Medical Student Involvement Research Articles

Navigating Patient Comfort: Gendered Perspectives on Medical Student Involvement in Healthcare Interactions in Peshawar, Pakistan

Patient interactions are fundamental to medical education, influencing the training of medical students and shaping their clinical understanding. Objective: To probe patient perspectives on the presence of medical students during consultations, clinical examinations and surgical procedures, with a focus on identifying gender-based differences in preferences and comfort levels. Methodology: This cross-sectional study was conducted in tertiary care hospitals in Peshawar involving 500 patients from Northwest General Hospital and Research Center and Northwest Teaching Hospital, data collected through a self-structured questionnaire revealed distinct gender disparities. Results: Male participants generally exhibited higher approval and comfort levels with medical student involvement, particularly during consultations, examinations, and surgery. Variations were evident in preferences related to medical history taking, comfort during physical examinations, and willingness to permit students in the operating room. Patients underscored the importance of recognizing gender preferences in medical student interactions. Conclusions: This study emphasized the significance of tailoring medical education practices to address gender-specific variations, ensuring a patient-centered approach and fostering positive healthcare experiences for all.

The Case for Advocacy Curricula and Opportunities in Medical Education: Past Examples to Inform Future Instruction.

With recent advances in understanding racial, socioeconomic, and mental health issues in medicine and their relation to policy and legislation, medical professionals are increasingly involved in local and national advocacy efforts. At the frontlines of these initiatives are medical students who, in addition to completing required coursework and clinical training, devote themselves to serving patients through civic participation. The burgeoning evidence concerning health care disparities and inequity, along with greater awareness of racial and socioeconomic discrimination, have made advocacy an essential aspect of many students' medical training. Every year, thousands of medical students join national medical advocacy organizations, in addition to regional, state, and local groups. Despite the rich history of medical student involvement in advocacy, there remains much speculation and skepticism about the practice as an essential component of the medical profession. From early initiatives pushing for national health insurance after World War II to encouraging anti-discrimination policies and practices, medical students have been collectively working to create change for themselves and their patients. Through efforts such as banning smoking on airplanes, creating safe syringe programs, and protesting against police brutality, many medical students work tirelessly in advocacy despite minimal educational support or guidance about the advocacy process. Given that medical student advocacy continues to grow and has shown measurable successes in the past, the authors believe that these efforts should be rewarded and expanded upon. The authors examine historical examples of medical student advocacy to suggest ways in which advocacy can be integrated into core medical school curricula and activities. They call attention to opportunities to support students' development of knowledge and skills to facilitate legislative change, expansion of interprofessional collaborations and credit, and curricular updates to promote social and health equity.

Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study.

Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine.

2000. Identifying Limitations and Opportunities for Undergraduate and Medical Student Involvement in Infectious Diseases Nationwide

Abstract Background Only 74% of infectious disease (ID) training positions were filled in the 2022 fellowship match. Novel and creative approaches to increasing interest and recruitment in the field must be explored. Here, we identify the lack of ID representation in medically-related student interest groups and clubs at the undergraduate and medical school levels nationwide and suggest such groups be considered for recruitment strategies. Methods The websites of 2,321 Universities and 173 medical schools across the United States were manually searched for the presence of undergraduate clubs and interest groups, respectively, for multiple medical specialties and subspecialties, including ID. Fields considered included ID, microbiology, emergency medicine, global/public health, neuroscience/psychology, pre-health, and STEM at the undergraduate level, and ID, wilderness medicine, global health, hematology/oncology, radiology, dermatology, family medicine, internal medicine, orthopedics/sports medicine, neurology/psychiatry, and emergency medicine at the medical school level. Furthermore, zip code data from mailing addresses was used to compare the proximity of 165 adult ID Fellowships to undergraduate institutions. Inclusion and Exclusion Criteria for Undergraduate Institutions Criteria were designed to exclude institutions unlikely to serve students with an eventual goal of pursuing medicine. Results Of 2,049 undergraduate institutions meeting inclusion criteria nationwide, 6 (0.29%) had a club for ID. Of 163 medical schools meeting inclusion criteria, 57 (35.0%) had an interest group for ID. ID student groups were the least prevalent among all the categories considered at both the undergraduate and medical school level. Our geographic proximity analysis found that every adult ID fellowship is in the same city and/or county as at least one undergraduate institution, and 28.5% of adult ID fellowships are in the same zip code as at least one undergraduate institution The websites of 2,321 undergraduate institutions with a minimum of 1,000 undergraduate enrollments were manually searched for the presence of medically-related clubs in various fields, including ID. Club counts are shown for 2,049 institutions meeting inclusion criteria. The websites of 173 medical schools were manually searched for the presence of medically-related interest groups in various fields, including ID. Group counts are shown for the 163 institutions with full accreditation status. Conclusion ID clubs and interest groups are the least prevalent among medically-related student interest groups. This paucity presents an opportunity for the ID community to begin outreach and recruitment at the undergraduate and medical student levels, specifically through student groups. Our own group, InfectED, can be used as a model for future groups nationwide. Disclosures All Authors: No reported disclosures

