Number Of Training Positions Research Articles

A 10-year analysis of application and match rates for pain medicine training in the United States.

We analyzed application and match rates for pain medicine training in the United States and hypothesized that there would be (1) greater growth in the number of training positions than applicants, (2) higher match rates among US allopathic graduates relative to non-US allopathic graduates, and (3) greater number of unfilled training positions over time. Retrospective, cross-sectional study of all applicants for pain medicine training in the United States. National Resident Matching Program data were obtained over a ten-year period (2014-2023). Match rates and applicant-to-position ratios were calculated and compared over time with linear regression. Comparisons were made with chi-square tests. Growth in the number of annual training positions (261-377, 44% increase) exceeded growth in the number of interested applicants (398-415, 4% increase) (P < .001). Annual applicant-to-training position ratios decreased (1.5-1.1, P < .001). The representation of US allopathic graduates among incoming pain medicine fellows decreased over the study period (73%-58%, P < .001) while US osteopathic graduates increased (9%-28%, P < .001).Match rates increased for both US allopathic graduates (71%-91%, P < .001) and non-US allopathic graduates (51%-81%, P < .001). From 2018 to 2023, US allopathic graduates (79%) had higher match rates than US osteopathic graduates (60%, P < .001) and international medical graduates (57%, P < .001). More available annual training positions went unfilled over the study period (2%-5%, P = .006). Stagnant annual applicant volume and increasing number of available training positions have led to increasing match rates for pain medicine fellowship training. Fewer US allopathic graduates are pursuing pain medicine training. The increasing percentage of unfilled training positions warrants ongoing surveillance.

Comparing Match Outcomes in a Surgical Subspecialty: Independent Versus Integrated Training Pathways

In recent years, the Thoracic Surgery Match (TSM) has become increasingly competitive. The purpose of this study was to compare recent trends in application and match rates in the TSM by training pathway. This was a retrospective cohort study of all applicants to Integrated and Independent pathways for Thoracic Surgery training (2008-2021). Chi square tests were used to elucidate temporal trends and make comparisons by training pathway. Accreditation Council for Graduate Medical Education (ACGME)-accredited Thoracic Surgery training programs in the United States. 1500 Independent and 1242 Integrated pathway applicants for Thoracic Surgery training. From 2008 to 2021, the annual match rate decreased from 91% to 71% in the Independent pathway (p < 0.001). This was driven by a decrease in the number of training positions (130-101, 22% decrease) and increase in number of applicants (96-140, 46% increase). In the Integrated pathway, the annual match rate increased from 33% to 35% (p < 0.001) as did the number of training positions (3 to 46, 1430% increase) and applicants (9-129, 1333% increase). During each year, match rates in the Independent pathway exceeded those in the Integrated pathway (p < 0.001). U.S. Allopathic graduates had higher match rates than non-U.S. Allopathic graduates for both Integrated and Independent training pathways. The percentage of applicants in the Independent pathway matching at one of their top 3 choices decreased from 73% to 40% (p < 0.001). The percentage of Independent thoracic surgery training positions that went unmatched decreased from 28% to 2% (p < 0.001). This percentage was stable at an average of 1% in the Integrated pathway (p > 0.05). The TSM has become increasingly competitive for Independent pathway applicants and remains ultracompetitive for Integrated pathway applicants. More research is needed to understand disparities in match rates by Thoracic Surgery training pathway.

Dissection of plastic surgery national selection

Owing to the popularity of plastic surgery as a career choice and the limited number of training posts, applicants need to be highly competitive. Preparation can start at an early stage and even as an undergraduate.

Emergency medicine training posts will rise by 5.6% in 2014

Health Education England (HEE) will increase the number of training posts in emergency medicine and general practice and decrease the number of core surgical training places next year. On Tuesday, after approval from its board, HEE published its first workforce plan for England,1 setting out the investments it intends to make in education and training programmes that begin in September 2014. HEE local education and training boards are proposing 20 additional posts in acute care common stem (ACCS) core training in emergency medicine, a 5.6% increase. HEE is working with the College of Emergency Medicine “to increase the number of entry points into ACCS training, in order to provide a larger pool of doctors able …

Neural Network Training Techniques for Enhancing the Performance of a Distributive Tactile Sensor

This work describes neural network training techniques for enhancing the performance of a one-dimensional beam for determining load positions. The system was a distributive system which relied on the detection of changes in the surface properties that can be seen across the surface. The demonstrated distributive system was 400 mm in length. The applied load positions within the range 60–300 mm could be determined with an average percentage error of 0.2% of the beam length which corresponded to a position error of 0.8 mm using a network trained with 10 training positions. It was found that the errors were higher for the load applied near the edges of the beam, leading to an average percentage error of 3.6% for the whole length of the beam. The normalization of the network output can be employed to reduce the average percentage error by approximately 1% for a given number of training positions. The performance was improved by introducing more training positions in the less sensitive area. The described training technique not only reduced the prediction error but also enlarged the areas where the prediction errors were satisfactorily small. Using the described technique, the overall prediction error could be decreased by 0.13–0.24% of the beam length for 30–10 training positions. The area where the prediction errors were within 2 mm was increased by 14.5–7.3% of the beam length for a network trained with 4 training positions in the middle portion using 10–30 training positions.

