Association Of American Medical Colleges Research Articles

Examining Racial and Gender Diversity in the Plastic Surgery Pipeline: Where is the Leak?

There is limited information about minority representation throughout the plastic and reconstructive surgery (PRS) pipeline. The aim of this study was to examine trends in representation among minorities at different stages of the PRS training pathway, starting with potential candidates in high school through practicing physicians. The PRS pipeline was defined as high school; college; medical school applicants, matriculants, and graduates; PRS residency applicants, matriculants, and active residents; and PRS practicing physicians. Racial data for each stage were obtained from the US Census and Association of American Medical Colleges. The proportion of races at each stage were divided by their US population counterpart proportions to produce representation quotients (RQs). Medians and interquartile ranges (IQRs) are reported. Mann-Whitney U tests compared RQ values within identities between successive stages. Black students had high representation in high school (RQ = 1.26 [IQR: 1.21-1.29]) but had significant, stepwise decreases in representation in subsequent stages. A similar trend was observed for Hispanic individuals, who had their highest representation in high school (1.43 [1.37-1.50]), followed by significant decreases in RQ at nearly every subsequent stage up to and including practicing physicians (0.30 [0.28-0.31). Asian individuals were overrepresented at every stage (high school RQ: 1.01 [1.00-1.03]; practicing physician RQ: 2.30 [2.27-2.32]). White individuals were underrepresented before residency but had an RQ that approximated 1 in subsequent stages. Racial minorities experienced decreases in representation at each successive stage in the PRS pipeline following high school. Ongoing diversity efforts should focus on premedical recruitment and professional support for minority students.

Shortage of Black physicians: Florida Black medical student enrollment from 2013 to 2021

On average, Black patients have substantially better health outcomes when they are under the care of Black physicians. The percentage of Black physicians in America has remained at approximately 5% for nearly half a century, even though Black people comprise 14% of the United States population. We used data from the Association of American Medical Colleges and Florida medical schools to examine two important research questions. First, we hypothesized that since the state of Florida has the twelfth largest percentage of Black residents, Florida medical schools enrolled a higher percentage of Black first-year students compared to the national average. We found that Florida medical schools that provided data enrolled a higher percentage of Black first-year students (13.5%) than the national average (9%), which supported our first hypothesis. Second, we hypothesized that the percentage of Black first-year medical students enrolled nationally was higher in 2021 compared to 2013, correlating with the emergence and rise of social justice movements, including Black Lives Matter. We found that the national average of enrolled Black first-year medical students was 6% in 2013 and 9% in 2021, which supported our second hypothesis. An increase in the percentage of Black medical students and physicians could help diminish race-based health and class inequity in America, leading to a significant increase in the health of many Black people.

Gender diversity in pediatric surgery: academic ranks and scholarly productivity amongst pediatric surgeons.

Despite a growing number of women entering medical school, a small proportion of women pursue surgical specialties, including pediatric surgery. This multi-center study assesses gender-based differences in measures of scholarly productivity and distribution of faculty positions. This is a retrospective web-based study of all pediatric surgeons at twelve large institutions across the United States. Data published by the American Association of Medical Colleges was compiled and analyzed to understand the gender distributions of medical students, general surgery residents, and pediatric surgery fellows. P-values were calculated using two-sided Student's independent t-tests and chi-squared tests. There have been a growing number of women applying into pediatric surgery, but the proportion of women matriculating into these fellowships is not concordant. Women are still underrepresented (28%) amongst the pediatric surgeon workforce. A total of 111 pediatric surgeons were identified for this study, which included 31 women (28%) and 80 males (72%). There was a significant difference in the distribution across academic ranks between genders (p < 0.001). Women had significantly fewer publications per year after residency, fewer total publications, and a lower h-index in comparison to men (p < .001, p = .005, p = .002, respectively). Women are not only underrepresented in pediatric surgery, but there are also significant differences in the distribution of faculty positions and scholarly productivity when comparing men and women. There is a pressing need to improve gender diversity and identify barriers that may prevent women from advancing to leadership positions and achieving professional success.