Understanding Medical Students’ Concerns about Explicit Informed Consent for Pelvic Exams Under Anesthesia

Medical student involvement in procedures, including pelvic exams under anesthesia (EUAs), is a fundamental part of medical education. While guidelines exist regarding informed consent for medical student participation, there is ongoing debate and uncertainty regarding the requirement and modality of obtaining explicit consent for pelvic EUAs. This study aims to explore the perceptions and experiences of medical students who do not favor an explicit informed consent process for pelvic EUAs. An anonymous online questionnaire was distributed to third- and fourth-year medical students at the University of Pittsburgh School of Medicine who had completed their obstetrics and gynecology core clerkship. The questionnaire included both quantitative and qualitative sections. Qualitative analysis was conducted using a mixed inductive and deductive coding approach, with key patterns, categories, and themes identified through content analysis. Among the 201 students included in the analysis, 50 students did not endorse an explicit informed consent process for pelvic EUAs. Themes that emerged from their open-ended responses included: (1) the belief that medical student involvement is implicitly included in patient agreements at teaching hospitals; (2) the perception that pelvic EUAs are an essential first step in gynecologic surgery; (3) the view that pelvic EUAs are comparable to other medical procedures; (4) concern that explicit consent would limit educational opportunities; and (5) the belief that pelvic EUAs are not harmful or traumatic to patients. The findings highlight the justifications provided by medical students who do not support explicit informed consent for pelvic EUAs. While some arguments align with previous ethical analyses, this study provides empirical and qualitative insights into students' perspectives. The belief that patients implicitly consent to medical student involvement at teaching hospitals warrants further examination, as patient awareness and understanding may vary. The differentiation between pelvic exams and other EUAs, as well as the perception of minimal harm, should be critically evaluated in the context of trauma-informed care and patient autonomy. Furthermore, the interconnectedness of educational and surgical aspects of pelvic EUAs should be clarified in patient-physician communication. Understanding the perspectives of medical students who do not favor explicit consent for pelvic EUAs is crucial for developing and implementing consent processes. The findings emphasize the need for enhanced patient-physician communication, standardized frameworks for learner involvement, and curricular adaptations to address patient perceptions and trauma-informed care. Future research should explore these themes in larger and more diverse cohorts to inform best practices in obtaining informed consent for medical student participation in pelvic EUAs.

Implementation of a shared research database to increase medical student awareness and involvement in urology research A pilot study.

We aimed to assess the effect of a shared institutional research database on medical students' scholarly work, perceived research competency, and self-reported satisfaction. An institutional inventory database was created on Google Sheets with a listing of available mentors and a description of their ongoing research projects. The inventory database was shared with interested students and faculty. Students who agreed to participate were surveyed pre- and post-inventory. Survey questions assessed student demographics, prior research experience, and their perception of research competency and satisfaction. The number of presentations, publications, and articles pre- and post-inventory were also abstracted. Survey responses were compared using the Mann-Whitney U test. A total of 20 students were surveyed pre-inventory and at a median followup of six months (5-7) post-inventory. There was a significant increase in scholarly presentations and publications post-inventory (p<0.05 for all). Furthermore, post-inventory, students reported feeling more confident in establishing an academic career, finding good mentors, managing their relationship with their mentor, managing professional challenges, and effectively showcasing themselves professionally and describing their research (p<0.05 for all). More than 65% of students agreed or strongly agreed that the database was easy to use, accessible, transparent, and would like a similar database created for other specialty departments. After performing mentorship-guided research through an institutional research database, medical students felt more confident in their ability to perform research and produced more scholarly work. Therefore, we recommend a research database be created across all institutional departments to foster interest in conducting research.

