Residency Positions Research Articles

Assessing Efficiency of Preferential Treatment from Resident Position

The article deals with the research analyzing adverse factors influencing the efficiency of preferential treatment functioning in the Far-East Federal Area. To build a complex assessment of factors hindering the development of business and affecting the demand for preferential treatment on the part of investors a survey of effective residents of preferential treatment zones was conducted. The author came to practical conclusions, which can be used for further upgrading of statutory enactments necessary to establish and regulate preferential treatment in the Far-East Federal Area. The research is based on statistic data of the Ministry on Developing the Far East and the Arctic and the limited company ‘The Corporation of Developing the Far East and the Arctic’. The findings of the research can be used by federal authorities of the Russian Federation, bodies of power in entities of the Russian Federation and controlling companies in order to improve investment climate on the territory of the Far-East Federal Area.

Neurosurgery Fellowships and the Residencies That Enfold Them: A Nationwide Correlational Analysis.

Accredited neurosurgery fellowship training is available in 10 subspecialties and can sometimes be completed during the postgraduate year (PGY)-7 residency year. However, it is not clear whether there are sufficient residency graduates to fill the number of positions available, and residency curriculum structure to support enfolded training is evolving. Detailed information about the 117 accredited neurosurgery residency programs and the 282 accredited neurosurgery fellowships was obtained from the Accreditation Council for Graduate Medical Education and Committee on Advanced Subspecialty Training, respectively. Information about residency chief year structure (PGY-6 vs PGY-7) was obtained electronically from each program. An analysis was performed to correlate residency and fellowship training characteristics at each program. The total number of neurosurgery fellowship positions available per year (352) is much higher than the total number of residency positions (237). Eighty-eight (75%) institutions with a neurosurgery residency offer at least 1 fellowship, and 51 of these have more fellowships than graduating residents. The resident complement at each program correlates with the number of fellowships offered (r2 = .56, P < .05), and the average institutional resident complement where fellowships are offered is greater than 2 per year. Thirty-eight residencies (32%) use a PGY-6 chief model (allowing for enfolded fellowships), and these programs offer significantly more fellowship programs on average than those using a traditional PGY-7 chief model (3.0 vs 2.1, P < .05). For most subspecialties, a minority of fellowships are offered in programs with a PGY-6 chief model. The number of accredited neurosurgery subspecialty fellowship slots in the United States far exceeds the number of graduating neurosurgery residents. There is no standard for residency curriculum or enfolded fellowships, but smaller programs offer fewer opportunities for subspecialty training. There may be advantages to a uniform approach that standardizes subspecialty training across programs and matches fellowship availability to demand.

Personality traits, interests, and values in medical students: a proposal for a vocational assessment tool for specialty choice

Choosing a medical specialty is a complex, multifactorial process, influenced by a range of factors, including personal motivations, experiences during medical school, job opportunities and remuneration, career stability, availability of residency positions, personality traits, cultural values, sociodemographic factors, and others. The increasing number of medical graduates directly impacts this decision, intensifying competition for residency positions. Universities play a key role in guiding graduates through this decision-making process. However, further research is needed to assist both teachers and students in identifying the most relevant factors influencing this choice. This study aims to explore these factors, considering the individual characteristics of both the medical student and the specialist doctor. It represents the initial step in a research agenda that seeks to develop a psychometric vocational tool to aid in selecting a medical specialty.

Examining dermatology residency applicant profiles for the 2023-2024 cycle: a cross-sectional analysis.

