Medical School Graduates Research Articles

Targeting Inflammation to Control Tissue Fibrosis

Review Targeting Inflammation to Control Tissue Fibrosis Weihua Song 1, Wu Sun 2, Zilong Wang 3, Kelvin Yi Chong Teo 2,4,5, Chui Ming Gemmy Cheung 2,4,5, and Xiaomeng Wang 4,5,6,* 1 Innoland Biosciences, 6 West Beijing Road, Taicang 215400, Jiangsu, China. 2 Singapore National Eye Center, 11 Third Hospital Ave 168751, Singapore. 3 Ocean University of China, 5 Yushan Rd, Shinan District, Qingdao 266005, Shandong, China. 4 Singapore Eye Research Institute, 20 College Road 169856, Singapore. 5 Duke-NUS Graduate Medical School, 20 College Road 169856, Singapore. 6 Insitute of Molecular and Cell Biology, 61 Biopolis Dr, Proteos 138673, Singapore. * Correspondence: xiaomeng.wang@duke-nus.edu.sg Received: 17 November 2022 Accepted: 19 November 2022 Published: 21 December 2022 Abstract: Remodeling of the extracellular matrix (ECM) is an essential process in host defense against pathogens and tissue repair following injury. However, aberrant inflammatory responses could disturb ECM homeostasis leading to progressive disruption in tissue architecture and organ function. Fibrosis is the common outcome of a wide range of diseases, especially chronic inflammatory disorders, and represents the leading cause of morbidity and mortality globally. This review provides the current understanding of the pathogenesis of fibrosis, with particular emphasis on the role of inflammation in this process and the translational potential of targeting inflammation as a strategy to control fibrotic progression.

1305. PrEParing for success: An intervention to increase HIV prevention awareness among internal medicine residents.

Abstract Background PrEP (Pre-Exposure Prophylaxis) is a strategy that involves a combination of antiretrovirals medications aimed to reduce HIV transmission among at-risk individuals. The purpose of this quality improvement project is to increase internal medicine residents' knowledge and prescribing of PrEP. Methods We administered an anonymous paper survey to internal medicine residents at all stages of training at our suburban community hospital in the Hudson Valley, NY in the summer of 2021 during the academic half-day of their ambulatory block rotation. The survey consisted of questions about the residents’ demographics, PrEP knowledge, and previous prescribing of PrEP. Following the survey participants were given a 1-hour lecture by the authors on sexual history and PrEP including indications, available options, dosing, monitoring, side effects, and access to the therapy. Six months later we reissued the same survey to the residents. Surveys were analyzed using descriptive statistics. Results All 74 eligible residents completed the survey. Out of the 74, 35 (47.3%) identified as male and 40 (52.7%) identified as female. Medical school graduation year range between 2007 to 2021. Only 69 residents completed the post-survey. To Q1 “which medications are FDA approved to be used as PrEP,” 40 (54.05%) answered correctly prior to the intervention, whereas 51 (73.91%) did after. When they were asked Q3 “How effective was PrEP at reducing the risk of contracting HIV through sex,” 21 (28.38%) responded correctly, which improved to 46 (66.67%) after. To the other knowledge-based questions there was no significant improvement (see table). The number of people who reported prescribing PrEP increased from 2 (2.7%) to 7 (10.14%). PrEP survey Pre and Post results Conclusion Although experiencing this educational intervention did not improve long-term retention of knowledge among the participants, there was a substantial increase in the number of residents who prescribed PrEP. One of the limitations that can contribute to these results; is the short time frame between the intervention and post-survey. These findings demonstrate the need for early introduction of this topic into medical school and residency program curricula. Disclosures All Authors: No reported disclosures.

1026. What Proportion of Infectious Diseases Physicians Have Buprenorphine Waivers to Treat Opioid Use Disorder in the United States?

