Graduation Questionnaire Research Articles

Accelerated 3-Year MD Pathway Programs: Graduates' Perspectives on Education Quality, the Learning Environment, Residency Readiness, Debt, Burnout, and Career Plans.

PurposeTo compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans.MethodCustomized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools.ResultsGQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student–faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons).ConclusionsThese findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.

Rising Above our Reputation: Strategies to Improve the Learning Environment on the Birthing Unit

The learning environment during obstetrics and gynecology clerkship is often poorly perceived, routinely rated lowest on the AAMC’s Medical School Graduation Questionnaire. Similar experiences were reported at our institution, prompting initiatives for improvement, prioritizing our birthing unit (BU).

Pimping: Valuable Teaching Tool or Mistreatment? Perceptions of Medical Students and Faculty Differ.

ImportanceThe AAMC Graduate Questionnaire has drawn attention to medical student mistreatment. Pimping, a form of Socratic teaching often used in medical education where students are singled out by faculty for questioning, may be considered by some students and faculty as mistreatment. To date, minimal research has been performed on the viewpoints of students and faculty regarding pimping and its relation to mistreatment.&amp;nbsp;ObjectiveThis study aims to formally define pimping and determine if there is a difference in the perception of students and faculty on its role in medical education.Design: Medical students and faculty of Michigan medical schools were surveyed via electronic questionnaire. Chi-squared and Fisher’s exact tests were performed.SettingMedical schools within the state of Michigan&amp;nbsp;ParticipantsStudents who had completed their core clerkships and faculty with experience educating medical students in a clinical setting&amp;nbsp;ResultsThe student response rate was 42%; the faculty response rate could not be determined. The majority of students agreed with our operational definition of pimping and 100% had experienced pimping. 54% of students reported a positive experience with pimping, 26% neutral, and 20% reported a negative experience. The majority of students reported it was challenging and educational and should be used regularly. Several differences were found between students and faculty as to why faculty use pimping. Students’ perception of their role on the clinical care team influenced their perception of pimping as mistreatment, and students reported pimping made them feel more a part of the team.Conclusion and relevanceThis study helps to define pimping and sheds more light on the perceptions of pimping from students and faculty and their differences. Most medical students report a benefit from pimping, even though it may be stressful, and suggest it should be used regularly, which is in contrast to faculty opinion. Pimping may make students feel more a part of the clinical care team, but their role on the team may not influence whether they perceive it as mistreatment.&amp;nbsp; Our data suggest medical schools should educate students and faculty on pimping and not move toward discouraging or banning it.

Demographic Differences in Medical Students' Perceptions of Respect for Diversity Among Faculty.

