International Medical School Graduates Research Articles

Inequities at the Transition to Obstetrics and Gynecology Residency

Although approximately one-fifth of obstetrics and gynecology (OBGYN) residents matriculate from osteopathic or international medical schools, most literature regarding the transition to residency focuses on allopathic medical school graduates. To create comprehensive interventions for this educational transition, we must understand the needs of all incoming residents. Our objective was to examine OBGYN residents' perceptions of their transition to residency, and to understand how residents' background and medical school environment influence their perceived sense of readiness. A 16-item survey asked questions about demographics, the transition to residency, resident well-being, burnout, and the transition to fellowship. Perception of preparedness was assessed with the question "I felt that I was well-prepared for the first year of residency" (1=strongly agree, 5=strongly disagree). Chi-squared and Fisher's exact tests and logistic regression explored association of perceived preparedness with residents' backgrounds. Survey administered at time of the in-training examination in 2022. All OBGYN residents. Of 5761 eligible participants, 3741 (64.9%) provided consent and completed the survey. Of the 3687 participants who answered the question, 2441 (66.2%) either agreed or strongly agreed that they felt well-prepared. Fewer osteopathic graduates reported feeling prepared compared to allopathic graduates (379/610, 62.1% vs 1,924/2,766, 69.6%) (OR 0.72, 95%CI 0.60-0.86, p < 0.01). International medical school graduates were seven times less likely to report feeling prepared compared to those from allopathic institutions (137/304, 45.1% vs 1924/2776, 69.6%) (OR 0.60, 95%CI 0.53-0.68, p < 0.01). Respondents from underrepresented racial and ethnic backgrounds were less likely to report feeling prepared compared to White respondents (276/535, 51.6% vs 1738/2387, 72.8%) (OR 0.39, 95%CI 0.33-0.48, p < 0.01). Differences in residents' perceptions of their transition to residency highlight the need to begin offsetting pervasive inequities with comprehensive and accessible resources.

A self-selecting prophecy: prevalence of burnout in surgical fellows.

BackgroundBurnout has become a prominent topic, yet there are limited data on the manifestation of this phenomenon among surgical fellows. The goal of this study is to elucidate the prevalence of burnout and determine if there are protective or predisposing factors in surgical fellowship training.MethodsA confidential electronic survey was distributed to Fellowship Council accredited fellows during the 2020–2021 academic year. Demographic information and training characteristics were queried. The fellows were then asked to complete the Maslach Burnout Inventory (MBI), Perceived Stress Scale (PSS), Short Grit Scale (SGS), Satisfaction with Life Scale (SLS), and General Self-Efficacy Scale (SE). Data were analyzed using p values of ≤ 0.05 as statistically significant.ResultsAt the end of the survey period, 92 out of 196 (46.9%) fellowship trainees responded. 69.6% of respondents identified as men, 29.7% as international medical school graduates (IMGs), and 15.3% non-US IMGs. Based on criteria defined by the MBI, there was an 8.4% rate of burnout. Most respondents noted low stress levels (62.3%), good satisfaction with life (58.9%), a moderate amount of grit, and a high level of self-esteem. On comparative analysis, fellows with burnout had significantly higher stress levels, lower levels of satisfaction with life, and less self-esteem.ConclusionsOverall, there was a low rate of burnout among fellows. We suggest this may be reflective of a self-selecting effect, as trainees who choose to undergo additional training may be less likely to experience this syndrome. In addition, there may be a protective factor during fellowship that results from inherent mentoring, increased specialization, and autonomy. Further investigation of the predisposing factors to burnout in fellowship trainees is warranted based on the results of this study.

Diversity, equity and inclusion: a survey of pediatric radiology fellowship graduates from 1996 to 2020.

