International Medical Graduate Status Research Articles

Comparison Between Surgical Trainee Self-Assessment With Supervisor Scores in Technical and Nontechnical Skills to Identify Underperforming Trainees

This study aims to compare trainee self-assessment with supervisor assessment to identify differences in correlations of the demographic data and evaluate whether the instrument can be utilized to identify underperforming trainees. A novel instrument was designed based off the Royal Australasian College of Surgeons original 9 competencies utilizing the JDocs framework and covers 48-items across all surgical competencies. A multiple regression model using age, gender, postgraduate year, IMG status, and level of training as the variables was performed with backwards elimination, and pairwise comparisons made to identify the degree and direction of influence each variable contributed to trainee and supervisor ratings. Surgical trainees employed in tertiary centers within the Australian Capital Territory and South-East New South Wales health network in Australia. A total of 36 of 59 (61%) trainees responded. Two grossly incomplete responses were excluded from further analysis resulting in 34 completed self-assessments for analysis. There was a total of 68 supervisor assessments provided by 25 different nominated supervisors. Of these assessments, 67 were fully completed and one was partially complete. We identified that for both self-ratings and supervisor ratings, the most significant correlation is with the postgraduate year of the trainee, with correlation identified in 7 out of 9 competencies, although in different competency domains. International Medical Graduate status is associated in 2 of 9 self-ratings, and in 3 of 9 supervisor ratings. Underperforming trainees were able to be identified through supervisor assessment but not self-assessment. The supervisor assessment form was able to identify underperforming trainees. Our findings resonate with existing literature in other specialty fields, and surgical units that employ assessment forms should feel more confident in the interpretation of the data and provision of feedback to trainees.

Factors associated with emergency physician income.

Income fairness is important, but there are limited data that describe income equity among emergency physicians. Understanding the magnitude of and factors associated with income differences may be helpful in eliminating disparities. This study analyzed the associations of demographic factors, training, practice setting, and board certification with emergency physician income. We distributed a survey to professional members of the American College of Emergency Physicians. The survey included questions on annual income, educational background, practice characteristics, gender, age, race, ethnicity, international medical graduate status, type of medical degree (MD vs DO), completion of a subspecialty fellowship, job characteristics, and board certification. Respondents also reported annual income. We used linear regression to determine the respondent characteristics associated with reported annual income. From 45,961 members we received 3407 responses (7.4%); 2350 contained complete data for regression analysis. The mean reported annual income was $315,306 (95% confidence interval [CI], $310,649 to $319,964). The mean age of the respondents was 47.4 years, 37.4% were women, 3.2% were races underrepresented in medicine (Black, American Indian, or Alaskan Native), and 4.8% were Hispanic or Latino. On linear regression, female gender was associated with lower reported annual income; difference -$43,565, 95% CI, -$52,217 to -$34,913. Physician age, degree (MD vs DO), underrepresented racial minority status, and underrepresented ethnic minority status were not associated with annual income. Fellowship training was associated with lower income; Accreditation Council for Graduate Medical Education (ACGME) program difference -$30,048; 95% CI, -$48,183 to -$11,912, non-ACGME-program difference -$27,640, 95% CI, -$40,970 to -$14,257. Working at a for-profit institution was associated with higher income; difference $12,290, 95% CI, $3693 to $20,888. Board certification was associated with higher income; difference, $43,267, 95% CI, $30,767 to $55,767. This study identified income disparities associated with gender, practice setting, fellowship completion, and American Board of Emergency Medicine or American Osteopathic Board of Emergency Medicine certification.

Diversity, equity, and inclusion within the Society for Pediatric Anesthesia: A mixed methods assessment.

