Recruitment for Ped Fellowships APPD Fall 2015[4] · Fellowship Training ! “To advance the health...

Fellowship Recruitment Kammy McGann Bruce Herman Angie Myers

Meredith van der Velden Mark Atlas

Chris@ne Barron Geoffrey Fleming

The overview

Fellowship Recruitment: The Trials and Tribula@ons •  Trainee Decision Making re: pursuit/type of fellowship

•  Compe@@veness of different fellowships •  How to recruit in the under-‐filled subspecial@es? •  Best prac@ces for Recruitment •  Reading and Wri@ng LeMers of Recommenda@on

•  A.) Applicants to my specialty are increasing •  B.) Applicants to my specialty have been preMy stable

•  C.) Applicants to my specialty are decreasing

In regards to applicants to my field I would say that:

Goal of Pediatric Subspecialty Fellowship Training

§  “To advance the health of children by preparing graduates who are competent in clinical care, education, and research.”

§  Goal best achieved by fellowship training that

fosters the development of future academic pediatricians, recognizing the diverse roles they now play.

Federation of Pediatric Organizations. Pediatrics 2004:114;295-6

Increasing Number of Trainees Overall entering Subspecialty Training

Freed and Stockman, 2009

Percent Pediatricians selec;ng Subspecialty Careers over Time, 1990 -‐ 2014

ABP 2014-15 Workforce Data

Number of First Year Fellows in Different Subspecial;es


Number First Year Fellows in Different Subspecial;es


Decision to Pursue Fellowship: Factors and Timing

•  What factors impact decision to pursue fellowship training?

•  When do trainees decide to pursue a fellowship? – When can we influence them?

What are Most Important Factors in Decision to Become a Subspecialist (per Recent Graduates)?

Pediatrics 2009:123;S44-S49

Timing of Decisions to Pursue a Subspecialty and to Pursue a Specific Subspecialty

67%

64%

What Factors influence Trainees’ Decisions re: which Subspecialty to

Pursue?

MANY OPTIONS: ACGME Accredited Training Programs

# of Programs # of Trainees

ACGME.org; 8/12/14

Additional trainee considerations when choosing their fellowship?

n Focus on Inpatients vs Outpatients n Procedural or not n One or many organ systems n Patient population

Long-‐term Financial Impact of choosing Different Subspecialty Careers Do finances impact choice?

JM Rochlin, HK Simon. Pediatrics 2011;127:254

The good Pediatrics 2011;127;254

A Nowalk, The economics of pediatrics in 2014, UPMC

The ugly

A Nowalk, The economics of pediatrics in 2014, UPMC

Debt §  Recent compilation of data from AAP

resident surveys 2006-2010 §  Debt

–  3 of every 4 graduating residents – Those with debt saw increase of 24% from 2006 to

2010 ($146K to $181K) – More in younger, married to a physician

§  Does it affect us?

Pediatrics 2013;131;312

Pediatrics 2013;131;312

Yes OR 1.46 OR 1.51

What factors most influence the trainee’s ranking a specific program

within the subspecialty?

Two Most Important Factors to Trainees in Selec;on of

a Specific Fellowship Program

What can we learn from the NRMP Pediatric Subspecialty Match Data?

Pediatric Subspecialty

App

lican

ts p

er P

ositi

on

Compe;;veness varies by Pediatric Subspecialty Fellowship (# applicants per posi@on)

Modified from NRMP Subspecialty Match Data 2015

# Applicants and % Unfilled Programs by Subspecialty

Subspecialty # Applicants

% Filled

US Grads All Applicts Posi;ons

Offered #

Programs

US Grads All Apps # Unfilled Pgms

% Prgrms Unfilled

Pediatric Nephrology 10 23 58 39 17.2 36.2 31 79

Pediatric Pulmonology 19 33 61 43 29.5 49.2 28 65

Pediatric Infec;ous Diseases 21 34 66 51 31.8 45.5 30 59

Pediatric Rheumatology 13 27 40 30 30 55 16 53

Child Abuse 13 15 20 19 60 65 7 37

Pediatric Endocrinology 43 75 85 57 49.4 76.5 17 30

Developmental and Behavioral Pediatrics 18 38 41 33 34.1 73.2 10 30

Adolescent Medicine 22 31 36 25 55.6 77.8 7 28

Pediatric Hospital Medicine 26 37 30 24 63.3 90 3 16

Pediatric Hematology/Oncology 94 181 162 65 54.3 94.4 7 11

Pediatric Cri;cal Care Medicine 136 206 168 62 70.2 95.2 5 8

Pediatric Gastroenterology 64 117 85 51 64.7 96.5 3 6

Pediatric Cardiology 112 181 141 57 68.1 97.2 3 5

Neonatal-‐Perinatal Medicine 166 295 242 92 59.9 98.3 4 4

Pediatric Emergency Medicine 126 201 162 73 64.2 98.1 3 4

What does the data tells us? •  The compe@@veness of Pediatric subspecial@es varies markedly