Purpose: Faculty role modeling is critical to medical students’ professional development to provide culturally adept, patient-centered care. The behaviors displayed by faculty can directly influence students’ attitudes and behaviors and is considered a part of the “hidden curriculum.” 1 However, little is known about students’ perceptions of faculty role modeling of respect for diversity. The purpose of our study was to examine the perceptions of faculty role modeling of respect for diversity among a nationally representative sample of medical students and to assess the extent to which perceptions varied by student demographics. We hypothesized that students from historically marginalized groups (females; racial/ethnic minorities; and lesbian, gay, or bisexual [LGB]) and older students with greater lived experiences would be more likely to have a negative perception of faculty respect for diversity. Approach/Methods: This cross-sectional study analyzed data from respondents of the 2016 and 2017 Association of American Medical Colleges Graduate Questionnaire (AAMC-GQ). The AAMC-GQ surveyed graduating students at the 140 accredited allopathic U.S. medical schools with graduates as of 2017. Students’ responses from the GQ were linked to self-reported demographic data via AAMC data applications and services, including the American Medical College Application Service, Medical College Admissions Test, and Electronic Residency Application Service. Demographic variables included sex (male vs female), race/ethnicity, sexual orientation (heterosexual, LGB, or unknown), and age. Using multivariable logistic regression, we examined the extent to which student-reported faculty respect for diversity varied by demographic characteristics and sequentially adjusted all logistic regression models first for demographics then for marital status and financial variables. Results: The final study sample consisted of survey responses from 28,778 students, which represented 75.4% of the total 38,160 U.S. medical graduates in 2016 and 2017. Of 28,778 respondents, 48.6% were female, 5.2% identified as LGB. Most identified as White, 20.7% Asian, 5.1% as Black/African American, 8.5% Hispanic/Latinx, and 0.3% American Indian/Alaskan Native/Native Hawaiian or Pacific Islander (AIAN-NHOPI). Over a third (36.8%) of Black/African American students reported a lack of faculty respect for diversity compared with 14.4% of White students—a 3-fold higher odds of perceived lack of respect (OR, 3.24; 95% CI, 2.86–3.66) after adjusting for other demographics and covariates. AIAN-NHOPI (OR, 1.73; 95% CI, 1.03–2.92), Asian (OR, 1.62; 95% CI, 1.49–1.75), and Hispanic/Latinx (OR, 1.43; 95% CI, 1.26–1.75) students also had higher odds compared with White students, as did female compared with male students (OR, 1.17; 95% CI, 1.10–1.25), LGB (OR, 1.96; 95% CI, 1.74–2.22), and “unknown” sexual orientation (OR, 1.79; 95% CI, 1.29–2.47) compared with heterosexual students. Discussion: Over 1 in 6 medical students in our sample reported that faculty lacked respect for diversity. Medical students who identified as racial/ethnic minorities, females, LGB, and older students had higher odds of reporting that faculty lacked respect for diversity when compared with their majority counterparts. This perceived lack of respect for diversity may manifest itself during faculty–patient interactions. Gaps in patient–provider communication perpetuate health disparities and lead to higher levels of bias toward females, LGB, and racial/ethnic minority patients. 2–5 Our study also raises concern that for certain subgroups, a greater prevalence of the perceived lack of faculty respect for diversity may contribute to a more negative institutional psychological climate. Our findings support prior literature that negative faculty behavior contributes to the hidden curriculum. 1 Significance: This study’s findings highlight the need for medical schools, accrediting bodies, and leaders in academia to reaffirm their approach to creating an inclusive environment for all students. Students from marginalized groups disproportionately reported a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of trainees. Acknowledgments: Louisa Holaday, MD, and Joe Ross, MD, MHS (Yale School of Medicine), provided advice and nonfinancial support for this study. No compensation was given for these contributions.

Association of Demographic Factors and Medical School Experiences With Students’ Intention to Pursue a Surgical Specialty and Practice in Underserved Areas

The surgical workforce shortage is a threat to promoting health equity in medically underserved areas. Although the Health Resources and Services Administration and the American College of Surgeons have called to increase the surgical pipeline for trainees to mitigate this shortage, the demographic factors associated with students' intention to practice in underserved areas is unknown. To evaluate the association between students' demographics and medical school experiences with intention to pursue surgery and practice in underserved areas. This cross-sectional study surveyed graduating US allopathic medical students who matriculated between 2007-2008 and 2011-2012. Analysis began June 2020 and ended December 2020. Intention to pursue surgery and practice in underserved areas were retrieved from the Association of American Medical Colleges graduation questionnaire. Logistic regression models were constructed to evaluate (1) the association between demographic factors and medical students' intention to pursue surgical specialties vs medical specialties and (2) the association between demographic factors and medical school electives with intention to practice in underserved areas. Among 57 307 students who completed the graduation questionnaire, 48 096 (83.9%) had complete demographic data and were included in the study cohort. The mean (SD) age at matriculation was 23.4 (2.5) years. Compared with students who reported intent to pursue nonsurgical careers, a lower proportion of students who reported intent to pursue a surgical specialty identified as female (3264 [32.4%] vs 19 731 [51.9%]; χ2 P < .001). Multiracial Black and White students (adjusted odds ratio [aOR], 1.72; 95% CI, 1.11-2.65) were more likely to report an intent for surgery compared with White students. Among students who reported an intention to pursue surgery, Black/African American students (aOR, 3.24; 95% CI, 2.49-4.22), Hispanic students (aOR, 2.00; 95% CI, 1.61-2.47), multiracial Black and White students (aOR, 2.27; 95% CI, 1.03-5.01), and Indian/Pakistani students (aOR, 1.31; 95% CI, 1.02-1.69) were more likely than White students to report an intent to practice in underserved areas. Students who reported participating in community health (aOR, 1.61; 95% CI, 1.42-1.83) or global health (aOR, 1.83; 95% CI, 1.61-2.07) experiences were more likely to report an intention to practice in underserved areas. This study suggests that diversifying the surgical training pipeline and incorporating health disparity and community health in undergraduate or graduate medical education may promote students' motivation to practice in underserved areas.

