Pediatric Orthopaedics Fellowship Review 2018-19

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3 years 7 months ago #36615 by pedipod2
As you probably know, there’s very little info on peds ortho fellowships out there. The POSNA webinar and program websites can be good starting points. Admittedly some of the websites can have little to no info on them. A few years back, someone posted something similar to this which I found helpful so I thought I would pass along my 2 cents. This is just 1 person’s opinions and impressions. Hopefully it can give you a little insight as you prepare for your interview season/career in pediatric orthopaedics.
Important things to think about

1.Know yourself:this is not residency match. The cliché that is completely true is it’s all about fit. You know how you learn. You’re an adult who can decide what kind of learner and what kind of environment you will thrive in. Be careful about getting completely focused on the most illustrious name if the structure or faculty do not really fit with who you are. That’s the short route to an unhappy fellowship. Trust your gut. Take good notes on interview day.

2. Structure of Program: this probably has the highest level of variability place to place. This can range from nearly every day scheduled out from Day 1 to Day 365 to nearly no structure at all with freedom to construct your own experience. I think the pluses and minuses of this are very much dependent on one’s individual learning style. Are you someone who can structure their own well rounded program or want to hyperspecialize from the get go? Programs with less structure are probably the way to go. Do you want to make sure you are forced a bit to have exposure to all areas of peds ortho? Programs with more structure is probably a better way to go. Same deal kind of follows along for didactics. Most programs are a hybrid somewhere in the middle but it can vary a lot how the elective time is set up.

3. Fellows/Faculty- This again is a bit of a personal choice. As you probably already know there are big differences in the number of fellows ( peds ortho plus possibly others) and sizes of faculty at the different fellowships. There are a lot of advantages to having a lot of fellows for sure. For example, it’s good to have colleagues at same level of training, help dissipate call and busy work, larger network of alumni etc. At the same time, there’s a risk of competing for the same cases (although many places say this never happens. It’s hard to believe). Overall, some of these places did tend to have fewer cases per fellow than some others, but this certainly was not universal. Probably the most objective way I could think to look at this is look at a ratio of the faculty to the number of fellows at the children’s hospital. It’s not a perfect measure, but for me, it did make me a little worried at smaller ratio places where fellows were a little evasive on how many cases they actually were doing. The other side of the coin is being a lone wolf single fellow. In those places, you are not competing for any of the same cases and there’s more of a singular focus on your education. This comes at the cost of not having co fellows and potentially taking more call.

4. Case Volume- this can be a bit tricky to figure out sometimes. Some programs are very public on publishing what their past several years of fellows have done. Others can be pretty vague if you ask what the averages are. There are many reports of some very prestigious programs barely making it over the 250 minimum case volume for POSNA Accreditation. That having been said, these are just numbers and do not reflect the average complexity per case. It’s another data point to consider, as obviously this is your last chance to be a learner so you want to be busy. That having been said it is certainly not a be all end all.


5. Accreditation: I did not find this very important. ACGME program cannot leave you alone in a room and you cannot take attending level call. POSNA only program allow you to take call, operate on your own, and function as junior faculty at times. This can be a good or bad thing. Certainly autonomy is nice to try to spread your wings with a bit of a safety net. There are places where the fellows felt like they were “used” in some way under the POSNA only system. At the end of the day I think this is a low priority.

6. Have fun. The interview season is a blast. It’s such an exciting time to meet so many of your future colleague and the community of pediatric orthopaedics. Being a pediatric orthopaedic surgeon is the best job in the world ( IMHO), and you will have such a great time getting to know the community around the country.