Empathy among Undergraduates in an Academy of Health Sciences in Hetauda, Nepal

Introduction: Empathy is the ability to understand one’s perspective and experience, and further use this understanding to communicate with the other person. It has been incorporated as one of the learning objectives by the Association of American Medical Colleges. Empathy in a profession may decline with the pressure of a job or the other way may improve with experience. Objectives: The objective of this study is to measure the empathy score among undergraduate students of an Academy in Hetauda. Methods: This is a cross sectional analytical study conducted among 96 undergraduate students. Jefferson Scale of Empathy Health Profession Students’ version was used to measure the empathy scores among the participants. Results: The mean empathy score of the students in Madan Bhandari Academy of Health Sciences was 98.71±15.62. Mean empathy score was significantly higher among the female participants (103.56 ± 14.07 vears 93.43 ± 15.66). The highest mean empathy score was observed among the third semester students 110.18±11.28. A significant difference was observed among the mean empathy values in accordance with discipline where Bachelors of Public Health had the highest mean empathy value 107.95±12.65. In accordance with age the relatively younger age group had higher mean empathy value where males had a mean value of 104.03 ± 13.85 and females had a mean value of 95.83 ± 15.73. Conclusion: Females had a higher mean empathy score than males. Students in the third semester had the highest mean empathy score. Relatively younger students had a mean higher empathy score.

Racial, Ethnic, and Sex Diversity Trends in Health Professions Programs From Applicants to Graduates

Diversity is an essential element of an effective health care system. A key to developing a diverse workforce is establishing a diverse student population in health professions programs. To examine the diversity of students in Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Doctor of Dental Surgery (DDS), Doctor of Dental Medicine (DMD), and Doctor of Pharmacy (PharmD) programs with emphasis on the trends of underrepresented minoritized groups (American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander) and sex relative to the overall age-adjusted US population. This cross-sectional study used deidentified, self-reported data from 2003 to 2019 from the Association of American Medical Colleges, American Association of Colleges of Osteopathic Medicine, American Dental Education Association, American Dental Association, and American Association of Colleges of Pharmacy. Data analysis was performed from 2003 to 2004 and from 2018 to 2019. Data on the race, ethnicity, and sex of applicants, matriculants, and degrees conferred by health professions programs were collected and compared with the age-adjusted population in the US Census (aged 20-34 years) over time. The main outcomes were trends in the proportions of underrepresented minoritized groups and sex diversity among applicants, matriculants, and degrees conferred relative to the overall age-adjusted US population. Trends were measured using the representation quotient, which is defined as the ratio of the proportion of each subgroup to the total population of applicants, matriculants, or graduates relative to the proportion for that subgroup within the US Census population of similar age. Regression analysis was used to evaluate the trend over time. A total of 594 352 applicants were analyzed across the examined programs. From 2003 to 2019, the proportions of individuals from underrepresented groups increased for DDS and DMD (applicants, from 1003 of 8176 to 1962 of 11 298 [5.1%]; matriculants, from 510 of 4528 to 966 of 6163 [4.2%]; degrees awarded, from 484 of 4350 to 878 of 6340 [2.7%]), PharmD (applicants, from 9045 of 71 966 to 11 653 of 50 482 [9.0%]; matriculants, from 5979 of 42 627 to 10 129 to 62 504 [6.3%]; degrees awarded, from 922 of 7770 to 2190 of 14 800 [3.0%]), and DO (applicants, from 740 of 6814 to 3478 of 21 090 [5.4%]; degrees awarded, 199 of 2713 to 582 of 6703 [1.4%]) programs, but decreased for MD programs (applicants, from 6066 of 34 791 to 7889 of 52 777 [-2.3%]; matriculants, 2506 of 16 541 to 2952 of 21 622 [-2.4%]; degrees awarded, from 2167 of 15 829 to 2349 of 19 937 [-0.1%]). Compared with age-adjusted US Census data, all programs had more Asian students and fewer male, American Indian or Alaska Native, Black or African American, Hispanic or Latino, and Native Hawaiian or Other Pacific Islander students (representation quotient <1). In this cross-sectional study, most of the health professions in the study saw increases in underrepresented minority applicants, matriculants, and degrees conferred from 2003 to 2019; however, all programs were below the age-adjusted US Census data. The increased racial, ethnic, and sex diversity in the programs illustrates progress, but additional strategies are needed to achieve a more representative health care workforce.