Characteristics of medical students interested in emergency medicine with intention to practice in underserved areas.

Emergency departments serve a wide variety of racial, ethnic, socioeconomic, and gender backgrounds. It is currently unknown what characteristics of students who express interest in emergency medicine (EM) are associated with a simultaneous desire to work in medically underserved areas. We hypothesize that those who are underrepresented in medicine, are female, learn another language, and have more student debt will be more likely to practice in a medically underserved area. Data from the National Board of Medical Examiners, Association of American Medical Colleges (AAMC) Student Record System, and the AAMC Graduation Questionnaire were collected on a national cohort of 92,013 U.S. medical students who matriculated from 2007 through 2012. Extracted variables included planned practice area, intention to practice in underserved areas, race/ethnicity, sex, medical school experiences, age at matriculation, debt at graduation, and first-attempt USMLE Step 1score. EM-intending students who identified as female, non-Hispanic Black/African American, or Latinx/Hispanic; had a larger debt at graduation; had experiences with health education in the community; had global health experience; and had learned more than one language were more likely to report an intention to practice in underserved areas. With the increasing importance of physician diversity to match those of the community being served, this study identifies factors associated with a desire of EM students to work in underserved areas. Medical schools and EM residencies may wish to consider these factors in their admissions process.

Association of Characteristics of the Learning Environment and US Medical Student Burnout, Empathy, and Career Regret

Previous studies have shown that medical student mistreatment and burnout are common. However, few longitudinal data exist to describe how mistreatment and other learning environment experiences are associated with subsequent burnout and other student characteristics. To examine the association between mistreatment and perceptions of the learning environment with subsequent burnout, empathy, and career regret among US medical students. This cohort study analyzed data from the 2014-2016 Association of American Medical Colleges (AAMC) Medical School Year 2 Questionnaire (Y2Q) and 2016-2018 AAMC Graduation Questionnaire (GQ). Medical students from 140 allopathic medical schools who responded to both AAMC surveys were included in the analysis. Data were analyzed from December 1, 2019, to January 11, 2021. Self-reported medical student mistreatment (eg, experiences of negative behaviors and discrimination related to sex, race/ethnicity, and sexual orientation) and perceptions of the learning environment (Medical School Learning Environment Survey subscales for faculty, emotional climate, and student-student interactions). Burnout, empathy, and career regret as measured by Oldenburg Burnout Inventory data for burnout, Interpersonal Reactivity Index scores for empathy, and a single item assessing career regret. Data from 14 126 medical students were analyzed; 52.0% were women, and the mean (SD) age was 27.7 (2.9) years at graduation. Mistreatment was reported by 22.9% of respondents on the Y2Q. In multivariable analysis adjusted for Y2Q measures, mistreatment reported on the Y2Q was associated with a higher exhaustion score (1.81 [95% CI, 1.60-2.02]), a higher disengagement score (0.71 [95% CI, 0.58-0.84]), and higher likelihood of career regret on the GQ (186 of 989 [18.8%]; all P < .001). A more positive emotional climate reported on the Y2Q was associated with a lower exhaustion score (for each 1-point increase, -0.05 [95% CI, -0.08 to -0.02]; P = .001) and lower disengagement score (for each 1-point increase, -0.04 [95% CI, -0.06 to -0.02]; P < .001) on the GQ. More positive faculty interactions on the Y2Q were associated with higher empathy score on the GQ (for each 1-point increase, 0.02 [95% CI, 0.01-0.05]; P = .04). Better student-student interactions were associated with lower odds of career regret during year 4 of medical school (odds ratio for each 1-point increase, 0.97 [95% CI, 0.95-1.00]; P = .04). The findings of this cohort study suggest that medical students who experienced mistreatment and perceived the learning environment less favorably were more likely to develop higher levels of exhaustion and disengagement, lower levels of empathy, and career regret compared with medical students with more positive experiences. Strategies to improve student well-being, empathy, and experience should include approaches to eliminate mistreatment and improve the learning environment.