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3 years 7 months ago - 3 years 7 months ago #36616 by pedipod2
In no particular order:


St. Louis Children’s/ Shriner’s St. Louis- WUSTL

Faculty/Fellow Ratio: 5:1
Accreditation: POSNA
Positions: 2
Structure- Quite flexible. 3 months rotations alternating between Shriners and St. Louis Children’s Hospital, although fellows can go to other hospital if an interesting case comes up ( about 5 min away from each other). Final 3 months of year offer basically complete choice of anything based upon if you feel there are any areas of extra subspecialty interest you wish to proceed or are need for the job you’ve taken. Average 4 days OR, 1 day clinic. Fellow makes schedule with chief resident. No rounding. Fellows each go for 1 week to St. Vincent’s/Grenadines for mission work. Opportunities to moonlight at Shrine. 400-500 cases with 1200 procedural codes per fellow
Call: 1 weekday per week, 1 weekend per month. First 6 months as fellow backing up in house residents, second 6 months attending level call with attending available on double back up if needed. 6 am room for small trauma cases, other trauma worked in during the day.
Subspecialties: Everything represented. Minimal tumor. As many spines as you want with Luhmann and Kelly including tethering, VRC, complex deformity. Can be shared somewhat with Adult Spine fellow, but it sounds like plenty to go around. Otherwise whatever you want to make it with great faculty in every subspecialty, Schoenecker for Hip (Clohisy also) , Hand with Goldfarb, Frames with Gordon, FA with Dobbs. Basically, very open ended depending on interests.
Conferences: 2-3 conferences per week. Not onerous requirement. Send fellows to IPOS, POSNA, subspecialty course if desired (e.g. Spinal deformity course )
Misc: Very impressed in a program I did not know much about prior to interview. Fellows very grateful for extra 3 months to hone practice based on job taken. WUSTL is an excellent department as a whole. All specialties available, no limitations on hand, sports, spine as subspecialists in all areas. Autonomy in OR seems very good, and 6 months of “safety net” attending call to end the year and spring board practice. Kind and approachable faculty.


TSRH Dallas

Positions: 5 + Peds Hand
FFR: 3.6:1
Accreditation: ACGME + POSNA
Structure: Famously probably the most structured program, mainly because they have seen that model successfully work and create successful surgeons. 9 months of 1 month rotations with attending teams of 2 physicians. They have tried to alter the schedule to provide more OR time. Average balance is probable 2.5-3 OR, 2-2/5 clinic. The have built 3 months of flexibility at end of rotation but that is an elective on any of the 2 attending teams as opposed to a complete free for all. Which could be an issue with all 5 fellows and what their varied interests are. Surprised me the size of the inpatient wards. Roughly 50 beds and 7 progressive care beds but no ICU (any sicker kids can be sent across the street). The mentorship model seems like it makes for very strong clinical decision making training but there probably is a little bit more scut than some other programs. That having been said, the size and prominence of the alumni network of this institution may be second to none and there is a very fraternal feel of TSRH doing everything it can to support TSRH grads.
Call: Heavy. Q5 weekend F-Sunday IN HOUSE call. The call room is basically a 2 bedroom apartment and most of the fellows said they use it to get work done. However, during that time you are literally the only physician in house and would have to run anything that happens ( codes etc). Additional Q5 weekend call at CMC Dallas which is back up call to residents and only coming in to operate.
Subspecialities: Very strong spine, hip preservation, club foot experience. Solid sports. Less strong CP, deformity. Has a gait lab. Very little tumor or hand. There is a hand superfellow. Most faculty will do everything with some niches.
Conference: probably the strongest conferences. Daily conference with major conference being Monday night preop where all cases are presented. I have heard these can be pretty intense grilling sessions but was tame the day I visited. Definitely intense but you can tell fellows are very well read and are confident clinical decision makers. They make a TON of powerpoints. Go to IPOS with 3k fund for other conferences.
Misc: Clearly an institution that has trained generations of leaders. The knock has definitely been case volume. High numbers were presented but it is hard to tell if others say barely 250 cases and fellows reporting 700, where the actual volume lies. That having been said, the average complexity per case is quite high and it seems the CMC Dallas experience does help to augment the shorter formalized trauma experience. That having been said, from a network and prestige standpoint, there are few other programs with the size and clout of TSRH, but highly regimented structure may not be for everyone and will operate less than some other places.