Residency Training and International Medical Graduates

Residency Training and International Medical Graduates

An agenda for UK clinical pharmacology: UK medicines policy: the role of clinical pharmacologists

Clinical pharmacologists are the only medical specialists whose training focuses specifically on the safe, effective and cost‐effective use of medicines, underpinned by an understanding of drug discovery, drug regulation, pharmacology, translational medicine and the performance of clinical trials. This unique perspective has allowed them to provide expertise and leadership in medicines regulation, medicines policy, health technology assessment and drug pricing. Clinical pharmacologists assisted in the creation of the Committee on Safety of Medicines (now the Commission on Human Medicines), the Yellow Card Scheme, the National Institute of Health and Clinical Excellence (NICE) and related organizations in Scotland and Wales, and contributed to clinical guidelines (through the Scottish Intercollegiate Guidelines Network) and the British National Formulary. Their research work has contributed substantially, through translational medicine and therapeutics, to the development of new medicines and, as a result, creation of health and wealth in the UK. Their work in medicines policy has served to protect patients from harms associated with the use of medicines. A reduction in the number of able junior doctors attracted to a career in clinical pharmacology, a reduction in the number of training posts, and an ageing population of academic trainers, puts the future of the specialty, and its contribution to patient safety and UK wealth creation, at substantial risk. Urgent measures are needed to convince the NHS and government that these essential skills should be protected and nurtured.

Funding cuts will leave Wales with fewer children’s nursing undergraduates

Government says the number of training posts is in line with health boards’ staffing plans

Thoracic Surgery Training in Canada According to the Residents: The Thoracic Surgery Resident Survey, of the Canadian Thoracic Manpower and Education Study (T-Med)

The resident component of the Canadian Thoracic Manpower and Education Study (T-MED) was conducted to understand the basic demographic of Canadian thoracic surgery residents, the factors influencing their selection of training programs, current work conditions, training and competencies, and opinions in regard to the manpower needs for the specialty. A modified Delphi process was used to develop a survey applicable to thoracic surgery residents. In May and June 2009, residents completed the voluntary anonymous Internet-based survey. All Canadian residents participated in the survey, providing a 100% response rate. Most respondents were male (11/12), and the average age was 34 years old with an anticipated debt greater than $50,000 on graduation. All residents worked more than 70 hours per week, with most doing 1 : 3 or 1 : 4 on-call. Two-thirds of respondents reported being satisfied or very satisfied with their training program. Rates of anticipated competence in performing various thoracic surgeries on graduation differed between residents and program directors. Two-thirds (8/12) of residents planned to practice thoracic surgery exclusively, and hoped to practice in an academic setting. Most residents (10/12) agreed or strongly agreed that not enough jobs are available in Canada for graduating trainees and that the number of residency positions should reflect the predicted availability of jobs. This study has provided detailed information on thoracic surgery resident demographics and training programs. Most thoracic surgery residents are satisfied with their current training program but have concerns about their job prospects on graduation, and they believe that the number of training positions should reflect potential job opportunities. This survey represents the first attempt to characterize the current state of thoracic surgery training in Canada from the resident's perspective and may help in directing educational and manpower planning.

Editorial

As we look forward to the warmer months. Last year saw a dramatic rise in the number of training posts in Acute Medicine, a trend which will continue this August. The Department of Health considers Acute Medicine to be one of the few hospital specialities with the potential for future expansion, and additional funded NTNs have been made available. This is undoubtedly good news for the speciality; however, it is clearly important to ensure that any additional numbers can be accommodated without diluting the opportunities for our existing trainees. From discussions with trainers and trainees alike, it is clear that there remains wide variation in Acute Medicine training programmes across different regions. The recently formed Acute Medicine Programme Directors group has started to address these issues, and has presented proposals for a more formalised training structure to the JRCPTB. Speciality skills training remains one of the most contentious areas, which is likely to increase as trainee numbers rise. The feasibility of providing every acute medicine trainee with suffi cient exposure to a practical procedure such as echocardiography or ultrasound may require a rethink in future training plans. Development of a special interest in Medical Education, management or research may be more appropriate and arguably more useful to future consultants and employers. A respiratory fl avour fl ows through many of the articles in this edition of the journal. Alistair Proudfoot’s article on the treatment of pulmonary embolism follows on from his review of the diagnosis of this condition in the previous edition. If there were a prize for the most comprehensive referencing this review would certainly win by some margin. Of course this list would have been pruned, were it not for his inclusion of the editors own paper at citation number 106. It clearly pays to save the best until last! In another sequel Mayank Patel follows up the previous review on the management of acute symptomatic hyponatraemia with a comprehensive summary of the more common scenario of the asymptomatic hyponatraemic patient on the AMU. The article on pleural effusion is the fi rst of two papers on management of pleural disease; pneumothorax will follow in a future edition. As usual the case reports have been selected for publication to highlight important teaching messages. Orthodeoxia platypnoea may be unfamiliar to acute physicians, but the case illustrates the importance of apparently minor details in the history in this case the marked variation in symptoms relating to posture. The challenges of risk versus benefi t for anticoagulation in patients with metallic heart valves are highlighted by the case of fatal intra-hepatic haemorrhage; this month’s picture quiz demonstrates the importance of the history when considering intercostal tube insertion for a ‘radiological diagnosis’ of pneumothorax. ‘Viewpoint’ is intended as an opportunity to stir up debate, and the article by Clare et al in the last edition produced a ripple of disquiet amongst some readers. The interface between acute and emergency medicine remains a contentious area, and further contributions to this debate are welcomed for consideration in future editions.

