Graduate Medical Education Programs Research Articles

Evidence-Based Practices for Interviewing Graduate Medical Education Applicants: A Systematic Review

Background Although the selection interview is a standard admission practice for graduate medical education (GME) programs in the United States, there is a dearth of recent reviews on optimizing the trainee interview process, which has low reliability, high cost, and major risk of bias. Objective To investigate the evidence base for different selection interview practices in GME. Methods We searched 4 literature databases from inception through September 2022. Two investigators independently conducted title/abstract screening, full-text review, data extraction, and quality assessment. Disagreements were mediated by discussion. We used backward reference searching of included articles to identify additional studies. We included studies of different interview methods and excluded literature reviews, non-GME related publications, and studies comparing different applicant populations. We examined study characteristics, applicant and interviewer preferences, and interview format. We evaluated study quality using the Medical Education Research Study Quality Instrument (MERSQI). Results Of 2192 studies, 39 (2%) met our inclusion criteria. The evidence base was rated as moderately low quality using MERSQI criteria. Applicants reported preferences for several one-on-one interviews lasting 15 to 20 minutes, interviews by current trainees, and interviews including social events with only trainees. Applicants had mixed perceptions of virtual versus in-person interviews and reported that virtual interviews saved costs. The multiple mini interview (MMI) required more applicant and interviewer time than individual interviews but demonstrated construct and predictive validity and was preferred by applicants and interviewers. Conclusions Based on moderately low-quality evidence, using the MMI, training interviewers, and providing applicants with basic program information in advance should be considered for GME selection interviews.

An Innovative Approach to E-mentorship for Black Applicants to Graduate Medical Education (GME) Programs

The path to medical education is complex and challenging. This is particularly true for Black applicants seeking to pursue graduate medical education. These individuals encounter a multitude of challenges due to disparities in access and resources. These hurdles include difficulties in navigating the residency application process and lower matriculation rates. To address these issues, medical schools need to support diverse and innovative mentorship initiatives, including E-mentoring that is specifically tailored to Black applicants. This article examines the benefits of E-mentoring from the perspectives of our innovative E-mentorship platforms.

Components of an Updated Disaster Medicine Curriculum Included in Emergency Medicine Residency and Emergency Medical Services Fellowship in the United States.

Disaster medicine (DM) is a unique field that has undergone significant development as disaster events become increasingly complicated to respond to. However, DM is not recognized by the American Board of Medical Specialties (ABMS) or Accreditation Committee of Graduate Medical Education (ACGME), and therefore lacks board certification. Furthermore, prior studies have shown that there is unique body of DM knowledge not being addressed in emergency medicine (EM) residency or Emergency Medical Services (EMS) fellowship, resulting in fundamental DM topics not being covered amongst graduate medical education (GME) programs most prepared to produce DM physicians. A recently published DM core curriculum addresses this knowledge gap and seeks to promote standardization of DM training. The objective of this study is to analyze EM residency and EMS fellowship curricula for the inclusion of DM major curriculum topics and subtopics, using the most recently published DM core curriculum as a control. Both EM residency and EMS fellowship curricula were analyzed for inclusion of DM curriculum topics and subtopics, using the DM curriculum recommendations published by Wexler, et al as a control. A major curriculum topic was deemed covered if at least one related subtopic was described in the curricula. The included and excluded DM topics and subtopics were analyzed using descriptive statistics. While all the DM major curriculum topics were covered by either EM residency or EMS fellowship, EMS fellowship covered more major curriculum topics (14/15; 93%) than EM residency (12/15; 80%) and EMS fellowship covered more DM curriculum subtopics (58/153; 38%) than EM residency (24/153; 16%). Combined, EM residency and EMS fellowship covered 65 out of 153 (42%) of the DM curriculum subtopics. Although this study finds that all the DM major curriculum topics will be covered in EM residency followed by EMS fellowship, over one-half of the subtopics are not covered by either program (16% and 38%, respectively) or both programs combined (42%). Increasingly relevant subtopics, such as climate change, droughts, and flooding, are amongst those not covered by either curriculum. Even amongst the DM topics included in GME curricula, an emphasis on themes such as mass treatment, preparedness, and mitigation is likely under-represented. Accreditation from ACGME for DM fellowship would further promote uniform implementation of the updated core curriculum and ensure optimal training of disaster-ready physicians.