Columbia

Accreditation: ACGME and POSNA
FFR: 4:1
Postitons: 1
Structure: Mentorship, attendings broken down in to 2 services. Loose rotations, choose cases as you want. Famously, a ton of spine availability (which can be good or bad depending on your persuasion), although this is shared with adult spine fellows and 1 advanced pediatric deformity fellow. Seems that even with that, there are still uncovered spine cases. Otherwise specialists focused on other areas of interest available. Sports, Neuromuscular, spine all very strong. Did not get a read on case volume. Avg 3 days OR, 2 days clinic.
Call: backup to in house residents. Very low trauma and almost never operating during the night.
Subspecialties: Especially strong spine, others including tumor well represented. Trauma somewhat limited, but if you wanted to work in spine, neuromuscular, foot and ankle would be excellent.
Conferences:
Misc: Strong place for spine and CP. Somewhat weaker for some other specialties. Kind faculty and NYC is awesome (although not for everyone). Building a gait lab to be open in 2020.

CHOP

Positions: 4
FFR: 3.5:1
Accreditation: ACGME + POSNA
Structure: Famously near complete freedom throughout the year. Typically 4 days OR 1 day clinic. Clinic coverage up to the fellows. There are minimums set for the year to make sure adequate exposure to each area of subspecialty. That having been said, clinic built to function without fellows, no notes, no daily progress notes. Otherwise near complete freedom for scrubbing the cases you want, although there is an honor system that certain complex cases are covered by a fellow or chief resident (which are cases you probably want to be in anyway). Fellows seem extremely happy. Embrace the philosophy of a “golden year” with near complete freedom with almost nonexistent scut. Cohesive faculty, no superfellows except occasional hand. Research machine.
Call: 1 week straight Q4 weeks. Trauma room daily, minimal operating overnight.
Subspecialities: Everything covered. Very strong sports, trauma, spine. Hip, CP very good, but no gait lab, but some fellows have made the effort to travel down to DuPont to see some gait lab in action. One of the lower faculty to fellow ratios so definitely some concern if you and your cofellows have similar interests. That having been said, case numbers ~500 so volume appears to justify. Otherwise, everything well covered with roughly 2 faculty in each area of subinterest. Minimal frames, but do seem to seem plenty of complex deformity. Probably one of top centers for early onset scoli, growing rods, VEPTR if that is of interest.
Conference: With residents for first 3 months daily. Wednesday preop conference. Thursday fellows conference with near complete flexibility. Topics have included contracts, private vs. academic job search, surgical skills labs with leaders in the field. Fellows are afforded near complete freedom to identify the education that they need. Go to IPOS, and get 3k education fund that fellows have used for POSNA, or other subspecialty courses.
Misc: Dr. Flynn seems like an amazing mentor and clearly a thought leader for the field. The faculty appears to get along very well. All subspecialties covered but perhaps a little fewer fellowship faculty than some other places with large numbers of fellows. Everything well covered and there is great freedom to tailor the experience to your needs. Definitely an adult learner place: need self motivation and self organization to ensure a fruitful year. With the faculty size, it does seem there could be some butting heads with other fellows for cases if same interests, but this does not seem to have been a issue in recent years. That having been said, there probably is no where else with the resources of CHOP that affords to freedom to really build your own experience.