Leadership of the Society for Pediatric Anesthesia created the Diversity, Equity, and Inclusion committee in 2018 to prioritize diversity work. The Society for Pediatric Anesthesia-Diversity, Equity, and Inclusion committee implemented a baseline survey of the Society for Pediatric Anesthesia membership in 2020 to assess demographics, equity in leadership, inclusivity, and attitudes toward diversity work. The Society for Pediatric Anesthesia plays a significant role in shaping the future of pediatric anesthesiology and in supporting our diverse pediatric patients. This study is an IRB-exempt, cross-sectional survey of the Society for Pediatric Anesthesia membership. Quantitative analysis provided descriptive statistics of demographics, practice characteristics, and involvement within the Society for Pediatric Anesthesia. Qualitative thematic analysis provided an in-depth assessment of perceptions of diversity, challenges faced, and prioritization of Diversity, Equity, and Inclusion efforts within the Society for Pediatric Anesthesia. Out of 3 242 Society for Pediatric Anesthesia members, 1 232 completed the survey representing 38% of overall membership. Respondents were 89.2% United States members, 52.7% female, 55.7% non-Hispanic White, 88.6% heterosexual, 95.7% non-military, 59.2% religious, and 2.1% have an Americans with Disabilities Act recognized disability. All major United States geographical areas were represented equally with 71% practicing in urban areas and 67% in academic settings. Ethnic/racial minorities were more likely to be international medical graduates (p< .001). Among United States members, 41.5% report being fluent in a language other than English, and 23.5% of those fluent in another language are certified to interpret. Compared to men, women are less likely to be in leadership roles (p< .003), but we found no difference in participation and leadership when stratified by race/ethnicity, geography, international medical graduate status, or sexuality. Racial/ethnic minorities (p< .028), women (p< .001), and lesbian, gay, bisexual, transgender, and queer members (p< .044) more frequently hold lower academic rank positions when compared to white, heterosexual, and male members. Half of respondents were unsure whether diversity, equity, and inclusion challenges existed within the Society for Pediatric Anesthesia while the other half demonstrated opposing views. Among those who reported diversity, equity, and inclusion challenges, the themes centered around persistent marginalization, the need for more inclusive policies and increased psychological safety, and lack of leadership diversity. Compared to the diversity of the pediatric population we serve, there are still significant gaps in demographic representation within the Society for Pediatric Anesthesia. As well, there is no consensus among Society for Pediatric Anesthesia membership regarding perceptions of diversity, equity, and inclusion in pediatric anesthesia in the United States. Among those who reported diversity challenges, opportunities for the Society for Pediatric Anesthesia and Anesthesiology Departments to better support minoritized members included bolstering workforce diversity efforts and awareness via more inclusive policies, improved psychological safety, and increasing diversity in leadership. If pediatric anesthesiology is like other specialties, gaining consensus and improving diversity in the workforce might advance pediatric anesthesia innovation, quality, and safety for children of all backgrounds in the United States.

Characterization of Applicant Preference Signals, Invitations for Interviews, and Inclusion on Match Lists for Residency Positions in Urology

Preference signals were to be implemented in over 15 specialties during the 2022-2023 residency match. Analyzing results from the implementation of signals during the American Urological Association (AUA) urology match may inform future behavior. To characterize applicant and program signal usage and results in the Society of Academic Urology and AUA databases with respect to interview invites and rank list creation. This cohort study involved all applicants and residencies in the 2021-2022 AUA match with data analysis conducted in April through July 2022. Five signals indicating interest. Using verified match and survey data reported by applicants and programs, a logistic regression was performed on applicant factors associated with obtaining an interview-the main outcome (using inclusion on rank list as a proxy): age, gender, degree (MD or DO), dispersal of signal, US senior status, racial minority group status, Latino ethnicity, international medical graduate status, presence of a home program, AUA geographic section, and US Medical Licensing Examination Step 1 score. Applicant signal dispersal strategies were stratified by applicant and program competitiveness, as well as program behavior upon receipt of signal with respect to extending interviews and rank list ordering of applicants. A total of 2659 signals were sent by 553 candidates (mean [SD] age, 27.4 [2.9] years; 179 female [32.4%], 243 racial minority candidates [61.2%]) submitting rank lists for 364 positions at 143 programs. Programs received a median (IQR) of 352 (295-411) applications and were signaled to a median of 16 (8-26) times each. In a logistic regression estimating interview status, geographic proximity (OR, 3.25; 95% CI, 2.05-5.15; P = .001) and signal status (OR, 6.04; 95% CI, 3.50-10.40; P < .001) were associated with receiving an interview. Using multiple imputation by chained equations to impute missing data and broadening the data set, male gender (OR, 0.64; 95% CI, 0.45-0.92; P = .04) and international medical graduate status (OR, 0.35; 95% CI, 0.15-0.81; P = .04) were negative variables, while MD degree (OR, 2.36; 95% CI, 1.27-4.36; P = .02) and US senior status (OR, 1.91; 95% CI, 1.13-3.23; P = .04) were positive variables. This study of the usage and trends of the newly added preference signals reported the most common strategies for signal dispersal; in an analysis of factors involved in obtaining an interview, geographic similarity between applicant and program and preference signal usage were associated with successful applications.