Deeper Pathways for Recruitment Efforts: Identifying Opportunities for Undergraduate and Medical Student Involvement in Infectious Diseases.

Only 74% of infectious diseases (ID) training positions were filled in the 2022 fellowship match, indicating a need to find increasingly novel and creative solutions for ID recruitment and outreach. The websites of 2321 universities and 181 medical schools across the United States were manually searched for the presence of undergraduate clubs and interest groups, respectively, for multiple medical specialties and subspecialties, including ID. Geographic data were used to compare the proximity of ID fellowships to undergraduate institutions. ID student groups were extremely rare among the categories studied throughout undergraduate institutions (6 out of 2048, or 0.29%). Only 58 of 163 (35.6%) medical schools nationwide included an ID student group. Geographic comparison found that every adult ID fellowship is in the same county and/or city as at least 1 undergraduate institution and 28.5% of adult ID fellowships are in the same zip code as at least 1 undergraduate institution. The relative paucity of ID student interest groups presents an opportunity for the ID community to begin outreach and recruitment at the undergraduate and medical student levels, specifically through student groups.

Informed consent for medical student involvement in patient care: an updated consensus statement.

Enabling patients to consent to or decline involvement of medical students in their care is an essential aspect of ethically sound, patient-centred, mana-enhancing healthcare. It is required by Aotearoa New Zealand law and Te Kaunihera Rata o Aotearoa Medical Council of New Zealand policy. This requirement was affirmed and explored in a 2015 Consensus Statement jointly authored by the Auckland and Otago Medical Schools. Student reporting through published studies, reflective assignments and anecdotal experiences of students and teachers indicate procedures for obtaining patient consent to student involvement in care remain substandard at times. Between 2020 and 2023 senior leaders of Aotearoa New Zealand's two medical schools, and faculty involved with teaching ethics and professionalism, met to discuss these challenges and reflect on ways they could be addressed. Key stakeholders were engaged to inform proposed responses. This updated consensus statement is the result. It does not establish new standards but outlines Aotearoa New Zealand's existing cultural, ethical, legal and regulatory requirements, and considers how these may be reasonably and feasibly met using some examples.

Medical student otolaryngology research: Involvement, perceptions, motivations

ObjectiveOtolaryngology is a competitive specialty that emphasizes research. This study explored medical student involvement in otolaryngology research including training, productivity, perceptions and career goals. Study designCross-sectional survey. MethodsA 27 question multiple choice survey was generated using Qualtrics and posted on an otolaryngology forum (Otomatch) from 10/09/2022 to 12/11/2022. ResultsThirty fourth year medical students (MS4) applying to U.S. otolaryngology residency programs responded. Nearly all (26/30 = 86.7 %) believe there should be dedicated time to research in medical school. MS4 produced an average of 3.23 otolaryngology papers (± 3.13), 5.23 poster presentations (± 9.22) and 2.50 oral presentations (± 5.06). MS4 feel it is more important for physicians to read (mean 4.47 on a 5-point scale; ± 0.76) than to conduct research (3.03 ± 0.87) or to emphasize it in evaluating residency applicants (2.79 ± 0.96). Seventeen respondents (17/30 = 56.7 %) lack interest in continuing research after medical school. Twenty-eight MS4 were evenly split (14/30 = 46.7 %) between a research-heavy or traditional residency. Students felt pressure to publish in low-impact journals (3.93 ± 0.94) for career advancement. ConclusionAll respondents were involved in research yet the majority (16/30 = 53.3 %) eschew a research-heavy residency. Using research to evaluate success entices involvement for some who may not be interested. Pressure to publish may exacerbate ethical issues like inaccurately assigned authorship and deceptive reporting of publications. A decreased emphasis on research will enable students truly interested to continue without pressure to publish, leading to a potential increase in generalizable studies.

