Objective: The training of fellows in medical subspecialties has historically been left to individual subspecialty divisions with little cross division collaboration, despite the fact that medicine fellows face many common issues in professional development regardless of subspecialty and educational needs. All subspecialty fellows need assistance in deciphering academic pathways and identifying keys to success in their chosen career pathways. The Accreditation Council for Graduate Medical Education requires trainees in all subspecialty medicine programs to have training in end-of-life-care, ethics, health systems, and quality improvement. However, it can be difficult to ensure compliance in these areas across subspecialties. In addition, fellowship may be a time of isolation, particularly for fellows who have come from outside institutions in training in small divisions' subspecialty programs. The objective of our First-year Fellows' Retreat is to create a forum to bring together fellows across subspecialties and expose them to objectives that are not specialty specific; build collegiality; and provide structured learning opportunities for addressing material that is important regardless of specialty. Description: With the assistance of subspecialty program fellowship directors, we identified four common needs for fellows in the University of California, San Francisco, Department of Medicine. The four common needs were (1) understanding of academic pathways and criteria for promotion, (2) providing effective consultations, (3) sharing bad news and managing end-of-life care issues, and (4) promoting collegiality. To meet these needs, two years ago we developed and continue to refine an annual three-quarterday, off-campus retreat, held in the fall, that is mandatory for all first-year subspecialty-medicine fellows. Each subspecialty program makes its own arrangements to free first-year fellows from their clinical work to attend this mandatory retreat. The day begins with an icebreaker. The chairman of medicine welcomes the group and leads a discussion of effective consulting and the structure, funding, and promotion processes of academic medicine departments. Breakout groups led by senior faculty focus on strategies for obtaining funding and achieving academic success as clinician educator, basic science researcher, and clinical researcher. The breakout session focuses on issues in funding and strategies for achieving academic success. The end-of-life section, structured in small-group sessions, was structured differently each year. In the first year, fellows received a lecture each on breaking bad news and on providing competent end-of-life care, followed by small-group discussions led by a geriatrician or generalist with end-of-life care expertise. Our experience suggested that many subspecialty fellows felt that they did not have any responsibility for breaking bad news or providing end-of-life care. We modified the structure in the second year by shortening the presentations, providing a brief overview of end-of-life care and sharing bad news. Discussion: A total of 90 fellows have participated in the retreat. Last year, fellows rated the career-pathways sessions 4.5, the end-of-life-care groups 4.6, and the overall educational value of the retreat 4.0 (4 = very good, 5 = excellent). Fellows' comments about what they liked most about the retreat included the following: “Career advising at the outset of fellowship is useful”; “[I enjoyed] interactions with other fellows [and] sense that department is supportive of fellow's education”; “Very useful advice, excellent to bring Chairman to retreat [who gave] excellent advice on how to be a consultant.” Feedback from the first retreat suggested that first-year fellows found it most relevant to discuss end-of-life care examples from their own specialties with their own faculty, so now small groups are co-led by subspecialty faculty and a geriatrician or general internist with expertise in end-of-life care. The groups now address specialty specific challenges in providing end-of-life care as well as how subspecialists and generalists can best work together in this area. Based on other feedback from the first retreat, we revised the end-of-life care, small-group sessions to group fellows by subspecialty, co-led by a subspecialty faculty member and a geriatrician or general internist with expertise in end-of-life care. We have found the fellowship retreat fills an important void by addressing professional needs and training requirements common to all first-year, subspecialty-medicine fellows while promoting collegiality across subspecialty programs. This format could be expanded to address many other topics and adapted to the needs of second-year fellows as well as fellows in other departments.
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Johnston et al. (2002) studied this question.