Collaboration and Community

Former Le Bonheur Infectious Disease Specialist Joan Chesney, MD, CM, saw an opportunity to improve the infrastructure, curriculum and experience for fellowship programs at Le Bonheur Children’s in the University of Tennessee Health Science Center (UTHSC) Department of Pediatrics. By uniting the programs in a centralized fellowship office, she could bridge gaps among programs and create a true community of fellows.

At the time, each pediatric fellowship program operated semi-autonomously, often working in silos. To mitigate this, Chesney worked with Le Bonheur Pediatrician- in-Chief Jon McCullers, MD, and previous Le Bonheur President and CEO Meri Armour in 2016 to create the Pediatric Fellowship Office — funded by Le Bonheur and the UTHSC Department of Pediatrics — with the intention of neutralizing imbalances among programs through a centralized administrative design.

“We wanted to standardize certain elements of the fellowships,” said McCullers. “Some of the largest fellowships had more developed programming than smaller or newer fellowships. Developing an overarching office allowed sharing among programs and would address some imbalances so that all were able to operate at a high level.”

Chesney retired in 2020 but left the legacy of the centralized fellowship office. Now led by Pediatric Cardiologist Michael Rebolledo, MD, MBA, MPH, director, and Jayme McGrail, administrative coordinator, the Pediatric Fellowship Office aims to create a centralized point of contact for pediatric fellows and help them navigate campus resources throughout their fellowship training.

“Fellowships must meet uniform GME [Graduate Medical Education] requirements that can be difficult for smaller programs to accomplish,” said Rebolledo. “Through our centralized office, we can focus on large-scale issues common to all pediatric fellowship programs and create a more uniform experience for fellows.”

Michael Rebolledo, MD, MBA, MPH, educates first-year fellows on quality improvement and patient safety. Rebolledo is director of the Pediatric Fellowship Office.

Mutual Benefits

The Pediatric Fellowship Office organizes all aspects of the fellowship experience outside of subspecialty medical training on behalf of the 20 programs that are part of the centralized administrative model. This includes everything from professional development to recruitment efforts to research training, which has proven to provide benefits for all entities involved in the fellowship experience — from program directors to the hospital to the fellows themselves.

In this centralized model, program directors from each fellowship can collaborate and synchronize recruitment, including interviewee feedback and marketing strategies. Regular meetings among all program directors allow discussion about fellowship issues in a collective manner with the intention to benefit from each other’s ideas and efforts.

“Previously the program directors weren’t getting in the same room,” said McGrail. “Our monthly program director meetings allow them to ask the question ‘How can I advance or better my program?’”

Le Bonheur Hospital Medicine Fellow Mary Katherine Hood, MD, examines a patient. The centralized fellowship office allows fellows to connect outside of clinical time and better coordinate care within the hospital.

A centralized office positively impacts care in the hospital, too, as the community created among fellows allows for better coordination of care. Previously fellows may have shared patients and never known they were providing care alongside another fellow. Now they are able to connect with each other within the hospital.

And that community also positively impacts fellows’ mental and emotional health. Since fellows spend several years in training, it’s important for them to have community and friendship in order to focus clinically, and it’s hard to do a good job if you’re lonely, says McGrail.

“The centralized office has successfully fomented a sense of connection between fellows from different programs that may not have occurred organically without the office,” said McCullers.

In addition to making lifelong friends, the Pediatric Fellowship Office provides a centralized place to connect fellows with the right resource at the right time. Navigating resources can be challenging, especially for fellows who come from outside the UTHSC system, says Rebolledo. The office also provides opportunities for fellows to present their research. And the additional support from a central office fosters collaboration among fellows — whether in clinical care, research or socially.

“The centralized office could put me in contact with the right people and provide me with information about many more opportunities that are available to fellows,” said former Le Bonheur Allergy/Immunology Fellow Amy Ragsdale, DO. “I was able to collaborate with other specialties in my research, too, and see what other fellows were doing for their projects.”

A Unique Design

Preparing fellows to become specialists requires more than just medical training. The Pediatric Fellowship Office organizes a Noon Conference series for personal and professional development, teaching skills that will transfer beyond the fellowship experience. Topics covered include professionalism, interviewing skills, personal finance, CV preparation, managed care and more.

“Attending Noon Conferences has helped me from an overall career perspective. They go beyond the scope of what we learn in fellowship medical training to actual career building,” said Noel Joseph, MD, a current Critical Care Medicine fellow. “Fellowship training is a lot about the medicine, but the centralized office takes care of things that doctors might not think about when thrust into the real world.”

Community and wellness are also important pieces of the Pediatric Fellowship Office’s role. The centralized format provides an avenue to build friendships and have support outside of training. In addition, the office recently established a new wellness committee for all pediatric fellows, run by the fellows themselves with the purpose of providing regular opportunities to unwind and spend time with other fellows outside of the hospital. And a huge part of wellness is building connections and friendships during training, says McGrail.