Multidisciplinary Perceptions and Considerations for Spiritual Care and Biblical Framework Counseling in Mental Health

Background: Religious/Spiritual (R/S) care is often desirable by mental health clients for culturally sensitive, patient-focused treatment; yet providers may experience hesitancy or overlook this need and treatment guidelines are limited. The aim of this qualitative study was to explore existing R/S care, as well as perspectives on what support care would be considered for patients choosing BFC. This is part of a project to collaboratively extend population-based mental health care access in resource–constrained communities of both the US, a High-Income Country (HIC) and Low-to-Middle Income Countries (LMICs) in Africa. 
  
 Methods: A qualitative literature synthesis, then an online survey was conducted with 54 multidisciplinary participants recruited via snowballing. Survey participants were asked to review a case as described by a BFC provider and respond  anonymously to an open-ended questionnaire. The data collected was distilled with qualitative coding and thematic analysis. 
  
 Results: Literature synthesis identified multidisciplinary health professional provision of R/S, medical and/or psychological interventions as monotherapy or integrated strategies. There was a paucity of medical education guidelines. Qualitative themes included willingness to coordinate care for BFC clients, to what capacity should care be provided, and perceptions of BFC efficacy. R/S care was often integrated as part of a holistic treatment approach. Scheduled BFC patient follow-ups, ethical hand-offs or referrals were considered important for majority of survey respondents based on comfort-level with biblical counseling and perceived relapse potential. Spiritual growth and maintenance, medication management, and individual psychotherapy were recommended by survey respondents. There were contrasts in BFC and non-R/S provider perspectives on pertinent mental health history and inferences from the case. Significant information for patient support included symptoms and confirmatory diagnosis, medical comorbidities, relevant childhood issues, faith-health beliefs, family history and genetics, medication and therapy adherence, and substance use. Faith-health belief congruence of providers with BFC patients and ethical decision-making should be considered. Graduate Medical Education (GME) and other health professional programs may incorporate these considerations, existing R/S interventions, and multidisciplinary provider scope of practice as options for clinician training. Future research steps should include growing the body of anecdotal case reports, evidence-based case series and implementation science studies across a broader range of mental disorders.
  

Graduate Medical Education: Is There Value Beyond What Meets the Eye?

Graduate medical education programs are a part of the mission of all academic healthcare centers. Graduate medical education provides significant value to institutions, and it is worth examining in detail the manners in which this occurs. The better we outline its added value in hospital systems, the better we can adjust the strategic plan of our organizations to capitalize on these benefits. This article discusses both the conventional and unconventional values of graduate medical education programs, as well as their impact on personal and organizational branding within a hospital system. It also examines the influence of these programs on diversity, equity, and inclusion, and their long-term impact on social responsibility.

Impact of Medical Training Programs on Time-to-Fill Physician Vacancies at the Veterans Health Administration.

The Department of Veterans Affairs (VA) provides the largest Graduate Medical Education (GME) training platform for health professionals in the United States. Studies on the impact of VA GME programs on physician recruitment were lacking. To examine the impact of the size of residency training programs at a VA facility on the facility's time-to-fill physician vacancies, and whether the impact differs by the socioeconomic deprivation and public school quality of the geographic area. We constructed an instrumental variable for training program size by interacting the facility clinicians share with the total training allocation nationally. Our evaluation used national data on filled physician vacancies in the VA that were posted between 2020 and 2021. The outcome evaluated was time-to-fill physician vacancies. Our explanatory variable was the facility-year level number of physician residency slots. For positions posted in 2020, an increase of one training slot was significantly associated with a decrease of 1.33 days to fill physician vacancies (95% CI, 0.38-2.28) in facilities in less deprived areas, a decrease of 1.50 days (95% CI, 0.75-2.25) in facilities with better public schools, a decrease of 3.30 days (95% CI, 0.85-5.76) in facilities in both less deprived areas and better public schools. We found similar results for positions posted in 2020 and 2021 when limiting time-to-fill to <500 days. We found that increasing the size of the residency program at a VA facility could decrease the facility's time-to-fill vacant physician positions in places with less socioeconomic deprivation or better public schools.

Teaming in Graduate Medical Education: Ward Rounds and Beyond.

