Advertisement - Members don't see this ad
It looks like peds fellowships are moving to be 2 years instead of 3 and they are dropping the scholarly requirement. Big changes!
Fellowships moving to 2 year model
Started by pawprint
Get help with your application
Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.
It looks like peds fellowships are moving to be 2 years instead of 3 and they are dropping the scholarly requirement. Big changes!
A couple of interesting points. First, this announcement doesn't have a start time, elsewhere I've seen it suggested it will be for those starting fellowship July 2028 but not sure that is finalized.
One other point. Evaluations mandate 360 evaluations. Not sure what the details will be about these but often for trainees like fellows these are not ideal in terms of who evaluates them in a "360" model.
- Increased clinical time to 18 clinical educational blocks, to ensure sufficient opportunity to achieve readiness for practice within a shorter (i.e., two-year) overall duration of training
- No required scholarly work product for certification and no minimum scholarship time requirements
One other point. Evaluations mandate 360 evaluations. Not sure what the details will be about these but often for trainees like fellows these are not ideal in terms of who evaluates them in a "360" model.
Whoa!
To some degree, I'm relieved because most pediatric subspeciality scholarly projects are stupid as hell and teach the trainee nothing. On the other hand, it will reinforce that most fellowship trainees are essentially glorified NPs without any deeper knowledge or understanding of basic biochemistry or pathophysiology. I suppose it's that way already, but guess this just solidifies it.
In pediatric critical care, there are already too many trainees for jobs available. At least with scholarly activity that is serious, one can differentiate oneself from the rest of the herd who is a just a warm body. Not anymore.
Anyway, I'm too far along to really care. This seems like a natural progression of a unserious field beginning to embrace it's unseriousness. So...
The transition from 3 years to 2 years is gonna piss that last class of 3 years off though.
To some degree, I'm relieved because most pediatric subspeciality scholarly projects are stupid as hell and teach the trainee nothing. On the other hand, it will reinforce that most fellowship trainees are essentially glorified NPs without any deeper knowledge or understanding of basic biochemistry or pathophysiology. I suppose it's that way already, but guess this just solidifies it.
In pediatric critical care, there are already too many trainees for jobs available. At least with scholarly activity that is serious, one can differentiate oneself from the rest of the herd who is a just a warm body. Not anymore.
Anyway, I'm too far along to really care. This seems like a natural progression of a unserious field beginning to embrace it's unseriousness. So...
The transition from 3 years to 2 years is gonna piss that last class of 3 years off though.
Advertisement - Members don't see this ad
If by last class, you mean those entering in 2027 (applying this summer), I suppose they could delay application for a year and just work and make some hospitalist/private money before applying. I wonder if that issue won't lead to some implementation for the entering 2027ers? In pedi crit care (and maybe cards and heme/onc) I wonder if there will be pressure to do the third year in order to get any type of job. In neo I don't think that will be the case. This change was certainly pushed related to the fields that can't get many applicants relative to positions/need, but I think some other flelds may have some pushback on getting jobs.
Maybe, but there's an inherent problem in this. Of course, intensivists are mostly non-cognitive operators in the realm of pediatrics. This doesn't lend itself to intellectually curious people joining the field. Thus, many (or most) applicant's are going to pick the 2 year route and maybe tack on a 1 year CVICU fellowship (or one of the incredibly BS fellowships people have come up with... eg ultrasounds, ECMO, whatever). I suspect that will eventually lead to more compartmentalization within critical care and other fields. But then we all these people enter the job field, what are they going to do? Nothing academic, that's not what there training was in. And if the pendulum swings and now new trainees want scholarship because they need a skill set, who is going to train them? The ultrasonographer? Yeah... no. That ship has sailed.
Again, I don't see a good answer because in critical care, most of the scholarly work is hot garbage so I get the desire to get rid of it, but we essentially turn the field into a speciality of the intellectually devoid. I guess that was the natural progression of pediatrics (and maybe medicine in general).