“What’s Next in My Arc of Development?”: An Exploratory Study of What Medical Students Need to Care for Patients of Different Backgrounds

Phenomenon Medical schools must equip future physicians to provide equitable patient care. The best approach, however, is mainly dependent on a medical school’s context. Graduating students from our institution have reported feeling ill-equipped to care for patients from “different backgrounds” on the Association of American Medical Colleges’ Graduation Questionnaire. We explored how medical students interpret “different patient backgrounds” and what they need to feel prepared to care for diverse patients. Approach We conducted an exploratory qualitative case study using focus groups with 11, Year 2 (MS2) and Year 4 (MS4) medical students at our institution. Focus groups were recorded, transcribed, and coded using thematic analysis. We used Bobbie Harro’s cycles of socialization and liberation to understand how the entire medical school experience, not solely the curriculum, informs how medical students learn to interact with all patients. Findings We organized our findings into four major themes to characterize students’ medical education experience when learning to care for patients of different backgrounds: (1) Understandings of different backgrounds (prior to medical school); (2) Admissions process; (3) Curricular socialization; and (4) Co-curricular (or environmental) socialization. We further divided themes 2, 3, and 4 into two subthemes when learning how to care for patients of different backgrounds: (a) the current state and (b) proposed changes. We anticipate that following the proposed changes will help students feel more prepared to care for patients of differing backgrounds. Insights Our findings show that preparing medical students to care for diverse patient populations requires a multitude of intentional changes throughout medical students’ education. Using Harro’s cycles of socialization and liberation as an analytic lens, we identified multiple places throughout medical students’ educational experience that are barriers to learning how to care for diverse populations. We propose changes within medical students’ education that build upon each other to adequately prepare students to care for patients of diverse backgrounds. Each proposed change culminates into a systemic shift within an academic institution and requires an intentional commitment by administration, faculty, admissions, curriculum, and student affairs.

Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study.

The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students. Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses. Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision-making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty. This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

Reimagining Core Entrustable Professional Activities for Undergraduate Medical Education in the Era of Artificial Intelligence.

The proliferation of generative artificial intelligence (AI) and its extensive potential for integration into many aspects of health care signal a transformational shift within the health care environment. In this context, medical education must evolve to ensure that medical trainees are adequately prepared to navigate the rapidly changing health care landscape. Medical education has moved toward a competency-based education paradigm, leading the Association of American Medical Colleges (AAMC) to define a set of Entrustable Professional Activities (EPAs) as its practical operational framework in undergraduate medical education. The AAMC's 13 core EPAs for entering residencies have been implemented with varying levels of success across medical schools. In this paper, we critically assess the existing core EPAs in the context of rapid AI integration in medicine. We identify EPAs that require refinement, redefinition, or comprehensive change to align with the emerging trends in health care. Moreover, this perspective proposes a set of "emerging" EPAs, informed by the changing landscape and capabilities presented by generative AI technologies. We provide a practical evaluation of the EPAs, alongside actionable recommendations on how medical education, viewed through the lens of the AAMC EPAs, can adapt and remain relevant amid rapid technological advancements. By leveraging the transformative potential of AI, we can reshape medical education to align with an AI-integrated future of medicine. This approach will help equip future health care professionals with technological competence and adaptive skills to meet the dynamic and evolving demands in health care.