ENHANCING PROFESSIONAL COMPENENCE OF PHARMACEUTICAL STUDENTS IN THE ACADEMIC ENGLISH COURSE

The paper presents the ideas on integration of English language academic writing into the training of Mater of Pharmacy students. The academic literature demonstrates a powerful didactic potential for the development of both language and professional competence of students majoring in pharmacy. This fact is evidenced by the empirical study that demonstrates the finding reflected in students’ graduation academic project performance. As a measurement tools we employed assessment rubrics of the graduate project, content analysis and questionnaire on teachers’ feedback. The participants of the study were students from the Pharmacy faculty and teachers of English for Academic Purposes in cooperation with teachers of pharmacy. Together they outlined the criteria for the texts selection. According to the results, students mastered not only academic writing skills, but also the skills of information processing and evaluation, critical thinking, presentation of information and academic integrity. The paper also presents methodological recommendations on academic texts selection for pharmaceutical students and forms of teachingacademic writing to students of non-linguistic specialties. The results of the study allow to draw the conclusion academic writing course will enhance professional competence and reduce students’ misinterpreting of academic language.

A survey of midwifery graduates\u2019 opinions about midwifery education in Iran: a cross-sectional study

BackgroundAttaining high-quality education requires continuous evaluation and revision of the curriculum. The view of the graduate students can provide valuable insight into the necessary evaluations and revisions. Therefore, this study aimed to evaluate the opinions of midwifery graduates about midwifery education in IranMethodsThis was a descriptive cross-sectional study and the research data were collected through a census sampling procedure from all (82) midwifery graduates of the Nursing and Midwifery School of Shiraz University of Medical Sciences between 2018 and 2020. The data collection instrument was a validated researcher-made questionnaire derived from the Graduation Questionnaire (GQ) developed by the Association of American Medical Colleges (AAMC). The data were then analyzed using SPSS 22.ResultsIn this study, about 62% of the graduates were satisfied with the quality of the midwifery education they had received during the four-year program. Moreover, 61% of the graduates maintained that theoretical courses were well-integrated with the clinical experience they needed. The quality of the internships in different wards and departments was also evaluated from the viewpoints of the graduates, and the results indicated that they were relatively satisfied with their internship experiences. However, only 40% of the graduates were satisfied with the quality of their clinical evaluation, since they faced the most significant challenges in the clinical and maternity wards (47%) with the midwifery staff and gynecology residents and found the quality of facilities in the clinical program to be lacking. According to the participants, the quality of teaching was not good for some courses such as biochemistry and microbiology.ConclusionIt seems that the midwifery curriculum needs to be constantly revised, aiming to improve student satisfaction with their midwifery education. Some effective measures in this regard are employing experienced professors, developing cooperation between midwifery instructors and clinical departments, and trying to improve the educational environment. Attention to the improvement of facilities and equipment and agreement between the content of the theoretical education and practical topics are also recommended to improve the quality of midwifery education.

Medical Students’ Demographic Characteristics and Their Perceptions of Faculty Role Modeling of Respect for Diversity

