North American Medical Schools Research Articles

Gender Disparity Among Top North American Medical Schools and Their Affiliated Radiology Departments: Medical school vs Radiology - Gender Diverse?

PurposeThis study aimed to evaluate the degree of gender disparity in leadership positions at the top 25 medical schools in North America compared to their affiliated radiology departments. MethodsThe academic rank and leadership appointment of medical school and radiology faculty were obtained from publicly available official websites between June-November 2022. Gender was determined using self-identified pronouns on website biographies. Alternatively, gender API software was used. Finally, SCOPUS Elsevier was used to extract research output metrics including publication counts, citations, and h-indices. Statistical analysis was conducted using the IBM SPSS Statistics version 25 software. Results2216 individuals across 25 medical schools were included in this study. 1301 (58.7%) were part of the medical school and 915 (41.3%) were part of the affiliated radiology departments. Additionally, 1575 (71.1%) were identified as men and 641 (28.9%) as women. Rank biserial correlations showed a significant association between higher academic rank and male gender (rpb = 0.143, p < 0.001) regardless of affiliation (medical school leadership versus radiology faculty); this disparity was largest at the highest academic ranks. Male gender was associated with higher research productivity relative to female gender regardless of affiliation (p < 0.001). There were minimal statistical differences in leadership positions between genders, however the proportion of men holding the position of dean was two times higher than women. ConclusionThe underrepresentation of women in academic medicine is prevalent in the top-ranking medical institutions in North America and disproportionately involves senior academic ranks and leadership positions.

The state of wellbeing education across North American medical schools: a scoping review.

Medical students experience increased rates of burnout and mental illness compared to the general population. Yet, it is unclear to what extent North American medical schools have adopted formal wellbeing curricula. We sought to establish prevailing themes of existing wellbeing educational interventions to identify opportunities for further curricular development. We conducted a scoping review of the literature to identify wellbeing education programs implemented for undergraduate medical students across North America. We searched four comprehensive databases and grey literature and only included published original research. Two independent researchers screened all papers, with a third resolving disagreements. Two researchers conducted the data extraction using a continuously refined template, with a third researcher resolving any discrepancies. We identified 3996 articles in the initial search of which 30 met inclusion criteria and were included for further analysis. The most common types of interventions were mindfulness and meditation practices. 27 studies found that their wellbeing sessions contributed to positive wellbeing outcomes of learners. Our review identified that there are few wellbeing curricular initiatives that have been evaluated and published in the literature. Additionally, the methodology and rigour of wellbeing curriculum evaluation to date leaves significant room for improvement. The existing literature does suggest that the adoption of a wellbeing curriculum has the potential to improve outcomes for medical students. These findings can be used to assist the development of a validated wellbeing curricular framework for wellbeing initiatives. However, while such a curriculum may represent an effective tool in enhancing medical trainee wellbeing, it cannot effect change in isolation; lasting and meaningful change will require concurrent shifts within the broader systemic framework and cultural fabric of the medical education system.

Intraprofessionalism and Peer-to-Peer Learning in American Medical Education.

As previous research has observed, medical students and physicians alike confront vast amounts of knowledge in their education and practice, such that no one clinician can know everything there is to know about biomedicine. Even before clerkships, medical students learn to cope with this impossibility by prioritizing certain information based on its perceived utility for exams and clinical practice. Many factors can shape this process, including teamwork, wherein individual medical students rely on one another to address gaps in knowledge at the level of the group. This paper will draw on qualitative data from two allopathic medical schools in the American Midwest to demonstrate that peer-to-peer learning, a widely utilized pedagogical modality in North American medical schools, is amongst the earliest places where future physicians learn how to rely on their peers in the profession as they make choices about what to know and what not to know about biomedicine: cultivating a culture of "intraprofessionalism" between students with different knowledges and values, as they prepare to enter the same profession. The paper will also consider how differences in the student populations at two field sites impact intraprofessional development. Drawing on scholarship of peer-based learning strategies and the sociology and anthropology of medical education, the authors argue that peer-to-peer learning is a key site in the professional socialization of medical students toward the effective management of medical knowledge.

