Abstract
Background
Scholarly activity is a key requirement in pediatric subspecialty fellowship training. However, clear guidance on how to effectively support fellows in their scholarly endeavors remains limited.
Objective
This study assesses the impact of a week-long departmental scholarship curriculum designed to enhance fellows’ research competencies.
Methods
In 2024, a curriculum was designed and delivered to first-year pediatric subspecialty fellows over 5 days, combining group learning sessions with individualized tasks. Pre- and post-curriculum surveys assessed fellows’ confidence and knowledge across key scholarly domains. Daily session evaluations provided additional feedback. Fourteen fellows from 9 pediatric subspecialty programs participated.
Results
All first-year fellows (n = 14, 100%) participated. Improvements in fellows’ confidence were observed across all domains (P < .05). While knowledge scores increased, the gains were not statistically significant. Participants rated the overall curriculum positively, and notably, appreciated the individualized tasks and experience of presenting their developing project.
Conclusions
This week-long curriculum increased fellows’ confidence in their scholarly abilities, highlighting the value of a structured, departmental approach to fostering academic engagement. While knowledge improvements were modest, the overwhelmingly positive evaluations support this curriculum approach as a potential model for enhancing scholarly activity in fellowship programs. Further research is needed to explore the long-term impacts on fellows’ scholarly productivity and career development.
Introduction
Scholarly activity is a requirement for both the Accreditation Council for Graduate Medical Education (ACGME) Common Core and the American Board of Pediatrics (ABP) requirement for completion of pediatric subspecialty fellowship training.1,2 While fellowship programs are charged with fostering their trainees’ scholarly endeavors, clear guidance on how to best support these activities is lacking.3,4 Scholarship experiences during fellowship not only contribute to fellows’ academic development, but also influence their likelihood of continuing research pursuits as faculty. 3 As the number of pediatric subspecialty researchers declines nationwide, it is crucial to consider how we can better support and educate fellows in their scholarly pursuits.3–6
Fellowship is a distinctive phase in medical training during which fellows undergo additional training to acquire advanced expertise in their chosen subspecialty instead of transitioning directly to faculty positions after residency. 7 To understand how to guide fellows effectively during this stage, it is useful to turn to educational theories that explore how learners can advance their capabilities with appropriate support. 8 One such framework is the theory of the zone of proximal development, which illustrates the gap between what a willing learner can accomplish independently and what can be achieved with guidance and support.8–10 This framework offers a lens through which to consider the necessary components for fellows to produce a scholarly project, emphasizing 3 key tenets: (1) guidance by knowledgeable, skilled mentors, (2) scaffolded activities to build on existing knowledge and skills, and (3) opportunities to practice newly introduced scholarship skills.8–12 A departmental curriculum model in which fellows engage in challenging yet supported activities may offer a feasible approach that is not dependent on divisional resources.
Mentorship that prioritizes support, clear expectations, and accountability, as well as dedicated research curricula, has been shown to enhance the dissemination of scholarly projects by fellows.5,7 These findings are predominantly reported from division-based scholarship programs that consist of 4-8 trainees per year in a single subspecialty. 5 However, for smaller programs, the division-based model may not be practical or efficient due to limitations in faculty size, resources, and available scope of expertise. 13 Importantly, insufficient available divisional mentorship is a well-documented barrier to successful fellowship scholarly projects.4,6 A departmental approach offers several advantages, including resource sharing, reduction in curriculum duplication, and facilitation of community-building efforts. 14 These efforts can foster the development of mentoring networks that extend beyond individual divisions, providing fellows with access to a broader range of knowledge, skills, and guidance. 11
Explicit education and guidance on developing a research question and designing a scholarly project that can feasibly be completed within the constraints of fellowship training have been lacking for many pediatric subspecialty fellows. 15 To address identified gaps in our fellowship education program, a team of academic pediatricians with educational leadership experience developed this curriculum after no published scholarship curricula specifically targeting fellows were identified. This report describes a week-long departmental scholarship curriculum designed for pediatric subspecialty fellows, developed with consideration of the zone of proximal development framework. It also presents fellows’ evaluations of the curriculum, which we refer to as the Scholarship Academy, as well as its effects on their confidence in and knowledge of skills necessary to complete their scholarly activity requirement.