•  Trends are stable, but overall fewer spots are filling

•  Procedural special@es are doing well, non-‐procedural not as well

•  Where do we go from here?

Panel Ques@on

What elements seem to affect fellowship choices?

Audience Thoughts?

Recruitment

The Truth

•  The Program Director and Program Coordinator are the only ones truly responsible for the process. (and the only ones paying aMen@on)

•  You are a team! •  Look around at successful programs and ask them how they do it.

•  You are salesmen, selling your program. – You must sell reality, warts and all, or you will have unhappy trainees.

Planning Recruitment Season and Interview Day

•  Know your ERAS and NRMP @melines •  When will you begin interviews? •  When will you interview? (day of week?) •  How many at a @me? •  Lunch? Tour? •  How long for each interview? •  Who should interview? •  Do you have any data from last season’s applicants about areas of improvement?

•  All your Key Stakeholders available?

ERAS & NRMP: Rank Lists & Match Timeline, 2015 Subspecialty ERAS Opens

for FPDs NRMP opens Rank Order Lists Due Match Day

Adolescent Medicine 7/15/15 8/5/15 11/4/15 11/18/15 Allergy/Immunology (& all Med Subspecial;es)

7/15/15 7/29/15 11/11/15 12/2/15

Medical Gene;cs 7/15/15 7/22/15 10/28/15 11/11/15 Pediatric Special>es Fall Match 2013

7/15/15 8/26/15 12/2/15 12/16/15

Child Abuse

Cri;cal Care Medicine

Developmental-‐Behavioral Pediatrics

Emergency Medicine

Endocrinology

Hospital Medicine

Infec;ous Diseases

Neonatal-‐Perinatal Medicine

Nephrology

Rheumatology

Pediatric Special>es Spring Match 2014

12/01/15 2/4/15 5/13/15 5/27/15

Cardiology

Gastroenterology (2016 moving to Fall)

Hematology-‐Oncology

Pulmonology (2016 moving to Fall)

How to manage the applica@ons

•  ERAS-‐PWDS –  Built in features for tracking applica@ons, interviews, correspondence etc..

–  Print to PDF feature –  -‐Export to EXCEL

•  Excel – Allows for spreadsheet approach to data –  Sort and track numeric data – Hyperlink to applica@on file on your hard drive – Use color forma_ng of cells for easy view

Define Your Criteria •  Some data are on the NRMP site

– What residency is required to apply

•  The new common requirements limit this residency to a US or Canadian site

•  Some of these are specific to your ins@tu@on or program. You have to have a recruitment policy in place – Visas? (understand the nuances of visa categories) – Number of LeMers of Recommenda@on – Score thresholds etc.

Grouping Applicants Before Interviews •  Do Not Invite (DNI)

– Don’t meet basic criteria for your program •  Group 1 (First wave of invitees)

–  Top applicant to your program, you want them in your program. Invite immediately…

– Usually very easy to pick out. •  Group 2-‐3 (Waitlisted or second wave of invitees)

– Grada@on of applicants – Ofen the toughest group to differen@ate and also the largest group.

– Depending on your applicant pool size, you may or may not invite some or all of these groupings.

•  A.) Most Important factor •  B.) Extremely important •  C.) Very Important •  D.) Somewhat Important •  E.) Not so important

How important is the applicants’ board pass history to you?

Holis@c Review

•  The Advancing Holis@c Review Ini@a@ve (AAMC), established in 2007, was originally designed to develop mission-‐centered, admissions-‐related tools and resources that medical schools can use to create and sustain diversity.

What is holis;c review?