Faculty role modeling is critical to medical students' professional development to provide culturally adept, patient-centered care. However, little is known about students' perceptions of faculty role modeling of respect for diversity. To examine whether variation exists in medical students' perceptions of faculty role modeling of respect for diversity by student demographic characteristics. This cross-sectional study analyzed data from the Association of American Medical Colleges' 2016 and 2017 Medical School Graduation Questionnaire, which was administered to graduating students at 140 accredited allopathic US medical schools. Data were analyzed from January 1 to November 1, 2020. Students' perceptions of faculty role modeling of respect for diversity by the independent variables sex, race/ethnicity, sexual orientation, and age. Multivariable logistic regression was used to examine the extent to which student-reported perceptions of faculty respect for diversity varied by demographic characteristics, and logistic regression models were sequentially adjusted first for demographic characteristics and then for marital status and financial variables. Of 30 651 students who completed the survey, the final study sample consisted of 28 778 respondents, representing 75.4% of the 38 160 total US medical school graduates in 2016 and 2017. Of the respondents, 14 804 (51.4%) were male participants and 1506 (5.2%) identified as lesbian, gay, or bisexual (LGB); a total of 11 926 respondents (41.4%) were 26 years or younger. A total of 17 159 respondents (59.6%) identified as White, 5958 (20.7%) as Asian, 1469 (5.1%) as Black/African American, 2431 (8.4%) as Hispanic/Latinx, and 87 (0.3%) as American Indian/Alaska Native/Native Hawaiian/Pacific Islander individuals. Overall, 5101 students (17.7%) reported perceiving that faculty showed a lack of respect for diversity. Of those who identified as Black/African American students, 540 (36.8%) reported perceiving a lack of faculty respect for diversity compared with 2468 White students (14.4%), with an OR of perceived lack of respect of 3.24 (95% CI, 2.86-3.66) after adjusting for other demographic characteristics and covariates. American Indian/Alaska Native/Native Hawaiian/Pacific Islander (OR, 1.73; 95% CI, 1.03-2.92), Asian (OR, 1.62; 95% CI, 1.49-1.75), or Hispanic/Latinx (OR, 1.43; 95% CI, 1.26-1.75) students also had greater odds of perceiving a lack of faculty respect for diversity compared with White students. Female students had greater odds compared with male students (OR, 1.17; 95% CI, 1.10-1.25), and students who identified as LGB (OR, 1.96; 95% CI, 1.74-2.22) or unknown sexual orientation (OR, 1.79; 95% CI, 1.29-2.47) had greater odds compared with heterosexual students. Students aged 33 years or older had greater odds of reporting a perceived lack of respect compared with students aged 26 years or younger (OR, 1.81; 95% CI, 1.58-2.08). In this cross-sectional study, female students, students belonging to racial/ethnic minority groups, and LGB students disproportionately reported perceiving a lack of respect for diversity among faculty, which has important implications for patient care, the learning environment, and the well-being of medical trainees.

Medical Pharmacology Education at a Crossroads: Looking in a Future Direction

Introduction After more than a year of pharmacology delivery through a virtual curriculum to help prepare medical students to successfully complete the USMLE Step-1 and/or COMLEX Level-1 (for osteopathic medical students), these high stakes board exams will transition to a Pass/Fail system in 2022. To reflect on the effectiveness of the pharmacology educational approaches used before and after the rapid implementation of emergency remote teaching, board results outcomes, faculty student evaluations and student feedback were reviewed and compared to results from national satisfaction instruments during the past decade. Our hypothesis is that satisfaction with the pre-clerkship pharmacology instruction will increase during the clerkship years as measured by the satisfaction instruments after graduation. Methods The aggregate data published between 2010-2020 by national satisfaction instruments including: 1) Academic Year Graduating Seniors Survey Report published by the AACOM and 2) All-Schools Summary Report Medical School Graduation Questionnaire published by the AAMC, was used to develop a construct of satisfaction scores in pharmacology. Pharmacology faculty student evaluations from the Alabama College of Osteopathic Medicine were analyzed using a thematic analysis method for student satisfaction. Class performance outcomes on boards were also analyzed. Results The population of medical students graduating has increased over the past decade, and national satisfaction instruments show that satisfaction of pharmacology instruction amongst the medical graduates also increased with the highest satisfaction score achieved in 2019 (2.13) and 2020 (2.14) compared to the lowest achieved in 2012 (1.97). Similarly, more osteopathic medical graduates agreed that instruction of clinical pharmacology was appropriate in 2019 (85%) compared to the lowest in 2011 (75%) (data from 2020 not yet available). Conclusions Pre-clerkship student satisfaction can be difficult to assess during a very stressful period, especially before the boards. Pharmacology teaching is more intense, and in our institution, it has yielded positive outcomes in board passing rates. In March of 2020, pharmacology faculty were faced with the challenge of rapidly transitioning into emergency remote teaching due to the Covid-19 pandemic. This pandemic will likely continue to disrupt medical education well into the end of 2021, just before the USMLE Step-1/COMLEX Level-1 boards implement the pass/fail grading system. With all these changes and disruptions, pharmacology education is at a crossroads and it hinges on the future direction.