Methods
Settings and Participants
Training of subspecialty fellows for our institution is based at a free-standing quaternary care children's hospital. The departmental number of pediatric first-year fellows has ranged from 5 to 14 in the past 5 years with 0 to 3 fellows per subspecialty per year of training. Attendance was required of all first-year fellows in the fall of 2024.
Curriculum Development and Implementation
In response to the identified gaps in structured, comprehensive scholarly training for first-year pediatric subspecialty fellows, we designed an intensive, 1-week curriculum, following Kern's 6-step approach. 11 The design and content of this curriculum were informed by a literature search and by consulting national leaders in fellowship education to learn from their practice. Consideration was given to the timing of this new scholarship curriculum implementation, to its integration with our existing core curriculum, and to its alignment with the ACGME and ABP requirements for fellowship scholarly projects. The curriculum was implemented in the fall of the first year of fellowship, soon after the general pediatrics board examination, to avoid interference with their preparation for that high stakes assessment while also addressing the need for scholarly projects to begin early in fellowship. General and targeted needs assessments further informed the content of the curriculum.
Session authors were selected for their content knowledge and experience in facilitating active learning sessions. We intentionally included faculty from across the school of medicine, including facilitators from a variety of specialties and subspecialties, and with diverse scholarship backgrounds, in order to provide a broad range of perspectives.
The structure of the Scholarship Academy curriculum was informed by the 3 tenets of Zone of Proximal Development theory: guidance of mentors, scaffolding activities, and opportunities to practice. Each day consisted of active group learning sessions in the mornings and individualized tasks with available mentor support in the afternoons (Supplemental material). The curriculum was presented over 1 week. The group learning sessions lasted 3 to 4 h for 5 successive mornings and consisted of brief didactics, large group discussions, facilitated small group work, and gamification strategies. The sessions built on learning and activities from the previous day and provided scaffolding activities. The individualized afternoon tasks included worksheets, meetings with faculty and staff with expertise on the topics covered each day, and additional contact with mentors, allowing fellows to augment their skills and resources identified as necessary for their developing projects. The tasks each afternoon were designed to build on the concepts and skills learned that morning and tailored to the research domain the fellows planned to pursue, providing opportunities to practice. To support this intensive schedule, all participating fellows were free of clinical duties for the week. All group sessions took place in a hospital-based conference room with space to accommodate breakout groups.
To ensure consistency in expectations for scholarly projects, program directors or previously identified mentors attended the initial sessions on day 1, during which expectations were outlined. They also attended on the closing day when the fellows presented their developing projects and timelines were finalized, allowing for additional mentoring as the fellows practiced this culmination of the scaffolding activities.
Outcomes Measured
We surveyed participants to assess their baseline confidence and knowledge across 10 domains on the first day of the curriculum, prior to the first session. The survey, developed by the investigators, was informed by the ACGME and ABP objectives and requirements for fellows.1,2 The survey was repeated at the conclusion of the curriculum, which addressed all 10 domains, to assess changes in participants’ confidence and knowledge. Validity evidence was obtained by (1) content review by experts in medical education assessment with experience in survey design, (2) response process testing by a cohort of senior fellows, and (3) pilot testing by a separate cohort of senior fellows. 15 The pre- and post-knowledge surveys utilized multiple-choice and true-false questions (Supplemental material). Confidence was assessed using a 5-point Likert scale (1 = Not at all confident; would need a mentor to tell me exactly what to do, 5 = Very confident; could teach this to others).