Teamwork in graduate medical education (GME) is often hindered in clinical learning environments where discontinuity among residents, supervisors, and other health care professionals is typical. Teaming is a conceptual approach to teamwork in dynamic environments with constantly changing team members and goals. Teaming is built on principles of project management and team leadership, which together provide an attractive strategy for addressing teamwork challenges in GME. Indeed, teaming is now a requirement of the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review program. However, many clinician-educators and leaders may be unfamiliar with teaming and how to integrate it into their GME programs. In this article, the teaming framework is described with a specific example of how it can be applied to improve hospital ward rounds, a common setting of teamwork breakdown. The goal of this article is to educate and encourage GME leaders as they learn new ways to implement teaming to improve patient care and education in their programs.

The selection of chief residents across residency programs at a large academic medical center

BackgroundChief residents have a unique role in graduate medical education (GME). They not only connect residents with program and hospital leadership, but also advocate for the wellbeing and educational priorities of trainees. Previous studies have focused on describing the characteristics of chief residents (CRs), however little is known about how CRs are selected across GME programs.MethodsOne-on-one semi-structured interviews with all (n = 21) GME program directors at the Johns Hopkins University School of Medicine were conducted from January to March 2022. Investigators independently coded the transcripts using an inductive approach to categorize meaningful segments of text; this culminated in the identification of explanatory themes.Results From discussions with 21 program directors, four themes were identified: (1) identifying candidates: timing, recruitment, nominations, as well as desirable attributes and data considered; (2) applications: expression of intent and participation in interviews; (3) selections: voting, discussions leading to consensus, and program director intimately involved in the choice(s); and (4) confidence in processes and outcomes.ConclusionsOur results provide a deeper understanding of the nuances associated with the selection of CRs. It is hoped that the descriptions of the similarities and differences across GME programs will prompt reflection about what is done at one institution such that all programs can consider what are the best practices to serve their individual goals and needs.

Survey on the Perceptions of Pregnancy and Parenthood in Trainees: Advances, Obstacles, and Growth Opportunities

IntroductionDespite national policy changes, perspective changes on pregnancy and parenting in training are often lacking. We evaluated current viewpoints regarding pregnancy, parenthood, leave needs, and perceptions of support across trainees at our institution. MethodsA cross-sectional survey was sent to all residents and fellows at a tertiary care academic center with >700 trainees. Demographic information, opinions on maternity and paternity leave, and opinions on institutional support and career goals were collected. The survey was sent via the Graduate Medical Education Office listserv -- 66 Accreditation Council for Graduate Medical Education (ACGME) programs and 40 non-ACGME programs. ResultsSeven hundred and forty-seven house officers received the survey with a response rate of 21.9% (n = 164). Of respondents, 81% were residents and 99 respondents were female (representing 31% of female trainees at our institution). Thirty-seven point two percent of respondents reported being parents. Twenty-five point three percent of respondents had been pregnant while a trainee with no statistical difference by specialty type (P = 0.0817). Statistically significant difference was noted in having children based on sex with men becoming parents at twice the rate of women (56% vs 26%, P < 0.001). No difference was noted between specialties on perceived support while pregnant and peripartum. Thirty percent of parent respondents reported thinking about leaving medical training after having children given family stressors. Statistical difference in thoughts of leaving medicine overall between females (46%) and males (17.6%; P = 0.0238). ConclusionsMen and women need support as they navigate becoming parents at a naturally stressful transition period. Females consider leaving medicine at twice the rate of males after becoming parents. Our institution and other ACGME programs need greater transparency and consistent leave practices that reflect changing times.

Tools for Addressing Microaggressions: An Interactive Workshop for Perioperative Trainees.

Graduate trainees from diverse backgrounds may experience discrimination, mistreatment, and microaggressions. While the ability to identify and respond to microaggressions is a much-needed skill for all emerging trainees, limited training workshops exist for residents, especially within perioperative medicine. To embody the principles of diversity, equity, inclusion, and anti-racism (DEIA), we aimed to empower trainees in the perioperative environment with several strategies for addressing microaggressions to bridge this training gap. Based on critical race theory, transformative learning, minority stress theory, and the structural theory of gender and power, this workshop was developed with the primary aim of educating trainees on microaggressions, amplifying the role of allyship, and providing tools to respond to microaggressions as an ally. We used a mixed methods approach to examine participants' pre/post self-evaluations of microaggression intervention tools and the overall effectiveness of the workshop. The postsurvey captured the experiences of 54 trainees, including 37 of 44 (84%) first-year clinical anesthesia residents and 14 of 24 (58%) surgery residents. The facilitator and course feedback was remarkably positive. Paired t test analyses on participants' pre- and postsurvey responses demonstrated a statistically significant increase in knowledge of microaggressions. This workshop also significantly increased learners' self-reported tools for responding to microaggressions. Overall, these promising findings suggest that the strategies presented in this workshop could be applied across other graduate medical education programs. Institutions may wish to customize workshop elements, such as the case scenarios, and the workshop can also be incorporated within a DEIA curriculum.