The Influencing Factors of Gender Differences on Mental Burdens in Young Physiotherapists and Occupational Therapist

Background: Gender differences in personal discrimination experience, burnout, and job stress among physiotherapists and occupational therapists are considered as associated factors of job loss, poor job quality, high turnover, and economic losses due to the outflow of medical personnel. Thus, the purpose of this study is to analyze the level of burnout, personal discrimination experience, and job stress according to gender differences for young physiotherapists and occupational therapists. Furthermore, we used regression analyses to determine the contribution of gender differences in personal discrimination experience and job stress to self-reported burnout, considering gender and two age groups (younger than 30 years old vs. 30 years old and over). Methods: A total of 325 professional physiotherapists and occupational therapists were part of this study (n = 325; male n = 131; female n = 194. Age: 20–29 years old, n = 178; ≥30 years old, n = 147). Data were collected using a questionnaire including our three study variables (scales: the Maslach Burnout Inventory (MBI), a modified version of the gender section of the Medical School Graduation Questionnaire from the Association of American Medical Colleges; and the Korean version of the Job Content Questionnaire (JCQ)). Further, data on socio-demographic factors, job-related factors, health-related factors, and subjective job satisfaction were also collected. Results: There were significant positive correlations between job stress and gender differences in personal discrimination experience and job stress and burnout in women 30 years old and over. Personal experience of gender discrimination (β = 0.179, p = 0.015) and job stress (β = 0.162, p = 0.028) explained a significant 42.4% of the variance in burnout in the case of younger female participants (20–29 years old). However, this model did not explain a significant amount of the variance in burnout in the case of younger male participants (R2 = 0.156, p = 0.072). Regarding participants aged 30 years and over, our results showed that only job stress (but no personal experience of gender discrimination) was a relevant predictor for both males (β = 0.471, p < 0.001) and females (β = 0.373, p = 0.001). Conclusion: In this study, female therapists showed higher levels of burnout than male therapists. In particular, personal discrimination experience and job stress significantly contributed to burnout in younger female therapists while job stress was the most relevant predictor variable of burnout for both males (under 30 years old and 30 years old and over) and females in their thirties and beyond. For young female physiotherapists and occupational therapists, safe working environments should be created to reduce work-related mental burdens. It is also necessary to consider policies and regulations that can prevent job stress for therapists and measures that can positively resolve the unavoidable job stress.

National Survey of Wellness Programs in U.S. and Canadian Medical Schools.

To describe the prevalence and scope of wellness programs at U.S. and Canadian medical schools. In July 2019, the authors surveyed 159 U.S. and Canadian medical schools regarding the prevalence, structure, and scope of their wellness programs. They inquired about the scope of programming, mental health initiatives, and evaluation strategies. Of the 159 schools, 104 responded (65%). Ninety schools (93%, 90/97) had a formal wellness program, and across 75 schools, the mean full-time equivalent (FTE) support for leadership was 0.77 (standard deviation [SD] 0.76). The wellness budget did not correlate with school type or size (respectively, P = .24 and P = .88). Most schools reported adequate preventative programming (62%, 53/85), reactive programming (86%, 73/85), and cultural programming (52%, 44/85), but most reported too little focus on structural programming (56%, 48/85). The most commonly reported barrier was lack of financial support (52%, 45/86), followed by lack of administrative support (35%, 30/86). Most schools (65%, 55/84) reported in-house mental health professionals with dedicated time to see medical students; across 43 schools, overall mean FTE for mental health professions was 1.62 (SD 1.41) and mean FTE per student enrolled was 0.0024 (SD 0.0019). Most schools (62%, 52/84) evaluated their wellness programs; they used the Association of American Medical Colleges Graduation Questionnaire (83%, 43/52) and/or annual student surveys (62%, 32/52). The most commonly reported barrier to evaluation was lack of time (54%, 45/84), followed by lack of administrative support (43%, 36/84). Wellness programs are widely established at U.S. and Canadian medical schools, and most focus on preventative and reactive programming, as opposed to structural programming. Rigorous evaluation of the effectiveness of programs on student well-being is needed to inform resource allocation and program development. Schools should ensure adequate financial and administrative support to promote students' well-being and success.

Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students

Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)-accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.

Ophthalmology Departments Remain Among the Least Diverse Clinical Departments at United States Medical Schools

The current demographics of the ophthalmology workforce do not reflect the diverse United States population, which has implications for addressing health disparities. The demographics of ophthalmology department faculty may influence the recruitment of underrepresented students into the field. This study sought to determine how the racial and ethnic demographics of ophthalmology department faculty compare with those of other clinical departments at United States medical schools. Secondary data analysis of medical school faculty demographic data from the 2019 American Association of Medical Colleges (AAMC) Faculty Roster. Clinical faculty and department chairs at United States medical schools. We analyzed the racial and ethnic demographics of clinical department faculty and department chairpersons using data from the 2019 AAMC Faculty Roster. We calculated the proportion of underrepresented minority (URM) faculty in ophthalmology and in 17 other clinical departments. We analyzed these data for statistically significant differences between ophthalmology and other clinical departments. In addition, we compared the percentage of URM ophthalmology faculty with the proportion of URM persons among graduating United States medical students and in the United States population using data from the Medical School Graduation Questionnaire and the United States census, respectively. The proportion of URM persons, defined as Black, Hispanic or Latino, Native American, or Native Hawaiian or Pacific Islander among clinical faculty and department chairs. Ophthalmology faculty are less racially and ethnically diverse than graduating medical students and the general United States population. When compared with 17 other clinical departments, ophthalmology has the third-lowest proportion of URM faculty, with only radiology and orthopedic surgery having a smaller proportion of URM faculty. These differences were statistically significant in most departments (12 of 18). No statistically significant difference was found in the proportion of URM department chairs in ophthalmology compared with most other clinical departments, although the absolute number of URM chairs in ophthalmology is low at only 8 chairpersons. More work must be done to increase the recruitment of URM physicians into ophthalmology faculty positions to obtain parity with other clinical departments and with the diverse patient populations that physicians serve.

Training Medical Students as Peer-Facilitators to Identify Medical Student Mistreatment in the Clerkship Year.

IntroductionData from the Association of American Medical Colleges' Medical School Graduation Questionnaire show persistent trends of medical student mistreatment nationwide. To reduce the barriers and increase actionable reporting of mistreatment, we integrated peer-facilitated learning environment sessions led by a group of trained third- and fourth-year medical students in all core clinical clerkships.MethodsDuring the 2018–2019 academic year, third-year medical students were recruited, oriented, and trained to act as facilitators of sessions on mistreatment. The sessions occurred once every clerkship block, using a standardized session introduction and guide. After a 6-month pilot, new medical students were recruited and worked as scribe/facilitator pairs, receiving an additional 1.5-hour training midyear, which was evaluated with a postworkshop survey.ResultsThirty-eight students implemented 43 peer-facilitated sessions and completed deidentified minutes of each session, which were shared with clerkship directors and the Medical Education Office for review. Survey data from midyear facilitator training indicated that facilitators highly agreed peer-led sessions were an important avenue for students to process experiences of mistreatment (3.9 out of 4), understood barriers to reporting (3.8 out of 4) and definitions of mistreatment (3.6 out of 4), and felt confident to facilitate these sessions (3.6 out of 4).DiscussionPeer-facilitated sessions offer a method to learn more about student experiences with mistreatment in real time and create a new avenue for communication between faculty and students. Assembling a stable core team of third- and fourth-year students trained in facilitation skills ensures the sustainability and relevance of the program.

Calibration Bias and the Interpretation of Clinical Learning Environment Perceptions Surveys.