Abstract Background Since the onset of the COVID-19 pandemic, opioid-related overdose deaths have increased. Buprenorphine, a medication for opioid use disorder (OUD), is safe and effective but is underutilized and requires qualifying physicians to obtain a waiver. Infectious diseases (ID) physicians are uniquely positioned to treat OUD, as persons with OUD may present with infectious complications from injection drug use. We sought to understand the proportion and distribution of ID physicians with waivers in the United States (US). Methods This was a cross-sectional study merging data from the Centers for Medicare & Medicaid Services and the Drug Enforcement Agency Substance Abuse and Mental Health Services Agency. Our primary outcome was proportion of ID physicians who possess buprenorphine waivers. We used multivariable regression models to identify individual and county-level characteristics associated with buprenorphine waiver possession. We used geospatial analysis to describe county-level distribution of buprenorphine-waivered ID physicians. Results Among 6439 ID physicians in the US, 170 (2.6%) possessed buprenorphine waivers. Overall, 57.2% of ID physicians were male with a median 23 (IQR 15-33) years since medical school. Most (97.3%) practiced in metropolitan counties. In multivariable analysis, medical school graduation beyond 20 years was associated with lower odds of waiver possession compared to those graduating within 20 years (OR 0.59, 95% CI 0.43-0.80). ID physicians practicing in counties with median income > 50,000/year and in counties with higher proportion of uninsured residents also had lower odds of having a waiver (OR 0.58, 95% CI 0.35-0.97; OR 0.93, 95% CI 0.90-0.97). Among counties with at least one ID physician (n=519), 86.6% had no buprenorphine-waivered ID physicians (Figure 1). Figure 1County-Level Distribution of Infectious Diseases Physicians with Buprenorphine Waivers Conclusion Fewer than 3% of ID physicians in the US have obtained waivers to prescribe buprenorphine, highlighting missed opportunities to treat individuals with OUD, especially in rural America. Education on OUD management should be integrated into ID continuing medical education, and policies are urgently needed to expand buprenorphine access to persons without insurance. Disclosures All Authors: No reported disclosures.

Predictors of Interest in Radiation Oncology: The Effect of Race, Ethnicity, Gender, and Other Diversity Measures

The presence of women and people underrepresented in medicine (URiM) continues to be lower in radiation oncology (RO) than within the United States population, medical school graduates, and oncology fellowship applicants. The objective of this study was to identify demographics of matriculating medical students who are inclined to consider pursuing a residency in RO and identify barriers to entry that students may perceive before medical school training. A survey of incoming medical students at New York Medical College was distributed via e-mail and assessed demographic background information, interest in and awareness of oncologic subspecialties, and perceived barriers to RO. Students of the incoming class of 2026 had a complete response rate of 72% (155 complete responses and 8 incomplete responses of 214 class members). Two-thirds of participants had prior awareness of RO, and half have considered pursuing an oncologic subspecialty, but less than one-fourth have ever previously considered a career in RO. Students responded that they need more education, clinical exposure, and mentorship to increase their chance of choosing RO. Male participants had 3.4 times the odds of having an acquaintance in the community tell them about the specialty and also had significantly greater interest in using advanced technologies. There were no URiM participants who had personal relationships with an RO physician compared with 6 (4.5%) non-URiM participants. The average response to "What is the likelihood that you will pursue a career in RO?" showed no significant difference between genders. All races and ethnicities scored a similar likelihood of pursuing a career in RO, which differs greatly from the current RO workforce. Responses emphasized the importance of education, mentorship, and exposure to RO. This study demonstrates the need for support of female and URiM students during medical school.

Coworker Reports about Unprofessional Behavior in Plastic Surgery.

Patient reports of unprofessional conduct by surgeons have been linked to postprocedure complications and increased risk for malpractice claims. Coworkers are also positioned to observe and report unprofessional behaviors, including concerns related to delivery of competent medical care, clear and respectful communication, integrity, and responsibility. This study compared rates of coworker concerns between plastic surgeons and other physicians (other surgical specialists and nonsurgeons), and characterized whether plastic surgery subspecialties differed in their rates of complaints. Coworker concern data from January 1, 2014, to December 31, 2019, were retrieved from the Vanderbilt Center for Patient and Professional Advocacy's Coworker Observation Reporting System database. Specialty was classified as plastic surgery, non-plastic surgical, and nonsurgical. The plastic surgery cohort was further characterized by sex, medical school graduation year, predominant practice type (reconstructive only, aesthetic only, or hybrid), and postresidency training (ie, completion of a fellowship). The study cohort included 34,170 physicians (302 plastic surgeons, 7593 non-plastic surgeons, and 26,275 nonsurgeons). A greater proportion of plastic surgeons (13.6%) had one or more coworker concerns compared with nonsurgeons (10.8%) and non-plastic surgeons (6.1%) ( P < 0.001). The most prevalent concern category reported for plastic surgeons was clear and respectful communication. Among plastic surgeons who had no concerns versus those who had at least one concern, there was no significant difference when comparing sex, medical school graduation year, predominant practice type, or postresidency training. Plastic surgeons in this cohort study received more coworker reports than other surgeons and nonsurgical physicians. These data may be used by institutions to identify plastic surgeons at risk for preventable postprocedure complications and intervene with peer feedback intended to promote self-regulation.