•  Holis@c review is a flexible, individualized way of assessing an applicant’s capabili@es by which balanced considera@on is given to experiences, aMributes, and academic metrics and, when considered in combina@on, how the individual might contribute value as a medical student and physician.

https://www.aamc.org/initiatives/holisticreview/

Holis@c Review Principles

•  1. In a holis@c admissions process, selec@on criteria are broad-‐based, clearly linked to school mission and goals, and promote diversity as an essen@al element to achieving ins@tu@onal excellence.



•  2. A balance of experiences, aMributes, and academic metrics (EAM) is – Used to assess applicants with the intent of crea@ng a richly diverse interview and selec@on pool and student body;

– Applied equitably across the en@re candidate pool; and – Grounded in data that provide evidence suppor@ng the use of selec@on criteria beyond grades and test scores.



•  3. Admission staff and commiMee members give individualized considera@on to how each applicant may contribute to the medical school learning environment and prac@ce of medicine, weighing and balancing the range of criteria needed in a class to achieve the outcomes desired by the school.



•  4. Race and ethnicity may be considered as factors when making admission-‐related decisions only when such considera@on is narrowly tailored to achieve mission-‐related educa@onal interests and goals associated with student diversity, and when considered as part of a broader mix of factors, which may include personal aMributes, experien@al factors, and demographics. Or other considera@ons.*


Panel Ques@on

How do you screen-‐sort applica@ons? What elements are key?

Comments from the audience….


How important is the Program Director’s LeMer?


How important is the subspecialist in your field’s leMer?

LETTERS OF RECOMMENDATION: UNRAVELING THE MYSTERY

Meyer, E. “How to say ‘this is crap’ in different cultures.” February 25, 2014. hbr.org

WHAT WE KNOW • Not predictive of performance in training • Predictive of receiving a position in a training program; program

directors value LORs • Mostly convention • Only about 50% of faculty receive any training or guidance on

how to write LORs • Significant variability in how LORs written and interpreted

DeZee KJ, Thomas MR, Mintz M, Durning SJ. Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine. Teach Learn Med. 2009 Apr-Jun;21(2):153-8. Morgenstern, BZ, Zalneraitis E, Slavin S. Improving the letter of recommendation for pediatric residency applicants: an idea whose time has come? J Pediatr. 2003 Aug;143(2):143-4.

WHAT WE KNOW •  Superlative Inflation

•  “As with grade inflation, there has been a superlative inflation as well. Although not codified, there is an unofficial hierarchy of superlatives. ‘‘Excellent,’’ for example, is now a third-tier superlative, bested by ‘‘outstanding,’’ and even more so by ‘‘one of the best.’’ ‘‘One of the best’’ as a superlative has been subdivided into its own hierarchy: ‘‘one of the best students ever’’ beats ‘‘one of the best students in recent history’’ (or ‘‘in the past few years’’), which is better than ‘‘one of the best students this year.’’

•  Unintended insufficient praise •  Demonstrating improvement can be perceived as negative •  Offering a contact can be perceived as negative •  “Very good” or “solid” may be red flag •  “Recommend” needs a modifier

Morgenstern, BZ, Zalneraitis E, Slavin S. Improving the letter of recommendation for pediatric residency applicants: an idea whose time has come? J Pediatr. 2003 Aug;143(2):143-4. Girzadas DV Jr, Harwood RC, Dearie J, Garrett S. A comparison of standardized and narrative letters of recommendation. Acad Emerg Med 1998;5:1101-4.

INTERPRETING LETTERS

INTERPRETING LETTERS • Significant variability in interpretation of letters • Other things to consider:

•  Rank or seniority of faculty member •  Differences between subspecialties •  Non-U.S. faculty member

•  Look for internal consistency within letter

Dirschl DL, Adams GL. Reliability in evaluating letters of recommendation. Acad Med. 200 Oct; 75 (10): 1029.

THE BEST •  PERCENTAGES

•  “Top 5% of residents…” (10%) •  NUMBERS

•  “One of the top 3 (5, 10?) residents I have ever worked with” •  SUPERLATIVES

•  Strongest/highest + recommendation/recommend •  Most + exceptional/promising •  Greatest pleasure •  Enthusiastically

•  FONT CHANGES •  BEST RESIDENT •  BEST RESIDENT •  BEST RESIDENT

•  OTHER •  Hope to recruit back for a faculty position; intend to recruit highly •  “If I had a sick child, this is who….” •  “If I had a daughter, this is exactly how I would want her to be” •  “Rarely encountered a trainee….” •  “Only person I have encountered with this degree of talent is X”

THE GREAT •  PERCENTAGES

•  “Top 25% of residents…” •  NUMBERS

•  “One of the top 25 residents I have ever worked with” •  SUPERLATIVES

•  Strong “recommendation”, highly “recommend” •  Exceptional or promising minus “the most” •  Great pleasure •  Enthusiastically?