Understanding the sociodemographic diversity and the experiences of trainees is imperative for developing an inclusive pediatric radiology workforce and improving patient outcomes. To describe the sociodemographics of a pediatric radiology fellowship program over 25 years and examine potential associations with (a) a trainee's sense of inclusion and belonging during training and (b) graduates' ultimate choice/type of practice, progression to positions of leadership and mentorship of others. We designed and administered an online survey of sociodemographic diversity to graduates of one of the largest pediatric radiology fellowship programs in North America who graduated over the last 25 years. Respondents answered questions regarding (a) racial/ethnic identity, gender identity, sexual orientation, disability and other sociodemographics; (b) their sense of inclusion and belonging during fellowship training; and (c) their current type of practice, leadership and mentorship of others. Univariate analysis of variance (ANOVA) tests determined whether sociodemographic background was associated with inclusion/belonging during training, and with current type of radiology practice, leadership and mentorship. We assessed associations with covariates of interest and current leadership and mentorship roles using chi-square or Fisher exact tests. A heat map assessed individual and overall Likert scores across covariates. Seventy-six graduates completed the survey (46% response rate). Three percent of respondents identified as Black/African American, 7% as Latino/a/x, 45% as female, 4% as LGBTQ (lesbian, gay, bisexual, transgender, queer/questioning) and 5% as living with a disability at the time of fellowship. Graduates of international medical schools (P = 0.09) and osteopathic medical (DO) schools (P = 0.09), first-generation college graduates (P = 0.023), those with a first language other than English (P = 0.02) and U.S. military veterans (P = 0.048) reported significantly lower feelings of inclusion and belonging during training. Gender identity and sexual orientation did not correlate with feelings of exclusion or inequity.Graduates between 1996 and 2010 were significantly morelikely to have filled a leadership rolethan those graduating after 2011 (P = 0.004) and were also significantly more likely to have mentored individuals underrepresented in medicine/pediatric radiology than those who graduated after 2011 (P = 0.04). None of theother sociodemographic variables demonstrated an associationwith leadership or mentorship, although 92.3%of those with a first language other than English served as amentor compared to 68.2% of native English speakers (P = 0.097). Efforts to promote a more diverse and inclusive workforce in pediatric radiology should be directed toward increasing numbers of fellows who are underrepresented in medicine (Black/African American, Hispanic/Latino/a/x) and providing a more inclusive training environment for first-generation college graduates, graduates of international and DO medical schools, fellows whose first language is not English, and veterans of the U.S. Armed Forces.

Impact of PhD Degree Versus Non-PhD Research Fellowship on Future Research Productivity Among Academic Cardiothoracic Surgeons.

A PhD degree can offer significant research experience, but previous studies yielded conflicting conclusions on the relationship between a PhD degree and future research output. We compared the impact of a PhD degree versus research fellowship(RF) training on research productivity in cardiothoracic surgeons, hypothesizing that training pathways may influence potential associations. CT surgeons practicing at all accredited United States CT surgery training programs in 2018 who pursued dedicated time for research (n = 597), including earning a PhD degree (n = 92) or completing a non-PhD RF (n = 505), were included. To control for training pathways, we performed subanalyses of U.S. medical school graduates (n = 466) and international medical school graduates (IMGs) (n = 131). Surgeon-specific data were obtained from publicly available sources (e.g., institutional webpages, Scopus). PhD surgeons published greater total papers (68.5 vs. 52.0, p = 0.0179) and total papers per year as an attending (4.6 vs. 3.0, p = 0.0150). For U.S. medical school graduates, there were 40 PhD surgeons and 426 non-PhD RF surgeons; both groups published a similar number of total papers (64.5 vs. 54.0, p = 0.3738) and total papers per year (3.2 vs. 3.0, p = 0.7909). For IMGs, there were 52 PhD surgeons and 79 non-PhD RF surgeons; the PhD surgeons published greater total papers (80.5 vs. 45.0, p = 0.0101) and total papers per year (5.7 vs. 2.7, p = 0.0037). CT surgeons with dedicated research training are highly academically productive. Although a PhD degree may be associated with enhanced career-long research productivity for IMGs, this association was not observed for U.S. medical school graduates.