Leadership, Centering Equity Vital to Future of Medical Education

Leadership, Centering Equity Vital to Future of Medical Education

Building on 2022’s Successes in the Year Ahead

Building on 2022’s Successes in the Year Ahead

The Virtual Interview Experience: Advantages, Disadvantages, and Trends in Applicant Behavior.

A survey was distributed to 302 applicants to a single plastic surgery residency program during the 2020 application cycle. Demographics, social media presence and utilization, and experience with the virtual application and interview process were analyzed. A 2018 survey from our institution was compared with a subset of questions for longitudinal analysis. Seventy-six respondents (25.2%) completed the survey. Most applicants (88.2%) spent less than $1000 during the interview and application cycle. Over half (56.6%) did not receive letters of recommendation from outside their home program. A significant minority (27.6%) of applicants attended more than one interview in a single day. Compared to 2018, applicants in 2021 were significantly more likely to access alternative digital resources (forums/discussion boards, social media, and podcasts) when learning about programs. Average number of interviews remains in the range of pre-COVID studies, but the percentage of interviews attended increased. Applicants spent substantially less money on interviews and relied on alternative digital sources to learn about residency programs. This study objectively quantifies the advantages of virtual interviews. Disadvantages include inability to assess "fit" and lack of nonverbal communication.

The impact of gendered experiences on female medical students’ specialty choice: A systematic review

BackgroundWomen make up 50% of American medical school graduates, yet are not equally represented in the vast spectrum of medical specialties. Many fields within medicine remain male dominated. This systematic review will explore social factors that affect female medical students’ specialty choice. HypothesisGendered experiences influence the specialty choice of female medical students, resulting in their concentration in a specific cohort of specialties. MethodsStudies were gathered by searching MEDLINE/Pubmed and EBSCOhost for sociological factors that impact female medical students’ specialty choice. Results34 articles were selected for this systematic review. Factors that contribute to gender segregation within medical specialties include gender discrimination, socialization, lifestyle considerations, negative perceptions of male-dominated medical specialties and lack of female role models. ConclusionThis systematic review supported the hypothesis that gendered experiences impact women's medical specialty choice, and thus result in their concentration in specialties such as family medicine, pediatrics and obstetrics and gynecology.

Applying Representation Quotient Methodology to Racial, Ethnic, and Gender Trends of Applicants and Matriculants to Urology Residency Programs From 2010-2018

ObjectiveTo accurately examine the trends in the racial and gender composition of medical students applying and matriculating to urology residency programs. MethodsReports on race/ethnicity and gender for medical school graduates, and urology residency applicants and matriculants were obtained for years 2010-2018. The proportions of individuals representing different racial and gender identities among urology applicants and matriculants were divided by a denominator of their proportion in medical school graduating classes to produce representation quotients (RQapp and RQmat, respectively). Linear regression models were performed on yearly RQs to estimate the RQ changes over time. Nonparametric testing was used to evaluate for differences in applicant to matriculant representation within each identity. ANOVA was performed separately on RQapp and RQmat values to assess differences in representation between identities in the applicant and matriculant populations. ResultsAsian men experienced increases in representation among urology applicants (RQapp: slope 2.04 × 10−2; P = .03) and matriculants (RQmat slope: 7.46 × 10−2; P = .0076) during the study period. Black men trended towards under-representation among applicants (RQapp slope –1.51 × 10−1; P = .03) and matriculants (RQmat slope: –1.71 × 10−1; P = .02). When examining genders, both men (RQapp=1.43 vs RQmat=1.44; P = .80) and women (RQapp=0.52 vs RQmat = 0.51; P = .67) had unchanged representation in the applicant and matriculant cohorts, but women severely underrepresented on average. ConclusionsWomen and Black men are underrepresented in the urology workforce. These concerning findings demonstrate the dire need for initiatives regarding recruitment into urology to support and to ensure successful entry into the field for minority groups.

COVID-19 related disruptions to medical education and perceived clinical capability of new resident physicians: a nationwide study of over 1200 first-year residents

ABSTRACT The COVID-19 pandemic transformed the final year of undergraduate medical education for thousands of medical students across the globe. Out of concern for spreading SARS-CoV-2 and conserving personal protective equipment, many students experienced declines in bedside clinical exposures. The perceived competency of this class within the context of the pandemic is unclear. We designed and distributed a survey to measure the degree to which recent medical school graduates from the USA felt clinically prepared on 13 core clinical skills. Of the 1283 graduates who matched at HCA Healthcare facilities, 90% (1156) completed the survey. In this national survey, most participants felt they were competent in their clinical skills. However, approximately one out of four soon-to-be residents felt they were clinically below where they should be with regard to calling consultations, performing procedures, and performing pelvic and rectal exams. One in five felt they were below where they should be with regard to safely transitioning care. These perceived deficits in important skill sets suggest the need for evaluation and revised educational approaches in these areas, especially when traditional in-person practical skills teaching and practice are disrupted.

