Taking fellowship training from three years to two, corporate-academic partnerships considered primary options
BY: LISA MUNGER
There are 49 accredited fellowship programs, as of the Accreditation Council for Graduate Medical Education's most recent data from the 2021-2022 academic year. ACGME assumed accreditation responsibilities for the first year in 2016 from the American Board of Obstetrics and Gynecology; 41 REI fellowships existed.
As first reported by Inside Reproductive Health, the University of Miami/Jackson Health System Program and the University of Washington Program received ACGME approval in fall 2022, making them the latest programs to receive approval.
Academic Years and New Programs Accredited By ACGME
2021-2022 University of Rochester
2020-2021 None
2019-2020 SUNY Downstate Health Sciences
2018-2019 None
Before the 2018-2019 academic year, all previously ABOG-accredited programs had to apply for accreditation with ACGME. Thus, in 2016-2018 all existing were re-approved.
What’s more, the National Resident Matching Program matched 49 out of 49 open fellowship positions in 2022. There were 78 individual applicants for REI fellowship program positions for the 2021-2022 academic year in the most recent available data.
The Pipeline for New Programs
ACGME cannot estimate new programs coming in the pipeline.
“It depends on receiving and approving new program applications,” said Susan Holub, director of communications at ACGME.
Currently, 49 fellowship programs exist, with 175 fellows, according to ACGME.
How to Increase REI Fellowships: Challenges
One hurdle in establishing new REI Fellowships is finding qualified faculty. REI is a specialized field; a limited number of qualified physicians can teach in fellowship programs. Another barrier is finding a suitable location for the program. REI programs require access to a large number of patients, as well as state-of-the-art facilities—all costly prospects.
Ruben Alvero, M.D., past president of SREI, professor of Obstetrics and Gynecology at Stanford Medical School and division director of Reproductive Endocrinology and Infertility at the Lucille Packard Children’s Hospital told Inside Reproductive Health there are several impediments to establishing programs and in adding fellows.
“It's onerous to establish new programs or fellows,” he said. The biggest stumbling blocks that exist are securing financing and in terms of the paperwork and the actual application itself.”
Alvero said the cost of adding fellows is highly variable, as is the prospect of beginning a new fellowship program. Costs vary based on the geographic area, cost of living, demographics, facilities in place, availability of private partnerships and faculty recruitment needs; thus, no amalgamate data exist as these factors are unique to each case.
Securing Accreditation: The Process
The process of starting an REI fellowship program is complex and requires a significant investment of time and resources. The first step is to obtain accreditation from the ACGME. A five-step journey is outlined on their website.
This process involves submitting a detailed application with information about the program's curriculum, faculty and facilities. Once accreditation is granted, the program can begin recruiting fellows.
Step 1—Locate and Read Program Requirements and FAQs
Step 2—Locate and Save Review Committee Staff Contact Information
Step 3—Gather Information Needed to Prepare the Application
Complete the specialty-specific application, which can be found on the Program Requirements and FAQs and Applications page of the REI specialty section of the ACGME website.
Provide a block diagram for each year of education in the program
All Program Letters of Agreement for participating sites with required rotations
Policies and procedures for resident/fellow clinical and educational work hours, including policies on moonlighting
Policy for supervision of residents and fellows
Establish competency-based goals and objectives for one educational experience at each educational level.
Evaluation forms for residents/fellows, faculty, program assessors
Semi-annual, summative and final evaluation forms
Policy for resident/fellow and faculty member well-being
Step 4—Initiate Application to ACGME’s Accreditation Data System
Step 5—Submit the Application
A Letter of Notification (LoN) will be sent through ADS after the Review Committee reviews the application.
The LoN will detail the accreditation decision and any citations or areas for Improvement issued during the review.
It can take four to 12 months following the submission of an application to undergo a review and receive an accreditation decision from the Review Committee.
Viable Options for Expanding Fellows
Alvero said one option under discussion is possibly shortening the fellowship term from three years to two. However, given the rigor the programs require, this may not be an appealing choice.
Alvero’s colleague and current president of the American Society for Reproductive Medicine, Michael A. Thomas, MD, told Inside Reproductive Health that though ASRM will look to SREI for guidance, as an REI specialist himself, moving from three years to two may be untenable.
“In a short amount of time, it’s not just learning how to get the eggs and put the embryos back, but also learned understanding the physiology, understanding and contributing to the research,” said Thomas, professor and department chair of Obstetrics and Gynecology at the University of Cincinnati College of Medicine. “From what we know from a clinical standpoint, it takes longer than six months to contribute the research necessary to advance the field.”
Alvero said that a second option is to secure public/private investments to support academic programs financially.
One example is private funding from Shady Grove Fertility with publicly-held Walter Reed National Military Medical Center, intended to benefit military families.
“The program at Shady Grove has fellows from Walter Reed from the National with support through NIH [fellowship program] so that there's a collaboration there,” he said.
Alvero said he expects more of these collaborations to develop.
In the interim, Thomas said he hopes more fellows will mean REI specialty services will be available to a broader audience and, promisingly, with insurance coverage to increase access to more marginalized populations.
“The problem is you can’t just expand a program; they must be good programs. You want to make sure that you have fellows that are being trained rigorously and make sure that those fellows have the opportunity to go wherever they want [rather than limited by geography near major population centers.].”
The themes reported in this publication are those of the news. They do not reflect the views of Inside Reproductive Health.
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