Memphis- Campbell Clinic

Accrediation: AGME and POSNA
FFR: 6:1
Positions: 1
Structure: 5 attendings each with subspecialty interests but see general pediatric ortho patients as well. Near complete freedom for fellow. Fellow makes OR schedule, chooses cases for the week. All attendings have clinics at both LeBohner and at private clinics spread over Memphis. 2 rooms + trauma add on room each day. Avg 4 days OR, 1 day clinic. As year goes on, fellow tends to do more clinic to be ready for practice. Good autonomy for most cases, especially trauma. Ability to moonlight at acute injury clinic a few times per month to make extra money.
Call: 1-2x per month, chief call you for operative cases only.
Subspecialties: Especially strong in trauma and spine. Good neuromuscular and deformity and sports. Some exposure to hip preservation, very few spatial frames. Oncology and hand available, but it seems St. Jude’s does take up some of that volume. Can go there to scrub cases.
Conferences: conference with peds service once per week, journal clubs. Cover IPOS, AAOS, POSNA. POST course is in town and multiple faculty are instructors.
Misc: Impressive academic footprint for size of division at 5 faculty. Past AAOS and POSNA presidents in departments and extremely well connected academically. Research powerhouse that seemed very keen on plugging fellows into machine and making fellowship year very productive. Faculty family oriented and private practice mentality for efficient OR days. Seemed like a program that would allow a fellow to launch a career in private practice or academics. Solid culture place.
Last edit: 3 years 7 months ago by pedipod2.

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3 years 7 months ago - 3 years 7 months ago #36617 by pedipod2
Cincinnati Children’s

Positions: 3
FFR: 4:1
Accreditation: ACGME + POSNA
Structure: 6 months on set rotations with 6 months of roughly elective time. The catch is the 6 of each may not be 6/6, electives may be spread throughout the year. That having been said current fellows stated there is a lot more flexibility than you might think. Avg 3 OR/2 clinic but can be up to 5/0 if you want. Trauma room daily and seems there is a lot of trauma to go around. Current fellows seemed very happy with experience with a good mx of academic and private practice future plans
Call: 2 per week, 1 weekend per month. Daily trauma room so almost no operating at night. May have to come in on occasional to tap pediatric hip. Otherwise not a large burden.
Subspecialities: Roughly 2 faculty in each subspecialty area. Especially strong CP, certified gait lab, and trauma, but everything covered. There are pediatric hand superfellows for 6 months which may compromise hand experience if that is your thing. Otherwise everything covered.
Conference: 6 months resident level daily, pre and post op, followed by few times per week fellow level. IPOS and POSNA covered.
Misc: Nice facilities with very diverse and large referral base. One of the few top tier children’s hospitals in medium sized cities. Cincinnati seems like a nice midwestern/southern city with all the outdoor and cultural amenities you could want. All specialties covered, with army of APNs that are able to make life much easier for fellows. Fellows go to mission trip in India if you want.

University of Michigan

FFR: 4:1
Accreditation: ACGME and POSNA
Positions: 1
Structure: Currently 3 ( hiring 4th) faculty, all handle general with some subspecialty interest. Chief resident does make schedule with fellow input, did not seem like this prevented getting any cases desired. Avg 2 days clinic 3 days OR. Very kind faculty with genuine commitment to fellow education. It sounds as if Dr. Farley is a great advocate in the job search and career mentorship areas. Good autonomy in OR. 300-400 cases. Unique opportunity to spend time with former fellow in Mexico City for rotation.
Call: Rounding 1 weekend per month, never operate at night. Cases on weekends
Subspecialties: all faculty generalists with subspecialty focus. Good spine and CP exposure. Good trauma, somewhat limited hand and sports but seemed like available if you sought it out. No frames.
Conferences: Pre/post op conference with faculty and residents, challenging case conference with faculty weekly. Cover 2/3 big courses (IPOS, POSNA, AAOS)
Misc: Solid place for well rounded general pediatric orthopaedics. Subspecialty exposure perhaps a little less than some places due to smaller faculty size. Both navigation and free hand technique education for spine. Dr. Caird seems a like rock star fellow advocate to work with. Very nice hospital.