Barriers to Entry: Socioeconomic Discrepancies Between Unmatched First-Time Applicants and Reapplicants in the Field of Orthopaedic Surgery.

Orthopaedic surgery remains a competitive surgical subspecialty with more applicants than spots each year. As a result, numerous students fail to match into these competitive positions each year with a growing number of reapplicants in consecutive application cycles. We sought to understand the socioeconomic factors at play between this growing reapplicant pool compared with first-time applicants to better understand potential discrepancies between these groups. Our hypothesis is that reapplicants would have higher socioeconomic status and have less underrepresented minority representation compared with successful first-time applicants. A retrospective review of deidentified individual orthopaedic surgery applicant data from the American Association of Medical Colleges was reviewed from 2011 to 2021. Individual demographic and application data as well as self-reported socioeconomic and parental data were analyzed using descriptive and advanced statistics. Of the 12,112 applicants included in this data set, 77% were first-time applicants (61% versus 17% successfully entered into an orthopaedic surgery residency vs versus unmatched, respectively), whereas 22% were reapplicants. In successful first-time applicants, 12% identified as underrepresented minorities in medicine. The proportion of underrepresented minorities was significantly higher among unmatched first-time applicants (20%) and reapplicants (25%) ( P < 0.001). Reapplicants (mean = $83,364) and unmatched first-time applicants (mean = $80,174) had less medical school debt compared with first time applicants (mean = $101,663) ( P < 0.001). More than 21% of reapplicants were found to have parents in healthcare fields, whereas only 16% of successful first-time applicants and 15% of unsuccessful first-applicants had parents in health care ( P < 0.001). Reapplicants to orthopaedic surgery residency have less educational debt and are more likely to have parental figures in a healthcare field compared with first-time applicants. This suggests the discrepancies in socioeconomic status between reapplicants and first-time applicants and the importance of providing resources for reapplicants.

Education Research: Evaluating Medical Student Learning Preference and Its Relationship to Clerkship Satisfaction.

The Accreditation Council for Graduate Medical Education and the Association of American Medical Colleges' commitment to competency-based medical education (CBME) has shifted the medical education landscape. Education methods conducive to CBME are learner-centered and give educators the opportunity to develop a more personalized approach to curricular development and delivery. By understanding learning preferences, educators are better positioned to respond to the changing needs of students. The Learning Preference Inventory (LPI) is a validated tool that assesses preferences across 3 domains: (1) content delivery (concrete vs abstract), (2) instruction (teacher-centered vs student-centered), and (3) learning structure (individual vs interpersonal). Using the LPI, our objective was to describe the learning preferences of medical students in the Neurology clerkship and to evaluate how preferences correlate with satisfaction with curricular elements. A cohort of second-year through fourth-year medical students rotating through the required Neurology clerkship at a single institution was identified. All students completed the LPI and a survey to assess satisfaction with curricular elements, including an in-person localization session, virtual simulation, and a summative case study. Five hundred thirty medical students were included. Preference for concrete content delivery was much more common than abstract (83% vs 17%); otherwise students were evenly divided in their preferences for teacher-centered vs learner-centered instruction and interpersonal vs individual learning structure. There was a significant difference in LPI responses across medical school years: More third-year and fourth-year students preferred individual learning structure compared with second-year students (p = 0.040). Learning preferences also correlated with course satisfaction survey responses. Student satisfaction with the course activities was overall positive, with 69% of students agreeing that the course enhanced their learning. Abstract learners were significantly more likely to report that the virtual simulation enhanced their learning than concrete learners (p = 0.018). Neurology clerkship students demonstrated clear learning preferences that were associated with satisfaction with specific curricular content. There were significant differences in learning preferences across medical school years, suggesting that learning preferences may shift throughout training and may be influenced by clinical exposure. In an educational environment that cultivates the success of all learners, the LPI provides important data to inform curricular development and achieve personalized medical education.