Additionally, course evaluations were collected and managed using REDCap electronic data capture tools hosted at our institution. 16 REDCap (Research Electronic Data Capture) is a secure, web-based software platform designed to support data capture for research studies. Comprehensive evaluations were collected on the final day of the curriculum. Evaluations consisted of questions requesting ranking on a 5-point Likert scale (1 = Poor, 5 = Excellent), and open-ended questions. All responses were collected electronically, without identifying information, but with an individualized code that allowed for comparison of responses for each participant.
Analysis
Results were summarized using descriptive statistics. Differences were considered as significant, and not due to chance, with a P-value <.05. Narrative responses to open-ended questions were coded, and through discussion, consensus was reached.
Equator Network Guidelines
The reporting of this study conforms to the Defined Criteria To Report INnovations in Education (DoCTRINE) guidelines. 17
IRB Statement
The Louisiana State University Health Sciences Center Institutional Review Board granted the study exempt status (IRB Protocol 7562).
Results
All first-year fellows (n = 14, 100%), representing 9 pediatric subspecialty programs, participated in the Scholarship Academy. The represented pediatric subspecialties were cardiology, emergency medicine, endocrinology, gastroenterology, hematology-oncology, hospital medicine, infectious diseases, nephrology, and neonatology.
Confidence and Knowledge
Pre- and post-surveys were completed by 100% of participants. Comparisons revealed statistically significant improvements in participants’ confidence across all domains (see Figure 1). While participants’ knowledge trended up, there was no statistically significant difference in participants’ pre- and post-curriculum knowledge assessments.
Confidence of 14 Participants Assessed by 5-Point Likert Scale (1 = Not at all Confident; Would Need a Mentor to Tell me Exactly What to do, 5 = Very Confident; Could Teach This to Others) Before and After the Scholarship Curricular Intervention. The Increase in Confidence for Each Participant was Statistically Significant (P-Value <.05).
Evaluations
Evaluations were completed by 100% of participants on days 1, 2, 3, and 5, and 93% (13 of 14) of participants on day 4. Participants rated the Scholarship Academy overall positively, and the majority of individual sessions received evaluations of 4-Very Good or 5-Excellent. The sessions on refining the question, biostatistics, hypothesis, methods, and survey design were less favorably reviewed. A breakdown of ratings for each session is shown in Table 1. Themes emerged from analysis of the open-ended questions, specifically, 4 themes regarding the value of the curriculum, 3 areas for improvement, and 2 general domains. See Table 2 for themes and selected comments from the qualitative questions.
Evaluations of Each Curriculum Component and the Overall Departmental Fellows’ Scholarship Curriculum.
The P-value is for the hypothesis that the majority (>50%) of fellows have a response of 4 (Very Good) or 5 (Excellent). This was significant (P < .05) for every session with the exception of the sessions on refining the question, biostatistics, hypothesis, methods, and survey design (noted with *).
Selected Themes From the Participant Answers to Open-Ended Questions on the Scholarship Curriculum Evaluation.
Discussion
This study evaluated the effectiveness of a week-long, departmental scholarship curriculum for first-year pediatric subspecialty fellows. Our findings indicate that this curricular intervention significantly improved fellows’ confidence in their ability to conduct scholarly projects. These results suggest that adding structured, intensive, and interactive support within a departmental framework can enhance fellows’ self-perceived competencies in scholarship, potentially leading to more successful scholarly endeavors.