Exploring the ‘January effect’ at a university hospital in Pakistan: a retrospective cohort study investigating the impact of trainee turnover on patient care quality outcomes

ObjectiveThere are reports of a potential rise in a teaching hospital’s morbidity and mortality rates during the trainee turnover period, i.e., with the induction of new residents and house staffs, and the changeover of clinical teams. The published literature displays mixed reports on this topic with lack of reproducible observations. The current study was conducted to explore existence of any such phenomenon (January effect) in Pakistan.MethodsThis retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, Pakistan. Five-year (2013–2018) record of all the patients in all age groups related to these outcomes was retrieved and recorded in specifically designed questionnaire. Different outcome measures were used as indicators of patient care and change in these outcomes at the time of new induction was related to possible January effect.ResultsDuring the five-year study period, more than 1100 new trainees were inducted into the post graduate medical education program (average of 237 per year) with more than 22,000 inpatient admissions (average of 45,469 per year). Some patterns were observed in frequencies of surgical site infections, medication errors, sentinel events, patient complaints, and adverse drug reactions. However, these were not consistently reproducible and could not be directly attributed to the trainee turnover. All other indicators did not show any pattern and were considered inconclusive. No effect of overlap was observed.ConclusionsInconsistency in the patient care quality indicators do not favor existence of January effect in our study. Further research is recommended to establish our results.

Let the Program Evaluation Committee SOAR: Applying the Strengths, Opportunities, Aspirations, and Results (SOAR) Framework for Program Evaluation.

Annual program evaluations are important activities of all graduate medical education programs. Although the Accreditation Council for Graduate Medical Education provides general guidelines, there is substantial scope for educational innovation. Strengths, opportunities, aspirations, and results (SOAR) is a strengths-based framework for strategic planning. Because SOAR emphasizes positivity and engagement, it is an appealing framework for evaluating graduate medical education programs. Our objective was to demonstrate the feasibility and acceptability of SOAR in a program evaluation committee of a fellowship program to generate strategic initiatives. The authors used the four steps of SOAR within the program evaluation committee in 2022. Interviewers collected positive stories to understand program strengths. Then, rapid ideation was used to translate strengths into opportunities. These opportunities were condensed and refined for fellows to assess how well they align with aspirations. The ones that aligned best with aspirations were prioritized for implementation. Results were monitored through a scorecard based on specific, measurable, achievable, relevant, and time-bound (SMART) goals every month. Of 15 divisional members, 11 participated (73.3%). Five major strengths were identified: supportive environment, variety of cases, scheduling flexibility, integration with larger networks, and multidisciplinary collaboration. These 5 yielded 15 opportunities, which were refined and condensed to 9. Four were selected for implementation: scholarly works accountability group, hybrid-flex curriculum, fellowship weekly huddles, and structured electives. Scorecards have shown successful implementation during a 4-month period. SOAR is an innovative and feasible approach to program evaluation that uses trainee engagement to translate and synergize existing program strengths into actionable program improvement.

Educator's blueprint: Holistic applicant file review in undergraduate and postgraduate medical education.

Medical schools and graduate medical education programs are tasked each year with selecting the next class of trainees, often from large applicant pools with enormous quantities of data to be processed. Review of applicant files must therefore be efficient, equitable, and effective in maximizing the likelihood of trainee success and alignment with institutional missions and values. In this article, we discuss 10 strategies to optimize the file review process for trainee selection. Using these strategies, educators can ensure rigorous and accountable file review processes for their training programs.

Implementing Holistic Review Practices in a Pulmonary and Critical Care Fellowship.