The Modern Integrated Plastic Surgery Applicant Pays 150% More Than Their Counterparts Four Years Ago

Background: Integrated plastic surgery residency positions are among the most difficult to obtain. We examine trends in the number of applicants, applications per applicant, and cost over the past five match cycles. Methods: In total, 2166 applicants to integrated plastic surgery programs were included. The American Association of Medical Colleges and Electronic Residency Application Service databases were examined to determine applicant trends for the years 2017 to 2021. Results: In 2017, there were 564 applicants for integrated plastic surgery residency positions, and in 2021, there were 416 (26% decrease). Across this same time period, the number of applications per applicant nearly doubled (97%) from 30 in 2017 to 59 in 2021, resulting in a 45% increase in the total number of applications. The largest increase in applications per applicant was seen between 2018 and 2019, a 70% increase. From 2017 to 2021, a 10% increase in the number of female applicants and a 43% decrease in the number of male applicants was observed. Cost of applications per applicant increased by 146%, from $514 in 2017 to $1265 in 2021. Total application costs in 2021 were $526,323, an 81% increase from 2017. The future value of these expenditures equals an economic burden of $801,855, assuming a 10-year term student loan at a conservative 4.3% interest rate. Conclusions: Despite substantial decreases in the number of applicants, the number of applications and resulting cost of applications have increased by large margins since 2017. This is representative of the increasingly competitive plastic surgery application process.

Evaluating a Situational Judgment Test for Use in Medical School Admissions: Two Years of AAMC PREview Exam Administration Data.

To examine the relationship between the Association of American Medical Colleges (AAMC) Professional Readiness Exam (PREview) scores and other admissions data, group differences in mean PREview scores, and whether adding a new assessment tool affected the volume and composition of applicant pools. Data from the 2020 and 2021 PREview exam administrations were analyzed. Two U.S. schools participated in the PREview pilot in 2020 and 6 U.S. schools participated in 2021. PREview scores were paired with data from the American Medical College Application Service (undergraduate grade point averages [GPAs], Medical College Admission Test [MCAT] scores, race, and ethnicity) and participating schools (interview ratings). Data included 19,525 PREview scores from 18,549 unique PREview examinees. Correlations between PREview scores and undergraduate GPAs ( r = .16) and MCAT scores ( r = .29) were small and positive. Correlations between PREview scores and interview ratings were also small and positive, ranging between .09 and .14 after correcting for range restriction. Small group differences in mean PREview scores were observed between White and Black or African American and White and Hispanic, Latino, or of Spanish origin examinees. The addition of the PREview exam did not substantially change the volume or composition of participating schools' applicant pools. Results suggest the PREview exam measures knowledge of competencies that are distinct from those measured by other measures used in medical school admissions. Observed group differences were smaller than group differences observed with traditional academic assessments and evaluations. The addition of the PREview exam did not substantially change the overall volume of applications or the proportions of out-of-state, underrepresented in medicine, or lower socioeconomic status applicants. While more research is needed, these results suggest the PREview exam may provide unique information to the admissions process without adversely affecting applicant pools.

An Analysis of Negative One-star Patient Reviews and Complaints for Pediatric Orthopaedic Surgeons throughout the United States: A Retrospective Study.