A career as a British trainee psychiatrist

It was refreshing to read Amin Muhammed Gadit's Article “A Career as a Canadian Pychiatrist.”1 In the current climate where a new system of training will be introduced and the number of training posts is being reduced, knowing that we can build our careers somewhere else feels like a breath of fresh air. Recently, I have seen a lot of my colleagues from overseas leave for Australia, Canada, and the United …

Meeting the need to train more doctors: The role of community-based preceptors

Community-based precepting is becoming a critical component of Canadian medical education. Calls from the public to train increased numbers of physicians have placed more students in community-based settings. Other countries are facing similar situations. Understanding the factors that make community-based practitioners decide to teach plays a significant role in recruiting and retaining potential preceptors. Ensuring that there are appropriate numbers of trainees and administrative supports, and that there is adequate recognition of these teachers, may be more important than financial incentives. A positive experience has been shown to reduce stress, enhance professional satisfaction and increase patients' perceptions of their physicians. Ultimately, a positive experience can influence a trainee to take root in a community-based setting. Recognizing the most common causes of preceptor burnout will help to protect this group of faculty. Some of the myths surrounding community precepting, including massive time commitments, significant financial impact and poor patient acceptance of medical students, are discussed. Providing a range of tools to further educate and support this group of medical teachers is critical, especially in light of the rapidly expanding number of training positions.

Effect of changes in graduate medical education funding on emergency medicine residency programs.

To determine whether changes in graduate medical education (GME) funding have had an impact on emergency medicine (EM) residency training programs. A 34-question survey was mailed to the program directors (PDs) of all 115 Accreditation Council for Graduate Medical Education (ACGME)-accredited EM residency programs in the United States in the fall of 1998, requesting information concerning the impact of changes in GME funding on various aspects of the EM training. The results were then compared with a similar unpublished survey conducted in the fall of 1996. One hundred one completed surveys were returned (88% response rate). Seventy-one (70%) of the responding EM residency programs were PGY-I through PGY-III, compared with 55 (61%) of the responding programs in 1996. The number of PGY-II through PGY-IV programs decreased from 25 (28%) of responding programs in 1996 to 17 (16%). The number of PGY-I through PGY-IV programs increased slightly (13 vs 10); the number of EM residency positions remained relatively stable. Fifteen programs projected an increase in their number of training positions in the next two years, while only three predicted a decrease. Of the respondents, 56 programs reported reductions in non-EM residency positions and 35 programs reported elimination of fellowship positions at their institutions. Only four of these were EM fellowships. Forty-six respondents reported a reduction in the number of non-EM residents rotating through their EDs, and of these, 11 programs reported this had a moderate to significant effect on their ability to adequately staff the ED with resident physicians. Sixteen programs limited resident recruitment to only those eligible for the full three years of GME funding. Eighty-seven EM programs reported no change in faculty size due to funding issues. Sixty-two programs reported no change in the total number of hours of faculty coverage in the ED, while 34 programs reported an increase. Three EM programs reported recommendations being made to close their residency programs in the near future. Changes in GME funding have not caused a decrease in the number of existing EM residency and fellowship training positions, but may have had an impact in other areas, including: an increase in the number of EM programs structured in a PGY-I through PGY-III format (with a corresponding decrease in the number of PGY-II through PGY-IV programs); a decrease in the number of non-EM residents rotating through the ED; restriction of resident applicants who are ineligible for full GME funding from consideration by some EM training programs; and an increase in the total number of faculty clinical hours without an increase in faculty size.

SURGICAL MANPOWER IN NEW SOUTH WALES

A series of surveys of general surgeons in the State of New South Wales is reported. Each five years the number of general surgeons entering practice has been proportionately greater than population growth, and has also been proportionally greater than that of other surgical specialities. The speciality is not growing and is so saturated that almost half the general surgeons are engaged in general practice. It is suggested that the number of training posts be reduced to a level near that required to satisfy the requirement of our community for replacement of those leaving practice.