Medical School Graduates Research Articles

Publication outcomes among intensive care trainees.

There is a paucity of literature describing the research productivity among trainees in intensive care medicine. We sought to examine the occurrence and determinants of successful publication outcomes associated with intensive care training. The study cohort consisted of all individuals admitted to fellowship of the College of Intensive Care Medicine of Australia and New Zealand (CICM) from 2012 to 2019. The primary outcome measure of this study was manuscripts indexed on PubMed within one year after and four years prior to admittance to CICM fellowship. Four hundred and eighty-five fellows were identified of whom 216 (45%) had at least one publication; 129 (27%) had one, 34 (7%) had two, 21 (4%) had three and 32 (7%) had four or more publications. Overall 138 (28%) fellows had at least one publication that was likely associated with their mandatory CICM training project for which they were first (n = 110; 80%) and/or corresponding (n = 72; 52%) author in the majority of cases. Overall 107 different senior/mentor authors were identified, with 13 individuals supporting more than one publication. Although gender and location at the time of fellowship award were not associated, location of receipt of medical degree, shorter time period between medical school graduation and fellowship award, more recent year of award, and completion of medical degree/fellowship in the same geographical region were associated with project publication. A minority of CICM fellows have PubMed-indexed publications related to their training. Further efforts are warranted to better define the determinants of successful project publication to optimise future opportunities.

Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment.

Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation.

Response time of high impact factor medical journals versus an expert-curated, online oncology platform before and during the COVID-19 pandemic.

465 Background: The objective of this study was to characterize the publication speed of high impact factor medical journals (HIFMJ) compared with the dissemination speed of a private, expert-curated, online platform (ECOP) designed for oncologists. We also aimed to describe determinants of response speed to questions on this platform. Methods: We selected 100 HIFMJ and calculated their reported peer review time (Submission to Acceptance [STA]). The platform database was queried between the dates 2017 and 2022 with information collected about day of query, response time (RespT), and poster gender, region, and medical school graduation year. This data was analyzed utilizing univariable median regression analyses and two t-tests as appropriate. Results: Of the 26 available medical journal response times, the average STA was 57.36 days (range: 2.6 - 204 days). Of the 4,346 online platform questions and answers (Q+A), the mean RespT was noted to be significantly lower at 2.63 days (CI, 2.19 - 3.07 days). With the ECOP, the mean RespT for male posters (mean: 2.58 days; CI, 2.08 - 3.08) and female posters (mean: 2.72 days, CI, 1.89 - 3.56) was not significantly different (p=0.61). RespT from 2017 to 2019 increased slightly (p&lt;0.001) before trending down during the COVID pandemic (p&lt;0.02). Mean RespT before the Covid pandemic in the United States, March 15, 2020 (2.68 days, CI, 2.11 - 3.25), was non-significantly reduced as compared with questions after March 15, 2020 (2.17 days, CI, 1.88 - 2.46, p=0.13). Conclusions: Traditional peer review proves a lengthy process in contrast to real-time, Q+A-based oncology platforms. An ECOP allows physicians the ability to provide their expertise regarding rare, nuanced patient cases in order to better ensure all patients receive the highest level of clinical care. During the onset of the COVID-19 pandemic, the ability to share medically curated information to ensure safe and effective oncologic care in a timely manner proved imperative, as information regarding the virus was evolving rapidly. During this unprecedented time, this platform provided oncologists with a novel way to quickly vet case reports and disseminate scientific information. This, in turn, translated into cancer care “best practices” during a rapidly evolving crisis.

Perspectives from two recent medical school graduates on exposure to pathology during undergraduate medical education: A narrative inquiry

The field of pathology is facing an inflection point where the demand for pathology services is not being met by a corresponding rise in recruitment into the field. Many of the myths about the field of pathology have been dispelled elsewhere, but there have not been many formal accounts of the experience medical students’ face when finding their path to pathology. Because of challenges in the visibility of pathology as a specialty and not simply a subject required for United States Medical Licensing Examination Step 1, students tend to fall into one of two categories: early differentiators or late discoverers. Here, we provide anecdotal accounts of these two paths at institutions with different curricular designs and provide a first-hand account of the challenges we faced and opportunities discovered in our journeys to pathology. Based on these experiences, we offer suggestions for ways to address some of the issues medical students must navigate when trying to explore pathology in curricula not built for such exploration.