Needs assessment for enhancing pediatric clerkship readiness

BackgroundMany students report feeling inadequately prepared for their clinical experiences in pediatrics. There is striking variability on how pediatric clinical skills are taught in pre-clerkship curricula.MethodsWe asked students who completed their clerkships in pediatrics, family medicine, surgery, obstetrics-gynecology and internal medicine to rate their pre-clinical training in preparing them for each clerkship, specifically asking about medical knowledge, communication, and physical exam skills. Based on these results, we surveyed pediatric clerkship and clinical skills course directors at North American medical schools to describe the competence students should have in the pediatric physical exam prior to their pediatric clerkship.ResultsClose to 1/3 of students reported not feeling adequately prepared for their pediatrics, obstetrics-gynecology, or surgery clerkship. Students felt less prepared to perform pediatric physical exam skills compared to physical exam skills in all other clerkships. Pediatric clerkship directors and clinical skills course directors felt students should have knowledge of and some ability to perform a wide spectrum of physical exam skills on children. There were no differences between the two groups except that clinical skills educators identified a slightly higher expected competence for development assessment skills compared to pediatric clerkship directors.ConclusionsAs medical schools undergo cycles of curricular reform, it may be beneficial to integrate more pre-clerkship exposure to pediatric topics and skills. Further exploration and collaboration establishing how and when to incorporate this learning could serve as a starting point for curricular improvements, with evaluation of effects on student experience and performance. A challenge is identifying infants and children for physical exam skills practice.

Abortion and Contraception in Medical School Curricula: A Survey of North American Family Medicine Clinical Curriculum Directors

Phenomenon: Contraception and abortion care are commonly accessed health services, and physicians in training will encounter patients seeking this care. Curricula that teach contraception and abortion provision during medical school equip medical students with valuable skills and may influence their intention to provide these services during their careers. Family planning is nevertheless understood to be underrepresented in most medical curricula, including in North American medical schools where the laws on providing contraception and abortion have been consequentially changing. This study investigated the prevalence and predictors of contraception and abortion education in North American medical curricula in 2021. Approach: We asked family medicine clerkship directors from Canada and the United States (US) to report about contraception and abortion teaching in their clinical curricula and their school’s whole curriculum and to report on associated factors. Survey questions were included in the 2021 Council of Academic Family Medicine’s Educational Research Alliance (CERA) survey of Family Medicine Clerkship Directors at accredited North American medical schools. Surveys were distributed between April 29 and May 28, 2021, to the 160 clerkship directors listed in the CERA organization database. Findings: Seventy-eight directors responded to the survey (78/160, 48%). 47% of responding directors reported no contraception teaching in the family medicine clerkship. 81.7% of responding directors reported no abortion teaching in the clerkship, and 66% indicated abortion was not being taught in their school’s whole curriculum. Medical school region correlated with the presence of abortion curricula, and schools with high graduation rates into the family medicine specialty reported abortion teaching more frequently. Fewer than 40% of responding directors had received training on both contraception and abortion care themselves. Insights: Contraception and abortion are both underrepresented in North American medical curricula. Formal abortion education may be absent from most family medicine clerkships and whole program curricula. To enhance family planning teaching in North American medical schools, we recommend that national curriculum resources be revised to include specific contraception and abortion learning objectives and for increased development and support for clinical curricula directors to universally include family planning teaching in whole program and family medicine clerkship curricula.

Content and strength of conflict of interest policies at Scandinavian medical schools: a cross sectional study

BackgroundConcerns around staffs’ and students’ interactions with commercial entities, for example drug companies, have led several North American medical schools to implement conflict of interest (COI) policies. However, little is known about COI policies at European medical schools. We analysed the content and strength of COI policies at Scandinavian medical schools.MethodsWe searched the websites of medical schools in Denmark, Norway, and Sweden and emailed the Deans for additional information. Using comparable methodology to previous studies, the strength of the COI policies was rated on a scale from 0 to 2 across 11 items (higher score more restrictive); we also assessed the presence of oversight mechanisms and sanctions.ResultsWe identified 77 unique policies for 15 medical schools (range 2–8 per school). Most of the policies (n = 72; 94%) were University wide and only five (6%) were specific for the medical schools. For six of eleven items one or more schools had a restrictive policy (score of two). None of the schools had a restrictive policy for the five additional items (speaking relationships, sales representatives, on-site education activities, medical school curriculum, and drug samples). Honoraria was the item with the highest score, with eight of the 15 schools having a score of two. Thirteen of the 15 schools had policies that identified a party responsible for policy oversight and mentioned sanctions for non-compliance.ConclusionOur study provides the first evaluation of all Scandinavian medical schools’ COI policies. We found that the content of COI policies varies widely and still has shortcomings. We encourage Scandinavian medical schools to develop more stringent COI policies to regulate industry interactions with both faculty and students.

