Medical School Career Research Articles

998 Reducing Medical Student Anxiety and Stress by Providing Guidance on Specialty Training and Self-Assessment Portfolios Early on Within Their Medical School Careers

998 Reducing Medical Student Anxiety and Stress by Providing Guidance on Specialty Training and Self-Assessment Portfolios Early on Within Their Medical School Careers

The gap year for college students interested in medicine: Can they contribute to your mission?

Gap years taken between undergraduate completion and entrance into medical school have become increasingly popular. We examine the role of gap years among college graduates interested in medicine and how they might contribute to academic research productivity within clinical environments. Recently, academic faculty have struggled to balance increasing clinical responsibilities with their scholarly endeavors. Academic medical departments may have incentives to hire pre-medical students to help ease the research burden on faculty. Properly motivated pre-medical students may view research positions in academic medical departments as ideal opportunities to learn in areas that will broaden their scientific knowledge and help prepare them for medical school, while greatly enhancing their medical school applications through distinguishing themselves as co-authors published in medical journals. Our experience, with two co-authors working as research associates while preparing for their medical school applications and careers, suggests that pre-medical students can strengthen their medical school applications during their gap year(s) while proving instrumental in enhancing research output thus alleviating the workload of clinical faculty.

When the Penny Drops: Understanding how social class influences speciality careers in the UK medical profession

In the UK, the medical profession is socially exclusive and socially stratified as doctors from more advantaged backgrounds are more likely to train for specialities with more competitive entry. However, in research to date the causes and consequences of social stratification have been overlooked. We explore this subject here, drawing on a qualitative study comprising in-depth interviews with 30 medical students and doctors from less advantaged socio-economic backgrounds negotiating medical school and early careers. Using Bourdieu's ‘theory of practice’ we show how socialisation in the family and at school influences how aspirant medics from less advantaged backgrounds view the world, suggesting some inclination towards more community orientated careers, which may be less competitive. However, these tendencies are encouraged as they lack stocks of social, economic and cultural capital, which are convertible to power and position in the field. While allowing for both choice and constraint our core argument is that speciality outcomes are sometimes inequitable and potentially inefficient, as doctors from more advantaged backgrounds have privileged access to more competitive careers for reasons not solely related to ability or skill. Our main theoretical contribution is to literature in the sociology of medical education where ours is the first study to open-up the ‘black box’ of causal factors connecting medical students' resources on entering the field of education and training with speciality outcomes, though our findings also have important implications for practitioners, the profession and for patients. We discuss the implications for safe and effective healthcare and how this informs directions for future research.

Exploring medical students’ perceptions of dermatology and dermatologists

Background: Recent survey results highlight the need for increased awareness and recognition of dermatology as a medical specialty within the broader medical community. Methods: A survey was conducted among 852 Polish medical students using Google Documents, modelled after a similar study conducted in Germany. Results: The survey identified significant findings: many respondents lacked awareness and understanding of dermatology’s scope and significance, often associating it primarily with cosmetic procedures. Dermatology was perceived as less prestigious and intellectually challenging, leading to its underrepresentation in medical school curricula and career preferences. Conclusions: There is a pressing need for advocacy and awareness campaigns to showcase the depth and complexity of dermatology as a medical field. Key words: Education, Medical, Undergraduate, Career choice, Dermatologists

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

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

Impact of a Preclinical Medical Student Anesthesiology Elective on the Attitudes and Perceptions of Medical Students Regarding Anesthesiology.

First- and second-year medical students typically have limited exposure to the field of anesthesiology, yet recent match data shows growing interest in the specialty. Early, structured exposure to anesthesiology in the form of a preclinical elective may allow medical students to make more informed decisions on their specialty of choice. The anesthesiology preclinical elective, BIOL 6704: "Anesthesia: Much More than Putting you to Sleep", is a one-credit course taught at The Warren Alpert Medical School of Brown University. A survey consisting of fifteen questions assessing changes in attitudes, perceptions, and interest in anesthesiology was distributed to first- and second-year medical students before and after course participation. The results were analyzed using the Wilcoxon's signed-rank test for paired samples. The biggest impact of the preclinical elective was observed in the students' subjective understanding of key aspects of the practice of anesthesiology. Statistically significant improvement was seen in the understanding of airway management, anesthetic pharmacology, basics of ultrasound, vascular access, anesthesiology subspecialties, and an understanding of anesthesiology residency. Overall, results were limited by our small sample size. Our elective allows medical students to explore anesthesiology early in their medical school career. After taking this course, students noted more familiarity with various topics in anesthesiology. Peer institutions lacking a similar course may consider using our experience to increase interest about the specialty of anesthesiology for future students.