Dermatology remains highly competitive, with strong USMLE Step 1 scores traditionally crucial for securing residency positions. The 2023-2024 cycle introduced significant changes, including pass/fail USMLE Step 1 score reports and an expanded program signaling system. This study explores dermatology residency applicant profiles within this new context. A survey of 2023-2024 dermatology applicants was conducted via social media to gather demographic and application data. A total of 63 survey responses were collected: 74.6% matched and 25.4% unmatched. The racial distribution was 54% White/Caucasian, 25.4% Asian/Pacific Islander, 9.5% Black/African American, 4.8% Hispanic/Latino, and 6.3% other. The median USMLE Step 2 score was 257 (215-277). Racial differences in USMLE Step 2 scores were significant (P = 0.031), but did not affect match rates (P = 0.116). Letters of recommendation from dermatology program directors were linked to lower match rates (P = 0.036). A positive correlation was found between the number of audition rotations completed and matching at such programs (r²=0.817). Of all matched respondents, 46.8% matched to a program they did not signal; of these, 50.0% matched to a program at which they completed an audition rotation and 40.9% to their home dermatology program affiliation. The mean number of interviews was 8.02, with matched applicants receiving more invitations than unmatched applicants (9.02 vs. 5.06, P = 0.002). The shift to pass/fail USMLE Step 1 scores and expanded program signaling did not notably affect the median USMLE Step 2 score from prior years or match rates among underrepresented minorities. Success in matching continues to depend on a holistic evaluation.

The Geographic Distribution of Vascular Surgeons and Trainees by State in 2023

Approximately 1.4 vascular surgeons/100,000 persons are estimated to fulfill current patient needs in the United States (US), but an ongoing shortage exists. The aims of this study are to provide an updated nationwide state-by-state workforce analysis and compare the distribution of practicing vascular surgeons and training opportunities. Vascular surgeons in the US were identified using the National Provider Identifier registry in 2023. Only board-certified and actively licensed vascular surgeons were included. To estimate the number of vascular surgery graduates per year in each state, integrated residency and fellowship-matched positions (trainees) were ascertained from the National Resident Matching Program website. Surgeons and trainees were totaled by state, and densities were calculated using the 2020 U.S. Census Bureau state populations. These 2 cohorts were also examined together using simple linear regression and geographic mapping. This study included 3,399 board-certified vascular surgeons and 228 newly matched trainees. The average densities of vascular surgeons and trainees in the US are 1/100,000 persons and 0.06/100,000 persons, respectively. The 5 states with the lowest densities of vascular surgeons are AR, ND, NV, OK, and WY, averaging 0.4/100,000 persons. 8 states (AK, ID, KS, ND, NM, NV, RI, WY) had 0 training programs offering positions in 2023 and ranked in the lowest quartile for the number of practicing vascular surgeons. Simple linear regression demonstrated a statistically significant correlation between state rates of vascular surgeons and trainees (P<0.001). States with 0 training positions also have the fewest vascular surgeons per capita. Statewide attention to expanding vascular surgery training opportunities targeted in these areas could positively impact the current maldistribution and shortage of vascular surgeons.

Non-Designated Preliminary to Categorical Resident: Is It All About the ABSITE?

Obtaining a categorical general surgery residency position is recognized as a highly challenging process, and many aspiring surgeons find themselves matching into a preliminary position. The American Board of Surgery In-Training Examination (ABSITE) is relevant as a discriminator, as it is the only national evaluation metric that compares residents between programs. This study examines the correlation between ABSITE performance and the likelihood of obtaining a categorical position for non-designated preliminary surgery residents. Retrospective analysis of preliminary residents who completed the ABSITE between 2011 and 2021 at a single academic training program. 108 preliminary residents were included. Among preliminary residents who were successful in securing a categorical position, the average ABSITE percentile was 59 (SD = 26.7). In contrast, those who were not able to secure a categorical position, the average ABSITE percentile was 23.6 (SD = 25.3). There was a strong significant correlation between ABSITE percentile and securing a categorical position (P < 0.001). There was a significant association between citizenship and gaining a categorical position, with US citizens being significantly more likely to successfully gain a categorical position (P = 0.01; OR 3.32 (95% CI 1.28-8.56)). There was not a significant correlation between citizenship and ABSITE score. This study presents compelling evidence that ABSITE percentile score is positively associated with the probability of securing a categorical position for preliminary general surgery residents. It is therefore imperative that both preliminary residents and their programs place a high value on ABSITE performance to enhance successful career progression.

Trends and predictors of unfilled emergency medicine residency positions: A comparative analysis of the 2023 and 2024 Match cycles.