Implementation of An Interactive Radiation Oncology Clinical Rotation for Medical Students

Background Our radiotherapy department is situated onsite at a university-affiliated hospital where medical students undertake clinical rotations. However, no formal programme for attachments to the radiation oncology service was previously in place. Student experience was limited to occasional classroom-based lectures and sporadic contact with cancer patients while rotating through other clinical services. Under-exposure to radiation oncology (RO) (and oncology generally) during medical school is common. A 2016 survey of medical students at two US universities found that only 4% of third year and 7% of fourth year students completed an RO rotation (Osvarak et al 2016). And 47% of Australian and New Zealand medical students recently reported that RO was not incorporated into their curriculum at all (Bravery et al 2020). We identified improving medical student involvement as a priority for our department. Methods We collaborated with tutors at the University to arrange for medical students to have allocated RO rotations during their clinical attachments at the hospital. Agreed learning objectives fitted into three categories: -fundamental clinical skills in history taking and physical examination -care of cancer patients -an introduction to RO and its role in the care of cancer patients. A multidisciplinary effort with involvement of consultant and trainee radiation oncologists, radiation therapists, nurses, and university representatives allowed us to develop a programme to deliver these learning objectives. Results The programme began in January 2022. One radiation oncologist takes overall responsibility for day-to-day operations and acts as the primary point of contact for the students and other staff members in case of any issues. Students receive tutorials on oncological emergencies and are involved in academic sessions in the department. They are supervised as they spend time contouring organs at risk and clinical targets and also have dedicated sessions with radiation therapists where they observe the delivery of external beam radiotherapy. Clinical experience is gained via attendance at outpatient clinics and on the inpatient oncology ward. Feedback on history taking and clinical examination is provided via tutorials with radiation oncologists and trainees. Students provided feedback which indicated that they had enjoyed their experience of the specialty and found the rotation beneficial. Discussion The rotation has been well-received by students and the university tutors. The primary goal of incorporating RO rotations into the medical school curriculum was successful and these attachments will continue in future. Involvement of relevant stakeholders within the department and the university contributed to the successful implantation. Our radiotherapy department is situated onsite at a university-affiliated hospital where medical students undertake clinical rotations. However, no formal programme for attachments to the radiation oncology service was previously in place. Student experience was limited to occasional classroom-based lectures and sporadic contact with cancer patients while rotating through other clinical services. Under-exposure to radiation oncology (RO) (and oncology generally) during medical school is common. A 2016 survey of medical students at two US universities found that only 4% of third year and 7% of fourth year students completed an RO rotation (Osvarak et al 2016). And 47% of Australian and New Zealand medical students recently reported that RO was not incorporated into their curriculum at all (Bravery et al 2020). We identified improving medical student involvement as a priority for our department. We collaborated with tutors at the University to arrange for medical students to have allocated RO rotations during their clinical attachments at the hospital. Agreed learning objectives fitted into three categories: -fundamental clinical skills in history taking and physical examination -care of cancer patients -an introduction to RO and its role in the care of cancer patients. A multidisciplinary effort with involvement of consultant and trainee radiation oncologists, radiation therapists, nurses, and university representatives allowed us to develop a programme to deliver these learning objectives. The programme began in January 2022. One radiation oncologist takes overall responsibility for day-to-day operations and acts as the primary point of contact for the students and other staff members in case of any issues. Students receive tutorials on oncological emergencies and are involved in academic sessions in the department. They are supervised as they spend time contouring organs at risk and clinical targets and also have dedicated sessions with radiation therapists where they observe the delivery of external beam radiotherapy. Clinical experience is gained via attendance at outpatient clinics and on the inpatient oncology ward. Feedback on history taking and clinical examination is provided via tutorials with radiation oncologists and trainees. Students provided feedback which indicated that they had enjoyed their experience of the specialty and found the rotation beneficial. The rotation has been well-received by students and the university tutors. The primary goal of incorporating RO rotations into the medical school curriculum was successful and these attachments will continue in future. Involvement of relevant stakeholders within the department and the university contributed to the successful implantation.