Survey of ASCO Sponsored Oncology Interest Groups in the United States Assessing Medical Student Perceptions of Education in Radiation Oncology and Future Employment Prospects

Over the last five years, applications to radiation oncology residency programs among graduates of medical schools in the United States (US) have declined by nearly 50% with a corresponding increase in unfilled positions in the National Resident Matching Program. This has led to ongoing concern regarding the future of the radiation oncology workforce and speculation regarding contributing factors. There are no published data substantiating medical student viewpoints on these issues. To better understand medical student perceptions of oncology specialties (medical oncology (MO), radiation oncology (RO), and surgical oncology/surgical subspecialties (SO)) and factors contributing to their career choices, we conducted a survey among oncology interest groups sponsored by the American Society of Clinical Oncology (ASCO). Survey content emphasized relative impressions of oncology specialties, exposure to these fields during medical school, and perceptions of future employment prospects. An IRB-approved thirty-item questionnaire was distributed electronically via SurveyMonkey to US medical student members of ASCO sponsored interest groups. Participation was optional at the institutional and individual level and responses anonymous. Chi square test or Fisher's exact test was used to compare categorical variables. Two-hundred seventy-nine students completed the survey (37% male, 62% female; 42% White, 40% Asian, 18% underrepresented minorities). Students report receiving less exposure to radiation oncology during medical school: 19% report RO is not included in their curriculum vs. 4% for MO (p<0.01); 77% report receiving lectures from MO faculty, 33% from RO, and 41% from SO (p <0.01); 41% were encouraged to consider RO as a specialty, compared to 62 % for MO and 42% for SO (p < 0.01); 45% report having a clear understanding of role of MO in oncology care vs. only 25% for RO and 38% for SO (p<0.01); 41% saw MO as leaders of the multidisciplinary cancer team, 1 % for RO, and 2% for SO, 47% felt all played equal roles (p<0.01). Students have more negative perceptions of future career prospects for RO: 81% feel that job prospects for MO are strong, 55% for RO and 73% for SO (p<0.01); 54% feel strongly that jobs are available in desirable geographic locations for MO, 36% for RO, 48% for SO (p<0.01); 27% of students report concerns about the future viability of RO, 10% for MO, and 11% for SO (p<0.01). Compared to other oncology specialties, students have less exposure to RO, less understanding of the role of RO in multidisciplinary cancer care, and more pessimism about the future job market/specialty viability. These are likely contributing factors to declining interest in RO among graduates of US medical schools. Current radiation oncologists should increase efforts to improve medical student interest and understanding of RO.

Projected Lifetime Earnings of a Radiation Oncologist

The estimated lifetime earnings of a radiation oncologist depend on many choices and have not been calculated. The objective of this work is to project the year-by-year and cumulative lifetime earnings of a US-based radiation oncologist based on various career pathways. We modeled lifetime earnings based on undergraduate training (reference: assumes starting at age 18, tuition/loans of $40,000 x 4 years), MD/DO (reference: assumes tuition/loans of $55,000 x 4 years, 8% interest) vs MD/PhD program (assumes no tuition, $30,000 yearly stipend x 8 years), gap year(s), fellowship, employment paths (academic, private practice, hospital employed, physician scientist with NIH salary cap), adjustable salary during employment (based on 2016-2018 AAMC and MGMA; e.g., promotion for academic track, partnership for private practice), adjustable state and federal income taxes, loan repayment options (e.g., out of pocket, NIH loan repayment program [LRP], public service loan forgiveness [PSLF]). The primary outcome was cumulative lifetime earnings, and additional analyses were conducted based on changes in career paths. We created a web-based application to simulate the various choices using R Shiny: https://physician-earnings.shinyapps.io/rshiny/. For an academic radiation oncologist, assuming MD/DO degree, national average of $220,000 in loans at medical school graduation, 5% state income tax, no gap years, pursuing PSLF, starting as assistant professor, 7 year promotion until associate professor, and 7 subsequent year promotion to full professor, and retirement age of 65, the post-tax median lifetime earnings are $9,610,675 (IQR $8,097,433 - $10,885,824), with $5,242,653 federal + state taxes. With the private practice setting, the median lifetime earnings are $11,383,781 (IQR $9,875,040 - $13,325,316). As a hospital employee, the median lifetime earnings are $8,834,886 (IQR $8,127,132 - $10,166,145). As an NIH-salary capped physician scientist, the median lifetime earnings are $4,678,668 (IQR not provided, given one set cap). Using the academic track as the reference group, the median lifetime earnings would change as follows: $9,333,434 (IQR $7,876,310 - $10,572,388) for those who pursue one paid undergraduate gap year; $9,125,590 (IQR $7,822,115 - $10,274,801) for those who pursue MD/PhD programs; $10,365,300 (IQR $8,725,954 - $11,746,712) for those with 0% state income tax during practice; and $9,565,364 (IQR $7,875,284 - $10,802,830) for those who repay their loans out of pocket at 50% of their attending salary. PSLF and NIH LRP allow one to cross a net worth of $0 by their mid-30s; pursuit of fellowship, starting as an instructor in academics, salary in bottom quartile %, paying loans out of pocket, and gap years all delay this landmark by 1-4 years. NIH-salary capped positions have the largest negative impact on lifetime earnings, by > $5,000,000. We created a model to estimate lifetime earnings of a radiation oncologist in the US.