Mentoring the Un-Matched: Clinical Externships Can Provide a Needed Boost

Back to table of contents Previous article Next article Education & TrainingFull AccessMentoring the Un-Matched: Clinical Externships Can Provide a Needed BoostJesus S. Ligot, M.D.Jesus S. LigotSearch for more papers by this author, M.D.Published Online:16 Aug 2021https://doi.org/10.1176/appi.pn.2021.8.33AbstractA 12-year-old externship program run by Rahn Bailey, M.D., gives unmatched medical school graduates valuable experience to increase their chance of matching in the future. Here is one success story.One of the most difficult experiences for a graduating medical student is going through the rigors of the complicated residency match process and finding out on match day that you have not matched. After all the preparations, expense, and hard work comes the disappointment and the likelihood that you will have to wait another year to repeat the whole process with no assurance that the outcome of next year’s match will be different.This year, about 10,000 medical school graduates—including 2,200 U.S. medical graduates, 2,143 U.S. citizens who graduated from international medical schools, and 5,730 non-U.S. international medical school graduates failed to match. If they decide to apply again for next year, how can they improve their chances of matching into a residency program? What are the opportunities available to them to create an edge in their resumes?I have been reflecting on my experience as an unofficial mentor to two residents who happen to be twins, Drs. Adrienne and Andrea Saldana. Both started their residency matching journey in 2017 and unfortunately did not match that year. They reached out to me to discuss what they could do to improve their chances of getting matched.Adrienne Saldana, M.D., was named intern of the year of the Brookdale Hospital Medical Center in Brooklyn, N.Y. She is a graduate of the externship program of former APA trustee Rahn Bailey, M.D., that helps biomedical scientists be successful in the residency match.I recommended that they take on clinical observerships with psychiatrists whom I personally knew, practicing in various settings. They did this the next year, and the number of interviews they were offered increased; however, they still did not get matched.It was then that I remembered sitting with a colleague in the APA Assembly who struck me as a good mentor and educator—Dr. Rahn Bailey. I knew he wrote books and journal articles and took a chance and asked him if he would take Adrienne and Andrea under his wings to mentor. Without hesitation, he agreed and offered to have them do an externship with him. Dr. Bailey also had other externs working with him who in turn welcomed Andrea and Adrienne into their community of externs.Externship with Dr. Bailey was an enriching learning experience for Adrienne and Andrea. Through Dr. Bailey’s mentorship and guidance, they read a number of books, journals, and other official publications but their confidence really grew by learning how to write and edit a scientific paper. They were immersed in major issues in psychiatry and were learning about the social determinants of mental health. They were also able to network with other externs who shared resources with them. Perhaps most importantly, the externship program gave them hope.Adrienne and Andrea are two of the most hard-working, motivated, and smart young doctors I have met, and their inability to match initially does not in any way reflect on their capabilities and skills. Adrienne has just completed her first year of residency at Brookdale Hospital Medical Center in Brooklyn, N.Y., and she was recently awarded the Most Outstanding Intern of the Year. Her sister, Andrea, is going to start her residency at Brookdale in June.Dr. Bailey and I are proud to see them accepted into residency training, and we look forward to seeing them achieve greater heights. Their story is one of grit, determination, and motivation. It is our hope that more psychiatrists will be open to mentoring medical school graduates who did not match into a residency and provide them a bridge to their dreams. ■Jesus S. Ligot, M.D., is an adjunct assistant professor of psychiatry at St. Louis University in St. Louis, Mo. ISSUES NewArchived

Matching 25% of Medical Students in Family Medicine by 2030: Realistic or Beyond Our Reach?

This article examines the America Needs More Family Doctors: 25x2030 Collaborative goal of "25x30"-that 25% of all medical students will enter family medicine residency programs by the year 2030. Filling 25% of all available postgraduate year-1 positions in the match is an important consideration in creating a strong primary care workforce. Data from the National Resident Matching Program (NRMP) matches for 2010 and 2020 are reviewed to examine trends not only in the US MD and DO categories, but also US international medical school graduates (IMGs) and non-US IMG categories over the last 10 years. If the total number of all programs and of all positions offered were held constant in 2030, what shifts in student choices would be required to reach the 25x30 goal in each applicant category as well as for all four categories combined? This discussion explores resources, power, physician income, and other factors that affect student numbers. Until a national health system is developed with national goals and priorities, it is unlikely that 25x30 will become a reality.

Regulating high-skilled immigration: The market for medical residents

The effect of high-skill immigration remains central to many US industries and policy debates. Beginning in 2009, the federal government heightened enforcement of existing laws and increased employer fees for the cost of obtaining certain common immigration visas. The change can be viewed as a de facto tax on immigrant labor. I estimate the extent to which high-skill non-citizen workers, in the form of international medical school graduates seeking residency training in US teaching hospitals, are displaced by US citizens who received their medical school training abroad. Changes in immigration policy can have important effects in this labor market with implications for the larger health care system. I find that demand for medical residents among teaching hospitals based on immigration status is highly responsive to increased regulatory cost.