A Bibliometric Analysis of Ophthalmology Resident Research Productivity in the United States.

Background The extent and impact of ophthalmology resident scholarly output is not well known. The authors aim to quantify scholarly activity of ophthalmology residents during residency and assess what factors may be associated with greater research productivity of these residents. Material and Methods Ophthalmology residents who graduated in 2021 were identified from their respective program Web sites. Bibliometric data published by these residents between the beginning of their postgraduate year 2 (July 1, 2018) until 3 months after graduation (September 30, 2021) were captured through searches via PubMed, Scopus, and Google Scholar. The association of the following factors with greater research productivity numbers was analyzed: residency tier, medical school rank, sex, doctorate degree, type of medical degree, and international medical graduate status. Results We found 418 ophthalmology residents from 98 residency programs. These residents published a mean (±standard deviation [SD]) number of 2.68 ± 3.81 peer-reviewed publications, 2.39 ± 3.40 ophthalmology-related publications, and 1.18 ± 1.96 first-author publications each. The mean (±SD) Hirsch index (h-index) for this cohort was 0.79 ± 1.17. Upon multivariate analysis, we discovered significant correlations between both residency tier and medical school rank and all bibliometric variables assessed. Pairwise comparisons revealed that residents from higher tier programs had greater research productivity numbers than those from lower tier programs. Conclusion We obtained bibliometric standards for ophthalmology residents on a national scale. Residents who graduated from higher-ranked residency programs and medical schools possessed higher h-indices and published more peer-reviewed publications, ophthalmology-related articles, and first-author publications.

Development of a novel behaviourally anchored instrument for the assessment of surgical trainees.

BackgroundThe Royal Australasian College of Surgeons (RACS) created its competency framework in 2003 which initially consisted of nine competencies each regarded as equally important for a practising surgeon. The JDocs Framework is aligned to these competencies and provides guidance for junior doctors working towards the Surgical Education and Training program.MethodsA novel assessment instrument was designed around the JDocs framework using 48 behaviourally anchored questions. The study was completed in 2020 across five public hospitals in the ACT and NSW. Participants were invited to complete the self‐assessment form online.ResultsThirty‐six of 59 (61%) trainees participated in the study, with 67 of 68 (98.5%) supervisors having completed the assessment form. Trainee self‐rating scores were lower than that of supervisor ratings across all competencies except communication. The self‐rating scores were negatively correlated with the seniority of a trainee's level in all nine competencies. The years of post‐graduate experience was positively correlated with seven of the nine competencies. For gender and International Medical Graduate status, correlation was only identified for health advocacy and medical expertise. There was no correlation identified with a trainee's age.ConclusionThis pilot study has provided an opportunity to explore a new assessment instrument for surgical trainees that is aligned to the RACS competency framework using behaviourally anchored questions. Looking ahead, a better understanding of this instrument will potentially be helpful in early identification of underperforming trainees in order to facilitate early intervention, or its use as a selection tool for formal training programs.