A comparison of the American Board of Anesthesiology's in-person and virtual objective structured clinical examinations

BackgroundThe American Board of Anesthesiology's Objective Structured Clinical Examination (OSCE), as a component of its initial certification process, had been administered in-person in a dedicated assessment center since its launch in 2018 until March 2020. Due to the COVID-19 pandemic, a virtual format of the exam was piloted in December 2020 and was administered in 2021. This study aimed to compare candidate performance, examiner grading severity, and scenario difficulty between these two formats of the OSCE. MethodsThe Many-Facet Rasch Model was utilized to estimate candidate performance, examiner grading severity, and scenario difficulty for the in-person and virtual OSCEs separately. The virtual OSCE was equated to the in-person OSCE by common examiners and common scenarios. Independent-samples t-test was used to compare candidate performance, and partially overlapping samples t-tests were applied to compare examiner grading severity and scenario difficulty between the in-person and virtual OSCEs. ResultsThe in-person (n = 3235) and virtual (n = 2934) first-time candidates were comparable in age, sex, race/ethnicity, and whether U.S. medical school graduates. The virtual scenarios (n = 35, mean [0.21] ± SD [0.38] in logits) were more difficult than the in-person scenarios (n = 93, 0.00 ± 0.69, Welch's partially overlapping samples t-test, p = 0.01); there were no statistically significant differences in examiner severity (n = 390, −0.01 ± 0.82 vs. n = 304, −0.02 ± 0.93, Welch's partially overlapping samples t-test, p = 0.81) or candidate performance (2.19 ± 0.93 vs. 2.18 ± 0.92, Welch's independent samples t-test, p = 0.83) between the in-person and virtual OSCEs. ConclusionsOur retrospective analyses of first-time OSCEs found comparable candidate performance and examiner grading severity between the in-person and virtual formats, despite the virtual scenarios being more difficult than the in-person scenarios. These results provided assurance that the virtual OSCE functioned reasonably well in a high-stakes setting.

Is it broken?

Orthopaedics: A specialty with 388 current active surgeons in Aotearoa New Zealand of whom just 25 (6.4%) are women. This is a pretty dismal statistic given that women represent more than 50% of our medical school graduates. We acknowledge that not everyone has a strong interest in orthopaedics and that it is possible that a greater number of female doctors may genuinely be more interested in other areas of medicine. However, the issue is about ensuring that those that do have the interest and the potential to become great surgeons are not discouraged by feeling as if they do not belong. With the current gender inequality in orthopaedics, we are missing out on potential talent and the benefits of diversity. In addition, there are few Māori and Pasifika surgeons in Aotearoa New Zealand and only one openly gay practicing orthopaedic surgeon. Beyond even the sense of fairness and equity or the moral imperative, we know that diversity benefits organisations. Diverse groups make better decisions and experience improved creativity, performance, collaboration, and innovation. In step with this, the 30% Club is an established global campaign to improve female representation at board level in the world’s biggest companies. Evidence based studies have shown that improving diversity, in orthopaedics specifically, leads to higher quality patient care and better outcomes.

Residency Training Pathways of Program Directors and Chiefs/Chairs in Plastic Surgery.

