Keywords
pediatric ophthalmology - fellowship - survey - program
Residents in ophthalmology have a desire to pursue fellowship after their initial
training. About 64% of residents decide to pursue a fellowship, and of those approximately
10% choose pediatric ophthalmology.[1] Factors influencing residents to pursue a fellowship include obtaining new skills
and becoming more marketable for jobs. The top reasons for residents to not pursue
a subspecialty in pediatric ophthalmology include a low interest in the clinical field
despite good training in residency, aversion to working with children, and lower financial
compensation. Pediatric ophthalmologists do have high job satisfaction in areas ranging
from diversity of pathology, intellectually stimulating field, and good lifestyle.[2]
Pediatric ophthalmology fellowship is one of the many fellowships offered in ophthalmology.
It includes a 1-year fellowship in pediatric ophthalmology and strabismus, which can
include adult strabismus. The fellowship match is through the San Francisco Matching
Program (SF Match). According to the SF Match statistics, the number of positions
offered in pediatric ophthalmology has remained stable at 57 to 62 spots per year.
However, pediatric ophthalmology has remained the subspecialty with the most vacancies
per year.[3]
Given the fewer number of applicants pursuing pediatric ophthalmology than the number
of positions available, fellowship programs are in competition for the best candidates.
However, each program has its own criteria for what they consider an ideal fellow.
There is a desire to learn more about what characteristics applicants consider in
choosing a fellowship program. This article highlights these characteristics to help
fellowship program directors to better understand what aspects of fellowship are most
valued.
Methods
A 14-question anonymous survey was created and included questions about applicants'
demographic data, the application and interview process in pediatric ophthalmology,
and the qualities of a fellowship program that were important to the applicant. This
survey was modeled after a similar survey given to the members of the American Society
of Ophthalmic and Plastic and Reconstructive Surgery in regard to their fellowship
match.[4] This is available in [Supplementary Material] (online only). The qualities of the fellowship were ranked on a 9-point Likert scale
(1: not important and 9: very important).
Prior pediatric ophthalmology fellows were identified using the American Association
of Pediatric Ophthalmology and Strabismus (AAPOS) physician member database. The survey
was then mailed to AAPOS members via addresses identified in the member database.
Respondents were asked to mail the completed survey back for statistical analysis.
The demographics of the respondent pool were analyzed with simple statistics. The
fellowship program qualities were evaluated with means and standard deviations. The
provided results are given as means and standard deviations for the entire respondent
population. Comparisons were done between demographic groups (gender, practice environment,
and years of training) using Benjamin–Hochberg adjustment for multiple testing. Comparisons
with a p-value of < 0.05 after the adjustment were considered significant.
Results
A total of 1,061 surveys were mailed, with 413 received, a 38.9% response rate. Of
the respondents, 58.4% were male, and 41.6% were female. Additional demographic data
are reported in [Table 1].
Table 1
Demographic data of respondents, N = 413
|
n
|
%
|
|
Gender
|
|
|
|
Male
|
241
|
58.4
|
|
Female
|
172
|
41.6
|
|
Spouse
|
|
|
|
Yes
|
332
|
80.6
|
|
No
|
80
|
19.4
|
|
Children
|
|
|
|
Yes
|
253
|
61.4
|
|
No
|
159
|
38.6
|
|
Years of training
|
|
|
|
Prior to 1989
|
129
|
31.2
|
|
1989–1998
|
118
|
28.6
|
|
1999–2008
|
92
|
22.3
|
|
2009–2012
|
74
|
17.9
|
|
Practice environment in 5 y
|
|
|
|
Private practice
|
166
|
40.6
|
|
Academic practice
|
114
|
27.9
|
|
Private and academic practice
|
128
|
31.3
|
|
Military
|
1
|
0.2
|
Most respondents applied either to 1, 5, or more than 10 to 19 AAPOS programs. Similarly,
most respondents received interviews to 1, 5, or more than 10 to 19 programs. Most
respondents attended five or less interviews.
The program qualities (summarized in [Table 2]) that had the highest mean response was diversity of surgical procedures and volume
of procedures/surgeries performed. This was followed by reputation of the fellowship
director, advice from mentor, and national reputation of the program. Emphasis on
the type of surgery performed was ranked at a mean of 7.5 with a standard deviation
of 1.6. Those who ranked emphasis on the type of surgeries performed with a rating
between 6 and 9 on a Likert scale were asked to rank the type of surgery that was
the most important. Respondents ranked strabismus surgery as the most important followed
by cataract surgery, oculoplastics, retinopathy of prematurity treatment, and glaucoma
in descending order.