The Transformation: Power in Persistence and Perspective

The Transformation:Power in Persistence and Perspective Tyler Bendrick We've got another meth napper," my resident stated. With an introduction like that, it is hard not to be immediately labeled as a "difficult patient." Being the only Spanish-speaking person on the team, I, a third-year medical student, became the primary point of contact for this severely injured patient. He was an only-Spanish-speaking, 36-year-old male admitted [End Page 7] to our trauma service after he was hit by a truck while riding his bicycle. Unbeknownst to me at the time, the 14 days I spent caring for this man would become one of the most pivotal learning experiences of my medical school career. It changed not only how I understand and approach "difficult patients" but expanded my knowledge of the complexities and challenges of the current healthcare system and how we, as physicians and healthcare providers, can deliver the best care to patients with low health literacy and limited resources. So, what is a "meth napper?" I questioned. "Well, meth is a super stimulant," my resident explained. "When people are frequent meth users, they get used to functioning normally with high levels of stimulants in their body, reducing the normal regulation of wakefulness. When the amphetamine is removed (such as upon admission to the hospital), the body is left to fend for itself, and thus patients oftentimes sleep for 23 hours a day for about 3 to 5 days while their body works to detox and normalize hormones." As predicted, my new friend, "Joe," was napping when I first went to see him. Thinking back, the word "napping" does not accurately describe his level of somnolence. He was virtually unarousable, and I took to a sternal rub to wake him up at 5 a.m. after his traumatic exploratory laparotomy the night before. Once aroused, he was furious. "Estoy bien. Tengo dolor y tengo hambre," he grunted at me. (I am fine, and I am in pain and hungry!). "Ok, Joe," I replied in Spanish, "I am just going to do a quick exam and you can go back to sleep. We will give you medications for your pain. You had a big surgery on your intestines, so you cannot eat or drink right now. If everything goes well in the next couple of days and you start walking around, we can advance your diet." He begrudgingly let me examine him, never opening his eyes, and I left and went about my day. We continued this routine for five days. I would periodically check on him and usually found him sleeping. When awake, he refused to work with physical therapists, get up and walk or go to the bathroom, shower, use his spirometer, or converse with the nursing staff. He seemed completely disinterested in recovery. About day three, we slowly advanced his diet to clear liquids so he could quench his thirst. Sometimes his wife was there, and she would ask for updates, to which I could only reply, "We have to wait until he is more awake or willing to work with us." I was getting frustrated, as it seemed that his noncompliance was becoming his barrier to discharge. But on day six, everything changed. I went to check on Joe, and he was wide awake, vomiting, and irate. He shouted that he was in incredible pain, and his incision was wet. He was also complaining that he had not eaten in five days, and was insisting that we were starving him. Again, I calmly explained (as I had multiple times a day for the past five days) that his major abdominal surgery prevented us from feeding him until his intestines healed. We were giving him fluids and nutrition through his IV lines, so he was not starving to death. I rushed to get my resident to examine his oozing wound, and after a CT scan and an x-ray, we discovered what we feared: His wound had opened down to the fascia, "dehiscence," as it is called. On top of this, he now had a bowel obstruction, causing his vomiting. His lack of mobility for the past five days had slowed his...

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Letter: Addressing Barriers to Student Participation in Neurosurgical Conferences: Experiences From the Inaugural Early Career Neuroscience Virtual Research Symposium.

Letter: Addressing Barriers to Student Participation in Neurosurgical Conferences: Experiences From the Inaugural Early Career Neuroscience Virtual Research Symposium.