The emergency medicine (EM) landscape has evolved due to the increasing number of programs paired with fewer applicants. This study analyzed the characteristics of EM residency programs associated with unfilled positions during the 2024 Match and compared them with data from the 2023 Match to identify persistent and emerging trends influencing these outcomes. In this cross-sectional, observational study, we investigated factors associated with unfilled EM residency positions in the 2024 Match. We used publicly accessible data from the National Resident Matching Program. To identify program-level predictors of unfilled positions, we constructed a Bayesian hierarchical logistic regression model, incorporating data from the 2023 Match season. In 2024, 54 out of 281 (19.2%) residency programs remained unfilled. Our Bayesian analysis reaffirmed that smaller program size, geographical location, prior osteopathic accreditation, and corporate ownership continue to be significant factors. Programs with vacancies in the previous year were also more likely to remain unfilled. Thus, several factors identified in 2023 remained associated with this year's Match outcomes, with the impact of previous unfilled positions being particularly pronounced. This study identified several factors associated with a greater likelihood of having unfilled EM residency positions, with previous unfilled positions emerging as the most significant predictor. These findings offer critical insights for residency programs and governing bodies, providing a basis for enhancing recruitment strategies, addressing the cyclical nature of unfilled positions, and tackling workforce challenges in EM.

Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study.

Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships. Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism. Expert panels were assembled of key stakeholders: program directors, clerkship directors, other education faculty, trainees, and recent subinterns. Three Delphi rounds were conducted from January to April 2023 to reach consensus defined a priori as a Cronbach α ≥ 0.8 and 80% or greater panel agreement. Forty-six expert panelists were recruited to participate in Delphi rounds, with 100%, 95.7%, and 97.8% response rates in the first, second, and third rounds, respectively. By the third round, 67 statements reached consensus as essential roles, responsibilities, and expectations of surgical subinterns. Key themes from these 67 statements included subinterns approximating the role of an intern with respect to work hours, patient care responsibilities, basic technical skills, and knowledge base. Panelists rated rounding and patient care as the most important domain, followed closely by professionalism. Additional key domains for evaluation in descending order were knowledge base, operating room conduct, clinic, and technical skills. By the third round, notable disagreements in the Delphi process included technical skills and rounding and patient care (93.3% and 88.9% agreement, respectively). This study provides a national consensus on core roles, responsibilities, and expectations for medical students completing surgical subinternships. Students can use these recommendations to prepare for subinternships, whereas faculty as well as residents and fellows can use them to evaluate applicants for general surgery residency positions.

Co-Existing Vascular Surgery Integrated Residencies are Associated with Increased General Surgery Resident Proficiency and Autonomy in Vascular Cases

Integrated vascular surgery residency positions have doubled more than the last decade. Studies have investigated the impact of co-existing subspecialty surgical training programs on case volume of general surgery residents (GSRs). However, no studies have explored the impact of subspecialty training on GSR operative competency. The aim of this study is to understand the impact of integrated residencies on operative performance and autonomy of GSR performing vascular procedures. Autonomy and performance ratings of GSR participating in vascular surgery cases were collected from all institutions participating in the Society for Improving Medical Professional Learning application database from 2015 to 2023. Faculty and self-assessments of autonomy and performance on vascular cases performed by GSRs at programs with co-existing vascular integrated residency (VIR), vascular surgery fellowship (VSF), or no subspecialty vascular training (VX) were compared using Fisher's exact tests with Bonferroni corrections across training levels and case complexity. Eleven thousand one hundred seventy five assessments (26% at institutions with VIR, 46% VSF, and 28% VX) were submitted by 920 GSRs and 343 faculty. Senior GSRs at programs with VSF achieved lower autonomy than those with VIR (P=0.049) or VX (P=0.042) based on faculty assessment. GSRs achieved a level of "practice ready" at significantly higher rates when training at programs with VIR, and at the lowest rates with VSF (P<0.001). However, self-perception of autonomy and performance was highest among GSRs at programs with VX compared with VIR and VSF (P<0.001). The presence of VIR was associated with higher achievement of "practice ready" competency and higher levels of operative autonomy among senior GSRs performing vascular procedures. Shared-learning among peers and faculty expertise in teaching resident-level trainees may contribute to this finding.

Trends of Rising Research Production Among Otolaryngology Residency Applicants.