Somewhat related, I was talking to the most senior person in my group today who is also a physician-scientist. They gave up on medical trainees long ago. But they were like:
I was like "Holy sh-t, they're right!"
We have plenty of Academics in IM and… every other field of medicine without requiring a 1 year scholarly project. If the field doesn’t naturally attract academics I’m not sure forcing a year will really solve anything
Working at a academic hospital doesnt mean one is academic. Heck, >90% of staff at an academic hospital are on a clinical track.
Nothing worse than being a mediocre “academic”.
(I stole that last one from someone on here)
I suppose this change just reinforces that.
Last edited:
FWIW, ACGME has not made any announcements regarding this new track. There will still be a 3 year track offered and I suspect more research oriented programs will stick with 3 years.
This will happen at the earliest for people starting in 2028. It isn’t guaranteed to be ready by then. Programs will need to change their curricula to successfully graduate people in 2 years (and there was recently a study suggesting that in a 3 year fellowship, people weren’t ready for practice at 2 years, so this is a real thing).
All this while ABP is asking programs to change their evaluation system.
Don’t get me wrong, my field has been arguing for this for years. Im excited about it. But it’s not a quick switch.
This will happen at the earliest for people starting in 2028. It isn’t guaranteed to be ready by then. Programs will need to change their curricula to successfully graduate people in 2 years (and there was recently a study suggesting that in a 3 year fellowship, people weren’t ready for practice at 2 years, so this is a real thing).
All this while ABP is asking programs to change their evaluation system.
Don’t get me wrong, my field has been arguing for this for years. Im excited about it. But it’s not a quick switch.
Will all programs be required to offer a 2 year track? Or will some programs be allowed to opt out?
I think this will be really good for fields that struggle to fill, but questionable for NICU (my field), and especially questionable for PICU and cards (where the majority of their jobs are in academics, unlike NICU which has a large percentage of private practice available).
I think this will be really good for fields that struggle to fill, but questionable for NICU (my field), and especially questionable for PICU and cards (where the majority of their jobs are in academics, unlike NICU which has a large percentage of private practice available).
The general problem is that if someone is really serious about research as a career, unless they have a PhD (or maybe a masters degree depending on the type), 12 months of "research" is woefully inadequate. For instance, in the PICU programs that used to be serious about research, it was expected that combined clinical and research training would require at least 4 years of fellowship, usually on a T or F grant. The 3-year version of that was the ABP meeting halfway (because the 4-year track was wildly unpopular), but it produced poor results. So realizing that, the ABP is just scraping it altogether. There's nothing wrong with that per se, but it would be a mistake to assume that an extra 12 months of "research" makes one an academic researcher because the results directly counter that point.
Of course, the ability to get research funding is getting harder, which throws an additional wrench into it all, but that is somewhat besides the point (... or maybe not).
Oh God... I've been asked to sit in a Departmental meeting about this and fellowship directors telling us how important a 3 year fellowship is to produce little value whilst justifying their own existence....
My colleagues in neonatology are not pleased. Compressing neonatal-perinatal medicine fellowship training: a critical appraisal of the American Board of Pediatrics proposed 2-year pathway - Journal of Perinatology
It’s funny to hear them concerned about training hours when you guys work some of the worst hours in medicine once you finish
It was quite humorous (and an utter waste of time) sitting in the departmental meeting yesterday. Granted, I was at the physician-scientist table, and there were no neonatologists at the table, but several "leaders" including the department chair and some division directors. One of the division directors was adamant that their field was not going to change. Then the chair was like "So are there going to be programs that are going to go to 2 years in your field?" And that division director was like "Of course. There will be some. But we won't be one." And the chair was like "So will people just go to the 2 year programs and you won't fill?"