Nemours DuPont

Accreditation: ACGME/POSNA
FFR: 5:1
Positions: 3
Structure: 6 months of 2 month rotations followed by 6 months of elective. Very fellow focused. Fellows make schedule, sometimes at the expense of residents. No other super fellows, in fact these have apparently been turned away in the past to protect the clinical fellows. Avg 2 days clinic, 3 days OR. Case volumes low, ~250-350 felt to be due in part to complexity of average case. Very collegial and mentoring faculty with good mix of early, mid, and later career surgeons. Originally an exclusively pediatric orthopaedic hospital now with all services. A really great culture seems to pervade the place. Smaller faculty per fellow ratio than some places with multiple fellows (15 faculty).
Call: 1 week at a time every 3 weeks. Burden seems light. Trauma room each day so seldom operate at night but trauma exposure may be lighter than many places.
Subspecialties: Phenomenal spine and CP with some big names who seem like strong mentors. Possible premier skeletal dysplasia center in US. Diverse national and international referral base. All other subspecialties represented with at least 1-2 faculty. I had some concerns going in regarding trauma experience since it’s a smaller city in Wilmington, current fellows felt they had plenty. Research opportunities abound.
Conference: structured and frequent. Daily conference with robust pre and post op which were well attended by faculty. Morning 1 on 1 faculty lectures ranging from clinical knowledge to starting practice, billing, etc. Seemed like a strong and non malignant culture in conference.
Misc: Incredibly strong culture place. Faculty all very collegial and seem genuinely invested in fellow mentoring and education. Seems to have very diverse and complex patient population along with plenty of bread and butter along the way. Possibly the premier spot for spine in the country. The mentorship seems to lend to pretty advanced autonomy for an ACGME program.

Nationwide Children’s (Columbus)

Accreditation: ACGME, POSNA
FFR: 11:1
Positions: 1
Structure: Scheduled rotations for 8 months with near complete flexibility to scrub interesting off service cases. Take call with attending you are on service with and can set that up as you wish in terms of responsibility. 4 months elective at end for catering to individual interests and job needs. 9 attendings with all subspecialties covered. High volume available, the high faculty ration has been done purposely to maximize experience for single fellow ( Former fellows > 500-600 cases), pretty heavy trauma as only Level 1 children’s in fast growing city.
Call: With attending on service about 1 per week and 1 weekend per month, can set up with residents to essentially act as attending and only call attending if taking case to OR.
Subspecialities: Everything strongly represented. Good CP ( new gait lab), hip preservation, spine, hand, sports. Especially strong deformity experience with Iobst now here, but unclear if will be watered down with new deformity fellow starting next year. 2 attendings scrubbing every spine with 1 dedicated as the “fellow coach”, which in practice could make for good education but not clear. Current fellow Limitation is no hip arthroscopist but steps being taken to rectify this.
Conferences: cover IPOS, POSNA, AAOS, sounds like with and interest can get just about any course paid for. Pre and Post Op conference. All very focused on fellow learning.
Misc: State of the art hospital that seems rapidly expanding with extremely approachable faculty. Did not know what to expect prior to interview, but came away feeling this is a true hidden gem. Perhaps less academically active in past that seems is being rapidly changed with rapidly increasing research support. It’s surprising this is a single fellow program. Current fellow was really enthusiastic to be there. Hands down the nicest facilities of any institution I visited.