Medical students interested in plastic surgery may become discouraged by barriers to career development during residency training. This study surveyed plastic surgery program directors (PDs) and chiefs/chairs to highlight the pathway followed by academic leaders in these positions. A self-administered anonymous survey was sent to a list of 189 PDs and chiefs/chairs identified via plastic surgery residency programs' websites. Chi-squared tests assessed answer distributions. Of the 189 recipients (25.9%), 49 completed the survey. Respondents' medical school graduation range was 1973-2009. Seventeen respondents entered a plastic surgery residency directly after medical school, and 32 began in another specialty. Comparison between these two groups showed no significant differences in preference rank of their program (P = 0.671). A total of 18 respondents conducted an academic enrichment year, but timing of this year differed significantly based on the initial specialty match (P = 0.012). There was no significant perceived difficulty in gaining recognition by gender (P = 0.107) or race (P = 0.125). Six respondents did not match into the specialty of first choice; five did not complete their initial residency programs; three did not match into plastic surgery at first attempt. Information on residency training pathways and barriers to career development of current academic leaders will improve transparency as to potential stumbling blocks that current PDs and chief/chairs of plastic surgery residency programs have faced during their initial training. This will help current trainees anticipate these stumbling blocks and place these in perspective based on the experience of senior plastic surgeons.

The spacing effect: Improving electrocardiogram interpretation.

Accurate electrocardiogram (ECG) interpretation is critical for safe patient care, making this skill a necessary competency for medical school graduation. Improved long-term memory retention with repeated exposure to material is one of the most evidenced-based components of adult learning science. This curricular innovation aimed to determine if implementing spaced repetition and retrieval practice using ECG quizzes during the principal clinical year would improve ECG interpretation skills among medical students enrolled in a Longitudinal Integrated Clerkship (LIC). The curricular innovation applied the spacing effect and retrieval practice. Cognitive science demonstrates enhanced long-term retention through repeated interval exposure to learned material. Studies of spaced retrieval indicate that memory retention is enhanced through tests involving effortful recall. LIC students in an intervention group were exposed to the spacing effect with periodic ECG quizzes throughout their clinical clerkship year. The results of the 17-item post-test for 140 students were analysed: LIC intervention, N= 54; block control, N= 62; and LIC control, N = 24. The ANOVA test was significant (p < 0.001). Games-Howell post hoc testing showed that the mean score in the LIC intervention group was significantly higher compared with the LIC control group (p < 0.001) and the block control group (p < 0.001). There was no significant difference between the LIC control and block control groups (p = 0.59). Spaced repetition of material through ECG quizzes improved ECG interpretation skills on an ECG post-test and mitigates the forgetting curve, maintaining student competency in ECG interpretation.

Key factors for residency interview selection from the National Resident Matching Program: analysis of residency Program Director surveys, 2016-2020.

As the number of medical school graduates continues to outpace the available residency training positions, applying for residency in the United States has become a highly competitive process, often associated with a low rate of selection and invitation for interview. The National Resident Matching Program (NRMP) Program Director survey provides data assessing factors considered by Program Directors (PD) in selecting and inviting candidates for interview. Assessing the evolution of these factors over time is efficacious to inform and guide prospective applicants toward improving preparation for residency application. We aim to synthesize NRMP data showing factors that PDs reported and rated as important in their decision to select and invite applicants for interview. Data from residency PD surveys from 2008 to 2021were accessed, but after applying inclusion/exclusion criteria, only the data from 2016 to 2020 were reviewed and analyzed. The NRMP survey reports provided two metrics that characterized PDs' evaluation of the residency factors for interview, namely, "percent citing factor" and "average rating" on a 0 to 5 Likert-type scale. These two metrics were combined into an aggregate measure of importance (AI), and another measure of relative importance (RI) was constructed from normalizing the AI of each individual factor to the sum of the AI within each survey year. The top ranked factors were United States Medical Licensing Examination (USMLE) Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, Letter of Recommendation (LOR) in the specialty, Medical Student Performance Evaluation (MSPE/Dean's Letter), and USMLE Step 2 Clinical Knowledge (CK)/COMLEX Level 2 Cognitive Exam (CE) score, any failed attempt in USMLE/COMLEX, and perceived commitment to specialty. Factors rising in importance were Audition Elective/Rotation Within Your Department, Personal Statement (PS), Perceived Commitment to Specialty, Perceived Interest in Program, LOR in the Specialty, Other Life Experience, and Personal Prior Knowledge of the Applicant. Factors with declining importance were Interest in Academic Career, Awards or Special Honors in Basic Sciences, Graduate of Highly Regarded US Medical School, Awards or Special Honors in Clinical Clerkships, Lack of Gaps in Medical Education, Awards or Special Honors in Clerkship in Desired Specialty, and Consistency of Grades. Compared to the 2021PD survey, our findings show continued predictive consistency, particularly related to specialty and program commitment. The factors identified for the selection of medical school graduates for interview into a residency program reveal that PDs move toward a more integrated approach. Specifically, PDs are placing increasing emphasis on factors that border on subjective qualities more so than the more traditional, quantitative, and objective metrics. Medical students and educators need to continually apprise themselves of the NRMP data to inform students' preparation endeavors throughout medical school to strengthen their application portfolios and enhance their competitiveness for the matching process.

Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas.

De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas. Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas. Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.

Evaluating the Impact of the Novel Geographic Preferences Section on Interview Rate and Residency Match Outcomes.

The American Association of Medical Colleges trialed residency application initiatives including geographic preferences and preference signals in 2022. To assess the impact of geographic preferences on application outcomes during the 2022 residency match year. Cross-sectional. Applicants to categorical and preliminary internal medicine during the 2022 application cycle who completed the Texas Seeking Transparency in Applications to Residency survey. The primary outcome was interview rate (interview offers/total applications) and whether an application resulted in a match. The key dependent variables were geographic preferences and program-specific preference signals. We also assessed differences in utilization of geographic preferences between specialties. A total of 970 applicants into categorical (n = 884) and preliminary (n = 86) internal medicine were included in our study. A total of 704 (72.6%) applicants submitted at least one geographic preference and 424 (43.7%) submitted three preferences. On average, applicants who submitted a geographic preference had a higher interview rate than those who did not (46.0% vs. 41.8%). Applications submitted with both a preference signal and geographic preference were significantly more likely to receive an interview offer (OR: 3.2, p < 0.01) and match (OR: 6.4, p < 0.01) than applications with neither a preference signal nor a geographic preference. Geographic preferences were associated with an increase in the odds of an application receiving an interview offer, even in the setting of a preference signal (OR: 1.4, p < 0.01). Both preference signals and geographic preferences have significant associations with odds of an application receiving an interview and matching for both categorical and preliminary internal medicine applicants. This study can be used to inform applicants, advisors, and programs how novel application strategies can affect important application outcomes for US medical school graduates. As more specialties pilot alternative processes, it will be important to study all application outcomes among varying applicant populations.

Effect of head-mounted displays on students' acquisition of surgical suturing techniques compared to an e-learning and tutor-led course: A randomized controlled trial.

Although surgical suturing is one of the most important basic skills, many medical school graduates do not acquire sufficient knowledge of it due to its lack of integration into the curriculum or a shortage of tutors. E-learning approaches attempt to address this issue but still rely on the involvement of tutors. Furthermore, the learning experience and visual-spatial ability appear to play a critical role in surgical skill acquisition. Virtual reality head-mounted displays (HMDs) could address this, but the benefits of immersive and stereoscopic learning of surgical suturing techniques are still unclear. In this multi-arm randomized controlled trial, 150 novices participated. Three teaching modalities were compared: an e-learning course (monoscopic), an HMD-based course (stereoscopic, immersive), both self-directed, and a tutor-led course with feedback. Suturing performance was recorded by video camera both before and after course participation (>26 hours of video material) and assessed in a blinded fashion using the OSATS Global Rating Score (GRS). Furthermore, the optical flow of the videos was determined using an algorithm. The number of sutures performed was counted, visual-spatial ability was measured with the mental rotation test (MRT), and courses were assessed with questionnaires. Students' self-assessment in the HMD-based course was comparable to that of the tutor-led course and significantly better than in the e-learning course (P=0.003). Course suitability was rated best for the tutor-led course (x̄=4.8), followed by the HMD-based (x̄=3.6) and e-learning (x̄=2.5) courses. The median ΔGRS between courses was comparable (P=0.15) at 12.4 (95% CI 10.0-12.7) for the e-learning course, 14.1 (95% CI 13.0-15.0) for the HMD-based course, and 12.7 (95% CI 10.3-14.2) for the tutor-led course. However, the ΔGRS was significantly correlated with the number of sutures performed during the training session (P=0.002), but not with visual-spatial ability (P=0.626). Optical flow (R2=0.15, P<0.001) and the number of sutures performed (R2=0.73, P<0.001) can be used as additional measures to GRS. The use of HMDs with stereoscopic and immersive video provides advantages in the learning experience and should be preferred over a traditional web application for e-learning. Contrary to expectations, feedback is not necessary for novices to achieve a sufficient level in suturing; only the number of surgical sutures performed during training is a good determinant of competence improvement. Nevertheless, feedback still enhances the learning experience. Therefore, automated assessment as an alternative feedback approach could further improve self-directed learning modalities. As a next step, the data from this study could be used to develop such automated AI-based assessments.