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

Bridging the Racial, Ethnic, and Gender Gap in Gastroenterology

The Effect of COVID-19 on the Medical School Experience, Specialty Selection, and Career Choice: A Qualitative Study

OBJECTIVEWhile COVID-19 had a profound impact on healthcare, its effects on medical students are less clear. This study explored the effects of COVID-19 safety measures on medical students’ specialty selection and career choices. It further considers the potential differential effects of COVID by gender.DESIGNBetween June and November 2020 at a Midwestern medical university, medical students with an anticipated graduation in 2021 through 2023 participated in virtual focus group sessions, which explored students’ transition to remote learning during COVID-19, perception of gender bias within medical education, and personal and professional goals. Nine focus groups were held, with two to six students per session (n = 22). Focus groups were video recorded, transcribed verbatim, and data were deidentified. Transcripts were coded and analyzed using consensual qualitative analysis to identify themes.RESULTSOur analysis captured 3 themes: (1) Impact of Institutional Decision-Making due to COVID-19, (2) Impact of Unstructured Time on Professional and Personal Decision Making, and (3) Impact of Societal Pressures, Gender Bias, and Mentorship on Career Planning.CONCLUSIONSCOVID-19 disrupted important learning opportunities for medical students. Mentorship and shadowing are critical in helping students make career and specialty decisions, particularly for women. The loss of these opportunities may have lasting career impacts for all students.

A mixed methods study to evaluate the impact of a student-run clinic on undergraduate medical education

BackgroundThe purpose of this study was to evaluate the extent to which a longitudinal student-run clinic (SRC) is meeting its stated learning objectives, including providing critical community services and developing physicians who more fully appreciate the social factors affecting their patients’ health.MethodsThis was a mixed methods program evaluation of an SRC at Mayo Clinic Alix School of Medicine (MCASOM). A survey was conducted of medical students who had participated in the clinic and seven interviews and three focus groups were conducted with SRC patients, students, faculty, staff, and board members. Transcripts were coded for systematic themes and sub-themes. Major themes were reported. Survey and interview data were integrated by comparing findings and discussing areas of convergence or divergence in order to more fully understand program success and potential areas for improvement.ResultsGreater than 85% of student survey respondents (N = 90) agreed or strongly agreed that the SRC met each of its objectives: to provide a vital community service, to explore social determinants of health (SDH), to understand barriers to healthcare access and to practice patience-centered examination. Qualitative data revealed that the SRC contextualized authentic patient care experiences early in students’ medical school careers, but the depth of learning was variable between students. Furthermore, exposure to SDH through the program did not necessarily translate to student understanding of the impact of these social factors on patient’s health nor did it clearly influence students’ future practice goals.ConclusionsThe MCASOM SRC experience met core learning objectives, but opportunities to improve long-term impact on students were identified. Participation in the SRC enabled students to engage in patient care early in training that is representative of future practices. SRCs are an avenue by which students can gain exposure to real-world applications of SDH and barriers to healthcare access, but additional focus on faculty development and intentional reflection may be needed to translate this exposure to actionable student understanding of social factors that impact patient care.

Bibliometric profiles of contemporary leaders in neurosurgery

Research is a significant component of academic neurosurgery. This analysis of current American leaders in neurosurgery provides a bibliometric review of research impact and productivity with a focus on m-quotient analysis throughout the stages of career development including medical school, residency and faculty. A random selection of neurosurgeons (n = 82) from the Society of Neurological Surgeons (SNS) was analyzed using Scopus to collect research and publication data including publication count, h-index, and m-quotient during each career phase. The mean number of publications, h-index, and m-quotient for medical school, residency, and faculty career stages are reported. Neurosurgeons with self-reported subspecialties of vascular, skull base, functional, spine, and pediatrics had significantly higher m-quotients than general neurosurgeons (p < 0.001). Those with either dual degrees consisting of an M.D. and Ph.D. (p = 0.472) or with a clinical fellowship (p = 0.127) training were not found to have significantly higher m-quotients than those without. No significant differences in m-quotients were found between faculty ranks including associate professor, professor, program director, and chairman. These findings provide a bibliometric analysis of research productivity throughout the career phases of current leaders in American academic neurosurgery which can serve as a reference for neurosurgeons at any stage of training or practice.