Burnout Among Nephrologists in the United States: A Survey Study

Rationale & ObjectiveBurnout decreases job satisfaction and leads to poor patient outcomes but remains underinvestigated in nephrology. We explored the prevalence and determinants of burnout among a sample of nephrologists.Study DesignCross-sectional.Setting & ParticipantsThe nephrologists were approached via the American Medical Association Physicians Masterfile, National Kidney Foundation listserv, email, and social media between April and August 2019. The predictors were demographics and practice characteristics. The outcome was burnout, defined as responding “once a week” or more on either 1 of the 2 validated measures of emotional exhaustion and depersonalization or both.Analytical ApproachParticipant characteristics were tabulated. Responses were compared using χ2 tests. Multivariable logistic regression was used to estimate the odds ratios (ORs) of burnout for risk factors. Free text responses were thematically analyzed.ResultsAbout half of 457 respondents were 40-59 years old (n=225; 49.2%), and the respondents were more predominantly men (n=296; 64.8%), US medical graduates (n=285; 62.4%), and in academic practice (n=286; 62.6%). Overall, 106 (23.2%) reported burnout. The most commonly reported primary drivers of burnout were the number of hours worked (n=27; 25.5%) and electronic health record requirements (n=26; 24.5%). Caring for ≤25 versus 26-75 patients per week (OR, 0.34; 95% confidence interval [95% CI], 0.15-0.77), practicing in academic versus nonacademic settings (OR, 0.33; 95% CI, 0.21-0.54), and spending time on other responsibilities versus patient care (OR, 0.32; 95% CI, 0.17-0.61) were each independently associated with nearly 70% lower odds of burnout after adjusting for age, sex, race, and international medical graduate status. The free text responses emphasized disinterested health care systems and dissatisfaction with remuneration as the drivers of burnout.LimitationsInability to precisely capture response rate.ConclusionsNearly one-quarter of the nephrologists in our sample reported burnout. Future studies should qualitatively investigate how the care setting, time spent on electronic medical records, and hours of clinical care drive burnout and explore other system-level drivers of burnout in nephrology.

The American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA): Validity Evidence From a Three-Year National Study.

To gather validity evidence supporting the use and interpretation of scores from the American College of Surgeons Entering Resident Readiness Assessment (ACS ERRA) Program. ACS ERRA is an online formative assessment program developed to assess entering surgery residents' ability to make critical clinical decisions, and includes 12 clinical areas and 20 topics identified by a national panel of surgeon educators and residency program directors. Data from 3 national testing administrations of ACS ERRA (2018-2020) were used to gather validity evidence regarding content, response process, internal structure (reliability), relations to other variables, and consequences. Over the 3 administrations, 1975 surgery residents participated from 125 distinct residency programs. Overall scores [Mean = 64% (SD = 7%)] remained consistent across the 3 years ( P = 0.670). There were no significant differences among resident characteristics (gender, age, international medical graduate status). The mean case discrimination index was 0.54 [SD = 0.15]. Kappa inter-rater reliability for scoring was 0.87; the overall test score reliability (G-coefficient) was 0.86 (Ф-coefficient = 0.83). Residents who completed residency readiness programs had higher ACS ERRA scores (66% versus 63%, Cohen's d = 0.23, P < 0.001). On average, 15% of decisions made (21/140 per test) involved potentially harmful actions. Variability in scores from graduating medical schools (7%) carried over twice as much weight than from matched residency programs (3%). ACS ERRA scores provide valuable information to entering surgery residents and surgery program directors to aid in development of individual and group learning plans.

Analysis of Performance Trends from 2010-2019 on the American Board of Internal Medicine Nephrology Certifying Exam.

The pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match. This retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied. Lower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates. Changes in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

Implicit Bias and the Association of Redaction of Identifiers With Residency Application Screening Scores