Pediatric research and evidence-based care are integral to improving child health outcomes.6,13 Therefore, fostering scholarship during pediatric subspecialty fellowship training is essential.1,2 Confidence in research skills is a well-documented predictor of sustained academic engagement, and for many pediatric subspecialists, scholarly activity is a critical component of their career advancement.4,6,9 This curriculum, using a zone of proximal development theory framework, was successful in enhancing fellows’ confidence in conceptualizing and executing scholarly projects, which may have lasting implications on their academic careers and be particularly important in subspecialties facing faculty shortages.3,4
While fellows’ confidence improved, knowledge gains were less pronounced. The absence of statistically significant differences in knowledge assessments may be attributed to the limited sensitivity of the assessment tool in detecting subtle improvements. The elevated pre-curriculum knowledge scores support this possibility. Confidence improvements outpacing knowledge gains have been reported in other scholarly curricula,5,7 highlighting the challenge of evaluating the true impact of educational intervention on knowledge retention and application. Outcome measures such as increases in presentations and publications of fellowship scholarly projects may represent more important markers of the impact of a fellowship scholarship curricular intervention and could be important components of future studies. 14
Fellow participants overwhelmingly rated the curriculum positively, indicating that it was both well-received and appreciated. Sessions that involved individualized tasks and meetings received high ratings, supporting the idea that fellows valued structured supports as these opportunities facilitated the building and extending through application of their new competencies.9,11,18 Additionally, participants highly rated their experience of presenting their project development to peers and faculty on the final day of the curriculum. These elevated ratings further demonstrate the confidence, knowledge, and skills they acquired or bolstered during the curriculum and offer support for including this high accountability component in the curriculum. 7
However, certain sessions, specifically those focused on refining research questions, biostatistics, hypothesis development, and survey design, received less favorable evaluations. These lower ratings may reflect the difficulty of presenting complex material concisely and accessibly, particularly to fellows early in their fellowship training. 12 Future iterations could benefit from aligning these topics more closely with the developmental stages of the fellows and their developing projects. 8 We will revisit each of these concepts in additional sessions later in fellowship.
The limitations of this study must be acknowledged. First, the study is limited by its single-institution design and small sample size (n = 14). Additionally, while this study assessed short-term effects on confidence and knowledge, the long-term impact of the curriculum on fellows’ scholarly productivity, dissemination of scholarship, and career trajectories remains uncertain. Longitudinal studies are needed to determine whether the improvements in confidence observed in this study translate into sustained engagement in research activities.
Conclusion
A week-long departmental fellowship scholarship curriculum is a feasible intervention for enhancing pediatric subspecialty fellows’ confidence in their ability to conduct scholarly projects. While knowledge improvements were less pronounced, the overwhelmingly positive evaluations suggest that the curriculum was well-received and could serve as a model for other fellowship programs seeking to support trainees in scholarly activity. As we consider workforce shortages in several subspecialties, fostering scholarship skills through structured, department-wide initiatives should be considered a promising model for promoting scholarship engagement among future pediatric subspecialty faculty.
Supplemental Material
sj-docx-1-mde-10.1177_23821205251391961 - Supplemental material for A Week-Long Departmental Scholarship Curriculum for Pediatric Subspecialty Fellows
Supplemental material, sj-docx-1-mde-10.1177_23821205251391961 for A Week-Long Departmental Scholarship Curriculum for Pediatric Subspecialty Fellows by Amy Creel, Amanda Messer and Robin English in Journal of Medical Education and Curricular Development
Footnotes
Acknowledgments
Dr Hayley Gans and the Pediatric Fellowship Education Department at Stanford University provided inspiration, guidance, and support for this project.
Ethical Approval
The Louisiana State University Health Sciences Center Institutional Review Board granted the study exempt status (IRB Protocol 7562).
Consent to Participate
The requirement for written informed consent was waived by the Louisiana State University Health Sciences Center Institutional Review Board. All participants gave verbal informed consent.
Author Contributions
Dr Amy Creel was responsible for conceptualization, methodology, formal analysis, investigation, writing the original draft, and editing the final manuscript. Dr Amanda Messer was involved in conceptualizing the curriculum, formal analysis of all results, writing the original draft, and reviewing and editing the final manuscript. Dr Robin English was involved in methodology of the study, formal analysis of results, writing the original draft, and reviewing and editing the final manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this article is available online.
References
Supplementary Material
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