International Medical Graduates: Promoting Equity and Belonging.

International medical school graduates (IMGs) play a vital role in the health care system of the United States. They constitute roughly one-quarter of the physician workforce, comprising a significant proportion of the primary care providers in high-need rural and urban areas, where they provide equal and, in some instances, better care than U.S. graduates. Nonetheless, they face a series of hurdles in entering U.S. residency programs and throughout their training experiences.IMGs must expend significant resources to obtain Education Commission for Foreign Medical Graduates certification, which includes Steps 1, 2 Clinical Knowledge and 2 Clinical Skills of the United States Medical Licensing Examination. They encounter the uncertainty of matching and, if successful, obtaining a visa to enter the United States. Once here, they need to adapt to the complexities of the health care system and familiarize themselves with the cultural nuances, professional behaviors, and communication skills of another country. They encounter biases and microaggressions and lack support groups and mentors. Those who choose an academic career are less likely to obtain leadership positions.This Perspective provides an overview of these challenges and highlights opportunities for change at local and national levels. Specifically, it identifies strategies that would assist IMGs before entry, at entry, during training, at the transition to practice, and in practice. The current COVID-19 pandemic highlights the shortage of physicians in the United States and illustrates the importance of ensuring that IMGs, who are essential health care workers, feel welcome, valued, and recognized for their contributions.

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.

Characteristics of Family Medicine Residency Graduates, 1994-2017: An Update.

The purpose of this study was to characterize graduates of family medicine (FM) residencies from 1994 to 2017 and determine whether they continue to practice family medicine after residency. We sampled physicians who completed FM residency training from 1994-2017 using 2017 American Medical Association (AMA) Physician Masterfile linked with administrative files of the American Board of Family Medicine (ABFM). The main outcomes measured were characteristics of FM residency graduates, including medical degree type (Doctor of Medicine, MD vs Doctor of Osteopathic Medicine, DO), international medical school graduates (IMGs) vs US graduates, sex, ABFM certification status, and self-designated primary specialty. Family medicine residency graduates were grouped into 4-year cohorts by year of residency completion. From 1994 to 2017, 66,778 residents completed training in an ACGME accredited FM residency, averaging 2,782 graduates per year. The number of FM residency graduates peaked in 1998-2001, averaging 3,053 each year. The composition of FM residents diversified with large increases in DOs, IMGs, and female graduates over the past 24 years. Of all the FM residency graduates, 91.9% claimed FM as their primary specialty and 81% were certified with ABFM in 2017. FM/sport medicine (2.1%), FM/geriatric medicine (0.9%), internal medicine/geriatrics (0.8%), and emergency medicine (0.7%) were the most common non-FM primary specialties reported. DOs, IMGs, and female family medicine residency graduates increased from 1994 to 2017. With 9 in 10 graduates of family medicine residencies designating FM as their primary specialty, FM residency programs not only train but supply family physicians who are likely to remain in the primary care workforce.

Special Report: Asian American Hate Incidents—A Co-occurring Epidemic During COVID-19

<i>Special Report:</i> Asian American Hate Incidents—A Co-occurring Epidemic During COVID-19

A Longitudinal Study of Differences in Canadian and US Medical Student Preparation for Family Medicine

Background and Objectives: Previous research has found differences in preparation for entry into family medicine training between graduates of US and Canadian medical schools. However, this research was limited in that it utilized cross-sectional data to examine a longitudinal issue. This study aimed to examine these differences with a longitudinal data set. Methods: A comparison of the performance on the American Board of Family Medicine (ABFM) In-Training Exam (ITE) between 2014 and 2016 was conducted by examining the performance of Canadian medical school graduates and US medical school graduates longitudinally, as well as cross-sectionally, using independent t tests. Results: For first-year residents (PGY1), the Canadian 2014/2015 cohort showed significantly higher mean scores than US medical school graduates (USMG) and international medical school graduates (IMG). The Canadian 2015/2016 cohort showed no statistical difference from the USMGs, but did have a significantly higher mean than the IMGs. For second-year residents (PGY2), the Canadian 2014/2015 cohort showed a significantly lower mean than the USMG cohort, but had a significantly higher mean than the IMG cohort. The Canadian 2015/2016 cohort showed a statistically lower mean than the USMG cohort and no difference compared to the IMG cohort. Conclusions: Based on a comparison of ABFM ITE scores between 2014 and 2016, the Canadian medical school graduates performed as well as or better than the US graduates upon entry into residency, but performance was reversed for the second year of training. Our results also suggest an equity value of ACGME residency training independent of location of undergraduate medical training.

