Update on Fellowship Accreditation

The fellowship application process can seem confusing and overwhelming. It’s important to understand your options and try to pick a program that fits your needs. After residency, fellowships offer the opportunity to subspecialize in an area of particular interest. There are numerous training options available, most of which are administrated by the Accreditaton Council for Graduate Medical Education (ACGME); however, there is some variability in the system. Resident Review contributor Dr. Pooya Hooseinzadeh recently interviewed Dr. Wudbhav (Woody) Sankar, Chair, Fellowship Training/Qualification for Practice Committee, to help clarify some of the issues facing those looking to train in pediatric orthopaedics.  

Q:   We know that some subspecialty fellowships in orthopaedics are moving towards ACGME accreditation. Could you please let us know where POSNA stands when it comes to fellowship accreditation?  

A:   Some subspecialty societies such as the Orthopaedic Trauma Association (OTA) have recently developed their own accreditation system out of concerns that ACGME was not as relevant to their particular subspecialty. Because of similar concerns, POSNA is considering the development of a POSNA accreditation system. The society is currently working to develop a framework of what this accreditation system might look like and how it could be implemented. This is not necessarily meant to replace ACGME accreditation but to offer an alternative for those fellowship programs that are not ACGME accredited because they think that system is less relevant and too onerous to pursue.

Q:   What efforts have been done in POSNA to address the accreditation issue?

A:   The POSNA Fellowship Committee and the Board of Directors is actively working on the concept of a POSNA accreditation system.

Q:   What is your message to future fellowship applicants regarding the accredited and non accredited fellowships? (Should that play a role in choosing the fellowship?)

A:   It should be noted that there is no subspecialty certification in pediatric orthopaedic surgery. Right now, many programs have voluntarily sought accreditation through the ACGME, but many excellent fellowship programs have elected not to enter this voluntary process. One goal of a proposed POSNA accreditation system would be to ensure basic standards across all types of pediatric orthopaedic fellowships, but, at this point, I would not advise future fellowship applicants to worry too much about whether or not a fellowship was currently accredited.

Q:   In the 2015 Match, the number of unfilled pediatric orthopaedic positions was much higher than in previous years. Do you see that as a new trend?

A:   This past year, all 53 North American applicants matched (100%). In 2014, 54 of 57 applicants from North America (95%) matched. Although this number does vary a bit year to year, there are typically 71 pediatric orthopaedic fellowship positions offered across the country. Taken together, the match rate in pediatric orthopaedics for North American applicants remains quite high, and those occasional applicants that do not match most likely would have if they had applied to more programs. Because of changes in requirements for ACGME accreditation, however, it has become somewhat more difficult for foreign medical graduates to match in ACGME accredited pediatric orthopaedic fellowships.

Q:   There is concern among some members that in the past 5 years we have trained too many pediatric orthopaedic surgeons which has decreased the number of available academic jobs. Do you believe that we are training too many pediatric orthopaedic surgeons? Does POSNA plan to address this issue?

A:   Opinions on this issue seem to swing back and forth like a pendulum. I remember a few years back when we were concerned as a society that there would be a workforce shortage because of the number of projected retirements of pediatric orthopaedists. Certainly, we have seen a swell in fellowship applicants over the past few years and this has made job searches more competitive. POSNA closely evaluates workforce projections through the practice management commitee. Jeff Sawyer and his committee have finished a comprehensive analysis of the pediatric orthopaedic workforce now and for the future. As I understand it, the need continues for more pediatric orthopaedists in many parts of the country, but perhaps not as much for sub-subspecialists in larger urban settings.