Diversity in the ophthalmology profession is important when providing care for an increasingly diverse patient population. However, implicit bias may inadvertently disadvantage underrepresented applicants during resident recruitment and selection. To evaluate the association of the redaction of applicant identifiers with the review scores on ophthalmology residency applications as an intervention to address implicit bias. In this quality improvement study, 46 faculty members reviewed randomized sets of 462 redacted and unredacted applications from a single academic institution during the 2019-2020 ophthalmology residency application cycle. Applications electronically redacted for applicant identifiers, including name, sex or gender, race and ethnicity, and related terms. The main outcome was the distribution of scores on redacted and unredacted applications, stratified by applicant's sex, underrepresentation in medicine (URiM; traditionally comprising American Indian or Alaskan Native, Black, and Hispanic individuals) status, and international medical graduate (IMG) status; the application score β coefficients for redaction and the applicant and reviewer characteristics were calculated. Applications were scored on a scale of 1 to 9, where 1 was the best score and 9 was the worst score. Scores were evaluated for a significant difference based on redaction among female, URiM, and IMG applicants. Linear regression was used to evaluate the adjusted association of redaction, self-reported applicant characteristics, and reviewer characteristics with scores on ophthalmology residency applications. In this study, 277 applicants (60.0%) were male and 71 (15.4%) had URiM status; 32 faculty reviewers (69.6%) were male and 2 (0.4%) had URiM status. The distribution of scores was similar for redacted vs unredacted applications, with no difference based on sex, URiM status, or IMG status. Applicant's sex, URiM status, and IMG status had no association with scores in multivariable analysis (sex, β = -0.08; 95% CI, -0.32 to 0.15; P = .26; URiM status, β = -0.03; (95% CI, -0.36 to 0.30; P = .94; and IMG status, β = 0.39; 95% CI, -0.24 to 1.02; P = .35). In adjusted regression, redaction was not associated with differences in scores (β = -0.06 points on a 1-9 scale; 95% CI, -0.22 to 0.10 points; P = .48). Factors most associated with better scores were attending a top 20 medical school (β = -1.06; 95% CI, -1.37 to -0.76; P < .001), holding an additional advanced degree (β = -0.86; 95% CI, -1.22 to -0.50; P < .001), and having a higher United States Medical Licensing Examination Step 1 score (β = -0.35 per 10-point increase; 95% CI, -0.45 to -0.26; P < .001). This quality improvement study did not detect an association between the redaction of applicant characteristics on ophthalmology residency applications and the application review scores among underrepresented candidates at this institution. Although the study may not have been powered adequately to find a difference, these findings suggest that the association of redaction with application review scores may be preempted by additional approaches to enhance diversity, including pipeline programs, implicit bias training, diversity-centered culture and priorities, and targeted applicant outreach. Programs may adapt this study design to probe their own application screening biases and track over time before-and-after bias-related interventions.

Rates of unverifiable and incomplete publications in pediatric ophthalmology fellowship applications

The publication patterns of pediatric ophthalmology fellowship applicants and in particular the rates of unverifiable and incomplete publications have not been previously reported. A 5-year retrospective cross-sectional study of fellowship candidates found 2.1% of publications listed as published were unverifiable, and only 49% of manuscripts listed as pending publication were published within 5years. There was lower likelihood to list an incomplete publication for applicants with additional degrees or prior fellowship training and higher likelihood with more manuscripts listed as in preparation. Sex, international medical graduate status, USMLE step scores, and number of publications did not corelate with unverifiable publications.

Racial and Ethnic Diversity of Family Physicians Delivering Maternity Care

Maternal and birth outcomes represent some of the most profound racial and ethnic disparities in health in the USA, and are, in part, attributed to a lack of diversity in the maternity care workforce. Family physicians are an often-overlooked part of the maternity care workforce, yet frequently provide care to underserved populations. This study aims to characterize the family physician workforce providing obstetric care in terms of race/ethnicity. In this cross-sectional study, we used data collected via the American Board of Family Medicine Exam Registration Questionnaire from 2017 to 2019. Respondents included family physicians seeking to continue their certification in those years. We conducted bivariate tests and an adjusted analysis using logistic regression to examine associations with providing obstetric deliveries. Variables included race, ethnicity, age, gender, degree type, international medical graduate status, practice site, and rurality. Of 20,820 family physicians in our sample, those identifying as Black/African American (OR 0.55, CI 0.41 to 0.74) and Asian (OR 0.40, CI 0.31 to 0.51) had significantly lower odds of including obstetrics in their practice than those identifying as White. We found no significant difference in practicing obstetrics between Hispanic and non-Hispanic family physicians (OR 0.94, CI 0.73 to 1.20). Asian (OR 0.40, CI 0.31 to 0.51) and Black/African American (OR 0.55, CI 0.41 to 0.74) physicians still have significantly lower odds of providing obstetric care than White physicians after controlling for rurality. Family physicians who identified as Black/African American or Asian are less likely to include obstetrics in their practice. A diverse and racially/ethnically representative maternity care workforce, including family physicians, may help to ameliorate disparities in maternal and birth outcomes. Enhanced efforts to diversify the family physician maternity care workforce should be implemented.