As competitiveness to obtain a residency position in the field of Otolaryngology-Head and Neck Surgery (Oto-HNS) has continued to rise, applicants have endeavored to set themselves apart. One increasingly popular strategy is maximizing research output. Over the past 6 years, applicant metrics such as board scores and volunteer and work experiences have risen incrementally, while research production has more than doubled, from 8.4 mean number of abstracts, presentations, and publications in 2016 to 17.2 in 2022. This coincides with the exponential surge of new research fellowships among Oto-HNS departments over a similar period, which is now up to at least 68 advertised positions. With a significant difference between the research production of matched and unmatched applicants, programs may be signaling a positive bias towards research-heavy applicants. Whether this is intended and/or preferable should be examined more closely.

Senior Mentorship and Scholarly Success: Assessing Influences on Successful Neurosurgery Residency Applicant's H-Index

Research productivity is on the rise as neurosurgical residency positions become increasingly competitive. We explored the relationship between neurosurgical residency applicant's senior author's research productivity and matching into a neurosurgery residency program. A retrospective analysis of bibliometric data for applicants who matched into neurosurgery in 2022-2023 and their senior authors was conducted using Scopus. Logistic regression revealed a significant association between h-index values and top 40 match outcomes (P= 0.038). The maximum h-index of senior authors significantly predicted matches at top 40 programs (P=0.003). Affiliation with a top 40 medical school increased both applicant and senior author h-indices (P=0.05, P < 0.001 respectively). Linear regression of the maximum h-index of senior authors in preresidency publications explained 42% of this variability (P < 0.001). A multiple linear regression model incorporating this with publication number elucidated 69% of the variance in interns' h-index. Authorship data categorized as first, second, and third author positions showed 1847 first author, 1417second author, and 118 third author publications over 2-years. Applicants at top 40 residency programs had more first and second author publications compared to those from nontop 40 programs (P= 0.0158, P= 0.0275). There is a strong correlation between a neurosurgical applicant's academic output and that of their senior authors. The number of publications and the maximum h-index of senior authors significantly predict applicant h-indices. We also demonstrated that there is a significant difference in the academic productivity of applicants and senior authors of applicants who successfully match into a top 40 i(h)5 rated neurosurgical residency.

Value of Gold and Silver Signals and their Correlation with Step Scores on OBGYN Interview Offers

Competition for residency positions has led to application inflation. In the 2022-23 cycle, 16 residency specialties allowed applications to be submitted with a virtual “token” - signaling a preferred interest in a program. OBGYN was the only program using a two-tiered system that allowed applicants to assign signals using “gold” to indicate highest interest and “silver” indicating very high interest. We examined the impact of the tiered signals on interview offer trends of senior students pursuing OBGYN at a large allopathic medical school and if the interview rate was correlated with their USMLE step scores. A cross-sectional, anonymous survey included the number of interviews obtained from applications submitted using gold signals (3), silver signals (15), and no signal (no cap). Fifteen students identified as participating in the OBGYN match with 100% participation, ten of whom were from regional campuses (67%). The mean interview rate differed based on signaling, showing increased likelihood of interview offers based on signal type. Step 1 and step 2 quartile rank were not associated with signal interview rate. This study supports the use of tiered signals as a method for students to express an interest in specific programs and have it recognized by programs in extending interview offers. The authors have no conflicts of interest to disclose. This study was IRB exempt.

Abstract IA022: AI in bladder cancer pathology and research: What can we expect and what not?