Survey of Informed Consent Procedures in Urology: Disclosing Resident Participation to Patients.

AbstractThe American Urological Association (AUA) and American College of Surgeons (ACS) codes of professionalism require surgeons to disclose the specific roles and responsibilities of trainees to patients during the informed consent process. The objective of this study is to analyze how these requirements are met by urology training programs. An anonymous electronic survey was distributed to the program directors (PDs) of the 143 Accreditation Council for Graduate Medical Education urology residency programs in the United States in 2021. Information was collected regarding program demographics, aspects of the program's consent process, and the disclosure to patients of the role and participation of residents in their surgery. There were 49 responses to the survey (34.3% response rate). Nearly 70 percent of PDs reported that attending physicians lead the consent process. The topics covered during consent discussion include possible complications (25%), expected recovery time (23%), length of the surgery (22%), the people involved (18%), and their specific roles (7%). Many PDs do not explicitly discuss trainee involvement (48.8%) or when a resident is to perform the majority of the case (87.8%). The majority of PDs (78.8%) communicate medical student involvement, but 73.2 percent reported having a patient decline participation of a trainee after describing their role. Despite the AUA and ACS codes of professionalism, many urologists do not disclose resident involvement in surgery to patients. Further discussions are needed to explore how to better balance resident education and patient autonomy.

A Response to "Patient's Perceptions and Attitudes Towards Medical Student's Involvement in Their Healthcare at a Teaching Hospital in Jordan: A Cross Sectional Study" [Response to Letter

A Response to "Patient's Perceptions and Attitudes Towards Medical Student's Involvement in Their Healthcare at a Teaching Hospital in Jordan: A Cross Sectional Study" [Response to Letter

The effects of educational intervention on perceived barriers toward medical student research involvement: A pilot study

Background: Competency in research as a medical student is a core skill set in training to be a physician and also supports effective continuing education as a physician. Although it is highlighted as an expected competency for educating medical students, there are no specific requirements on the type or depth of educational content that should be offered in the area of research skills for medical students. This observation led us to explore the potential benefits of informative lectures on research fundamentals and their impact on medical students’ perceptions on conducting research in school. Methods: In this study, students were surveyed before (n=71) and after (n=33) formal lectures on research principles to exam changes in perceived barriers to participating in research related activities. Barriers were categorized into three categories: Personal; Competency; and Value. Results: The results of this study demonstrated significantly decreased perception of several barriers within the personal and competency categories after the lecture series on research principles was completed. Although statistically insignificant, a separate and possibly interesting observation is that respondents appeared to have a decreased interest in research and decreased perception that participating in research would add value to their profile as a residency applicant or impact their care of patients as a future physician. Conclusions: Our pilot study suggests that offering formal lectures on research principles may lead to decreased perceived barriers of medical students in becoming involved in research related activities during medical school.

Medical students remote consulting from home and from the health centre: A survey of prevalence and supervisor perspectives

Purpose A shift to remote consulting characterised the early stages of the COVID-19 pandemic in general practice which resulted in significant changes in the delivery of medical education. It is unclear whether these changes have been sustained and how they are perceived by faculty. Methods We surveyed a defined population of GP practices during April 2022 with questions to elicit estimates of medical student involvement in different types of remote consultation and supervisor ratings of their confidence in supervising different modalities of remote consultation. We performed thematic analysis on free text responses from a 'resistance to change’ perspective. Results A response rate of 96% (n = 115) was achieved. Analysis of quantitative data identified that a significant proportion of student consultations were remote, however there was a large variation between practices. Supervisor confidence was lowest for students consulting from home. Thematic analysis identified ways in which clinical supervisors may perceive the innovation to be at odds with their overriding commitments to safety, simplicity and quality. Conclusions Remote consultations form a significant proportion of medical student activity in many practices. Some supervisors are reluctant to supervise medical students consulting from home and our findings suggest ways of addressing this so that the benefits of the innovation can be harnessed.