Toward a comparative history of medical genetics as a medical specialty in North America.

Much of what has been written about the history of medical genetics in North America has focused on physician involvement in eugenics and the transition from heredity counseling to genetic counseling in the United States. What are typically missing in these accounts are details concerning the formation of a new medical specialty, i.e., medical genetics, and Canada's involvement in specialty formation. Accordingly, this paper begins to fill in gaps by investigating, on the one hand, the history of American and Canadian geneticists working together to support the creation of examining and teaching positions in human genetics in North American medical schools and, on the other, working independently of one another to monitor the rate and direction of workloads and patient access to local genetic counseling and laboratory services and, subsequently, achieve recognition for medical genetics as a medical specialty at the national level.

A Cautionary Tale: Exploring Stakeholder Emotions During Curricular Change Using Group Concept Mapping

PhenomenonCurricular change is essential but challenging. Change efforts often struggle and some fail due to well-articulated challenges as well as other barriers less understood. The curricular change literature characterizes the organizational and operational features of successful change yet virtually ignores stakeholder emotions. A deeper understanding of these emotional responses during the change process could enhance participant and organizational well-being and support change success. Approach In 2019, data were collected at one large North American medical school using group concept mapping methodology, an asynchronous mixed methods approach. We sought to generate themes characterizing the emotional responses of faculty, administrative staff, and students across multiple stakeholder groups participating in the new and traditional (legacy) curricula 27 months after curricular change initiation. Participants brainstormed, sorted, and rated statements on emotional responses. Rating participants rated each statement using a Likert scale from 1 (does not resonate) to 4 (very strongly resonates) according to this prompt: “This emotional response resonates with my emotional experience during the curricular change.” Multidimensional scaling and hierarchical cluster analyses were used to generate emotional profiles and compare them across stakeholders. Findings Of 335 stakeholders invited, 123 contributed to brainstorming (36.7%), 153 completed rating (45.7%) and 33 completed sorting (9.9%). Participants generated six themes of emotional responses to curricular change: enthusiastic, apprehensive, overwhelmed, missed opportunities, uncertain, and abandoned. The enthusiastic theme overall had the highest mean statement ratings while the abandoned theme had the lowest. Demographic subgroup analysis revealed new curriculum students (Class of 2021) were most enthusiastic while legacy curriculum students (Class of 2020) were more likely to feel abandoned. Overall, faculty and administrative staff were more enthusiastic than students whereas students rated the five other themes higher than faculty and administrative staff. InsightsCurricular change is emotionally taxing. Students in both curricula experienced greater uncertainty, apprehension, sense of missed opportunities, and feeling overwhelmed than did faculty and administrative staff. Legacy curriculum students rated statements in the abandoned cluster highest while new curriculum students rated statements in the enthusiastic cluster highest. Given the ubiquity of curricular change which often includes a legacy cohort, medical schools embarking on this journey must carefully attend to the varied emotional responses of their different stakeholder groups. The very activities recommended by organizational change models used in medical education, such as communicating wins early and often, could alienate legacy students, creating emotional polarization. These findings suggest that tailored communication strategies are necessary during change implementation to optimize success.

Diversity in Dermatology? An Assessment of Undergraduate Medical Education.

A lack of representation of skin of color (SoC) in dermatology curricula is well-documented across North American medical schools and may present a barrier to equitable and comprehensive undergraduate medical education. This study aims to examine representation in dermatologic educational materials and appreciate a link between bias in dermatologic education and student diagnostic ability and self-rated confidence. The University of Toronto Dermatology Undergraduate Medical Education curriculum was examined for the percentage photographic representation of SoC. A survey of 10 multiple-choice questions was administered to first- and third-year medical students at the University of Toronto to assess diagnostic accuracy and self-rated confidence in diagnosis of 5 common skin lesions in Fitzpatrick skin phototypes (SPT) I-III (white skin) and VI-VI (SoC). The curriculum audit showed that <7% of all images of skin disease were in SoC. Diagnostic accuracy was fair for both first- (77.8% and 85.9%) and third-year (71.3% and 72.4%) cohorts in white skin and SoC, respectively. Students' overall self-rated confidence was significantly greater in white skin when compared to SoC, in both first- (18.75/25 and 17.78/25, respectively) and third-year students (17.75/25 and 15.79/25, respectively) (P = .0002). This preliminary assessment identified a lack of confidence in diagnosing dermatologic conditions in SoC, a finding which may impact health outcomes of patients with SoC. This project is an important first step in diversifying curricular materials to provide comprehensive medical education.

