritoneal dialysis and insufficient peritoneal dialysis patient population contributed to inadequate fellows’ peritoneal dialysis training. Conclusions: Findings suggest that current nephrology fellowship training in peritoneal dialysis is inadequate and contributes to its underutilization.

Hunting for the Right Research Fellowship: The Dos and Don′ts  [cached]
Ghayur Muhammad
Saudi Journal of Kidney Diseases and Transplantation , 2008,
Abstract: Every year, thousands and thousands of people from Asia, most of them PhDs, make the ultimate transition in their lives when they travel to the west to take up fellowship positions (in this case a research fellowship position) in leading labs in North America and Europe. Many of these people travel with their families, not knowing what is coming their way. In this article, a number of issues have been discussed that might help these potential scientists of the future to plan ahead for such a shift and make their transition as smooth as possible.
The Current State and Needs of North American Movement Disorders Fellowship Programs  [PDF]
Ludy C. Shih,Daniel Tarsy,Michael S. Okun
Parkinson's Disease , 2013, DOI: 10.1155/2013/701426
Abstract: Background. Movement disorders fellowships are an important source of future clinician-specialists and clinician-scientists for the field. Scant published information exists on the number and characteristics of North American movement disorders fellowship training programs. Methods. A 31-item internet-based survey was formulated and distributed to academic movement disorders listed in the American Academy of Neurology (AAN) directory as having a movement disorders fellowship and to all National Parkinson Foundation Centers of Excellence and Care Centers in North America. Results. There was a 77% response rate among academic movement disorders centers. Broad similarities in clinical training were identified. The two most important rated missions of maintaining a movement disorders fellowship were contributions to scholarly activities and to fulfilling a critical need for specialists. Almost a quarter of fellowship programs did not offer a fellowship slot during the most recent academic year. Fellowship directors cited a wide variety of funding sources, but their top concern was lack of available funding for fellowship programs. Conclusions. North American movement disorders fellowship training programs currently offer similar methods of clinical training and education. Lack of funding was the most important obstacle to maintaining fellowship programs and should be made a priority for discussion in the field. 1. Introduction Movement disorders fellowship training programs in North America are postresidency training experiences that are specifically designed to provide neurologists with expertise in the diagnosis and management of conditions such as Parkinson’s disease (PD), parkinsonism, tremor, dystonia, tics, chorea, myoclonus, and other basal ganglia-related movement disorders. Since the 1980s in North America, there has been a steady growth from a handful of centers to the current landscape which includes dozens of centers that offer subspecialty training in movement disorders. Little published data exists concerning the type of training, the curriculum content, and the clinical experience that is offered by these training programs. Only one publication has detailed the clinical training and didactic experience at a single large movement disorders center and fellowship training program [1]. United States-based programs are not funded by the government or American Council on Graduate Medical Education (ACGME). Concern exists among fellowship directors that available support and training will not meet the needs of an aging population. Additionally, the
Resident interest and factors involved in entering a pediatric pulmonary fellowship
William M Gershan
BMC Medical Education , 2004, DOI: 10.1186/1472-6920-4-11
Abstract: A questionnaire was distributed to all 52 pediatric residents at this institution in 1992 and to all 59 pediatric residents and 14 combined internal medicine/pediatrics residents in 2002, following development of a pulmonary fellowship program.Response rates were 79% in 1992 and 86% in 2002. Eight of the 43 responders in 1992 (19%) had considered doing a pulmonary fellowship compared to 7 of 63 (11%) in 2002. The highest ranked factors given by the residents who had considered a fellowship included wanting to continue one's education after residency, enjoying caring for pulmonary patients, and liking pulmonary physiology and the pulmonary faculty. Major factors listed by residents who had not considered a pulmonary fellowship included not enjoying the tracheostomy/ventilator population and chronic pulmonary patients in general, and a desire to enter general pediatrics or another fellowship. Most residents during both survey periods believed that they would be in non-academic or academic general pediatrics in 5 years. Only 1 of the 106 responding residents (~1%) anticipated becoming a pediatric pulmonologist.Although many pediatric residents consider enrolling in a pulmonary fellowship (~10–20% here), few (~1% here) will actually pursue a career in pediatric pulmonology. The presence of a pulmonary fellowship program did not significantly alter resident interest, though other confounding factors may be involved.The specialty of pediatric pulmonology is relatively new, having been recognized as a pediatric sub-specialty by the American Board of Medical Sub-specialties in 1984. In 1997, there were approximately 500 board certified pediatric pulmonologists in the United States and Canada [1]. This number has increased in recent years with 708 board certified pulmonologists being identified in 2003 [2]. It has been estimated that there is one pediatric pulmonologist for every 280,000 children in the United States [1]. There are over 50 pediatric pulmonary fellowship prog