Understanding motivations behind medical student involvement in COVID-19 pandemic relief efforts

BackgroundAlthough students were removed from patient-facing settings at the beginning of the COVID-19 pandemic due to concerns of burdening teaching physicians and depleting personal protective equipment, some leaders suggest students can be effectively utilized when personnel resources may be scarce. There have been narrative discussions surrounding medical student involvement, but no studies exploring the attitudes of these students. The authors aim to quantify the degree to which factors influenced a medical student’s decision to or to not volunteer during the pandemic and to characterize medical students’ attitudes towards medical professionals’ duty to serve in a pandemic.MethodsThe authors developed and tested a secure web-based survey before distribution to students at 23 different US allopathic medical schools that did not graduate medical students early to aid in pandemic efforts between April and June 2020. Of the 599 students who completed the survey, 65.5% self-identified as female and were on average 25.94 years old (SD = 2.5). Multiple comparisons were made based on volunteer status. Ordinal scale questions were compared with the Mann Whitney U test, and the Chi-Squared test was used for categorical variables using R version 3.62.Results67.6% of students volunteered in pandemic relief activities and a majority of those students volunteered in non-patient-facing roles. Community service, new skills, and time commitment were top 3 influencing factors for students who volunteered, while risk to other, time commitment, and risk to self were top 3 influencing factors for students who chose not to volunteer. Compared to other specialties, students interested in primary care specialties agreed to a greater degree that physicians have a duty to serve in pandemic relief efforts.ConclusionsMedical students who volunteered cited self-serving factors and altruistic values as significant motivators. Students who did not volunteer were significantly more concerned with risks of COVID-19 exposure. However, medical students in general agreed that students should be allowed to volunteer in COVID-19 related relief efforts. As large areas of the United States continue to experience increases in COVID-19 cases, institutions should involve medical students in balancing the level of acceptable risk with the educational benefits.

Implementation of a Post-Encounter Telephone Call at a Student-Run Free Clinic to Promote Preventive Medicine and Early Clinical Education.

The goals of this study were to determine the completion rates of patient order forms at the Cooper Rowan Clinic, a student-run free clinic, and to implement the use of a post-encounter phone call to improve completion rates, preventive medicine, and medical student clinical involvement. 151 patients completed a pre-intervention questionnaire before their visit. The questionnaire collected information regarding successfully completed order forms. First-year students were trained to perform phone calls and called their patients for five months. 205 patients then completed a post-intervention questionnaire. Dependent variables included completion rates for laboratory studies, specialty referrals, imaging studies and miscellaneous tests. Chi-squared tests were performed. Although the completion rates for laboratory testing (pre = 73.7% vs post = 81.1%), referrals (pre = 50.0% vs post = 65.1%) and imaging studies (pre = 60.9% vs post = 71.7%) increased, the results were not statistically significant. The completion rate of miscellaneous testing (pre = 41.7% vs post = 100.0%) increased following the implementation and was statistically significant. When patients were stratified to those who received a phone call, completion rates of referrals (73.0%), laboratory testing (86.1%), imaging studies (80.5%), and miscellaneous studies (100.0%) substantially increased. Although not statistically significant except for miscellaneous studies, there was an overall increase in completion in all categories. Further evidence to suggest that phone calls improved order completion was the substantial increase in completion rates in patients who received a call.The implementation improves completion of orders which could enhance preventive measures within the clinic. Additionally, it provides an opportunity for earlier student clinical exposure through direct patient contact.

Letter: Pressure to Publish-A Precarious Precedent Among Medical Students.