1156 Trends in Matching in GI Fellowship: Data From NRMP

INTRODUCTION: Gastroenterology (GI) fellowships continue to be highly sought after by internal medicine residents interested in pursuing subspecialty training. A recent study reported that GI fellowships had the highest number of applicants per available position among the major subspecialties. The National Resident Matching Program (NRMP) Specialties Matching Service® (SMS®) conducts Matches for fellowship positions. NRMP identified ten applicant characteristics that contribute to Match success: number of contiguous ranks, number of specialties ranked, USMLE scores, number of research, work, and volunteer experiences, number of publications, and Alpha Omega Alpha Honor Medical Society membership. We aim to compare the temporal trends in these characteristics by comparing data in 2011 and 2018. METHODS: Data was collected from the NRMP booklet: charting outcomes in the match in 2011 and 2018. Four applicant groups are included in the report: U.S. allopathic medical school graduates (USMG), U.S. citizen international medical school graduates (US-IMG), Non-U.S. citizen international medical school graduates (Non-US-IMG), and U.S. osteopathic medical school graduates (DO) We compared various variables from 2011 and 2018 including the number of applicants and positions offered, type of applicants, USMLE mean scores, research experiences. RESULTS: The total number of positions offered in 2011 was 383 and the number of applicants were 648; making 1.7 application per position, the most per any other IM subspecialties. In comparison, the total number of positions offered in 2018 was 496 and the number of applicants were 758; making 1.5 applicants per position. Percentage of matched USMG, US-IMG, Non-US-IMG and DOs in 2011 and 2018 were as follows: 65 vs 61%, 7 vs 9%, 18 vs 23%, 4 vs 5 %. The mean step 1, step 2, step 3 for USMG has increased as follows 223 to 235, 230 to 248, 221 to 235. A similar trend is observed in other groups. The mean number of scholarly activity have increased significantly in USMG (3 to 11), US-IMG (6 to 13) Non-US-MG (9 to 21) and in DOs 5 to 10.9. CONCLUSION: The total number of fellowship positions has increased, however positions per candidate have been relatively stable. There has been a slight increase in the proportion of Non-US-IMG (∼5%), US-IMG (2%), and DOs (1%) in GI fellowship match in the year 2018 as compared to 2011. However, a slight decrease in USMG (4%) was noted. There has been increase in USMLE step scores and scholarly activity in all groups.

Examining an Evidence-Based Medicine Culture in Residency Education

Reports of innovations in evidence-based medicine (EBM) training have focused on curriculum design and knowledge gained. Little is known about the educational culture and environment for EBM training and the extent to which those environments exist in family medicine residencies in the United States. A literature review on this topic identified a validated EBM environment scale intended for learner use. This scale was adapted for completion by family medicine residency program directors (PDs) and administered through an omnibus survey. Responses to this scale were analyzed descriptively with program and PD demographics. An EBM culture score was calculated for each program and the results were regressed with the correlated demographics. In our adapted survey, family medicine PDs generally rated their residencies high on the EBM culture scale, but admitted to challenges with faculty feedback to residents about EBM skills, ability to protect time for EBM instruction, and clinician skepticism about EBM. In linear regression analysis, the mean summary score on the EBM scale was lower for female PDs and in programs with a higher proportion of international medical school graduates. To improve the culture for EBM teaching, family medicine residency programs should focus on faculty engagement and support and the allocation of sufficient time for EBM education.

Performance on the Nephrology In-Training Examination and ABIM Nephrology Certification Examination Outcomes.