Analysis of Gender Disparity in US and Canadian Radiology Residency Programs

BackgroundEquity, diversity, and inclusion in academic radiology are a work in progress and although the gender gap has decreased, there remains a paucity of studies examining female representation among radiology trainees over the past decade. ObjectiveThe aim of our undertaking was to evaluate gender parity in United States (US) and Canadian radiology residency programs and to suggest future directions to improve female representation Materials and MethodsRetrospective analysis of publicly available data on radiology residents from the US and Canada was performed from 2007to 2019. Data on diagnostic radiology residents was collected from the Accreditation Council for Graduate Medical Education for the US and the Canadian Post M.D. Education Registry for Canada. Statistical tests including regression and ANOVA were used to study the gender proportions from 2007to 2019. ResultsThere has been little progress in bridging the gender gap in the last 12 years. The proportion of female residents pursuing radiology has remained at an average of 26.74% (n = 1,238of 4,629) in US programs and 31.78% (n = 28 of88) in Canadian programs. The average change in the percentage of female residents was 0.0% per year (P = 0.0) for US programs and -2.9% per year (P = 0.3) for Canadian programs. DiscussionDespite a higher proportion of females in North American medical schools, gender disparity persists among radiology residents. More research is needed to identify barriers limiting female representation and improve gender parity across North American radiology programs.

An evaluation of a medical student international service-learning experience in Southeast Asia.

International service-learning trips (ISLTs) are structured experiences in a different country where students interact and engage in cross-cultural dialog with others. Month-long ISLTs originating from North American or European medical schools enhance clinical acumen, cultural awareness, and global health familiarity. The impact of experiences shorter than 1 month or those that originate from Asia is unknown. We aimed to determine the impact of a short-term ISLT on medical students' clinical and cultural competence. At Duke-National University Singapore, we developed an ISLT incorporating peer-assisted learning and a 1-week on-site experience delivering supervised primary care, health screening, and health education in an underserved Southeast Asian community. Using a prospective controlled design, we assessed its impact on medical students' clinical and cultural competency using validated surveys. We compared medical students who participated in the ISTL (intervention group) to a control group of students before and after the ISTL experience. We analyzed responses using univariate analysis and the Kruskal-Wallis test. : Sixty-six students responded to the survey (100%). After the ISTL, the intervention group (n = 32) showed an increase in their ratings of clinical competency (preexperience mean = 3.39, postexperience mean = 3.81, P < 0.01) as well as an increase in their cultural competency domains (preexperience mean = 3.61, postexperience mean = 4.12, P < 0.01). Post the ISTL, students in the intervention group rated their clinical and cultural competency higher than the control group (n = 34) (clinical: intervention postexperience mean = 3.81, control postexperience mean = 3.30, P < 0.01; cultural: intervention postexperience mean = 4.12, control postexperience mean = 3.50, P < 0.01). After the ISTL, the intervention group reported increased ratings of self-efficacy (pre mean = 3.99, post mean = 4.29, P = 0.021), which were higher than the control group (pre mean = 4.29, post mean = 3.57, P < 0.01). : This short-term ISLT in an Asian medical school improved students' clinical and cultural competency and self-efficacy. Our findings suggest a positive impact of short-term ISLTs if designed and implemented with a student learning focus.

Competent to provide compassionate care? A critical discourse analysis of accreditation standards.

