Results from this study indicate that current fellows perceive their training in a variety of core-competency areas more favorably than graduates. Differences between these cohorts were most prominent for competences outside of clinical care (e.g. ethics, systems-based practice, research). We suggest that these findings represent an improvement in training areas over time. An alternative explanation would be that graduates realize deficiencies in their training in the context of practice. However, the finding that a greater percent of recent graduates compared with past graduates rate their training as adequate or better in several non-clinical areas provides strong support for the notion that training has improved over time. The basis for these improvements in training remained to be formally demonstrated. Nonetheless, these improvements appear to be temporally associated with institution of ACGME core competencies and correlate to areas of emphasis by the ACGME. Thus, it seems reasonable to hypothesize that they are connected, but additional study is warranted.
Our results also indicate that current fellows and graduates found their training to be adequate or better in most areas of clinical care. The extent of agreement between fellows and graduates was quite remarkable with the exception of HIV and gynecology. Both fellows and graduates identified several areas of clinical care training as inadequate, including: gynecology, sexually transmitted disease, travel medicine, ophthalmology, adolescent medicine, urology, transplantation, allergy and immunology and HIV care. Organ transplantation and travel medicine have previously been identified as deficient by adult infectious diseases fellows/practitioners [2, 3]. Some of these areas were previously noted as deficient in earlier studies of infectious disease practitioners. Our studies show an increase in the percent of recent compared with past fellows who have taken courses in Infection Control, a previously defined area of deficiency [2, 3]. These findings suggest that programs are actively trying to address perceived deficiencies. Nonetheless, there appears to be persistent deficiencies that require active interventions to remediate. We suggest that additional objective assessment regarding the adequacy of training in these areas should be considered. Furthermore, assessment by the Pediatric Infectious Diseases community and the American Board of Pediatrics as to the relative importance of these elements to the practice of Pediatric Infectious Diseases may be warranted.
Telephone consultation has been demonstrated to be a significant component of PID practice . However, a previous study suggested that only a minority of phone calls to a PID fellow were of educational value . Among fellows, excessive training (score 6) was most commonly reported in managing problems by phone This likely reflects the amount of time fellows spent on the phone with antibiotic approvals, consults, etc. The perceived additional phone call management did not appear to negatively affect the overall satisfaction of fellows with their training, but additional study may be warranted.
Currently the duration of the PID fellowship training in the United States is 3 years. More than a third of fellows suggested a 2-year fellowship duration, while only 11% of graduates felt training should be 2 yrs. Among fellows, there were no apparent differences in plans for an academic career based on suggested duration of fellowship training. In a recent survey, 42% of all pediatric subspecialists indicated they would have chosen a 2-year fellowship without research if they had the option .
The limitations of this survey included the relatively small number of the fellow respondents, though we achieved a higher response rate than anticipated compared with previous studies of this type [2, 3]. It should be noted that the responses to our surveys represent perceived deficiencies and do not necessarily reflect adequacy of training. Other limitations include the short time (5-6 months) that some of the 1st year fellows had been trained at the time of the survey. Finally, the precise contribution of perspective change (versus changes in educational experience) to the observed differences among fellows and graduates are difficult to define.