Medical specialty and subspecialty fellowship programs administer subject-specific in-training examinations to provide feedback about level of medical knowledge to fellows preparing for subsequent board certification. This study evaluated the association between the American Society of Nephrology In-Training Examination and the American Board of Internal Medicine Nephrology Certification Examination in terms of scores and passing status. The study included 1684 nephrology fellows who completed the American Society of Nephrology In-Training Examination in their second year of fellowship training between 2009 and 2014. Regression analysis examined the association between In-Training Examination and first-time Nephrology Certification Examination scores as well as passing status relative to other standardized assessments. This cohort included primarily men (62%) and international medical school graduates (62%), and fellows had an average age of 32 years old at the time of first completing the Nephrology Certification Examination. An overwhelming majority (89%) passed the Nephrology Certification on their first attempt. In-Training Examination scores showed the strongest association with first-time Nephrology Certification Examination scores, accounting for approximately 50% of the total explained variance in the model. Each SD increase in In-Training Examination scores was associated with a difference of 30 U (95% confidence interval, 27 to 33) in certification performance. In-Training Examination scores also were significantly associated with passing status on the Nephrology Certification Examination on the first attempt (odds ratio, 3.46 per SD difference in the In-Training Examination; 95% confidence interval, 2.68 to 4.54). An In-Training Examination threshold of 375, approximately 1 SD below the mean, yielded a positive predictive value of 0.92 and a negative predictive value of 0.50. American Society of Nephrology In-Training Examination performance is significantly associated with American Board of Internal Medicine Nephrology Certification Examination score and passing status.

Detecting cross-cultural differential item functioning for increasing validity: An example from the American board of family medicine in-training examination

Background: The present study describes the process used to detect items for cross-cultural differential item functioning (cc-DIF) and attempts to understand cc-DIF by both statistical analysis and content review using a cultural lens. Methods: Data from the 2014 American Board of Family Medicine (ABFM) In-Training Examination (ITE). Results: cc-DIF existed in ten items on the 2014 ABFM ITE and could not be eliminated over the residency program years. International medical school graduates were benefited by seven items, whereas the United States medical school graduates (USMGs) were benefited by three items. Discussion: Cultural specificities and differential content familiarity likely are the primary reasons for items exhibiting cc-DIF. Conclusions: Investigating cc-DIF is recommended for any examination involving multicultural groups. Further, items exhibiting cc-DIF offer opportunities for students to reflect on their implicit cultural differences that may ultimately affect how they practice medicine in a multicultural society.

Emergency Medicine Residency Applicant Characteristics Associated with Measured Adverse Outcomes During Residency.

IntroductionNegative outcomes in emergency medicine (EM) programs use a disproportionate amount of educational resources to the detriment of other residents. We sought to determine if any applicant characteristics identifiable during the selection process are associated with negative outcomes during residency.MethodsPrimary analysis consisted of looking at the association of each of the descriptors including resident characteristics and events during residency with a composite measure of negative outcomes. Components of the negative outcome composite were any formal remediation, failure to complete residency, or extension of residency.ResultsFrom a dataset of 260 residents who completed their residency over a 19-year period, 26 (10%) were osteopaths and 33 (13%) were international medical school graduates A leave of absence during medical school (p <.001), failure to send a thank-you note (p=.008), a failing score on United States Medical Licensing Examination Step I (p=.002), and a prior career in health (p=.034) were factors associated with greater likelihood of a negative outcome. All four residents with a “red flag” during their medicine clerkships experienced a negative outcome (p <.001).Conclusion“Red flags” during EM clerkships, a leave of absence during medical school for any reason and failure to send post-interview thank-you notes may be associated with negative outcomes during an EM residency.

The Recent Pathology Residency Graduate Job Search Experience: A Synthesis of 5 Years of College of American Pathologists Job Market Surveys.