A framework for evaluating the impact of the United Nations fellowship programmes
Arie Rotem, Michael A Zinovieff, Alexandre Goubarev
Human Resources for Health , 2010, DOI: 10.1186/1478-4491-8-7
Abstract: This paper presents an evaluation framework that was adopted by the 17th Meeting of the UN System Senior Fellowship Officers convened in London in 2008 in response to this challenge. It is arranged in three sections. First, the assumptions and constraints concerning impact evaluation of training are presented. Second, a framework for evaluating the impact of training in the context of UN System programmes is proposed. Third, necessary conditions and supportive measures to enable implementation of the impact evaluation framework are identified.The critical message emerging from this review is the importance of constructing a 'performance story' based on key milestones associated with the design and implementation of fellowship programmes as a way of assessing the contribution of different components of the fellowship programmes to institutional outcomes.The United Nations (UN) System's agencies have been criticized for not adequately assessing the impact of their training and fellowship programmes [1]. Critics point out that beyond documentation of the number of fellows that underwent training, and their immediate reaction to the experience, it is necessary to ascertain that fellows are using what they have learned, and most importantly that their institution and country are benefiting from the significant investments made in the fellowship programmes.In response to these concerns, the 16th Meeting of the UN System Senior Fellowship Officers (Paris, November 2006) mandated the design of a generic evaluation framework that defines the scope, dimensions and core indicators for evaluating the impact of UN Fellowship programmes [2].This paper presents an evaluation framework that was adopted by the 17th Meeting of the UN System Senior Fellowship Officers (London, November 2008). It is arranged in three major sections. First, the assumptions and constraints concerning impact evaluation of training are presented. Second, a framework for evaluating the impact of training in
MESOT Fellowship Program
Bassam Saeed, MD
International Journal of Organ Transplantation Medicine , 2010,
Abstract: The MESOT (Middle East Society for Organ Transplantation) is pleased to announce theMESOT Fellowship Program for the year 2010. This program has been established in 2008 for physicians and surgeons from the Middle East region willing to acquire some particular skills related to various aspects of organ transplantation in several centers of excellence from around the Middle East. The objective of this program is to promote and advance organ transplantation in underserved areas of this region of the world by helping them to establish local transplant programsor to improve an existing program. A limited number of grants are available for the time being. Application form is available in the MESOT website: www.mesot-tx.orgApplication deadline is the 30th of June, 2010. Any individual interested in this training program should direct his or her inquiries to the chairman of The MESOT Fellowship Program Committee:
Changes in medicine: fellowship
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2011,
Abstract: No abstract available. Article truncated at 150 words. Pulmonary fellowship in the late 70’s and early 80’s was largely unstructured. I had the advantage of doing two fellowships. One was at the University of Nebraska Medical Center and was predominantly clinical. There was one other fellow and we spent our time going to clinic, reading pulmonary function tests, supervising exercise testing, doing consults, and providing inpatient care both on the floors and the intensive care unit (ICU). We became involved with most of the patients in the ICU who were there for more than a day or two. The work was long and hard. We were mostly autonomous and only loosely supervised.The attending physicians relied on us to call when we needed help or there was something we thought they should know. Call was at home but it was unusual to leave before 8 PM. The fellows alternated call every other weekend making it tolerable. There were …
Is there a Learning Curve for Pancreaticoduodenectomy after Fellowship Training?  [PDF]
Jeffrey M. Hardacre
HPB Surgery , 2010, DOI: 10.1155/2010/230287