To the Editor: The National Resident Matching Program (NRMP) recently published its biennial report “Charting Outcomes in the Match” for the recent 2021 to 2022 application cycle.1 The goal of this report was to provide characteristics of both matched and unmatched applicants within each specialty. These data, which include measures such as average United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, average number of publications/presentations/abstracts, and average number of volunteer/research/work experiences, are often used by applicants and residency programs to compare an individual's characteristics with the average applicant profile. Neurosurgery is one of the most challenging specialties to match into, with the 2022 match rate being 61%.1 Given the relative scarcity of postgraduate year 1 (PGY-1) positions, several benchmarks have been established to assess applicant competitiveness, with research productivity being a primary measure.2,3 Although neurosurgery applicants have historically reported the highest number of publications, presentations, and abstracts, the NRMP's 2022 report revealed a departure from this trend. From 2020 to 2022, the average number of publications, presentations, and abstracts listed by matched U.S. MD plastic surgery applicants increased from 19.1 to 28.4 while the average number listed by matched U.S. MD neurosurgery applicants increased from 23.4 to 25.5.1,4 However, research productivity by unmatched U.S. MD neurosurgery applicants did not change dramatically between 2020 and 2022 while unmatched U.S. MD plastic surgery applicants saw a modest increase from 11.6 to 13.8.1,4 Not surprisingly, these data support an association between research productivity and likelihood of matching in each of these specialties.5,6 However, concerns over excessive research output by neurosurgery applicants have been raised previously.7 Now, it appears that the research “arms race” is beginning to involve other specialties. What has caused such an increase? As surgical residencies become increasingly competitive, applicants may opt to complete a dedicated research year to boost their research output. This is becoming more common in many surgical specialties, such as neurosurgery, orthopedic surgery, and plastic surgery.6,8 Although a research year is not necessary for every applicant, students may feel pressure to delay their graduation to achieve research output comparable with what is demonstrated in the 2022 Charting Outcomes data. This pressure is felt by US and international medical graduates alike.9 Indeed, research productivity is a valuable asset for academic residency programs, but there is evidence to suggest that the 2022 Charting Outcomes data may not necessarily represent an increase in high-quality publications. Rather, this rise in research output could be due to nonindexed publications, such as abstracts, book chapters, presentations, and “ghost” or “phantom” publications, which are unverifiable publications listed on residency applications.5,10,11 This presents a dilemma for applicants and residency programs alike. Peer-reviewed research is held to high standards, and medical student research is no exception to this. As applicants face more pressure to publish, they may gravitate away from performing high-quality research, which tends to be more difficult to complete in a timely manner. The value of quantity ought not to supersede that of quality, and a 49% increase in research output by successful plastic surgery applicants over the course of 2 years may threaten this principle. What can be done to address this trend? First, research mentors and residency program directors ought to emphasize the value of meaningful research projects, high-quality methodologies, and ethical principles of research.7 Second, the NRMP should consider reporting research output more granularly and specifically. Currently, publications, abstracts, and presentations are reported as a single number in the biennial Charting Outcomes report. However, these categories of research are not equivalent and should not be treated as such. Third, the Association of American Medical Colleges should consider changes to the formatting of research input in the Electronic Residency Application Service. For example, the American Council of Academic Plastic Surgeons has developed the Plastic Surgery Common Application, which is an alternative to Electronic Residency Application Service.12 Within the Plastic Surgery Common Application, applicants are required to list up to 3 publications to discuss during interviews and can list no more than 5 research, service, and leadership experiences. Although applicants are still able to list additional publications, this format draws attention to meaningful research endeavors.12 Although neurosurgery, and now plastic surgery, applicants lead all specialties in research output, there is an opportunity to set a new precedent. The value of medical student involvement in research should not be understated because it provides an opportunity to advance the field of medicine and collaborate with peers on a global scale. However, students must maintain a balanced educational experience with focus on patient care, academic excellence, and personal well-being. The 2022 Charting Outcomes data may be a signal that the academic medical community should reassess its current approach to applicant assessment.