Medical schools have used holistic review in admissions to increase mission-aligned enrollment of students from backgrounds underrepresented in medicine. Graduate medical education programs have increasingly followed suit. However, there is a paucity of literature regarding holistic review at the fellowship level. Here, we share our experience implementing the Association of American Medical Colleges core principles of holistic review during the 2021 recruitment cycle. We used a partially asynchronous and online learning strategy to train division members on the principles of holistic review. Following the match, we conducted a survey of faculty members and fellows to understand their opinions on our holistic review training and implementation. Although few of our colleagues clearly understood holistic review before the training, they were able to identify broad-based criteria that aligned with our division's mission and balanced applicants' experiences, attributes, competencies, and metrics. These were viewed as better selection criteria than traditional measures and were incorporated into the individualized consideration of applicants. Our survey had a 41.5% response rate, with 10 of 22 fellows and 24 of 60 faculty members responding. Most faculty members and fellows agreed that holistic review decreases socioeconomic disparities in fellowship recruitment (79.2% and 80.0%, respectively) and promotes inclusion and diversity (83.3% and 90.0%, respectively). Faculty members appeared more confident than fellows that our training efforts had influenced recruitment. All respondents agreed that it would be critical for such training to be repeated yearly. Although this was a single-institution experience, implementing holistic review was feasible and well received by faculty and fellows.

Implementation and Maturity of Clinical Learning Environment Components Across Pediatric Residency Programs.

Pediatric residency programs prioritize clinical learning environment components depending on resource availability, institutional constraints and culture, and accreditation requirements. However, there is limited literature on the landscape of implementation and maturity of clinical learning environment components across programs nationally. We used Nordquist's clinical learning environment conceptual framework to craft a survey around the implementation and maturity of learning environment components. We performed a cross-sectional survey of all pediatric program directors enrolled in the Pediatric Resident Burnout-Resiliency Study Consortium. Components with the highest implementation rates were resident retreats, in-person social events, and career development, while components least likely to be implemented were scribes, onsite childcare, and hidden curriculum topics. The most mature components were resident retreats, anonymous systems for reporting patient safety events, and faculty-resident mentoring programs, while the least mature components were use of scribes and formalized mentorship for trainees underrepresented in medicine. Learning environment components included in the Accreditation Council of Graduate Medical Education Program Requirements were significantly more likely to be implemented and mature than nonrequired components. To our knowledge, this is the first study to use an iterative and expert process to provide extensive and granular data about learning environment components for pediatric residencies.

A Qualitative Exploration of Pediatric Resident Perceptions of Autonomy in the Era of Pediatric Hospital Medicine Fellowship

ObjectiveSome pediatric residents report experiencing less autonomy when working clinically with pediatric hospital medicine (PHM) fellows than with attendings alone. We sought to explore pediatric senior resident (SR) experiences working clinically with PHM fellows, with a focus on characterizing fellow behaviors that could impact perceived resident autonomy. MethodsIn this qualitative study, we conducted virtual semistructured interviews with pediatric SRs. We recorded, deidentified, and transcribed interviews for codebook thematic analysis, making iterative adjustments to our codebook and themes until reaching thematic sufficiency. ResultsWe conducted 17 interviews. A subanalysis identified key components of the resident mental model of autonomy, including independent clinical decision-making with 3 core qualifiers: 1) plan follow-through, 2) availability of a safety net, and 3) ownership. Our primary analysis identified 4 key themes (with a total of 7 contributory subthemes) describing resident experiences of autonomy, scaffolded based on an organizing framework adapted from Bronfenbrenner’s ecological model including 1) microsystem factors (based on direct resident-fellow or resident-leadership team interactions), 2) mesosystem factors (based on fellow-attending interactions), 3) exosystem factors (based on fellow-intrinsic characteristics), and 4) macrosystem factors (cultural values, norms, and policies governing academic pediatrics). ConclusionsMany factors impact perceived resident autonomy on PHM fellow-inclusive teams. Although some are related to direct resident-fellow interactions, many others are more complex and may reflect resident interactions with the leadership team, attending-fellow dynamics, and the influence of cultural context. Based on our analysis, we propose several best-practice recommendations directed at fellows, attendings, the fellow-attending dyad, and Graduate Medical Education programs overall.

The Teaching Health Center Graduate Medical Education Program: A Permanent Funding Imperative.

The Teaching Health Center Graduate Medical Education Program: A Permanent Funding Imperative.

Measuring the Learning Orientation Fostered by Pediatric Residency Programs With the Graduate Medical Education Learning Environment Inventory Instrument.