Medical school accreditation is recognised internationally as an important quality control process for programmes that lead to the Medical Doctor (MD) degree. Accreditation standards govern the accreditation process which in turn drives educational objectives. Given the power of these standards to shape what becomes valued in the curricula, it is therefore imperative to ensure that core values and ideals of the profession are meaningfully incorporated. As the provision of compassionate care has long been a central medical value, this value should be clearly articulated in MD programme accreditation standards. We conducted a Critical Discourse Analysis of compassionate care within Undergraduate Medical Education (UME) Accreditation Standards governing North American medical schools since 1957. We explored how and to what extent the written language of the accreditation standards incorporated compassionate care. References to compassionate care in the UME Accreditation Standards were few and far between. Historically, a statement of 'The Objectives of Undergraduate Medical Education' published by the Association of American Medical Colleges (AAMC) was referenced for the first and only time in the 1957 standards, describing the development of attributes such as the provision of compassionate care as a basic objective of UME. Thereafter, there was infrequent mention of this value. Terms that could potentially incorporate aspects of compassionate care were identified, yet these were explicated in ways that limited connection to compassion. Instead, the term 'care' has increasingly been used instrumentally (ie acute care, chronic care). The relative absence of language pertaining to compassionate care in accreditation standards is troubling as compassion is integral to good medical care. This absence is particularly important to attend to in the current era of competency-based training where we must be explicit about all important curricular objectives lest essential values and practices be unintentionally lost.

Animating Primary Hemostasis for Medical Student Education

Physicians have difficulty recognizing and diagnosing disorders of primary hemostasis. The root of this may lie in their education, where students are often taught hemostasis using static graphics. We aimed to create a didactic animation on primary hemostasis for medical students to be used in North American medical schools. To promote widespread use of the animation, we surveyed hemostasis educators from Canada and the US on the animation’s learning objectives. The animation’s script and storyboard were developed using the Animation Processing Model (APM), a psychological processing model that addresses the perceptual limitations of learners. This animation is the first biomedical animation to use the APM in its design. Furthermore, this is the first didactic hemostasis animation which sought peer consensus for its learning objectives.

S1273 Are There Differences in the Academic Productivity Between Female and Male GI Fellowship Program Directors?

INTRODUCTION: The gastroenterology (GI) fellowship program directors (PDs) play a pivotal role in running the fellowship program. The purpose of this study was to analyze the demographic characteristics, academic background and scholarly activities of GI fellowship director workforce in the United States (US). METHODS: A list of all Accreditation Council for Graduate Medical Education (ACGME) accredited adult GI fellowship programs was obtained. PDs of all programs were included in the study. Publicly available sources were used to gather information about each PD, including the individual program websites, HealthGrades and Doximity websites, Scopus database. The variables collected included age, sex, educational background, fellowships of GI societies (AGAF, FASGE, FACG, FAASLD) and scholarly metrics. Non-parametric statistics including Mann-Whitney U and Kruskal Wallis tests were applied to compare the groups. RESULTS: A total of 207 GI PDs from 207 adult GI fellowship programs were included, of which 159 (76.8%) were males. Female PDs were significantly younger than male PDs (median age 45.5 vs 53 years, P < 0.001). The mean age at appointment of PDs was 45.5 years and the mean duration served as PD was 6.4 years. Majority of PDs graduated from North American medical schools (81%). General gastroenterologists comprised 79% of PDs, while the rest had specialized in hepatology (12%), advanced endoscopy (6%), IBD (2%), and gastric motility (1.0%). Majority of PDs (63.2%) were fellows of a professional GI society. The mean publications, citations and h-index were 37.324 ± 66.51, 1512.57 ± 3820.82 and 12.03 ± 18.27, respectively. No difference was observed in scholarly activities when stratified by sex. Academic rank was available for 113 individuals, amongst which 37 were assistant professors, 43 associate professors and 33 were professors. There was statistically significant increase in scholarly metrics with higher academic rank. Advanced endoscopists and hepatologists had significantly higher scholarly metrics compared to general gastroenterologists. CONCLUSION: While there is no difference in scholarly metrics between current male and female PDs and APDs, gender disparities exist in leadership roles in GI fellowship programs. Efforts should be made to bridge this gap.Figure 1.: Demographics of PDs – by gender (a) and by age* (b).

Investigating the Presence of the History of Medicine in North American Medical Education: Can One of the Medical Humanities Concisely Integrate with Biomedical and Clinical Content with Reference to Clinical Competencies?