Patients commonly use physician review websites when choosing a surgeon for an elective procedure. Although data exist regarding other orthopaedic specialties, no study has investigated one-star reviews for pediatric orthopaedic surgeons. The goal of this retrospective study was to classify the factors contributing to one-star reviews of pediatric orthopaedic surgeons to identify which areas contribute to lower patient satisfaction. Patient ratings on a 5-star system and comments about pediatric orthopaedic surgeons were collected from the state with the most physicians registered in the "Pediatric Orthopaedic Society of North American" database for each of the 9 geographical regions of the United States as defined by the Association of American Medical Colleges. One-star reviews that included comments were classified as either surgical or nonsurgical. These comments were then further classified based on their content. Three hundred fifty-four one-star reviews with 700 complaints were included in this study. Of these complaints, 481 (68.7%) were from nonsurgical patients and 219 (31.3%) were from surgical patients. Nonsurgical patients were significantly more likely to reference the amount of time spent with the physician (12.9% to 6.6%, P = 0.026), wait time (11.9% to 0.0%, P < 0.001), and bedside manner (41.2% to 22.8%, P < 0.001). Patients who said they had undergone a surgical procedure in their one-star review were significantly more likely to reference a disagreement with the physician's decision or plan (35.3% to 17.5%, P < 0.001), and uncontrolled pain (21.6% to 5.2%, P < 0.001). There was no significant difference in the comments that referenced medical staff or institutional complaints between surgical and nonsurgical patients (13.8% to 11.4%, P = 0.424). Most one-star reviews of pediatric orthopaedic surgeons referenced interpersonal skills and other nonclinical aspects of a clinical encounter, with bedside manner being the most frequent complaint. Patients who had undergone surgical procedures were less likely to leave a one-star review, but if they did, their comment was usually about a disagreement with the physician's plan. Prognostic studies III.

The Racial Disparities in Maternal Mortality and Impact of Structural Racism and Implicit Racial Bias on Pregnant Black Women: A Review of the Literature.

The maternal mortality rate (MMR) in the United States (USA) continues to increase despite medical advances and is exacerbated by stark racial disparities. Black women are disproportionately affected and are three times more likely to experience a pregnancy-related death (PRD) compared to Non-Hispanic White (NHW) women. A literature review was conducted to examine the racial disparities in the United States' MMR, specifically among pregnant Black women. PubMed and key organizations (World Health Organization, Center for Disease Control and Prevention, American College of Obstetricians and Gynecologists, Alliance for Innovation on Maternal Health, Association of American Medical Colleges, U.S. Census Bureau, and U.S. Congress) were searched for publications after 2014. Forty-two articles were reviewed to identify the role of structural racism, implicit biases, lack of cultural competence, and disparity education on pregnant Black women. This review highlights that maternal health disparities for Black women are further impacted by both structural racism and racial implicit biases. Cultural competence and educational courses targeting racial disparities among maternal healthcare providers (MHCP) are essential for the reduction of PRDs and pregnancy-related complications (PRC) among this target population. Additionally, quality and proper continuity of care require an increased awareness surrounding the risk of cardiovascular diseases for pregnant Black women. The surging MMR for Black women is a public health crisis that requires a multi-tiered approach. Interventions should be implemented at the provider and healthcare institution level to dismantle implicit biases and structural racism. Improving patient-provider relationships through increased cultural competency and disparity education will increase patient engagement with the maternal healthcare (MHC) system.

Neurosurgery Clerkships in United States Medical Schools: A Survey of Doctor of Medicine–Granting and Doctor of Osteopathic Medicine–Granting Schools

Exposure to neurosurgery is important for knowledge of neurosurgical conditions that physicians may encounter. The current status of neurosurgery nonsubinternship clerkships in the United States is unknown; this study determined the availability and format of non-subinternship neurosurgery clerkships in DO (Doctor of Osteopathic Medicine)-granting and MD (Doctor of Medicine)-granting U.S. medical schools. Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine websites were used to obtain contact information for all U.S. medical schools. Respondents were asked whether their school offered a non-subinternship neurosurgery clerkship, if it was required, clerkship length, and whether the clerkship was embedded in another clerkship. Nonsubinternship clerkships/electives/selectives were defined as an exploratory neurosurgery rotation. For nonresponding schools, data were collected from school websites. Data were obtained for 180/199 U.S. medical schools; 142 (79%) provided neurosurgery non-subinternships, including 125/150 (83.3%) MD-granting and 17/30 (57%) DO-granting schools. Four MD-granting schools (2.8%) required the clerkship; 87/142 (61%) offered a stand-alone clerkship, 34/142 (24%) an embedded clerkship, and 21/142 (15%) offered both. In total, 200 clerkships were offered across 142 schools. Most were either >1-2 weeks or >3-4 weeks (69/200, 35% and 89/200, 45%, respectively). Most U.S. medical schools provide elective neurosurgery non-subinternships. Fewer, although still a majority, of DO-granting schools offer a neurosurgery non-subinternship compared with MD-granting schools.