“In fellowship training it’s easy to stay in your own little world and be isolated in your specialty,” said Ragsdale. “The centralized office provided that extra layer of support so that you don’t work alone — you can meet people outside of your specialty and gain support from other fellows.”

To execute a successful recruitment season, the Pediatric Fellowship Office develops a coordinated recruitment strategy among all programs.

For example, during the interview process McGrail meets with each prospective fellow to highlight the Pediatric Fellowship Office’s resources and address specific questions. And the feedback is encouraging. Potential fellows are surprised by the centralized format and express that Le Bonheur is the only place they are interviewing with such an office, says McGrail.

Following interview season, McGrail and Rebolledo are able to collect and aggregate specific program feedback from applicants to implement during upcoming recruitment seasons. This past interview season the office hosted a virtual open house to provide potential fellowship candidates an opportunity to hear about Le Bonheur’s culture and life in Memphis — as virtual visits are still required due to COVID-19 safety precautions.

“The Pediatric Fellowship Office allows us to more effectively recruit the very best candidates and then complement their training programs so they have a truly exceptional educational experience,” said Le Bonheur President Michael Wiggins, DBA, FACHE.

Research Week provides first-year fellows the opportunity to learn core academic competencies for research and time to meet with their mentors about their projects. Above, fellows had the opportunity to hear from a panel of Le Bonheur researchers during 2021 Research Week.

A scholarly activity with a demonstrable work product is a key requirement of a fellowship. To assist with this training, the Pediatric Fellowship Office developed Research Week — a research “boot camp” free from clinical responsibilities for first-year fellows to learn core academic competencies for conducting research and to meet with mentors about their prospective research projects. The Fellows Grants Program is also administered through the Pediatric Fellowship Office and coordinated by McGrail. This merit-based internal grant award provides support for fellows who require funding for their research projects.

“Having the overarching office has allowed for development of added programming like Research Week that no single fellowship could have done on its own,” said McCullers. “The baseline research education is a huge boon to all the fellowships as it provides basic knowledge and experience and connects fellows to the appropriate resources.”

Surveying the Fellowship Landscape

To determine an overview of the landscape of fellowship offices across the country, McGrail and Rebolledo, with former Le Bonheur Scientific Editor Courtney Bricker-Anthony, PhD, recently published the article “Creating Value: Many Roles of a Centralized Pediatric Fellowship Office” in Academic Pediatrics. The intent of the article was to determine how frequently a centralized administrative model is used for fellowship programs and to better understand some of the barriers to implementation at other institutions.

“Not much has been published on fellowship office administrative models, and we wanted to build on the limited literature available,” said Rebolledo. “Through this paper, we’re also able to share the lessons we learned during the development of our own centralized fellowship office.”

McGrail and Rebolledo conducted a survey of designated institutional officials from children’s hospitals that ranked among the “Best Children’s Hospitals” in U.S. News & World Report for 2019-20. The six-question survey asked which fellowship programs were offered at their institution and if they used a centralized pediatric fellowship office model.

Among survey respondents, 54% utilized a centralized fellowship office model. And of those who did not, 78% had considered developing a centralized fellowship office. The greatest barriers to achieving this model were satisfaction with the current structure and difficulty achieving buy-in from stakeholders. The paper shared Le Bonheur and UTHSC’s framework for a centralized office and the benefits they have seen from this model in just a few short years.

“Among our survey sample, a centralized pediatric fellowship administrative model is not only feasible but commonly utilized,” said Rebolledo. “A centralized office can reduce overlap and streamline shared processes eliminating inefficiencies.”

Former Le Bonheur Cardiology Fellow Karan Karki, MD, (left) reviews ECHOs with Le Bonheur Cardiologist Hugo Martinez, MD. After completing his fellowship, Karki joined Le Bonheur’s Heart Institute as a cardiac critical care intensivist.

The Future of Le Bonheur Fellowships

In just a short few years, the Pediatric Fellowship Office has been able to add multiple initiatives to the fellowship program experience — a recruitment focus, coordination of marketing and post-interview surveys to name a few. The next goal: become more involved in and better support research for fellows.

“We’ve grown so much in just a short period of time,” said Rebolledo. “We incorporate feedback to deliver high yield topics to our fellows in various formats including practical workshops.”

Recently, the Pediatric Fellowship Office implemented Fellows Research Day — an opportunity for fellows to present their research and receive feedback from other fellows and UTHSC faculty — and additional opportunities to present research through the Children’s Foundation Research Institute, Le Bonheur’s research arm.

Ultimately, Rebolledo and McGrail aim to be a resource for fellows and program directors, provide a cohesive fellowship experience and build robust fellowship programs that emphasize collaboration and community. In the two to three years of pediatric fellowship, they make sure fellows’ time is used efficiently and that fellows stay on track to meet their key milestones.

And former fellows can attest to the value of a centralized fellowship office.

“I continue to have the support of my fellowship and stay in contact with my attendings,” said Ragsdale. “My experience as a fellow at Le Bonheur prepared me to be on my own but never made me feel like I was alone.”