As a curricular topic, the history of medicine can reinforce medical knowledge while integrating the benefits associated with humanities education. This study examined the degree to which medical history was present in the curricula of North American Medical Schools, how those sessions (if any) were delivered, and who delivered them. We hypothesized that medical history would be present but that very few American Medical schools would have mandatory sessions, that the presentation of this content would be very diverse, and that sessions would be presented by a variety of professionals. We compiled a contact list of deans and curricular administrators at each institution and recruited respondents from an online discussion board. Respondents completed a short survey regarding the curriculum at their home institution. We received responses from 96 of 209 institutions (46.0%). Of these, 29.2% of respondents indicated that their institution had mandatory sessions on medical history, 42.7% had non-mandatory curricular sessions, 49.0% had extracurricular sessions, and 21.4% had electives on the history of medicine. Lecture was the primary means of delivery in all modalities except for the electives, which primarily used small group discussion. Clinical faculty were the most common people overseeing these sessions, but a wide variety of others also contributed. While few North American medical schools had mandatory sessions on the history of medicine, the topic was present in very diverse ways. The lack of standardization in teaching the history of medicine may provide fertile ground for subsequent research in medical education.

Does conventional early life academic excellence predict later life scientific discovery? An assessment of the lives of great medical innovators.

SummaryBackgroundPerhaps, as never before, we need innovators. With our growing population numbers, and with increasing pressures on our education systems, are we in danger of becoming more rigid and formulaic and increasingly inhibiting innovation? When young can we predict who will become the great innovators? For example, in medicine, who will change clinical practice?AimsWe therefore determined to assess whether the current academic excellence approach to medical school entrance would have captured previous great innovators in medicine, assuming that they should all have well fulfilled current entrance requirements.MethodsThe authors assembled a list of 100 great medical innovators which was then approved, rejected or added to by a jury of 12 MD fellows of the Royal Society of Canada. Two reviewers, who had taken both the past and present Medical College Admission Test as part of North American medical school entrance requirements, independently assessed each innovator’s early life educational history in order to predict the innovator’s likely success at medical school entry, assuming excellence in all entrance requirements.ResultsThirty-one percent of the great medical innovators possessed no medical degree and 24% would likely be denied entry to medical school by today’s standards (e.g. had a history of poor performance, failure, dropout or expulsion) with only 24% being guaranteed entry. Even if excellence in only one topic was required, the figure would only rise to 41% certain of medical school entry.ConclusionThese data show that today’s medical school entry standards would have barred many great innovators and raise questions about whether we are losing medical innovators as a consequence. Our findings have important implications for promoting flexibility and innovation for medical education, and for promoting an environment for innovation in general.

Influences for Gender Disparity in Academic Family Medicine in North American Medical Schools.

BackgroundWomen physicians continue to comprise the minority of leadership roles in Academic Family Medicine (AFM) faculty across North American medical schools. Our study quantified the current state of gender disparity by analyzing academic position, leadership ranking, and research productivity.MethodsWe generated a database for 6,746 AFM faculty members. Gender and academic profiles were obtained for 2,892 academic ranks and 1,706 leadership roles by searching faculty listings enlisted in Fellowship and Residency Electronic Interactive Database (FREIDA) and Canadian Resident Matching Service (CaRMS). To measure research productivity, we obtained bibliometric data: h-index, citations, and tenure from 2,383 faculty members using Elsevier’s SCOPUS archives. Data analysis and h-index were formulated using Stata version 14.2 (StataCorp LP, College Station, TX).ResultsOur results indicated that women hold 46.11% (3,110/6,746) of faculty positions. The proportional composition decreased with increasing academic ranking (49.84% assistant, 46.78% associate, and 41.5% full professor). The same decreasing trend was demonstrated with leadership rank (57.14% minor leadership, 47.65% second-in-command, and 36.61 first-in-command). Compared to their gender counterparts, women in AFM demonstrated lower publication productivity as measured by citation number (p=0.04) and years of study (p=0.008). The final prediction equation model after multivariable analyses included gender, publications, citations, country of graduation, and years of active research (p<0.05).ConclusionsThe composition of academic family medicine faculty members included in this study demonstrated gender disparity. Inclusivity initiatives and policies to tackle the issue of female retention, promotion, and recruitment need to be further explored.