Table 2
Mean Likert rating of program characteristics (from highest to lowest rating)
|
Quality
|
n
|
Mean (SD)
|
|
Diversity of surgical procedures
|
409
|
8.0 (1.4)
|
|
Volume of procedures/surgeries
|
409
|
8.0 (1.5)
|
|
Reputation of fellowship director
|
411
|
7.7 (1.8)
|
|
Advice from mentor
|
409
|
7.6 (1.7)
|
|
National reputation of program
|
410
|
7.5 (1.8)
|
|
Emphasis on type of surgery performed
|
408
|
7.5 (1.6)
|
|
Program associated with academic institution
|
410
|
7.5 (1.8)
|
|
Patient diversity
|
413
|
6.8 (2.1)
|
|
Presence of children's hospital
|
412
|
6.6 (2.5)
|
|
Interview
|
396
|
6.5 (2.1)
|
|
Reputation of larger cognate ophthalmology department
|
408
|
6.5 (2.1)
|
|
Didactics
|
412
|
6.5 (1.9)
|
|
Collaboration with other specialties
|
410
|
6.5 (1.9)
|
|
Number of preceptors
|
413
|
6.4 (2.0)
|
|
Appointments of fellowship graduates
|
406
|
6.1 (2.2)
|
|
Fellow clinic
|
405
|
6.0 (2.1)
|
|
Spousal considerations
|
383
|
5.8 (2.9)
|
|
Appeal of city
|
409
|
5.7 (2.4)
|
|
Teaching responsibilities
|
411
|
5.5 (2.0)
|
|
Research reputation of program
|
409
|
5.3 (2.2)
|
|
Fellow call responsibility
|
411
|
5.1 (2.2)
|
|
Research opportunities
|
413
|
4.9 (2.1)
|
|
Proximity to family
|
411
|
4.7 (3.0)
|
|
Benefits
|
413
|
4.6 (2.2)
|
|
Presence of county hospital
|
408
|
3.3 (2.4)
|
|
Presence of Veteran's Administration hospital
|
409
|
2.8 (2.1)
|
Abbreviation: SD, standard deviation.
The program qualities that were ranked the lowest based on all respondents were the
presence of a Veteran's Administration hospital, presence of a county hospital, benefits,
proximity to family, and research opportunities.
When comparing these program qualities' Likert item ratings between the genders of
the applicant, the mean rating of proximity to family was higher for females compared
with males. There was a statistical difference in valuing research reputation of program
and research opportunities when comparing those whose future practice environment
was an academic institution or private practice with academic affiliation than those
whose practice environment was private practice alone. Benefits, number of preceptors,
and fellow call responsibility were rated significantly higher in more recent applicants
(2009–2012) than applicants before 1989 and reputation of fellowship director was
rated significantly lower in these recent applicants.
The last question of the survey asked the respondents to write what they considered
the most important quality that influenced their fellowship program ranking and selection.
There were a variety of responses including “mentor advice,” “fellowship director,”
and “autonomy/independence of fellow and surgery.” The most common responses among
all respondents were “program reputation,” “variety and volume of procedures,” “location,”
“environment of the department,” and “fellowship director.”
Discussion
Knowing what applicants consider important when choosing a fellowship program is very
helpful for fellowship directors. The overall most important aspects of fellowship
training were volume and diversity of surgical procedures, mentorship, and reputation
of the program and fellowship director. This is very much related to what pediatric
ophthalmologists value in their job satisfaction of diversity of pathology and intellectually
stimulating.[2]
A similar survey was conducted for evaluating characteristics important in oculoplastics
fellowship training.[4] In this survey, respondents highly valued a variety and volume of surgical cases,
personality of program director, the interview, and an emphasis on the type of surgeries
performed. Pediatric ophthalmology respondents were similar in considering the surgical
aspect of fellowship training as the most important. Another pediatric-based surgery
fellowship surveyed respondents in 2010 on program characteristics that are considered
important.[5] Similar to pediatric ophthalmology, pediatric surgery valued “diversity of cases,”
“advice from mentor,” “total number of cases,” and “academic prestige of program.”
This survey provides pediatric ophthalmology fellowship directors a better understanding
of the qualities an applicant seeks in their fellowship training. This survey was
sent to all physicians of AAPOS including those who were in fellowship over 10 years
ago. Different generations value specific qualities differently, such as number of
preceptors and fellow call responsibility. Applicants who wish to pursue a more academic
career did rank programs qualities with an emphasis on research as more important.
There are a few limitations to this survey. In the survey response, not every question
was answered. The response rate was low and we do not know whether respondents differ
from the entire cohort that was contact. Our low response rate may be due to fact
that the survey was delivered and responded via mail, and in the future an electronic
survey might help improve such results. The survey included fellows up to the 2012
academic year. Fellows in more recent years may have similar or different responses.
As the millennial generation begins[6] to enter the fellowship workforce, a repeat survey may be useful. Regardless of
these limitations, this survey is the only one to provide useful information for both
applicants and fellowship directors.