Are they ready? A survey of postgraduate year 1 and 2 surgical house officers.

An online survey was undertaken to analyse the perception of medical school graduates, in postgraduate years 1 and 2, of being ready to work (preparedness) and of managing the demands of practice as a junior doctor on a general surgical attachment. An email-based survey was designed to assess medical school graduates' sense of preparedness, and was sent electronically to all house officers at the beginning of their 3-month attachment in general surgery between December 2020 and December 2021. One email reminder was sent 2 weeks after the initial email with the embedded survey hyperlink. The overall response rate was 50%. Of those, over 90% had accompanied surgical teams on acute calls and over extended hours as a medical student. However, only 50% had ever attended a trauma call or a resuscitation call with clinical teams. Half of the respondents indicated that they would have liked specific teaching on mental and physical self-care, preparation for night shifts and extended periods of duty as well as in prioritisation, delegation and management of workloads. This survey showed that new doctors lacked dedicated teaching in professional behaviours and felt it to be an important part of medical training and preparation for medical practice.

Glimpsing Death Through Zoom.

This personal essay brings readers into what it is like to experience a patient's death for the first time as a medical student, but with a topical twist: this experience happens over Zoom. The author is part of the 2023 cohort of medical school graduates who will have spent at least half of medical school online. Most people think of virtual medical education as a loss, but this essay is about how “Zoom medical school” actually allowed one student to experience a “good death” very unlike the deaths typically witnessed in hospitals. The essay details and reflects upon the experience of shadowing a palliative care physician’s Zoom appointments with a patient, Mrs. K, over the weeks leading up to her death from cancer, surrounded by children and grandchildren at home. In contrast, the author weaves in the story of her own grandfather who died last year from COVID-19, intubated alone in an ICU all the way in Tehran, Iran. The essay concludes that medicine is not just about preventing death, but about making a good death possible—and that a good death is embedded in the communities that brought meaning to one’s life in the first place.

Wake up to the gender gap in academic anesthesiology and address the pipeline

Diversity, equity, and inclusion are important values in health care and academic medicine. Although women have comprised nearly 50% of all US medical school graduates since the early 2000s, gender disparities continue in many specialties and persist in medical education leadership. For women in anesthesiology, gender inequities exist along the academic pipeline, with greater disparity in the higher ranks of academia and leadership. Successful endeavors to improve gender equity in the specialty include increasing awareness, engaging in faculty development, and encouraging transparent promotions processes. The strides will be short and change will be slow unless we shift focus to when the gender imbalance begins—at the transition from undergraduate medical education to graduate medical education. Currently women comprise 37% of academic anesthesiology faculty; however, the current resident pool is only 33% women. If recruitment of a gender-equitable workforce at the undergraduate-to-graduate medical education transition is not a priority, the downstream measures will have minimal impact toward gender equity in academic anesthesiology.

The impact of volunteering with a student-run free clinic on medical student specialty selection

BackgroundThe shortage of primary care physicians in the United States is expected to grow to 17,800–48,000 physicians by 2034. Student Run Free Clinics are an increasingly popular component of medical schools and may provide an avenue for increasing medical student interest in primary care specialties. However, there is limited research on the impact of Student Run Free Clinics on medical student specialty choice. This investigation sought to determine whether volunteering with the Interprofessional Community Clinic (ICC), the Student Run Free Clinic associated with Chicago Medical School, was associated with an increased likelihood of matching into primary care specialties. Secondarily, the authors investigated associations between volunteering and matching into family practice. Finally, the authors explored associations between volunteering and the competitiveness of specialty choice.MethodsThis retrospective review utilized data on medical school graduates from 2015 – 2021 including their matched specialties, the number of ICC shifts they volunteered for, and whether they held an ICC leadership position (executive officers). Primary care specialties were defined as internal medicine, family practice, pediatrics, or combined internal medicine/pediatrics. Residency fill rate was used as a proxy for competitiveness.ResultsThis analysis included 506 medical students (254 ICC volunteers and 252 non-volunteers). Among ICC volunteers, 47.2% matched into a primary care specialty compared to 36.5% of non-volunteers (RR 1.29, 95% CI 1.05–1.59). Each additional shift worked at the ICC was correlated with increased odds of matching into family practice by a factor of 1.042 (95% CI 1.005–1.079).ConclusionsMedical students who volunteered with the ICC were more likely to match into primary care residencies. Students who volunteered more frequently were more likely to match into family practice. Further investigation is warranted to determine whether these associations are causative and could thus be leveraged to encourage medical students to pursue primary care careers.