Evaluation of a Novel Pediatric &amp; Adolescent Gynecology Sub-Internship for Medical Students [12G

INTRODUCTION: Although Pediatric and Adolescent Gynecology (PAG) is an important and growing field, training opportunities are limited, especially at the medical school level. To address this gap, we developed a PAG sub-internship and elective course for medical students. Our course represents the fourth PAG sub-internship available in North American medical schools; by contrast, other available sub-internships include 113 in Maternal Fetal Medicine and 82 in Gynecologic Oncology. METHODS: Our four-week PAG sub-internship and two-week elective include a multi-pronged evaluation system with three components: a written test taken on the first and last day of the sub-internship, direct observation and evaluation of clinical skills using the Entrustable Professional Activities (EPAs) framework, and a 360-degree feedback system allowing students to provide anonymous feedback regarding the sub-internship. RESULTS: In the first year of our sub-internship, seven students applied and five students enrolled; in the second year, eight students have applied. Mean overall EPA entrustability scores were 2.3 and 3.7 on the first and final day of the sub-internship, respectively. Preliminary evaluation data showed a mean score of 5.0 (strongly agree) for the evaluation question “Were you satisfied with the clinical teaching in this elective/sub-internship?” Excerpts from the written feedback provided via anonymous evaluations included “This elective provided an excellent cross-section between pediatrics and gynecology.” CONCLUSION: We have developed, implemented, and evaluated a PAG sub-internship for medical students. We share our evaluation data to demonstrate the value of such training opportunities and help other institutions who wish to create a PAG sub-internship.

Does exposure to anatomy education in medical school affect surgical residency applications? An analysis of Canadian residency match data

The time dedicated to teaching gross anatomy, including cadaveric dissection, has been decreasing in North American medical schools. The impact of this trend on surgical residency applications is unknown. We sought to identify trends in surgical residency applications in Canada and to determine if medical schools with more gross anatomy instruction and mandatory cadaveric dissection produced more applicants ranking surgical residency programs as their first choice. Canadian Resident Matching Service (CaRMS) data from 1997 to 2016 were analyzed. A questionnaire was distributed to Canadian medical schools requesting current and historic information on their anatomy curricula and the number of hours of anatomy instruction. The survey response rate was 35% (6 of the 17 Canadian medical schools responded); partial data were available for 16 (94%) of the 17 Canadian medical schools. A total of 4.3% of graduating students ranked general surgery as their first choice in the CaRMS match and 17.2% ranked any surgical program first. Over time, the percentage of graduating students who ranked surgical programs as their first choice decreased (p < 0.001). Three schools were significantly more likely than the others to produce graduates ranking general surgery as their first choice. Between 2012 and 2016 the percentage of graduating students ranking surgical programs first was significantly higher (2.2%, p = 0.024) in schools with mandatory cadaver dissection. There was no correlation between the number of hours of gross anatomy instruction and the percentage of graduates ranking any surgical program or a general surgical program first. The number of applications to surgical programs has decreased in Canada over the past 20 years. Certain schools are more likely than others to produce graduates ranking general surgery as their first choice. Programs with mandatory cadaver dissection produced more graduates favouring surgical programs.

Establishing a Pediatric and Adolescent Gynecology Subinternship for Medical Students.

Within the pediatric and adolescent gynecology (PAG) community, an important issue deserving of our attention is expansion of formalized PAG training opportunities for medical students. In addition to those in obstetrics and gynecology, many physicians practicing family medicine, internal medicine, and surgery provide care to young female patients. However, residency programs provide inconsistent training in addressing specific PAG health care needs and communication skills required for delivery of care to pediatric and adolescent patients; opportunities for supervised clinical experience in these areas at the medical school level therefore have great importance because they might not be offered again during some residencies. At the undergraduate medical education level, training opportunities in PAG are currently limited, with only 3 PAG subinternships in North American medical schools. In contrast, other available subinternships include 113 in maternal fetal medicine and 82 in gynecologic oncology. To address this gap in opportunities for medical students, we developed a PAG subinternship and elective for medical students, which we describe in this report. Our 4-week PAG subinternship and 2-week elective expose students to a variety of ambulatory and surgical opportunities, with formal, informal, and self-guided learning activities. In this article, we explain the process of developing the curriculum, gaining alignment from key stakeholders, obtaining formal approval for the course, and advertising the opportunity to medical students. We also provide resources and guidance for medical educators who wish to establish a PAG subinternship or elective course at their institutions.