Nature and outcomes of sanctioned medical misconduct in six international jurisdictions: a case series.

Objective The aim of this study was to determine the types of medical misconduct, the practitioner, specialities and jurisdictions at risk, patient outcomes and the sanctions imposed. Methods This study was a retrospective case series of 822 adverse medical tribunal determinations in Australia, New Zealand, Canada (Ontario, Alberta), Pennsylvania (USA), Singapore and Hong Kong in 2013-17. Results Inappropriate medical care and illegal or unethical prescribing were the most common types of misconduct. Misconduct varied with practitioner sex, international medical graduate status, speciality and jurisdiction (P<0.05). Cases of inappropriate medical care were more common in Singapore (46.7% of all Singapore cases; 95% confidence interval (CI) 31.9-62.0) and among surgeons (47.6% of all surgeon cases; 95% CI 36.5-58.8). Illegal or unethical prescribing was more common in Australia (31.1%; 95% CI 24.8-38.2) and among general or family practitioners (26.9%; 95% CI 20.0-35.0). Misconduct not related to patients was more common in Pennsylvania (30.3%; 95% CI 25.2-36.0) and among local graduates (20.5%; 95% CI 17.1-24.5). Sexual misconduct was more common in Australia (29.6%; 95% CI 23.4-36.6) and among males (19.6%, 95% CI 16.7-22.8). Healthcare dishonesty was more common in Hong Kong (21.8%; 95% CI 14.0-32.2) and among surgeons (13.4%; 95% CI 7.2-23.2). The most common patient outcomes were patient risk (40.6%; 95% CI 36.1-45.4) and death and actual physical harm combined (31.2%; 95% CI 26.9-35.7). Sanctions were most commonly suspension or deregistration. Deregistration was most common in cases of sexual misconduct. Conclusion Medical misconduct varies widely. Risk factors for particular misconduct types are apparent among jurisdictions and practitioner characteristics. The nature of patient harm varied by type of misconduct, with illegal unethical prescribing commonly leading to drug dependency and sexual misconduct leading to psychiatric injury. What is known about the topic? Medical misconduct is a continuing problem. Tribunals and medical boards sanction misconduct to protect patient safety and public trust. What does this paper add? Tribunals and boards differ in misconduct reporting and permitting public access to determinations. Types of misconduct vary between international jurisdictions, practitioner sex, international graduate status and speciality. Risk and physical injury (including death) are the most common patient outcomes. The nature of patient harm varied by type of misconduct, with illegal unethical prescribing commonly leading to drug dependency and sexual misconduct leading to psychiatric injury. What are the implications for practitioners? Medical colleges should tailor trainee programs to address the common types of misconduct within their specialities. Standardisation of misconduct reporting, and report access, across jurisdictions would facilitate ongoing surveillance and intervention evaluation.

Analysis of academic publishing output among 1634 successful applicants in the 2011–2018 neurosurgery residency match

BackgroundResearch productivity is a key criterion for applicant selection reported by residency program directors. Research volume reported on neurosurgery residency applications has risen steadily over the past decade. ObjectivePerform retrospective bibliographic searches of successful applicants who matched into U.S. neurosurgery residency programs from 2011 to 2018, and assess the relationship between academic publishing and residency placement. MethodsGender, MD/PhD status, U.S. News research ranking of medical school, and international medical graduate status (IMG) were determined for 1634 successful applicants from 2011 to 2018. Indexed publications before and after the start of residency were tabulated by Scopus®. Publication counts were stratified by first author, basic/clinical science, case reports, reviews, or other research. We then compared publishing trends across demographic variables and match cohorts. ResultsAverage pre-residency publications increased from 2.6 [1.7, 3.4] in 2011 to 6.5 [5.1, 7.9] in 2018. Men, PhD-holders, Top 20 and Top 40 U.S. medical school graduates, and IMGs had higher pre-residency publication counts overall. After stratifying by match cohort, however, there was no significant effect of gender on pre-residency publications. Applicants matching into residency programs with highly ranked affiliated hospitals had significantly higher pre-residency publications. ConclusionPublishing volume of successful neurosurgery applicants in the U.S. has risen recently and is associated with the stature of matched residency programs. Given the gap between verifiable and claimed research on residency applications, attention is needed to objectively evaluate research credentials in the selection process. The impending phase out of USMLE step 1 scores may increase emphasis on academic productivity.