Abstract IA48: Engagement with Native American communities

Abstract Increasing the numbers of underrepresented minorities (URM) in biomedical research, including cancer, is more than a laudable goal. It is an important priority because it will likely lead to better disease outcomes for people from within these communities. Therefore, we must build capacities to provide pathways for URM students to succeed. Over the past 15 years we have worked with both urban and reservation Native American communities to bring health and science education to their teachers and students. There are some salient and universal principals that must be acknowledged. First and foremost is trust. One does not alter decades of neglect, suspicion, and distrust without serious and open dialogue. Moreover, while one does find many stories of success, they are often anecdotal and, while no less powerful, a foundation must be laid to make these stories much more common. Among the first things that we learned was that the starting point needs to moved back. We had heard that there were programs and partnerships, past and present, within the University of Nebraska Medical Center (UNMC) with an area tribal college. These programs seemingly included collaborations to increase student enrollment in allied health professions or experience research opportunities. Unfortunately, neither had much, if any, success. Thus, we learned that post-secondary engagement was not sufficient to garner positive results. Our first program, even though UNMC is primarily a graduate institution, was a K-8 program for students and teachers. It is there that a foundation of learning, STEM engagement, tapping the natural curiosity of young learners, and providing resources to teachers, especially those in severely under-sourced areas, would have to be set. In addition, spending time within the schools and communities, at times hundreds of miles from campus, was essential to build the necessary trust for this work to continue and become impactful. We have not changed the world, but we have established trust with many communities. Our middle school summer programs have become practically standing room only. We have had many students, high school and undergraduates, engage in research, both bench and community based. We have students who have explored pathways to health careers, and now some are graduating college with their eyes on medical school and research careers. Clearly, decades of neglect will not be alleviated in just a few grant cycles, but significant steps have been made and continued concerted efforts will, in time, bridge gaps that seemed to be chasms not long before. Citation Format: Maurice Godfrey. Engagement with Native American communities [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr IA48.

Physician workforce planning and allocation model using agent‐based modeling: A case study in Thailand

To address the physician workforce challenges in Thailand using Agent-Based Modeling (ABM). Physician planning and allocating have been modeled with the life cycle framework starting from medical school intakes, residency training, and career retirement. This study proposes a systematic approach to physician planning and allocating which are modeled with a framework starting from medical school intakes, residency training, and career retirement. The ABM can estimate physician levels for provincial government hospitals (OPS-MOPH) and other sectors. The model can demonstrate any geographical imbalance issues at the provincial level under the existing rural recruitment program implementation. Based on the ABM simulation result, although person per physician ratios reached the target of 1800:1 at the national level in 2019, Bangkok is the only province that reached the target. For other provinces, the ratio of OPS-MOPH is far from the target. It will need 10 more years to reach the target, and a geographical imbalance will still exist. A solution of modified rural recruitment program with the limitation of hometown jobs has been proposed to reduce the geographical imbalance. With the proposed modified rural recruitment program, the model predicts that all provinces will reach the target in 2036.

Evaluating a Health Literacy Communication Training for Medical Students: Using Plain Language

ABSTRACT Medical students tend to use technical terminology without explanation when communicating with patients, and do not feel confident interacting with patients who have low health literacy (LHL). The present study consisted of an evaluation of a brief health literacy training for first-year medical students seeking to enhance their knowledge of health literacy, self-efficacy in communicating with patients who have LHL, and clear communication skills. The training was guided by patient-centered communication, social cognitive theory, and the universal precautions approach to health literacy, and developed and delivered by communication scholars. Results indicated that medical students had increased health literacy knowledge, confidence in communicating with patients who have LHL, and found the training to be useful. Medical student interactions with standardized patients from the cohort who received the training were compared with the previous year’s cohort who did not receive the training. Analysis of transcripts of interactions after the training indicated no significant differences in medical students’ use of examples. Health literacy trainings should be incorporated into the medical student curriculum, taught in collaboration with communication scholars, and be given more frequently throughout the medical school career to reinforce utilization of clear communication strategies.

