Residency Program Directors Research Articles

Advanced practice providers in academic emergency medicine: A national survey of chairs and program directors.

The Society for Academic Emergency Medicine Board of Directors convened a task force to elucidate the current state of workforce, operational, and educational issues being faced by academic medical centers related to advanced practice providers (APPs). The task force surveyed academic emergency department (ED) chairs and residency program directors (PDs). The survey was distributed to the Association of Academic Chairs of Emergency Medicine (AACEM)-member chairs and their respective residency PDs in 2021. We surveyed 125 chairs with their self-identified PDs. The survey sampled hiring, state-independent practice laws, scope of practice, teaching and supervision, training opportunities, delegation of procedures between physician learners and APPs, and perceptions of the impact on resident and medical student education. Of the AACEM-member chairs identified, 73% responded and 47% of PDs responded. Most (98%) employ either physician assistants or nurse practitioners. Among responding departments, 86% report APPs working in fast-track settings, 80% work in the main ED, and 54% work in the waiting room. In 44% of departments, APPs and residents evaluate patients concurrently, and 2% of respondents reported that APPs manage high-acuity patients without attending involvement. Two-thirds of chairs believe that APPs contribute positively to the quality of patient care, while 44% believe that APPs contribute to the academic environment. One-third of PDs believe that the presence of APPs interferes with resident education. Although 75% of PDs believe that residents require training to work effectively with APPs in the ED, almost half (49%) report zero hours of training around APP supervision or collaborative skills. APPs are ubiquitous across academic EDs. Future research is required for academic ED leaders to balance physician and APP deployment across the academic ED within the context of patient care, resident education, institutional resources, professional development opportunities for APP staff, and standardization of APP EM training.

Neurology residents' education in functional seizures.

We report a survey of neurology residency program directors (PDs) and recent neurology residency graduates about the education provided during residency on functional seizures (FS), a subtype of functional neurological disorder (FND). The purpose of our study was to assess the education gap for neurology residents about FS since patients with FS are frequently seen by neurologists, who typically conduct the evaluation and share the findings with the patient. A survey was sent to 93 Neurology residency program directors and 71 recent graduates. We obtained a low response rate of 17%. Results of the survey revealed that the most frequent settings for education on FS were within a clinical rotation in the Epilepsy Monitoring Unit (68.8% of PDs and 88.7% of recent graduate respondents) and via a single didactic lecture (81.3% of PDs and 80.3% of recent graduate respondents). The majority of programs did not provide a curriculum for training and feedback on best practices in communicating the diagnosis or on evidence-based treatments. Eighteen percent of neurology residents reported not learning how to communicate the diagnosis of FS to patients, while 77% responded that they were not taught about treatment. These results illustrate a curriculum gap in what neurology residents are taught about diagnosis and management of FS (and FND). We propose a standardized model that can be adapted in residencies.

Online promotion of resident research and research training among postgraduate year 1 (PGY1) pharmacy residency programs

AbstractIntroductionNational pharmacy organizations advocate for training relating to the investigation and evaluation of scientific evidence. Accordingly, most postgraduate year 1 (PGY1) residents conduct longitudinal research. However, residents typically report low confidence in their research abilities and may benefit from structured training within the residency program. The purpose of this study was to assess how PGY1 programs promote research on their websites, including the proportion offering resident research training.MethodsPGY1 residency programs were identified using the American Society of Health‐System Pharmacists residency directory. Community‐based, managed care, or PGY1/postgraduate year 2 (PGY2) combined programs were excluded. Study data were extracted using the residency directory and program websites and included program characteristics, research requirements, dedicated research time, promotion of past research, research mentorship and support, and research training. Characteristics of the programs with and without research training were compared.ResultsOf 1139 PGY1 residency program websites, 3.0% had a highly prominent research section, 19.7% had a clear paragraph relevant to research information, 63.4% had minimal information on research, and 14.0% offered no research information. Forty‐one percent of PGY1 residency programs required dissemination of research findings via poster presentation, platform presentation, or completed manuscript. Fifty‐one programs (4.5%) provided research development training through seminars, a development program, or a certificate program. Compared with programs without research training, these programs were more likely to be fully accredited (100% vs 92.2%, P = .028), offer five or more PGY1 positions (25.5% vs 14.0%, P = .037), and offer one or more PGY2 specialty residencies (60.8% vs 35.6%, P < .001).ConclusionMost PGY1 program websites had minimal information related to resident research. Although the presentation and dissemination of research was a commonly listed residency requirement, less than 5% of programs indicated that they provide resident research development. Residency program directors should ensure that their program websites accurately reflect their residents' research experience, including development opportunities.

