Transplant Hepatology Fellowship Websites: The Good, the Bad, and the Unhelpful

Introduction

The comprehensiveness and accuracy of a website are essential for improving access to individuals wishing to apply for a subspecialty fellowship. A lack of relevant website information may deter applicants from applying to smaller or less popular subspecialties, leading to a shortage of providers in specialties such as transplant hepatology. Moreover, workforce models have predicted an impending critical shortage of transplant hepatology providers as the prevalence of advanced liver disease steadily increases in the United States and worldwide [1]. This mismatch between qualified individuals providing and patients needing care further necessitates improved strategies to encourage the pursuit of this field. Overall, improving program websites is an inexpensive, necessary system improvement that can increase growth in the field of transplant hepatology.

As residents interested in a career in gastroenterology (GI), the authors identified additional training opportunities that could be pursued either after or in conjunction with GI fellowship. We identified several opportunities to pursue training in transplant hepatology via an online search. Through our research, we noticed a lack of standardization of website information among transplant hepatology programs. As trainees, we knew the importance of the information gathered from fellowship websites, which became especially relevant after the restrictions brought on by the COVID-19 pandemic led to a virtual application process [2–5]. Furthermore, with the American Association for the Study of Liver Diseases (AASLD) shifting to a standardized online application and interview process for the 2023–2024 cycle, fellowship program websites will likely act as the primary source of information for prospective applicants [1, 3–5]. Despite this shift toward an online application process, many fellowship websites have failed to include relevant and current information to applicants [3, 4].

We first had to establish what constitutes a good fellowship website. Based on previously published data in other fields of medicine and applicant surveys, we found that applicants sought information such as application requirements, compensation and benefits, contact information for program leadership (program directors/coordinators), and the demographics and accomplishments of current and previous fellows [1, 3–5]. With this in mind, we devised 23 criteria covering educational, recruitment, and compensation-related data that we could use to evaluate each of the 60 ACGME-accredited transplant hepatology fellowship programs within the United States of America. Each program was then evaluated for adherence to these criteria that were then tallied in their independent dimensions and in aggregate by two independent researchers. If there were variations in the data, they were resolved by the third independent researcher who reperformed the individual tally for that specific program. Our goal was to evaluate the online profiles of individual transplant hepatology fellowship programs, highlighting the potential areas of improvement for these programs.

Results

See Fig. 1.

Fig. 1.

Summary of data analysis of the completeness of the websites for 60 hepatic transplantation training programs. The number of program websites providing satisfactory data fulfilling each of the 23 required criteria is plotted for the 60 programs evaluated. Inset table provides further data regarding number of criteria met among all programs

Discussion

Through the use of a specific and standardized methodology, we evaluated each of these websites for clarity and completeness of information available to applicants. Since the majority of potential applicants rely solely upon the internet to inform themselves about the unique training opportunities offered by different institutions, the information presented on program websites must be relevant, current, accurate, and comprehensive. Since the post-pandemic era accelerated the shift toward digital information and minimized incentives to hold in-person informational sessions, tours, and interviews, even more importance is placed on the information contained in program websites.

Analysis of our data revealed that most program websites were outdated, lacking key details about their program including community demographics, fellow demographics, and program size. Other key information pertinent to the day-to-day life of applicants such as call scheduling, a curriculum summary, and board pass rate were mostly unavailable.

In general, institutions included information about their transplant hepatology programs in a tab located under the broader umbrella of available GI fellowships, usually a single page that often served as a bare minimum “snapshot” of the program that provided a brief overview of the curriculum along with any specific application instructions. Faculty and fellow directories were mostly linked in the sidebar as a catchall for all GI-derived fellowships. As the number of fellows accepted into most programs is in the low single digits, it is understandable why many programs do not invest resources into creating fully fledged websites for each advanced GI fellowship. A potential solution would be to include important details that are conserved across fellowships, such as compensation and non-discrimination statements, in a separate tab located in the website’s sidebar. This approach would lessen the work burden for individual programs while providing all applicants with this vital information.

Another issue with this generalized “snapshot approach” is that programs present very similar information since summarization is the enemy of uniqueness. Detailing key features of the program can help separate it from its peers and make it more memorable to applicants. For instance, few institutions included the number of hepatic transplant patients fellows were likely to see over the duration of their training. Similarly, providing applicants with a list of available research projects, fellow demographics, and even testimonials about the program can help applicants get a sense of the benefits that the particular fellowship offers. Furthermore, clinical and call schedules were notably absent from many sites, two factors that are key to an applicant’s ability to understand what their day-to-day routine would look like. Though not specifically included in our criteria, a few institutions incorporated guides to the city of location. Thoughtful inclusions such as these help applicants visualize both their work and personal life while in the program.

Most program websites omitted demographic information for current fellows and the patient population. With the rise of awareness surrounding health inequalities in the United States, community demographic information has become even more important to applicants seeking programs with an emphasis on serving vulnerable and underserved populations. Fellow demographic information provides applicants with a sense of the institution’s commitment to diversity. Hence, standardization of certain website requirements such as demographic information can ensure that programs are living up to their diversity and inclusion statements. This information also serves the additional purpose of differentiating a program from its peers. Competition among programs for qualified applicants may contribute to the content included on program websites that may include discussions about compensation, evaluations, fellow workload, and the overall quality of their education.

Though most programs included key contact information, especially for the program coordinator and director positions, these data were occasionally absent or challenging to locate. Since easily accessible points of contact invite applicant engagement, they should be given for any fellowship website. Moreover, including the emails of current fellows can further encourage applicants to reach out to the existing fellows. Individuals seeking a more ‘honest’ view of the program may feel more comfortable asking certain questions to fellows or faculty not directly associated with the admissions process.

Lastly, we found that many program websites were not updated regularly, containing outdated information, and omitting current information regarding the impact of the pandemic on the application cycle. The lack of updated content may have misled potential applicants and deterred those who realized that the information was outdated. One low-cost and easy solution that could be implemented into many websites is the inclusion of a date stamp that would assure its viewers that the information presented is current and show that the program is actively engaged in seeking new applicants (Fig. 2).

Fig. 2.

Potential applicant pathway. AASLD American Association for the Study of Liver Diseases. ACGME Accreditation Council for Graduate Medical Education

Conclusion

During our evaluation, we realized that the majority of transplant hepatology fellowships need to take full advantage of their websites to provide key details about their program. To ensure that applicants can make informed decisions about the future of their training as physicians, time and energy must be devoted to ensuring that these web pages are updated regularly and include key details as seen in the categories listed above. Thus, there is an opportunity for all transplant hepatology fellowship programs to improve their websites by providing prospective applicants with a more informed and comprehensive perspective of their program.

We hope that by improving depth and breadth of content in their websites, transplant hepatology programs can increase the quantity and quality of applicants. Likewise, applicants will greatly benefit from better access to information that will enable them to make educated choices about program fit and their future as a physician. This shift toward digital information gathering has been further accelerated by the COVID-19 pandemic; fellowship programs need to catch up in order to remain competitive.

Author’s contribution

FIJ, AMS, PR, TCV, CH, and DA contributed to conceptualization and critical revision for accuracy.

Declarations

Conflict of interest

The authors declare that they have nothing to disclose.