Characteristics of cardiac catheterization laboratory directors at the 2017 U.S. News & World Report top 100 U.S. cardiovascular hospitals.

The cardiac catheterization laboratory (CCL) is a focal point for cardiovascular programs and the CCL director represents the key personnel. We outline profiles of CCL directors at the 2017 U.S. News & World Report top 100 U.S. cardiovascular hospitals. Using hospital websites, LinkedIn, Healthgrades, Medicare Provider Utilization and Payment Data 2017, and Scopus, we described CCL directors (in 2017) by age, gender, years since medical graduation, international medical school graduate (IMG) status, academic rank, provider clinical focus, and Hirsch (h)-index. Nearly all CCL directors were male (97%). The median age (interquartile range [IQR]) was 53 (49-61) years and median (IQR) years since medical school graduation was 28 (23-35) years. Over a third of CCL directors (39.4%) were IMGs and 38.4% had completed fellowship training at the same facility where they were CCL director. The median (IQR) h-index was 11 (6-22). Of the 69.7% CCL directors who held faculty positions, 60.9% were professors and 30.4% were associate professors. From Medicare data, 45.5% performed only percutaneous coronary interventions, 41.4% performed structural interventions, 3.0% peripheral interventions, and 2.0% performed both structural and peripheral. CCL directors at the top 25 hospitals had higher h-indexes, and more likely to have completed fellowship training at their own institution. There are very few women CCL directors at the top U.S. cardiovascular hospitals. A third of the CCL directors were IMGs. A significant proportion of CCL directors primarily performed structural interventions and trained at the same institution, more so at the top 25 hospitals.

Association Between American Board of Surgery Initial Certification and Risk of Receiving Severe Disciplinary Actions Against Medical Licenses

Board certification is used as a marker of surgeon quality and professionalism. Although some research has linked certification in surgery to outcomes, more research is needed. To measure associations between surgeons obtaining American Board of Surgery (ABS) certification and examination performance with receiving future severe disciplinary actions against their medical licenses. Retrospective analysis of severe license action rates for surgeons who attempted ABS certification based on certification status and examination performance. Surgeons who attempted to become certified were classified as certified or failing to obtain certification. Additionally, groups were further categorized based on whether the surgeon had to repeat examinations and whether they ultimately passed. The study included surgeons who initially attempted certification between 1976 and 2017 (n = 44 290). Severe license actions from 1976 to 2018 were obtained from the Federation of State Medical Boards, and certification data were obtained from the ABS database. Data were analyzed between 1978 and 2008. Severe license action rates were analyzed across certified surgeons and those failing to obtain certification, as well as across examination performance groups. The final dataset included 36 197 men (81.7%) and 8093 women (18.3%). The incidence of severe license actions was significantly greater for surgeons who attempted and failed to obtain certification (incidence rate per 1000 person-years = 2.49; 95% CI, 2.13-2.85) than surgeons who were certified (incidence rate per 1000 person years = 0.77; 95% CI, 0.71-0.83). Adjusting for sex and international medical graduate status, the risk of receiving a severe license action across time was also significantly greater for surgeons who failed to obtain certification. Surgeons who progressed further in the certification examination sequence and had fewer repeated examinations had a lower incidence and less risk over time of receiving severe license actions. Obtaining board certification was associated with a lower rate of receiving severe license actions from a state medical board. Passing examinations in the certification examination process on the first attempt was also associated with lower severe license action rates. This study provides supporting evidence that board certification is 1 marker of surgeon quality and professionalism.

Differences in Medicare Beneficiary Risk Scores by Physician's International Medical Graduate Status.

Differences in Medicare Beneficiary Risk Scores by Physician's International Medical Graduate Status.

High-volume general practitioners in Alberta: a descriptive analysis.