•  FONT CHANGES •  None

•  OTHER •  KEY: All positive comments •  Intend to recruit highly

THE FAIR • PERCENTAGES

•  Likely absent • NUMBERS

•  Likely absent • SUPERLATIVES

•  Muted vs no adjective next to recommend/recommendation •  “good”

•  FONT CHANGES •  None

• OTHER •  “Despite struggling initially with X, they are doing quite well now…” •  “Responds to feedback well” •  “Happy to write a letter?...”

THE UGLY • Statement about prior sanctions • Failed a course • Dismissed from a program • Voluntarily resigned from a program • Absence of any adjective before “recommend” •  Letters without adjectives at all

✔REQUIRES HOMEWORK BY PROGRAM DIRECTOR

WRITING LETTERS

GENERAL CONSIDERATIONS • Relationship with candidate •  Length •  Internal consistency • Substantive • Personal

DeZee KJ, Thomas MR, Mintz M, Durning SJ. Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine. Teach Learn Med. 2009 Apr-Jun;21(2):153-8.

KEY ELEMENTS • Describe your relationship with trainee • Thoughtful use of adjectives •  Include numbers and percentages with denominator, if applicable

in the beginning or end • Use personalized, consistent examples to support declarations • Summary statement • OTHER POSSIBILITIES:

•  Summary of academic/clinical record •  Comment on “aware of no….”

DeZee KJ, Thomas MR, Mintz M, Durning SJ. Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine. Teach Learn Med. 2009 Apr-Jun;21(2):153-8. Perkins JN, Liang C, McFann K, Abaza MM, Streubel SO, Prager JD. Laryngoscope. 2013 Jan; 123(1):123-33.

FUTURE THOUGHTS

STANDARDIZED LETTER OF RECOMMENDATION (SLOR/E) •  In EM residency, goal is for the following:

•  Standardized •  Concise •  Discerning/Discriminating

Keim SM, Rein JA, Chisholm C, Dyne PL, Hendey GW, Jouriles NJ et al. A Standardized Letter of Recommendation for Residency Application. Acad Emerg Med. 1999;6:1141-1146.

Panel Ques@on

What leMers are important to you? What do you look for in leMers?

What is a warning sign?

Interview Day

•  Sell Your Program, Be Posi@ve – Have a “wrap up” period.

•  Review all the talking points of your program •  Make sure their last memory of your program is the list of why features that should lead them to choose you.

•  Use this @me to answer ques@ons. –  Ask them if they have any ques@ons about the current fellows’ concerns.

– Escort them out of your office space to the elevator, door etc…

Panel Ques@on

What are you looking for in the interview?

•  A.) Program director has the final say, other division members may not be aware of final rank list

•  B.) Collabora@ve process among all members of selec@on commiMee with PD’s input having equal weight to others

•  C.) All informa@on transposed into numerical score and ranked by overall score alone.

•  Something else

How does your ul@mate rank list get created?

Panel Ques@on

How do you ul@mately rank candidates?

Ranking

•  Begin with the DNR group. •  Use some method of crea@ng an ini@al ranking list.

–  It is easier for people to make sugges@ons about an exis@ng list than to create one from scratch.

–  I use the numeric faculty interview ranking score as a start.

•  Enlist all stakeholders in the process. –  I tell faculty they can’t complain about fellows if they are not part of the interview and ranking process.

NRMP

•  Do not miss the deadlines. – An@cipate computer foul-‐ups and technical issues. – Give yourself a buffer.

•  Do not put anybody on your list you wouldn’t actually want. They might come…

•  I personally enter the list. •  Triple check your list before cer@fying.

– Read the instruc@ons afer you modify the list, it has to be “Cer@fied” to be final.

Post-‐Match

•  Post-‐match survey of applicants – The people on your rank list that were above your matched candidates

– Ask for feedback about your program • What could be improved. • What was an issue •  How was the interview day, structure.

–  I do this by email and start off with a bit about how happy I am for them and what a great candidate they were.

Recruitment for Ped Fellowships APPD Fall 2015[4] · Fellowship Training ! “To advance the health...

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