The clinical learning environment (CLE) is frequently assessed using perceptions surveys, such as the AAMC Graduation Questionnaire and ACGME Resident/Fellow Survey. However, these survey responses often capture subjective factors not directly related to the trainee's CLE experiences. The authors aimed to assess these subjective factors as "calibration bias" and show how it varies by health professions education discipline, and co-varies by program, patient-mix, and trainee factors. We measured calibration bias using 2011-2017 US Department of Veterans Affairs (VA) Learners' Perceptions Survey data to compare medical students and physician residents and fellows (n = 32 830) with nursing (n = 29 758) and allied and associated health (n = 27 092) trainees. Compared to their physician counterparts, nursing trainees (OR 1.31, 95% CI 1.22-1.40) and allied/associated health trainees (1.18, 1.12-1.24) tended to overrate their CLE experiences. Across disciplines, respondents tended to overrate CLEs when reporting 1 higher level (of 5) of psychological safety (3.62, 3.52-3.73), 1 SD more time in the CLE (1.05, 1.04-1.07), female gender (1.13, 1.10-1.16), 1 of 7 lower academic level (0.95, 1.04-1.07), and having seen the lowest tercile of patients for their respective discipline who lacked social support (1.16, 1.12-1.21) and had low income (1.05, 1.01-1.09), co-occurring addictions (1.06, 1.02-1.10), and mental illness (1.06, 1.02-1.10). Accounting for calibration bias when using perception survey scores is important to better understand physician trainees and the complex clinical learning environments in which they train.

Incidence of resident mistreatment in the learning environment across three institutions

Introduction Mistreatment in the learning environment is associated with negative outcomes for trainees. While the Association of American Medical Colleges (AAMC) annual Graduation Questionnaire (GQ) has collected medical student reports of mistreatment for a decade, there is not a similar nationally benchmarked survey for residents. The objective of this study is to explore the prevalence of resident experiences with mistreatment. Methods Residents at three academic institutions were surveyed using questions similar to the GQ in 2018. Quantitative data were analyzed based on frequency and Mann-Whitney U tests to detect gender differences. Results Nine hundred ninety-six of 2682 residents (37.1%) responded to the survey. Thirty-nine percent of residents reported experiencing at least one incident of mistreatment. The highest reported incidents were public humiliation (23.7%) and subject to offensive sexist remarks/comments (16.0%). Female residents indicated experiencing significantly more incidents of public embarrassment, public humiliation, offensive sexist remarks, lower evaluations based on gender, denied opportunities for training or rewards, and unwanted sexual advances. Faculty were the most frequent instigators of mistreatment (66.4%). Of trainees who reported experiencing mistreatment, less than one-quarter reported the behavior. Conclusion Mistreatment in the academic learning environment is a concern in residency programs. There is increased frequency among female residents.

Factors Influencing the Commitment of Students to Radiology as a Career Choice During Medical School Education

The purpose of this study is to analyze the significance of specific factors in choosing radiology as a specialty compared to switching to/from a different specialty as reported in the Graduation Questionnaire (GQ) and Matriculating Student Questionnaire (MSQ) data provided by Association of American Medical Colleges. The study cohort included students who completed both the MSQ and GQ questionnaires in the span of 3-5 years. The cohort was divided into three groups-"Committed" (students who chose radiology in both the first and final year of medical school), "Switched Away" (students who chose radiology on the MSQ but later switched to a different specialty, and "Switched-To" (students who chose radiology on GQ after initially selecting an alternate specialty on the MSQ). Of 1965 students who chose radiology between the years 2013 and 2016, 281 were Committed, 625 Switched-Away, and 1059 Switched-To. There were significant differences among the groups for salary, length of residency, and work-life balance factors. In the Switched-Away group, more students were influenced by length of residency (18% vs. 5%, p < 0.001) and fewer were influenced by salary (21% vs. 30%, p=0.004) or work-life balance (54% vs. 66%, p = 0.001) when compared to the Committed group. The Switched-To group did not significantly differ from the Committed group (all p > 0.05) for length of residency (6% vs. 5%), salary (30% vs. 30%) and work-life balance (69% vs. 66%). The data provide insight into factors that influence medical students to initially commit to, switch away from, and switch to radiology during medical school. Understanding these dynamics can inform mentors to guide medical students who are interested in a radiology career.

University of North Dakota School of Medicine and Health Sciences.

University of North Dakota School of Medicine and Health Sciences.