Abstract: Background. Limited data exist regarding a learning curve for pancreaticoduodenectomy (PD). This study examines whether a learning curve exists for the performance of PD after fellowship training. Methods. Review of the outcomes of a single surgeon's first 60?PDs after completion of specialty training in pancreatic surgery. Results. Sixty?PDs were performed over five years, with the final 30 being done in the last 15 months. Patient age and gender did not differ between the first 30 and last 30 patients. When comparing the first 30?PDs to the second 30?PDs, significant improvements were found in operative time (463 versus 388 minutes), length of stay (10 versus 7 days), and receipt of adjuvant therapy (58% versus 91%). There were no significant differences found in mortality (7% versus 0%), complications (60% versus 50%), readmissions (18% versus 20%), or margin-positive resections (25% versus 24%). Conclusion. Even with extensive training in pancreatic surgery, a learning curve exists for the performance of PD. With experience, improvements were made in operative time, but more importantly in patient outcomes including length of stay and receipt of adjuvant therapy. 1. Introduction There is a growing literature about learning curves and the performance of advanced laparoscopic operations, such as fundoplication and colectomy [1, 2]. Open pancreaticoduodenectomy (PD) is a complex operation about which there are limited data regarding a learning curve. Tseng et al. examined the initial operative experiences with PD of three fellowship-trained surgeons [3]. They found that after 60 cases, each surgeon showed improvement with regard to estimated blood loss, operative time, length of stay, and achievement of margin-negative resections. They concluded that there was an “inherent learning curve” in the performance of pancreaticoduodenectomy. A question not answered by Tseng et al. is whether fewer than 60 PDs could be a threshold beyond which improvement is seen in the performance of PD by a fellowship-trained surgeon. This study examines the outcomes of a single surgeon’s first 60 PDs, assessing for changes over time. 2. Methods The Institutional Review Board of University Hospitals Case Medical Center approved this study. The medical records of a single surgeon’s first 60 pancreaticoduodenectomies were reviewed. During his chief resident year and an additional year of training in advanced gastrointestinal surgery, the surgeon performed 63 PDs, seven distal pancreatectomies, and five total pancreatectomies. The operations examined in this study occurred over
MESOT Fellowship Program
Bassam Saeed
International Journal of Organ Transplantation Medicine , 2011,
Abstract: MESOT Fellowship Program (MFP) is an initiative aimed at promoting and advancing organ transplantation in under-served areas of the Middle East by helping them to establish local transplantation programs or to improve an existing program. The fel lowship program gives a great opportunity to the young physicians and surgeons from this region willing to acquire some particular skills related to various aspects of organ transplantation and provides them with specific and hands-on training opportunities in host institutions. MESOT Fellows return home to share new skills and knowledge in medical and surgical transplantation and improve local standards. The proposal to establish MFP originated from Professor Nasser Simforoosh in Tehran. Later on, it was voted and approved during the general assembly of MESOT 2006 congress held in Kuwait. In fact, most of the credit goes to Professor Mustafa Mousawi from Kuwait who worked very hard to have it done and well established. The MESOT Council formed the MFP Commit tee and approved its training centers: Baskent in Ankara, Turkey; SIUT in Karachi, Pakistan; Labbafi Nezhad in Tehran, Iran; Shiraz Organ Transplant Center in Shiraz, Iran; Hamed El-Issa Organ Transplant Center in Kuwait, Kuwait; King Faisal Specialist Hospital and Research Cen ter in Riyadh, Saudi Arabia; and NUC in Mansoura, Egypt. The program was announced and well advertised. Some of the most eminent transplant surgeons and physicians from the Middle East region are heading the training process in the above-mentioned centers of excellence such as Professor Mehmet Haberal from Turkey, Professor Adib Rizvi and professor Anwar Naqvi from Pakistan, Professor Mustafa Mousawi from Kuwait, Professor Ali Malek-Hosseini and Professor Nasser Simforoosh from Iran, Professor Adel Bakr from Egypt and Professor Khalid El-Meshari from Saudi Arabia. The selection mechanism relies on five factors on the top of which is the availability of transplant activity of a given organ in the applicant center, city, and country and a written commitment by the applicant indicating his or her intent to return home upon completion of training to establish transplant unit at home center; in addition to affiliation of the applicant’s center, capability and suitability of the applicant’s center, academic position and age of the applicant. The application for MFP is online through MESOT Web site available at www.mesot-tx.org. The 30th of June of each year is the deadline to apply for MFP. The program was launched in January 2008. Yet 20 applicants from 10 Middle East countries have been
The fellowship of the saints in contemporary South African society  [cached]
L. Floor
Koers : Bulletin for Christian Scholarship , 1974, DOI: 10.4102/koers.v39i5&6.1276
Abstract: The subject of this study is: What does the fellowship of the saints that we practise in the Church, mean to us in the present South African society. The division of the subject is as follows: Firstly an analysis of the concept fellowship of the saints; secondly some remarks about the Church in the present situation; and thirdly a closer look at the meaning the fellowship of the saints can have on our behaviour in society.
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