Abstract Artificial intelligence (AI) applications are rapidly evolving, disruptive technologies that recently attracted tremendous public awareness including euphoria, bull runs at stock exchanges but also criticism and skepticism. Pathology, a crucial clinical diagnostic discipline, faces significant challenges despite its critical role and broad scope. A notable issue is the declining interest among medical graduates in pursuing further training in Surgical Pathology and Molecular Pathology. This disinterest is compounded by a trend towards part-time work and the aging demographic in Western industrial nations, which increases the demand for precise cancer diagnoses, molecular pathology and advanced oncological treatments. As the need for skilled pathologists grows, the availability of these professionals is steadily decreasing. Furthermore, political policies in heavily regulated healthcare systems (e.g., Germany) are exacerbating the shortage by limiting residency and specialist training positions despite the growing need. Adding to the reluctance among medical graduates to consider pathology as discipline is the looming “threat”” of replacing the field with Artificial Intelligence (AI) technologies. However, historical precedents suggest that necessity often spurs significant innovation. AI's role in pathology is expanding, reshaping the field with new technological advancements. AI, broadly encompassing various computational algorithms designed to perform tasks typically requiring human intelligence such as learning, reasoning, and pattern recognition, is now being applied extensively across different domains including medical diagnostics. Recent implementations in pathology include AI-driven algorithms that automate processes such as the Gleason grading of prostate biopsies, lymph node metastasis detection, detection of molecular bladder cancer subtypes or grading of kidney cancer showing high accuracy levels, speed and reproducibility in delivering results. These tools, while they do not replace pathologists, significantly reduce their workload by automating routine tasks, thus freeing up time for more complex diagnostic activities or simply dealing with the increasing workload. Despite the exciting possibilities, the use of AI in predicting molecular alterations, such as FGFR3 mutations in bladder cancer, faces limitations due to insufficient sensitivity and specificity, indicating that such technologies are not yet suitable for screening purposes. In conclusion, AI is increasingly vital in addressing the challenges of modern pathology, particularly in compensating for the shortage of pathologists. As technology advances, its integration into clinical practice offers promising solutions to enhance diagnostic accuracy and efficiency in uropathology, paving the way for more personalized and effective patient care. Citation Format: Markus Eckstein. AI in bladder cancer pathology and research: What can we expect and what not? [abstract]. In: Proceedings of the AACR Special Conference on Bladder Cancer: Transforming the Field; 2024 May 17-20; Charlotte, NC. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(10_Suppl):Abstract nr IA022.

Gender Bias in Artificial Intelligence-Written Letters of Reference.

Letters of reference (LORs) play an important role in postgraduate residency applications. Human-written LORs have been shown to carry implicit gender bias, such as using more agentic versus communal words for men, and more frequent doubt-raisers and references to appearance and personal life for women. This can result in inequitable access to residency opportunities for women. Given the known gendered language often unconsciously inserted into human-written LORs, we sought to identify whether LORs generated by artificial intelligence exhibit gender bias. Observational study. Multicenter academic collaboration. Prompts describing identical men and women applying for Otolaryngology residency positions were created and provided to ChatGPT to generate LORs. These letters were analyzed using a gender-bias calculator which assesses the proportion of male- versus female-associated words. Regardless of the gender, school, research, or other activities, all LORs generated by ChatGPT showed a bias towardmale-associated words. There was no significant difference between the percentage of male-biased words in letters written for women versus men (39.15 vs37.85, P = .77). There were significant differences in gender bias found by each of the other discrete variables (school, research, and other activities) chosen. While ChatGPT-generated LORs all showed a male bias in the language used, there was no gender bias difference in letters produced using traditionally masculine versus feminine names and pronouns. Other variables did induce gendered language, however. ChatGPT is a promising tool for LOR drafting, but users must be aware of potential biases introduced or propagated through these technologies.

Online Interest in Urology Residency: A Comprehensive Analysis of Current Internet Temporal and Geographic Patterns

Urology is one of the most competitive specialties in medicine, creating a challenge for prospective students looking to secure a residency position. Our study aims to assess online interest in urology residency by querying online interaction with search terms and criteria for urology residency programs. Utilizing Google Trends analysis from 2011 to 2024, this study examined urology-related search volume indexes, as well as temporal and geographical patterns. Furthermore, the number of residency positions from the American Urological Association database for the 2022 match process was evaluated. Our analysis of temporal trends revealed increased interest in urologist salaries from 2011 to 2019, followed by a decline from 2019 to 2023. Interest in urology-related interviews, applications, research, and letters increased in 2019, marked by the start of the COVID-19 pandemic. California, New York, and Texas had the lowest interest-to-position (IP) ratio, while Maryland, New Jersey, and Virginia had the highest IP ratio. Our analysis reveals an evolving interest in salaries, residency programs, and USMLE Step 1 changes in areas connected with urology. We report key geographical areas with high urology residency interest and low numbers of programs, implying a need for expanded residencies in underserved yet high-interest areas. Awareness and continued interest monitoring after the COVID-19 pandemic is critical for understanding interest in urology applicants.