- Pathology residents and fellows tailor their training and job search strategies to an actively evolving specialty in the setting of scientific and technical advances and simultaneous changes in health care economics. - To assess the experience and outcome of the job search process of pathologists searching for their first non-fellowship position. - The College of American Pathologists (CAP) Graduate Medical Education Committee has during the past 5 years sent an annual job search survey each June to CAP junior members and fellows in practice 3 years or less who have actively searched for a non-fellowship position. - Job market indicators including job interviews, job offers, positions accepted, and job satisfaction have remained stable during the 5 years of the survey. Most survey respondents who had applied for at least 1 position had accepted a position at the time of the survey, and most applicants who had accepted a position were satisfied or very satisfied. However, most attested that finding a non-fellowship position was difficult. Despite a perceived push toward subspecialization in surgical pathology, the reported number of fellowships completed was stable. Respondent demographics were not associated with job search success with 1 significant exception: international medical school graduate respondents reported greater perceived difficulty in finding a position, and indeed, fewer reported having accepted a position. - Pathology residents and fellows seeking their first position have faced a relatively stable job market during the last 5 years, with most accepting positions with which they were satisfied.

Addressing Professionalism, Social, and Communication Competencies in Surgical Residency Via Integrated Humanities Workshops: A Pilot Curriculum

We aimed to conduct professionalism and social competencies (PSC) training by integrating humanities into structured workshops, and to assess reception of this curriculum by first-year surgical residents. An IRB-approved, pilot curriculum consisting of 4 interactive workshops for surgical interns was developed. The workshops were scheduled quarterly, often in small group format, and supplemental readings were assigned. Humanities media utilized to illustrate PSC included survival scenarios, reflective writing, television portrayals, and social media. Emphasis was placed on recognizing personal values and experiences that influence judgment and decision-making, using social media responsibly, identifying and overcoming communication barriers related to generational changes in training (especially technology and work-life balance), and tackling stereotypes of surgeons. Anonymous and voluntary pre- and postcurriculum surveys were administered. Univariate analysis of responses was performed with JMP Pro v12 using Fisher's exact, χ2, and Students' t-tests for categorical and continuous variables. The study took place at the Cleveland Clinic in Cleveland, OH, within the general surgery program. Surgical interns at the Cleveland Clinic were included in the study. A total of 16 surgical interns completed the curriculum. Sixteen surgical interns participated in the curriculum: 69% were domestic medical school graduates (DG) and 31% were international medical school graduates (IMG). Overall, the majority (81%) of residents had received PSC courses during medical school: 100% of DG compared to 40% of IMG (p = 0.02). Before beginning the curriculum, 86% responded that additional PSC training would be useful during residency, which increased to 94% upon completion (p = 0.58). Mean number of responses supporting the usefulness of PSC training increased from 1.5 ± 0.2 before the curriculum to 1.75 ± 0.2 upon completion (p = 0.4). When describing public and medical student perceptions of surgeons, 60% and 83% of adjectives used were negative, respectively. When describing perceptions of female surgeons, 88% of adjectives used were negative. Most interns received prior PSC coursework; however, the majority still desired additional training during residency. After completion, a greater percentage of interns responded that PSC training was important and choose more reasons in favor of the curriculum. Formalized didactics should be strongly considered, especially in programs with IMG. Future areas of investigation include expanding the cohort to additional years of residency; potentially identifying unique PSC needs for each postgraduate year.

Comparison of Rate of Utilization of Medicare Services in Private Versus Academic Cardiology Practice

Cardiovascular services are the third largest source of Medicare spending. We examined the rate of cardiovascular service utilization in the community of Glendale, CA, compared with the nearest academic medical center, the University of Southern California. Publicly available utilization data released by Medicare for the years 2012 and 2013 were used to identify all inpatient and outpatient cardiology services provided in each practice setting. The analysis included 19 private and 17 academic cardiologists. In unadjusted analysis, academic physicians performed half as many services per Medicare beneficiary per year as those in private practice: 2.3 versus 4.8, p <0.001. Other factors associated with higher utilization included male physician, international (vs US) medical school graduate, interventional (vs general) cardiologist, and more years in practice. Factors independently associated with higher utilization rates by multivariable analysis included private practice setting (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.30 to 2.61, p <0.001), male physician (OR 1.64, 95% CI 1.00 to 2.67, p = 0.049), and international medical school graduate (OR 1.37, 95% CI 1.07 to 1.78, p = 0.014). In conclusion, in this analysis of 2 cardiology practice settings in southern California, medical service utilization per Medicare beneficiary was nearly 2-fold higher in private practice than in the academic setting, suggesting that there may be opportunity for substantially reducing costs of cardiology care in the community setting.