Boston Children’s

Accreditation: POSNA, ACGME
FFR: 5:1
Positions: 3 US + 1 international fellow (also peds sports, upper extremity, and hip)
Structure: 6 months of 2 month rotations followed by 6 months with repeat 2nd half with near complete flexibility. Significant flexibility in first half as well, fellows make schedule. Lots of other fellows and residents but also very large faculty but overall some overlap but only mild competition for cases. Avg clinic 2 days, OR 3 days per week. Opportunities for fracture care moonlighting one night per week. Round on your patients, but plenty of floor help for during the day issues. ~400 cases fellows think they will have by years end, but were a bit evasive when trying to talk numbers.
Call: 1 week at a time Q 4 weeks. Seldom operating at night. Usually operating on Saturday mornings of call week for trauma cases.
Subspecialties: Strong spine, CP, deformity. Strong hip, sports, upper extremity (but there are fellows in these areas). Routine Trauma mostly done at Waltham surgical center is plentiful, but does take discipline to schedule for yourself. Polytrauma at BCH. Faculty are leaders in just about every field. Academic powerhouse with ~200 publications from the department last year.
Conference: daily conference, fellow level on Monday. Check in with coffee with PD on Wednesdays. Indications not as involved as at some institutions, very informal.
Misc: Faculty very down to earth and approachable for an institution with this great of reputation. Solid faculty in nearly every subspecialty, but also many fellows and residents trying to learn from them. Unclear how crowded things get between all fellows and residents. Overall the volume appears to overcome this, but it is something to consider. Boston is an expensive place to live, especially with families, but people do seem to make it work. That having been said, clearly a great institution with excellent training and approachable faculty.

Stanford

Accreditation: POSNA
FFR: 12:1
Positions: 1
Structure: Basically complete flexibility. Fellow chooses cases without set rotations. Protected ½ day per week for research.. Independent fellow clinic second half of year where see your own patients (often your post op trauma patients). 12 attendings will all specialties covered. Brand new children’s hospital is main center with some many outlying facilities fellow can go to based on his or her educational goals. Traffic can be pretty bad between sites depending on the time of day. Avg 2 days OR, 2 days clinic, 0.5 days research time. Very strong research apparatus.
Call: Take attending level trauma call, cases often worked in first thing but sometimes later in the day. Can operate alone but call burden does not seem too heavy (1-2 per week)
Subspecialties: Excellent sports ( with recent additions of some big name faculty), strong spine, Foot and Ankle, hip preservation. Minimal hand, but is available if it’s a goal of yours. Fewer frames and deformity.
Conference: Pre and post op conference. Fewer journal clubs but this is improving. Cover POSNA, IPOS.
Misc: Seems to be on a rapidly growing and improving trajectory under Dr. Frick with multiple big name faculty recruits and powerhouse research infrastructure. Palo Alto is crazy expensive, even with 80-90 k salary, it seemed fellows are dipping into savings, finding roomates, etc to afford housing. That having been said, the Bay Area is gorgeous. Solid program with strong potential overall, definitely capable of providing the training, research, and contacts to help you launch any career you want but living situation might be tough.

Seattle Children’s

Accreditation: POSNA, ACGME
FFR: 7:1
Positions:2
Sttructure: 10 months of scheduled rotations, each 2 months, last 2 months elective. Freedom during rotations to scrub cases with other attendings if unique or interesting cases come up. Otherwise mentorship model with given attendings for first 10 months. Viewed as important to the philosophy of the fellowship to train well rounded pediatric orthopaedic surgeons. Clinic 2 day, 2 OR days, 1 research/admin day ( current fellows mostly use it to scrub more OR)
Call: 1 weekend/month, 1 weekday per month. Not many cases at night. Trauma room scheduled every morning. Call burden seemed minimal. Good trauma exposure, but it is a Level 2. All polytrauma goes to Harborview
Subspecialties: Excellent Foot and Ankle, very strong tumor exposure, strong spine, CP All other specialties represented with dedicated hand and sports exposure without hand/sports fellow interference. See above regarding trauma. Currently recruiting to replace deformity specialist who left.
Conference: Indications with residents on Wed. MM monthly, journal club every other month. Prepare 5 lectures for resident throughout the year. Education fund is 2k per year to use toward conferences as you wish.
Misc: Really kind and cohesive group of faculty, clear they care about and are dedicated to fellow education and would be great mentors. Seattle is a great city, but is a bit isolated in terms of travel. Current fellows very happy with their training. Mosca planning to continue to practice at least for several more years until the torch can be seamlessly passed. Very wide spread referral base with excellent exposure to diverse pathology. Maybe a bit tumor heavy in terms of faculty mix.
Last edit: 3 years 7 months ago by pedipod2.

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