Barriers to neurosurgery for medical students: a national study focused on the intersectionality of gender and race.

Despite 51.2% of medical school graduates being female, only 29.8% of neurosurgery residency applicants are female. Furthermore, only 12.6% of neurosurgery applicants identify as underrepresented in medicine (URM). Evaluating the entry barriers for female and URM students is crucial in promoting the equity and diversity of the neurosurgical workforce. The objective of this study was to evaluate barriers to neurosurgery for medical students while considering the interaction between gender and race. A Qualtrics survey was distributed widely to US medical students, assessing 14 factors of hesitancy toward neurosurgery. Likert scale responses, representing statement agreeability, converted to numeric values on a 7-point scale were analyzed by Mann-Whitney U-test and ANOVA comparisons with Bonferroni correction. Of 540 respondents, 68.7% were female and 22.6% were URM. There were 22.6% male non-URM, 7.4% male URM, 53.5% female non-URM, and 15.2% female URM respondents. The predominant reasons for hesitancy toward neurosurgery included work/life integration, length of training, competitiveness of residency position, and perceived malignancy of the field. Females were more hesitant toward neurosurgery due to maternity/paternity needs (p = 0.005), the absence of seeing people like them in the field (p < 0.001), and opportunities to pursue health equity work (p < 0.001). Females were more likely to have difficulties finding a mentor in neurosurgery who represented their identities (p = 0.017). URM students were more hesitant toward neurosurgery due to not seeing people like them in the field (p < 0.001). Subanalysis revealed that when students were stratified by both gender and URM status, there were more reasons for hesitancy toward neurosurgery that had significant differences between groups (male URM, male non-URM, female URM, and female non-URM students), suggesting the importance of intersectionality in this analysis. The authors highlight the implications of gender and racial diversity in the neurosurgical workforce on medical student interest and recruitment. Their findings suggest the importance of actively working to address these barriers, including 1) maternity/paternity policy reevaluation, standardization, and dissemination; and 2) actively providing resources for the creation of mentorship relationships for both women and URM students in an effort to create a workforce that aligns with the changing demographics of medical graduates to continue to improve diversity in neurosurgery.

Geographic Location and Corporate Ownership of Hospitals in Relation to Unfilled Positions in the 2023 Emergency Medicine Match.

In the 2023 National Resident Matching Program (NRMP) match, there were 554 unfilled emergency medicine (EM) positions before the Supplemental Offer and Acceptance Program (SOAP). We sought to describe features of EM programs that participated in the match and the association between select program characteristics and unfilled positions. The primary outcome measures included the proportion of positions filled in relation to state and population density, hospital ownership type, and physician employment model. Secondary outcome measures included comparing program-specific attributes between filled and unfilled programs, including original accreditation type, year of original accreditation, the total number of approved training positions, length of training, urban-rural designation, hospital size by number of beds, resident-to-bed ratio, and the percentage of disproportionate share patients seen. The NRMP Match had 276 unique participating EM programs with 554 unfilled positions. Six states offered 52% of the total NRMP positions available. Five states were associated with two-thirds of the unfilled positions. Public hospitals had a statistically significant higher match rate (88%) when compared to non-profit and for-profit hospitals, which had match rates of 80% and 75%, respectively (P < 0.001). Programs with faculty employed by a health system had the highest match rate of 87%, followed by clinician partnerships at 79% and private equity groups at 68% (P < 0.001 overall and between all subgroups). The 2023 match in EM saw increased rates in the number of residency positions and programs that did not fill before the SOAP. Public hospitals had higher match rates than for-profit or non-profit hospitals. Residency programs that employed academic faculty through the hospital or health system were associated with higher match rates.