Mastery learning orientation, conceptualized as a growth mindset, can be beneficial to learners in medical education and is supported by a program's learning environment. Currently, there are no instruments which reliably assess the learning orientation of a graduate medical education program's learning environment. To explore the reliability and validity of the Graduate Medical Education Learning Environment Inventory (GME-LEI). Leaders of the Education in Pediatrics Across the Continuum (EPAC) project revised Krupat's Educational Climate Inventory to create the GME-LEI. We investigated the GME-LEI's reliability and validity through confirmatory factor and parallel factor analyses and calculated Cronbach's alpha for each subscale. We compared mean subscale scores between residents in traditional programs and the EPAC project. As EPAC is known to foster a mastery-focused learning orientation, we hypothesized differences detected between resident groups would strengthen the instrument's validity. One hundred and twenty-seven pediatric residents completed the GME-LEI. The final 3-factor model was an acceptable fit to the data, and Cronbach's alpha for each subscale was acceptable (Centrality: 0.87; Stress: 0.73; Support: 0.77). Mean scores on each subscale varied by program type (EPAC vs traditional) with EPAC residents reporting statistically significant higher scores in the Centrality of Learning subscale (2.03, SD 0.30, vs 1.79, SD 0.42; P=.023; scale of 1-4). The GME-LEI reliably measures 3 distinct aspects of the GME learning environment with respect to learning orientation. The GME-LEI may be used to help programs better monitor the learning environment and make changes to support mastery-oriented learning.

Resident perception of obstetrics and gynecology residency breast disease curriculum: a national study

As part of the education objectives in obstetrics and gynecology residency programs, the Council on Resident Education in Obstetrics and Gynecology includes benign breast disease and breast cancer screening, diagnosis, and management. However, obstetrics and gynecology residency curricula vary highly in their focus on this subject. The comfort level of the average obstetrics and gynecology resident in the United States in managing breast disease is unknown. This study aimed to examine the perspective of obstetrics and gynecology residents in the United States on their education and training in breast disease. An 18-question survey was distributed to all Accreditation Council for Graduate Medical Education program coordinators to distribute to their residents collect demographic information, training environment, and perspective on breast disease education. All statistical analysis was performed using SPSS (version 2.0; IBM Corporation, Armonk, NY). The survey was distributed to 241 programs, and a response was received from 28 programs (a program response rate of 12.0%). Based on the programs' response, there was a total of 582 eligible residents, and the survey was completed by 180 residents (a response rate of 31.0%). Of all responses, 121 residents (67.2%) did not have a dedicated breast disease rotation or clinical time. Most residents were uncomfortable with their education, training, and ability to manage benign breast disease (mean of 4.14 on a scale of 1-10). Most residents desired additional dedicated time to breast education during their obstetrics and gynecology training. The only variable associated with an improved resident comfort level for the management of breast disease was dedicated clinical time (relative risk [RR], 2.0; 95% confidence interval [CI], 0.04-1.45; P=.04). Obstetrics and gynecology residency programs should consider adding dedicated clinical time to breast disease to increase their residents' comfort with breast disease management.

Internally versus externally trained residents and fellows hired as attendings at a large integrated healthcare system: a 20-year retrospective study

BackgroundThere remains a question of whether graduates trained internally are different than those trained elsewhere. We examine the difference between physicians trained within our Graduate Medical Education (GME) programs versus physicians trained elsewhere. Our large integrated healthcare system is unique in addressing this objective due to its large physician labor hiring needs across different specialties of GME graduates.MethodsA retrospective review was performed from Jan 2000 to August 2020 of Kaiser Permanente Southern California (KPSC) physicians hired: KPSC GME trained versus non-KPSC GME trained. We examined five variables: retention, leadership (current or historical), physician relations cases, member appraisal of physician and provider services survey (MAPPS) scores, and rate of board certification. Chi-square test of proportions was used for comparison, p < 0.05 was significant.ResultsFrom Jan 2000 to August 2020, 2940 residents and fellows graduated from KPSC GME programs, of which 1127 (38%) were hired on at KPSC as full time attendings. Across all five metrics (Retention 82% vs 76% (p =  < 0.01), Leadership [current 13% vs 10% (p =  < 0.01)or historical 17% vs 14% (p = 0.01)], Physician Relations 23% vs 26% (p = 0.04), MAPPS 75% vs 69% (p =  < 0.01), and Board Certification 81% vs 74% (p =  < 0.01)), KPSC outperformed non-KPSC GME-trained physicians to a statistically significant degree.ConclusionsWe have shown that an internally sponsored GME program can represent an opportunity for recruitment of physicians that may have higher retention rates, higher probability of being physician leaders, decreased likelihood of physician relations issues, improved patient satisfaction, and increased rates of board certification.