Cincinnati Children’s Hospital Medical Center
Cincinnati, OH

Program Director: Barbara Chini, MD

Program Associate Director: Gary McPhail, MD

Program Type: Pediatric Pulmonary

Abstract Authors: Nancy Y Lin, MD; Gregory Burg, MD; Barbara Chini, MD.

Description of Fellowship Program: The Pulmonary Fellowship Training Program at Cincinnati Children’s offers 3 years of clinical and research training in pulmonary medicine for graduates of accredited general pediatrics residency programs. Our goal is to train and educate the next generation of pediatric pulmonologists with the skills and knowledge required to achieve excellence in clinical medicine, research and medical education.

Abstract:

Background:

Fellowship training programs in Pediatric Pulmonology are based upon a solid foundation of clinical experience, research opportunities and educational programs that ensure fellows receive a well-rounded training experience. As one measure of competence, fellows take the American Board of Pediatrics (ABP) subspecialty certifying examination after completion of training. During training, subspecialty fellows can take the Subspecialty In-Training Examination (SITE), which is based on specific contents published by the ABP. SITE scores are used by the individual fellow and training program as a gauge of one’s current knowledge. For our program, improving SITE scores and first time board examination pass rate are used as a measure of success.

The fellowship training program at Cincinnati Children’s Hospital Medical Center has made multiple changes over the past several years to improve our educational program. As previously reported in 2015, following an 8-year period with board pass rate less than 80% for first time examinees, we instituted a physiology lecture series and separated our clinical services. This was associated with an increase in board passage rates in first time examinees from 77% to 100%. More recently, we have further improved our fellowship education program by changing the structure of the call schedule and increasing protected hours during on-call to maintain a more adequate balance between service and education. The aim of this study was to assess whether these new changes to the educational program would help sustain the previous improvement in SITE and board pass rates.

Results from the past 2 years were reviewed, and compiled with past data to compile a larger subject group, including the year 2000 to 2017. The subjects were separated into 2 groups: before and after curriculum change, and the scores were analyzed. After reviewing SITE and board examination scores, we found that first time board passage rates have continued to remain at 100% (n=16). Before curriculum change, the average SITE score was 65.4% (n=15) with a 3.5% mean improvement during training. After curriculum change, average SITE score increased to 68.4% (n=25) with a 6.8% average increase (p=0.21). When the subject groups were separated by training year, results showed that third year fellows had average SITE scores 64.2% (n=10) prior to curriculum change, which increased to 72.6% (n=17) after intervention (p=0.06). First time board examination pass rate increased from 76.9% (n=13) to 100% (n=16). Tables 1 and 2 show further details on correlation between SITE scores and board success. Overall, the changes in curriculum implemented over the past few years have improved our board success rates from 77% to 100%. SITE scores have shown a positive correlation to board exam success. We are excited that board success rates have remained at 100% since the last review. Further, we are encouraged by the results of our last Accreditation Council for Graduate Medical Education (ACGME) Resident’s Survey (2016-2017), which showed overall satisfaction of the fellowship program above the national average. It further showed that faculty and staff are engaged in the development and improvement of education program and the program’s full compliance with duty hours as regulated by ACGME.

Table 1. Board Exam Data and Average SITE scores (Years 2000-2017)

* There were 4 outliers: 1 with average SITE score of 65% who failed first attempt and 3 individuals with average SITE score of 49%, 53%, 54%, respectively, who passed first attempt.

Table 2. SITE Score Correlation to First Time Board Success (Years 2000-2017)