Otolaryngology Department and Society Leadership: Evaluation of Diversity in a Nationwide Study.

Diversity in medicine positively influences healthcare delivery. As we aim to make otolaryngology more diverse, it is essential to analyze our current leadership. Observational study. A total of 262 department chairs and chiefs, residency program directors, and assistant and associate directors from 117 otolaryngology residency programs as well as 92 society leaders from nine otolaryngology national societies from 2010 to 2020 in the United States are included in this study. The position, academic rank, name, gender, inferred race (based on name and image), and h-index are collected and recorded from publicly available data. Fisher's exact test, unpaired t tests, and analysis of variance tests are used. The ethno-racial breakdown of all otolaryngology residency leaders is as follows: 78.63% non-Hispanic (NH) White, 16.03% NH Asian, 2.29% Middle Eastern, 1.91% NH Black, and 1.15% Latinx. Male gender is found to be a predictor of full professorship title (P < .0001) with an odds ratio (OR) of 4.066. NH White male is also a predictor of full professorship (P < .0001) with an OR 3.05. When comparing h-index, males and females differ (P < .0001) across all residency leadership positions. There is a higher h-index among full professors compared to non-full professors (P < .0001). The ethno-racial breakdown of society leaders is 84% NH White, 11% NH Asian, 2% NH Black, 2% Latinx, and 1% Middle Eastern. In conclusion, otolaryngology leadership has an under-representation of women and certain ethno-racial groups. Continued efforts should be made to diversify our specialty's leadership. NA Laryngoscope, 132:1729-1737, 2022.

Perceptions of USMLE Step 1 Pass/Fail Score Reporting Among Orthopedic Surgery Residency Program Directors

The United States Medical Licensing Examination (USMLE) Step 1 examination will transition from graded to pass/fail scoring starting no earlier than January 2022. Orthopedic surgery residency programs will need to adapt to these changes. The goal of this study was to investigate the perceptions of orthopedic surgery residency program directors on the change of Step 1 from a graded to a pass/fail examination. We also investigated how the change would affect the other factors that are typically considered in the selection of orthopedic surgery residents. A survey was distributed to 161 directors of allopathic orthopedic surgery programs. Contact information was obtained from a national database. Of those contacted, 75 (46.6%) program directors responded. Most (85.3%) did not support the pass/fail change. Most believe that greater importance will be placed on the Step 2 Clinical Knowledge examination (96.0%), audition elective with their department (84.0%), personal knowledge of the applicant (78.7%), grades (74.7%), letters of recommendation from recognizable orthopedic surgeons (74.7%), and Alpha Omega Alpha status (69.3%). Most also believe that this change will advantage allopathic students who attend highly regarded schools (58.7%). Most of the program directors support a graded preclinical curriculum (69.3%) and caps on the number of orthopedic surgery residency applications (70.7%). Although most orthopedic surgery program directors disagree with the change to a pass/fail Step 1 examination, residency programs will need to reevaluate how they screen applicants for an interview once the scored Step 1 is no longer available. With this change, other factors, such as Step 2 score, audition rotations, and grades in clerkships, will be emphasized more heavily. [Orthopedics. 2022;45(1):e30-e34.].