A snapshot of underrepresented physicians 15 years after medical school

We conducted a study to compare medical school experiences, values, career paths, and career satisfaction of under-represented in medicine (URiM) and non-URiM physicians approximately 15years after medical school, guided by the Theory of Planned Behavior and the concept of stereotype threat. The sample consisted of four graduating classes, 1996-1999, of Harvard Medical School, 20% of whom were URiM. URiM respondents came from families of lower educational attainment and graduated with more debt. As students, they reported a greater experience of stereotype threat and, and at graduation they showed a tendency to place a higher value on avoiding a career that places them under constant pressure. Concerning their current status, URiM respondents expressed a lower level of satisfaction with their career progress. Multivariable analyses indicated that across the entire sample, URiM status was not a significant predictor of employment in academic medicine, but that being in academic medicine was predicted by mentors' encouragement for a research career, greater intention to pursue research, and a lower value on having a financially rewarding career. Lower career satisfaction was predicted by one's status as URiM, employment in academic medicine, greater involvement in research, and a greater value on avoiding constant pressure. The data suggest that negative student experiences in medical school, combined with the lack of mentor encouragement and financial pressures may discourage URiM medical students from pursuing academic careers, and that pressures for productivity and working in academic medicine may degrade the satisfaction derived by physicians in general.

Mentorship of US Medical Students: a Systematic Review.

Mentoring of medical students remains a core pillar of medical education, yet the changing landscape of medicine has called for new and innovative mentoring models to guide students in professional development, career placement, and overall student well-being. The objective of this review is to identify and describe models of mentorship for US medical students. We searched PubMed, PsycINFO, Education Resources Information Center, and Cochrane Databases of Systematic Reviews following PRISMA guidelines. We included original, English-language studies of any research design including descriptive studies that described a mentorship program at a US medical school designed for medical students. Our search yielded 3743 unique citations. Thirty articles met our inclusion criteria. There was significant diversity of the identified programs with regard to program objectives and size. The traditional dyad model of mentorship was the most frequently cited model, with a combination of models (dyad and group mentorship) cited as the second most common. Outcome measures of the programs were largely survey based, with satisfaction being the most measured outcome. Overall, satisfaction was highly rated throughout all the measured mentoring programs. Seven programs provided objective outcomes measures, including improved residency match data and increased scholarly productivity. The programs with objective outcomes measures were smaller, and 6/7 of them focused on a specific clinical area. Five of these programs relied on the traditional dyad model of mentorship. Cost and faculty time were the most frequently cited barriers to these programs. Our review demonstrates that mentoring programs for medical students can positively improve medical school satisfaction and career development. These results underscore the need for continued innovative mentoring programs to foster optimal student development in the setting of the increasingly competitive residency match process, growing expectations about student research productivity, and the national focus for overall student wellness.

Scientific activity by medical students: the relationship between academic publishing during medical school and publication careers after graduation.

IntroductionEngagement of clinicians in research is important for the integration of science and clinical practice. However, at this moment, there is a shortage of clinician-scientists. Success experiences can stimulate student interest in a research career. Conducting actual research leading to publication is a potential method to gain success experience. This study assessed whether publication as a medical student is associated with publication after graduation. We determined whether medical students in the Netherlands who are involved in research, as measured by publication in international journals before graduation: 1) are more likely to publish, 2) publish a greater number of papers, and 3) have higher citation impact scores after graduation.MethodsWe matched 2005–2008 MD graduates (with rare names, n = 4145 in total) from all eight Dutch university medical centres to their publications indexed in the Web of Science and published between 6 years before and 6 years after graduation. For sensitivity analysis we performed both automatic assignment on the whole group and manual assignment on a 10% random sample.ResultsStudents who had published before graduation: 1) were 1.9 times as likely to publish, 2) published more papers, and 3) had a slightly higher citation impact after graduation.DiscussionMedical students who conducted research leading to a publication before graduation were more likely to be scientifically active after graduation. While this is not a causal relationship per se, these results cautiously suggest that successful early involvement in research could influence the long-term scientific activity of clinicians.