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Prevalence of visual art education in medical school curricula: a national survey of US medical schools

ABSTRACT Background: The Association of American Medical Colleges (AAMC) has recommended integrating medically-relevant arts and humanities curricula into medical student education in order promote physician skills development. An analysis of the state of existing visual arts-based medical school pedagogies was conducted to inform future implementation strategies. Methodology: An electronic survey was distributed to representatives of US medical schools to describe the prevalence and characteristics of visual arts-based medical school curricula. Official courses, informal events, cross-registration opportunities, and established art museum partnerships were assessed. Results: Survey response rates were 65% for US allopathic medical schools and 56% for osteopathic medical schools. A majority (79%) of responding institutions incorporate or support medical student art experiences in some format. Thirty-one percent (n = 36) of schools offer stand-alone humanities courses using visual arts. These were primarily allopathic programs (n = 35; 37% of allopathic programs) and only one responding osteopathic program (n = 1; 5% of osteopathic programs). Schools without dedicated courses are less likely to report other curricular and extracurricular visual arts engagement. Most visual art medical courses are offered at medical schools located in the Northeastern United States. Conclusions: Many but not all medical schools are incorporating the visual arts into their medical education curriculum. Opportunities to promote increased uptake, more effective implementation, and collaboration strategies for the AAMC recommendations are proposed.

Positive feelings of daily accomplishment, role clarity, and academic balance may protect against stress and burnout in oncology.

53 Background: Burnout and stress have negative effects on physician well-being, workforce retention, and patient outcomes. Work overload, lack of control, and value mismatch are known drivers of burnout, but protective factors remain unclear. Methods: National data from the Association of American Medical Colleges (AAMC) StandPoint Faculty Engagement Survey, conducted 2020-2022 (overall response rate 58%) was analyzed. Job satisfaction questions assessed faculty autonomy (“I am satisfied with my autonomy at work”), accomplishment (“My day-to-day activities give me a sense of accomplishment”), clear roles (“My role here is clear to me”), institutional alignment (“I feel personally driven to help this medical school succeed”), and academic balance (“My effort assigned to service, teaching, and research, accurately reflects how my time is actually spent in the workplace”) with “agree”/“strongly agree” considered positive. Burnout measures included: “I enjoy my work”, “I am under stress”, or self-reported (at least) “one or more symptoms of burnout”. Faculty demographics included gender, race/ethnicity, sexual orientation, and rank. Multivariate analysis (MVA) identified factors associated with physician stress and burnout. Results: Of 1306 academic oncologists surveyed, most were male (56%), White (65%), and identified as heterosexual (96%); 7% were considered underrepresented in medicine by race or ethnicity. Of 814 (62% of sample) who self-assessed job satisfaction, most endorsed positive autonomy (82%), accomplishment (82%), clear roles (79%), institutional alignment (80%), and academic balance (59%). Of assessed demographics, women had slightly less institutional alignment (76% vs 83% men, p=0.026) and academic balance (55% vs 62% men, p=0.032). Of 751 (58% of sample) who self-assessed burnout, only 25% enjoyed their work; the rest were either under stress (46%) or had at least one symptom of burnout (29%). Of assessed demographics, women were more likely to report burnout (34% vs 25% men, p=0.0013). On MVA, women (OR=1.6, 95%CI 1.1-2.4) were more likely to be either under stress or endorse burnout. Any faculty (regardless of gender) who reported feelings of job accomplishment (OR=0.36, 95%CI 0.14-0.96), clear roles (OR=0.31, 95%CI 0.13-0.78), and academic balance (OR=0.32, 95%CI 0.20-0.51) were less likely to report stress or burnout. Conclusions: In a large mid-pandemic national survey of academic oncologists, the vast majority were either under stress or had symptoms of burnout, with women being at highest risk. Faculty who endorsed a sense of accomplishment, reported they had clear roles, and whose academic effort was aligned with their actual time at work had one-third the risk of stress and burnout as those who did not. Implementing programs to improve these vital aspects of academic work should be part of essential burnout mitigation efforts.