The Role of Medical Students in Global Pediatric Neurosurgery

Objective: Medical students are important for the long-term efficacy of global pediatric neurosurgery initiatives. In this manuscript, we describe the rationale for mobilizing medical students in global pediatric neurosurgery, delineate the potential impact of this mobilization, and detail how to increase exposure of medical students to global pediatric neurosurgery.&#x0D; &#x0D; Methods: A narrative review was conducted and supplemented with an anecdotal review.&#x0D; &#x0D; Results: Medical students are a critical asset for global pediatric neurosurgery due to their motivation and diligence, time management and organizational skills, technological proficiency, innovative perspective, and resourcefulness. Fostering the next generation of global pediatric neurosurgeons is important to facilitate long-term engagement in pediatric neurosurgery, ensure the sustainability of global pediatric neurosurgery, develop capacities to collaborate with diverse partners, teach knowledge and skills for engaging in advocacy and capacity-building, and facilitate determination of effective strategies for making progress in global pediatric neurosurgery. Opportunities for medical student involvement include reading key manuscripts; finding mentors; becoming involved in university-based global neurosurgery groups, auxiliary organizations, World Federation of Neurosurgical Societies Global Neurosurgery Committee, InciSion, or general neurosurgery medical student and trainee interest groups.&#x0D; &#x0D; Conclusion: Medical students represent a valuable asset for addressing the global burden of pediatric neurosurgical disease, ameliorating workforce and equipment deficits, and facilitating access to timely and affordable pediatric neurosurgical care. Involving medical students through existing opportunities and developing additional pathways specific to medical students will strengthen the impact and reach of global pediatric neurosurgical initiatives.

"They were an advocate for me": A Qualitative Study Exploring Medical Student Longitudinal Relationships and Patient Well-Being.

Patient navigators, community health workers, and care management teams improve patient experience and health outcomes. Medical student involvement in these roles is limited. Evaluation of these programs focuses on the student experience with less attention to patient participants. We sought (1) to understand the experience of being a participant in a medical education program; (2) to explore the patient-medical student relationship; and (3) to describe the impact of this relationship on patient health and well-being. This was a qualitative study that utilized in-depth semi-structured interviews. Participants were selected based on enrollment in a preceptorship program at an urban academic medical center between 2017 and 2020. Participants worked with a medical student during an 18-month period in which the medical student was embedded in a primary care medical home, serving as a health systems navigator for 1-2 medically and socially complex patients. Nine participants completed 1-h compensated phone interviews. This study was deemed IRB exempt. Three themes and eight subthemes were identified, including Navigators Were Key to Accessing the System, Interpersonal Partnerships Improved Health, and Fulfillment in Teaching of Lived Experience. Navigators eased the burden of chronic illness by being a point of contact in the health system, which improved participants' overall experience. Participants also described the relationship as therapeutic, citing improvement and stability in both mental and physical health. Lastly, participants found meaning in chronic illness by teaching their students empathy. Longitudinal patient-medical student relationships may provide stability and health benefits. These partnerships have the possibility of adding value to patients' healthcare experiences. This study complements current literature highlighting the value of these relationships for pre-clinical medical students. As such, additional opportunities for and additional research regarding the value of longitudinal patient connection should be incorporated in undergraduate medical education.

Increasing Medical Student Involvement in Research: Military Ob/Gyn HeadHunters.

Our goal was to develop a successful research collaboration program, Military Ob/Gyn HeadHunters, to connect military medical students with residents, fellows, and staff physicians across the Military Health System (MHS) to foster research collaboration and mentorship. We conducted a needs assessment of medical students from the Uniformed Services University and Health Professions Scholarship Program as well as staff physicians, residents, and fellows practicing in the MHS to better understand the barriers to initiating and conducting research within the MHS. We used the survey results to create a secure online spreadsheet to match medical students to researchers recruiting student researchers. A follow-up survey was sent to all respondents 3 months after the program launch to evaluate the program. Of the medical students who completed the needs assessment, 82.56% (n = 71/86) reported barriers in participating in research. The most common barrier was "I don't know where to look for research opportunities." Of the staff surveyed, 88.24% (n = 15/17) indicated that they were interested in medical student involvement in their research. However, 53.33% (n = 8/15) of the surveyed staff reported that they did not know any students who would be good candidates. Since the launch in April 2021, our 3-month follow-up survey had a response rate of 40.00% (n = 6/15) for staff and 47.06% (n = 32/68) for students. Hundred percent (n = 6/6) of faculty advertising projects recruited at least one student to join their project. 85.71% (n = 12/14) of students actively seeking participation joined a research team. Our novel research collaboration program successfully connected military medical students with active researchers in the MHS. Leaders in medical education can consider adopting this framework to improve trainee participation in research.