Trends and Predictors of Cost in the Obstetrics and Gynecology Residency Application Process [ID 2683644

INTRODUCTION: Travel restrictions from the COVID-19 pandemic required residency programs to transition from an in-person to virtual interview process. Obtaining an obstetrics and gynecology residency position is known to be competitive and places a considerable financial burden on applicants. This study aims to quantify the total costs in the application process before and after virtual interviews were implemented. METHODS: The Texas STAR database was queried to identify obstetrics and gynecology residency applicants from 2019 to 2023. The primary outcome was applicant-reported spending on the residency application process. Descriptive statistics and linear regression models were used to evaluate for associations with sociodemographic, temporal, and geographic factors. RESULTS: A total of 2,315 obstetrics and gynecology applicants were included. Applicants reported significantly less average total spending on the residency application process after the start of the COVID-19 pandemic compared to the years prior ($2,515 [SD 2,055] versus $4,909 [SD 2,869]; P&lt;.001). Applicants who identified as underrepresented in medicine (P=.022), had a DO degree (P&lt;.001), completed a research year (P=.030), participated in the couples match (P&lt;.001), or were from the Western region (P&lt;.001) reported significantly more total spending. There was a significant positive correlation between total non-interview-related spending and the number of interviews received (P&lt;.001). CONCLUSION: There was a significant reduction in applicant spending after the start of the COVID-19 pandemic, likely related to transition to virtual interviews and limitations on in-person away rotations. The association of applicant spending with the number of interview offers raises concern for possible equity implications.

AAPM WGVRTO report 390: A survey of veterinary radiation oncology equipment and infrastructure in 2022.

Since 2010, there has been little published data on the state of equipment and infrastructure in veterinary radiation oncology clinical practice. These data are important not only to identify the status and use of technology within the veterinary radiation oncology community but also to help identify the extent of medical physics support. The purpose of our study is to report findings from a survey of veterinary radiation oncologists in the USA, Canada, and select centers outside of North America in 2022. A 40-question survey covering topics such as type of radiotherapy equipment, techniques offered, treatment planning systems and dose calculation algorithms, special techniques, board-certified radiation oncologists and residents, and extent of medical physics support was distributed through an online survey tool. Results from 40 veterinary radiation oncology institutions, with equipment explicitly used for veterinary care, suggest that the current state of practice is not dissimilar to what currently exists in human radiation oncology facilities; techniques and technologies commonly employed include flattening filter-free mode megavoltage beams, volumetric arc therapy, daily cone-beam computed tomography, image-guided radiation therapy, and sophisticated dose calculation algorithms. These findings suggest the need for modern radiation oncology acceptance testing, commissioning, and quality assurance programs within the veterinary community. The increase in veterinary radiation oncology residency positions and increasing sophistication of equipment suggests that increased levels of standardized medical physics support would benefit the veterinary radiation oncology community.

Improving the ability to discriminate medical multiple-choice questions through the analysis of the competitive examination to assign residency positions in Spain

IntroductionPsychometrics plays a vital role in evaluating educational research, including the analysis of multiple-choice exams. This study aims to improve the discriminatory ability of the “Médico Interno Residente” (MIR) medical exam in Spain, used to rank candidates for specialized healthcare training, through psychometric analysis.MethodsWe analyzed 2,890 MIR exam questions from 2009 to 2021 (totaling 147,214 exams), categorizing them based on methodology and response type. Evaluation employed classical test theory and item response theory (IRT). Classical test theory determined difficulty and discrimination indices, while IRT assessed the relationship between knowledge levels and question performance.ResultsQuestion distribution varied across categories and years. Frequently addressed knowledge areas included various medical specialties. Non-image-associated clinical cases were the easiest, while case-based clinical questions exhibited the highest discriminatory capacity, differing significantly from image-based case or negative questions. High-quality questions without images had longer stems but shorter answer choices. Adding images reduced discriminatory power and question difficulty, with image-based questions being easier. Clinical cases with images had shorter stems and longer answer choices.ConclusionsFor improved exam performance, we recommend using a clinical case format followed by direct short-answer questions. Questions should be of low difficulty, providing clear and specific answers based on scientific evidence and avoiding ambiguity. Typical clinical cases with key characteristic features should be presented, excluding uncertain boundaries of medical knowledge. Questions should have lengthy stems and concise answer choices, minimizing speculation. If images are used, they should be typical, clear, consistent with the exam, and presented within clinical cases using clinical semiotics and propaedeutics.