Workforce Attrition Among Male and Female Physicians Working in US Academic Hospitals, 2014-2019

Retaining female physicians in the academic health care workforce is necessary to serve the needs of sociodemographically diverse patient populations. To investigate differences in rates of leaving academia between male and female physicians. This cohort study used Care Compare data from the Centers for Medicare & Medicaid Services for all physicians who billed Medicare from teaching hospitals from March 2014 to December 2019, excluding physicians who retired during the study period. Data were analyzed from November 11, 2021, to May 24, 2022. Physician gender. The primary outcome was leaving academia, which was defined as not billing Medicare from a teaching hospital for more than 1 year. Multivariable logistic regression was conducted adjusting for physician characteristics and region of the country. There were 294 963 physicians analyzed (69.5% male). The overall attrition rate from academia was 34.2% after 5 years (38.3% for female physicians and 32.4% for male physicians). Female physicians had higher attrition rates than their male counterparts across every career stage (time since medical school graduation: <15 years, 40.5% vs 34.8%; 15-29 years, 36.4% vs 30.3%; ≥30 years, 38.5% vs 33.3%). On adjusted analysis, female physicians were more likely to leave academia than were their male counterparts (odds ratio, 1.25; 95% CI, 1.23-1.28). In this cohort study, female physicians were more likely to leave academia than were male physicians at all career stages. The findings suggest that diversity, equity, and inclusion efforts should address attrition issues in addition to recruiting more female physicians into academic medicine.

Medical School Factors Associated With Students Entering Otolaryngology

To determine medical school characteristics that are associated with medical students entering otolaryngology residency programs. Cross-sectional study. Publically available data on otolaryngology residents and academic otolaryngology programs. Publicly available websites were used to collect demographic and bibliometric characteristics for 1527 residents in Accreditation Council for Graduate Medical Education (ACGME)-accredited otolaryngology programs accounting for the 2017 to 2021 match periods. For each medical school, information on class size, number of otolaryngology faculty, presence of a home academic otolaryngology program, NIH research funding, presence of a student interest group, and top 10 ranking by Doximity or U.S. News and World Report (USNWR) were collected. Univariate and multivariate analyses were performed between the medical school factors and the percentage of each medical school class that matriculated into an otolaryngology residency program. On multivariate analysis, the following factors were found to be associated with a higher percentage of graduates entering an otolaryngology residency program: presence of a home academic otolaryngology program (standardized beta value (β) = 0.397, p < 0.0001), a 2021 top 10 ENT ranking according to USNWR (β = 0.206, p = 0.0028), and the average h-index of students from a medical school (β = 0.327, p < 0.0001). After controlling for multiple factors including research productivity, we found that the presence of a home academic program and a top 10 ranking on USNWR were associated with an increasing percentage of medical school graduates entering otolaryngology. NIH funding and the number of otolaryngology faculty were not associated with more students matriculating into an otolaryngology residency program. These findings can help guide medical schools and otolaryngology programs to recruit students into the field.

Impact of Gap Years Following Medical School Graduation on Resident Research Productivity in Ophthalmology.