The clinical elective course and its effects on medical students and graduates of Jordanian medical schools

BackgroundThe elective course is part of the 6th-year medical school curriculum in Jordan. Students choose the specialty in which they wish to spend 8 weeks and choose their location even if it is outside their university’s affiliated hospitals. In this study, we try to understand student choices regarding the country of elective, chosen specialty, type of placement (observership/clerkship), and elective general value from participants' perspectives.MethodsThis paper used a cross-sectional study. The survey was distributed through social media platforms (mainly Facebook and WhatsApp) targeting 6th-year medical students and doctors who graduated from one of the 5 Jordanian medical schools (the University of Jordan, Jordan University of Science and Technology, Mutah University, Yarmouk University, and Hashemite University).ResultsThe majority of participants had an international elective (69.6%), mainly in the USA, followed by the UK. Internal medicine was the primary field of interest for 14.8%, followed by general surgery. Of these, 241 (62.6%) actively participated in work at their chosen hospitals as they had a clerkship/hands-on experience. In contrast, 142 (36.9%) were observers. The majority indicated that the elective is worth the time, money, and effort. Moreover, they had adequate supervision throughout the course and could achieve their preset objectives.ConclusionsThe elective course gives a unique experience to our students. General satisfaction is an indicator of the success of the course in actively exposing medical students to clinical practice.

Surgery of the Soul: Reflections on a Curious Career

Surgery of the Soul: Reflections on a Curious Career

Prior degree and academic performance in medical school: evidence for prioritising health students and moving away from a bio-medical science-focused entry stream

BackgroundGiven the importance of the selection process, many medical schools are reviewing their selection criteria. The traditional pathway for post-graduate medicine has been from science-based undergraduate degrees, however some programs are expanding their criteria. In this study we investigated academic success across all years and themes of the Deakin University medical degree, based on the type of degree undertaken prior to admission. We evaluated whether the traditional pathway of biomedical science into medicine should remain the undergraduate degree of choice, or whether other disciplines should be encouraged.MethodsData from 1159 students entering the degree from 2008 to 2016 was collected including undergraduate degree, grade point average (GPA), Graduate Medical Schools Admission Test (GAMSAT) score and academic outcomes during the 4 years of the degree. Z-scores were calculated for each assessment within each cohort and analysed using a one sample t-test to determine if they differed from the cohort average. Z-scores between groups were analysed by 1-way ANOVA with LSD post-hoc analysis correcting for multiple comparisons.ResultsThe majority of students had Science (34.3%) or Biomedical Science (31.0%) backgrounds. 27.9% of students had a Health-related undergraduate degree with smaller numbers of students from Business (3.5%) and Humanities (3.4%) backgrounds. At entry, GPA and GAMSAT scores varied significantly with Biomedical Science and Science students having significantly higher scores than Health students. Health students consistently outperformed students from other disciplines in all themes while Biomedical Science students underperformed.ConclusionsOur data suggest that a Health-related undergraduate degree results in the best performance throughout medical school, whereas a Biomedical Science background is associated with lower performance. These findings challenge the traditional Biomedical Science pathway into medicine and suggest that a health background might be more favourable when determining the selection criteria for graduate entry into medicine.

FAMILY BUILDING AND PARENTHOOD ALTERS THE CAREER TRAJECTORY OF WOMEN IN MEDICINE

Although most medical school graduates are women, pervasive gender disparities exist in time to promotion, achievement of academic rank, and appointment to leadership positions, with no narrowing of this gap over time. The objective of this study was to determine the extent to which women in medicine alter their career trajectories and family building plans in order to balance parenthood and career.

Employment, starting salaries, and educational indebtedness of year 2021 graduates of US veterinary medical colleges.

For year 2021 graduates of US veterinary medical schools and colleges who had accepted a full-time position in a private or public practice or an advanced education program (n = 2,448), mean starting annual salary was $80,844. Excluding salaries for individuals who were pursuing advanced education, mean starting annual salary for graduates who had accepted a full-time position in a private or public practice was $98,088. For the 2,771 year 2021 graduates who reported information on debt, mean educational debt accumulated during veterinary school was $156,221 (median, $160,000). Mean educational debt for the 2,322 year 2021 graduates who had educational debt was $186,430, compared with a mean of $188,853 for year 2020 graduates who had educational debt.