:: crickets ::
🤣
That article you linked is just more of the same. You can't train a neonatologist in 24 months? That sounds like nonsense since the clinical component of training is already less than that. I mean, the first day of my fellowship training, the senior intensivist said to me "I could train a monkey to do your job". They weren't wrong. Now, there is certainly an argument to be made that if you just train clinicians, you are essentially making subspecialists attendings into expensive NPs. There's definitely truth to that. But attending physicians don't want to admit that, hence the resistance.
This was also the paper they linked as a catalyst for the discussion of the meeting:
Scholarly Activity During Pediatric Fellowship - PubMed
Despite significant protected fellow research time, most fellows do not publish. Ensuring a program culture of research may provide the support needed to take projects to publication. The fellowship community may consider reevaluating the fellowship duration, particularly for those pursing...
pubmed.ncbi.nlm.nih.gov
Nothing like protecting time to achieve nothing in return. Also, there is no one to mentor trainees, so continuing the same and expecting different results is clearly nonsense too.
Last edited:
That article points towards the real solution - reduce pediatric residency time. People with a doctorate degree do not need to rotate in a nursery, and there are a numerous examples of utter wastes of time throughout a pediatric residency. If someone just wants to practice pediatric medicine outpatient (why?), it can be learned over a few weeks, so 2 years is completely reasonable to capture the bell curve of learners.
Advertisement - Members don't see this ad
Hmm... I would disagree that outpatient rotation are a waste of time or could be learned in two weeks, simply because you need to see the course of diseases as an outpatient. That being said, there are definitely things that could be eliminated. One is an advocacy rotation. That was clearly someone's pet project at the AAP, and based on the fact that, since adding it, the vaccination rates have gone down, not up, it is also very clear that it's achieved nothing. I also remember them adding a development rotation at some point. Also, that's just regular outpatient medicine and should not be a separate rotation other than a day or two. Your comment on nursery is also probably true in that it is good to have some time in a nursery, but you don't need a month to do reflexes on babies and weigh them, and for those with pathology, then end up in the NICU anyway.
So while I disagree with the two weeks of outpatient, which is silly, there has definitely been the creep of what could be a limited experience into whole rotations that add no value.
Never met a specialty that hates itself as much as pediatrics.
Yep, 1 week of nursery and 1 week of development should be sufficient. I remember doing a month of ‘adolescent’ - why? Saw plenty of adolescents in regular outpatient rotations.
Is the advocacy thing a real required rotation? Oof.
And now with decreased ICU time.
I just cannot make sense of what the AAP’s goals are with pediatric training
Their goal is probably to get trainees a better sense of normal child health.
The problem is, that a vast majority of children are some variation of normal development and so they (the directors, etc.) are hoping, by extending the training in the variances, trainees will be able to detect and treat something that is slightly aberrant. After all, that creates a lot of parental distress (which is a whole separate topic with its own issues related to a multitude of problems... which generally boil down to poverty and/or other life obligations). That's all fine, except for two issues 1) one can't tell if slightly aberrant is actually aberrant (there was a whole Atlantic on this subject What’s Behind the Rise in Mild Autism?) and 2) when you only look on how to address the slightly off, you miss the ability to treat the truly off (hence no training in critical care and the rise of hospitalist medicine).
Having been in this field for over 20 years at this point, I worry that the AAP's goal for advocacy has overtaken the AAP's role of achieving competency. Being involved in research, it reminds me of a research project of a person who I saw who was heavily involved in NAS. They received all this NIH/AHRQ funding to address NAS. Talked to all the big wigs about how NAS needed more support, dollars, research, etc. But when they analyzed and presented the data, it boiled down to poor people who have access to drugs like to make babies because they have nothing else to do... because they are poor with access to drugs and have reproductive organs. The AAP mantra would be "Well, we need to advocate and fix NAS for the babies"... but the real problem was that people who are poor, have access to drugs and like to have unprotected sex and make drug babies... and from the AAP's perspective... that's not their problem. It’s the consequence that is important, not the root cause.
From an outsider, looking into the problem... you can't help but shrug and shake your head.
Last edited:
Similar threads