Alberta is considering capping daily fee-for-service physician billings, but little is known about high-volume practice in the province and its impact on patient health outcomes. In this initial study, we conducted a descriptive analysis of general practitioners' patient volumes and billing practices in relation to associated practitioner demographic characteristics. We conducted a retrospective descriptive analysis of the associations of practitioner characteristics, including full-time versus non-full-time practice, provider sex, years in practice, geographic location and international medical graduate status, with high-volume (> 50 visits/d) practice using general practice billing data from 2011 to 2016. Use of general practitioner service codes was described and compared by general practitioner volume status, with adjustment for physician demographic characteristics and geographic parameters. We included 3465 general practitioners practising fee-for-service in Alberta between 2011 and 2016, of whom 233 (6.7%) were identified as high-volume providers. Physicians who had been in practice longer (odds ratio [OR] 1.04 per year, 95% confidence interval [CI] 1.02-1.05) and international medical graduates (OR 1.89, 95% CI 1.40-2.54) were more likely to exceed 50 patient visits/day. Female physicians were less likely to exceed 50 patient visits/day (OR 0.14, 95% CI 0.07-0.28). Rural practice location was negatively associated with high-volume practice (OR 0.87, 95% CI 0.79-0.95) when we controlled for zone within the province. Zone 5 (North) was associated with high-volume practice (OR 1.95, 95% CI 1.06-3.58). Less than full-time practice was prevalent (1836 providers [53.0%]). High-volume general practitioners billed fewer service codes requiring longer visits, except for the most highly remunerated code (patients with complex health issues). These results can inform policy-makers when considering payment system changes. Our next step is to examine the association of high-volume practice with outcomes important to patients, such as evidence of treatment failure (emergency department visits and hospital admissions) for conditions sensitive to primary care management.

Common Factors Among Family Medicine Residents Who Encounter Difficulty.

Residents in difficulty are costly to programs in both time and resources, and encountering difficulty can be emotionally harmful to residents. Approximately 10% of residents will encounter difficulty at some point in training. While there have been several studies looking at common factors among residents who encounter difficulty, some of the findings are inconsistent. The objective of this study was to determine whether there are common factors among the residents who encounter difficulty during training in a large Canadian family medicine residency program. Secondary data analysis was performed on archived resident files from a Canadian family medicine residency program. Residents who commenced an urban family medicine residency program between the years of 2006 and 2014 were included in the study. Five hundred nine family medicine residents were included in data analysis. Residents older than 30 years were 2.33 times (95% CI: 1.27-4.26) more likely to encounter difficulty than residents aged 30 years or younger. Nontransfer residents were 8.85 times (95% CI: 1.17-66.67) more likely to encounter difficulty than transfer residents. The effects of sex, training site, international medical graduate status, and rotation order on the likelihood of encountering difficulty were nonsignificant. Older and nontransfer residents may be facing unique circumstances and may benefit from additional support from the program.

Value of General Medical Knowledge Examinations in Performance Assessment of Practicing Physicians With Potential Competence and Performance Deficiencies.

Problems with a physician's performance may arise at any point during their career. As such, there is a need for effective, valid tools and processes to accurately assess and identify deficiencies in competence or performance. Although scores on multiple-choice questions have been shown to be predictive of some aspects of physician performance in practicing physicians, their relationship to overall clinical competence is somewhat uncertain particularly after the first 10 years of practice. As such, the purpose of this study was to examine how a general medical knowledge multiple-choice question examination is associated with a comprehensive assessment of competence and performance in experienced practicing physicians with potential competence and performance deficiencies. The study included 233 physicians, of varying specialties, assessed by the University of California, San Diego Physician Assessment and Clinical Education Program (PACE), between 2008 and 2012, who completed the Post-Licensure Assessment System Mechanisms of Disease (MoD) examination. Logistic regression determined if the examination score significantly predicted passing assessment outcome after correcting for gender, international medical graduate status, certification status, and age. Most physicians (89.7%) received an overall passing assessment outcome on the PACE assessment. The mean MoD score was 66.9% correct, with a median of 68.0%. Logistic regression (P = .038) was significant in indicating that physicians with higher MoD examination scores had an increased likelihood of achieving a passing assessment outcome (odds ratio = 1.057). Physician MoD scores are significant predictors of overall physician competence and performance as evaluated by PACE assessment.