A decade of diversity: using statistical indices to compare neurosurgery to other surgical specialties

OBJECTIVE Studies have demonstrated the benefits of diversity in neurosurgery. However, recruitment of minoritized groups within the neurosurgical workforce consistently lags other surgical specialties. While racial and gender demographics of neurosurgical residents are well documented, there has been minimal exploration into the multidimensional nature of diversity. The current study will evaluate the longitudinal diversity changes in neurosurgery residency programs compared with other surgical fields with validated diversity indices. METHODS Nationwide reports including data about resident physicians were obtained from the American Medical Association and the Association of American Medical Colleges for the academic years 2008–2021. Self-reported race, biological sex, and medical school affiliation were recorded for surgical residents in the 10 commonly recognized surgical fields. The Gini-Simpson Diversity Index was used to calculate the effective counts (ECs) of races, sexes, and medical school types for each field. A Composite Diversity Index (CDI) comprising the aforementioned diversity traits was used to calculate the percentage of characteristics upon which two randomly selected residents within each specialty would differ. CDIs were calculated for each field in every year from 2008 to 2021. Median CDIs were compared between fields using Kruskal-Wallis testing, and p values &lt; 0.05 were deemed statistically significant. RESULTS Plastic surgery had the highest median sex EC (1.92, interquartile range [IQR] 1.78–1.95), indicating greater diversity, while neurosurgery had the third lowest sex EC (1.40, IQR 1.35–1.41). All surgical fields examined had fewer than 3 races effectively represented among their residents, despite there being 8 races present. Neurosurgery ranked among the top fields in effective racial diversity (EC 2.17, IQR 2.09–2.21) and medical school type diversity (EC 1.25, IQR 1.21–1.26). There were statistically significant differences in the sex, race, and school ECs between surgical specialties. While neurosurgery had a relatively low median overall diversity (CDI = 32.7, IQR 32.0–34.6), there was a consistent longitudinal increase in CDI from 2015 to 2021. CONCLUSIONS Neurosurgery resident physicians have become increasingly diverse in the past decade but are more homogenous than residents in other surgical fields. The continued use of diversity indices to more accurately track diversity progress over time may better inform leaders in the field of how they may best focus their equity and inclusion efforts.

The Concept of Health Systems Science and Educational Needs in the Korean Context

Physicians should be able to address health-related issues of patients and populations from a multidimensional perspective. Therefore, medical schools have a social responsibility to develop and implement curricula that enable trainees to acquire the competencies needed to improve all aspects of patient care and healthcare delivery. This study explored the concept of health systems science concept as the third pillar of medical education (the other two are basic science and clinical medicine) in the Korean context, as well as related educational needs. The theoretical foundation of health systems science is the biopsychosocial conceptual model, which emphasizes the biological, psychological, and social factors surrounding patients. We concluded that the three domains (core functional, foundational, linking) and 12 subcategories of health systems science proposed by the Association of American Medical Colleges could be applied to Korean medical education. Health systems science education must be emphasized to solve the various healthcare problems facing Korea today and to train physicians to provide medical services in line with society’s needs. Introducing a health systems science curriculum will be challenging in the Korean medical environment, which has traditionally emphasized basic science and clinical medical education. Health systems science education should begin in the basic medical education phase, where physicians’ professional identity is formed, and continue through graduate medical education. It is essential to understand related educational needs, develop curricular content, conduct faculty development programs, and provide financial resources for the development of an integrated curriculum.