Background Gap years following medical school graduation have become more common, but research into their tangible career benefit is lacking. Examining the impact of gap years on resident scholarly productivity in ophthalmology may provide insight generalizable to all specialties. Objective To evaluate whether a gap year following medical school graduation significantly predicts scholarly productivity during ophthalmology residency. Methods In December 2021, residents were recorded from 110 publicly available American ophthalmology residency program webpages. They were included if educational history was listed on publicly accessible academic and social media profiles. Residents were then stratified into gap year and nongap year cohorts. Publication data were recorded from Scopus and PubMed. Pearson's chi-square, independent sample t -tests, and multivariable regression were performed. Results A total of 1,206 residents were analyzed, with 1,036 (85.9%) residents taking no gap year and 170 (14.1%) residents with at least one gap year. Gap year residents were predicted to have increase in the likelihoods of publishing at least one, two, or five total articles during residency, in addition to at least one article in a high-impact journal. There was no significant relationship between gap years and publications with senior authors affiliated with either the resident's medical school or residency program. Conclusion Residents taking gap years following graduation may publish more during residency, but these publications are not associated with senior authors at their institutions. Future investigations should continue to evaluate the significance of gap years in medical education.

Increasing Trend of Studying Abroad for Residency Training Among Medical Students

Physician emigration from developing and underdeveloped countries to developed countries is a growing problem that is taking place in current times and is an obstacle in achieving global health. Social circumstances, economic demands, as well as modern medical technologies and desire to pursue better career opportunities, are all driving factors for medical graduates’ emigration. This study investigates Turkish medical students’ intentions of pursuing residency training abroad and explores associated factors that play a significant role in instilling the tendency of moving overseas. A cross-sectional study was conducted at Ege University, Faculty of Medicine, İzmir, Turkey. Students’ future specialty intentions, preferred country for residency training, and the contributing factors in their decisions were questioned via an online survey questionnaire. Out of 617 students included in the study analysis, 183 (29.7%) expressed their desire for going abroad for residency training and Germany, United States of America, United Kingdom, and Canada were the top preferred destinations where 40 (25.3%) reported planning to stay permanently. Mother’s level of education and student’s training/ understanding of advanced levels of any foreign language were found significantly associated with the developed intention of going abroad for residency training. Qualitative analysis revealed better “living standards/conditions” was the most frequently uttered reason for studying abroad. It’s vital to know reasons out why medical school graduates want to go to another country. A better understanding of this issue will aid in developing actions to reduce the proclivity of medical graduates to relocate.

Racial and Ethnic Disparities in Selected Speakers at Plastic Surgery Conferences.

The researchers evaluated selected speakers at 12 plastic surgery annual meetings over 7 years (2014-2020). Racial and ethnic distribution in selected speakers at conferences were compared with those of medical school graduates, plastic surgery residents, and practicing plastic surgeons. There were a total of 79 meetings, with 8931 total speaking opportunities and 1276 unique speakers. The percentage of individuals underrepresented in medicine (UIM) is 15.2% in matriculating medical students, 8.9% in active PRS residents, 8.3% in practicing PRS physicians, and 4.7% in invited conference speakers. Within racial/ethnic groups of invited speakers, there was no significant difference in either the average number of fellowships completed or average number of plastic surgery publications (P = 0.44 and 0.39, respectively). No individual UIM speaker had more than 20 speaking opportunities over these 7 years, compared with 17.0% in non-UIM speakers. Given the results of the study, the researchers conclude that racial minorities are disproportionately underrepresented as selected speakers at plastic surgery conferences, despite similarities in qualifications such as fellowship training, publication number, and years since board certification.

Otolaryngology residency program factors associated with female resident representation.

Female representation in the field of otolaryngology is lacking. Residency is the first point at which medical school graduates specialize in a chosen field and thus represents an opportunity to recruit and train more female otolaryngologists. This study sought to identify program factors associated with greater female representation among resident physicians. Departmental websites of all 124 otolaryngology residency programs in the United States and Puerto Rico were examined for a list of residents. For programs with a resident roster available, the genders of residents, faculty, program directors, and chairpersons were recorded. Location and city population for each program was also recorded, as was female resident representation. Programs were compared using Pearson Chi-squared univariate tests. 1,632 residents and 2,605 faculty were included in the analysis of 109 programs. The median female resident representation was 40%. Programs with larger faculty sizes, more female faculty, and urban location were associated with an above-median female resident representation. Programs with a larger residency cohort approached significance regarding above-median female resident representation. Higher female faculty representation, program director gender, chairperson gender, and US region were not associated with variation in female resident representation. Greater female otolaryngology residency representation was associated with programs having an urban location and greater numbers of female and total faculty. It was also likely that a larger resident cohort size may affect female resident representation. The proportions of female faculty, program director, and chairperson gender, as well as theUS region, were not associated with variation in female resident gender representation.