Fertility Preservation and Infertility Treatment in Medical Training: An Assessment of Residency and Fellowship Program Directors' Attitudes.

Background: Given the concurrence of medical residency and fellowship training with typical childbearing years, trainees often must make difficult decisions regarding family planning, requiring the support of their residency and fellowship program directors (PDs) to guide them.Objective: Our hypothesis was that PDs have knowledge gaps and varying levels of support in terms of their trainees' fertility, and the goal of our study was to assess the knowledge and support of residency and fellowship PDs in the United States toward trainees' reproductive needs.Methods: Cross-sectional survey distributed to all residency and fellowship PDs providing contact information through the Accreditation Council for Graduate Medical Education website in August 2019.Results: Of 299 respondents, the most common lengths of leave reported were 6–8 weeks of maternity leave and under 2 weeks of paternity leave. A total of 57.2% did not know their program's insurance for infertility treatment, and 68.6% did not know fertility preservation coverage. A total of 52.2% of PDs were unaware of if their trainees faced infertility. PDs supported residents' needs through moral support (68.2%) and time off for appointments (65.2%). Similarly, most PDs (66.2%) never had a trainee express interest in fertility preservation to them but offered moral support (59.2%) and time off (48.5%). Respondents felt it was important to increase resources for trainees by increasing their awareness of needs (47.5%) and establishing reproduction-related policies (34.1%).Conclusion: The study found variations regarding PDs' knowledge and support levels for trainees' fertility needs. Most were unaware of their trainees' fertility needs, and many PDs felt it would be important to improve resources by increasing personal awareness and creating policies for support to promote reproductive health equity for trainees.

The Current State of Pediatric and Adolescent Gynecology Residency Training in Canada: Summary of Educational Resources to Enhance the Achievement of Pediatric and Adolescent Gynecology Objectives.

A previous study determined that Obstetrics and Gynecology (ObGyn) residency Program Directors (PD) endorse mandatory Pediatric and Adolescent Gynecology (PAG) training to achieve national PAG objectives. Although barriers exist that limit the achievement of PAG objectives, this paper presents existing PAG tools and curricula. These include the North American Society for Pediatric and Adolescent Gynecology (NASPAG) short and long curricula, a wide variety of PAG electives available across Canada, more than 25 online clinical cases, and a simulation curriculum. This paper details these resources and provides a 4-week PAG schedule to accommodate ObGyn residency training programs.

Looking Ahead: Succession Planning for Education Leadership Roles.

Consider the following scenario. You are the Chair of a small academic radiology department in the Midwest. It is Thursday morning, July 1, the start of a new academic year. You receive an email from Drs Smith and Hall, requesting to meet with you as soon as possible. Dr Smith is the Vice Chair of Education and the Residency Program Director, and Dr Hall is the Director of Medical Student Education. They are married to each other. During the meeting, they inform you that they have accepted positions at another academic center because of an urgent family situation and intend to start these new positions on August 1. You immediately go into crisis management mode because you do not have anyone in the leadership pipeline to assume their responsibilities. The radiology clerkship begins on August 1, residency applicants start submitting applications on September 1, and the residency program is scheduled for a reaccreditation site visit on September 10.

Virtual Residency Interviews: A Survey of Anesthesiology Program Director Perspectives Amidst the COVID-19 Pandemic.

The COVID-19 pandemic caused a rapid pivot from in-person to virtual residency interviews across the United States. We present a survey we conducted about the attitudes and opinions of anesthesiology program directors with regard to the 2021 virtual interview process. This was a 13-question online survey disseminated to 142 anesthesiology residency program directors in February 2021, asking them to compare the most recent interview cycle to their experience with prior cycles. There were 46 (37%) respondents. Generally, respondents saw an increase in applicants and reported perceiving worse interpersonal relationships with applicants, significantly so in programs with small resident classes. Past research has focused on the benefits of virtual interviews for the applicant, but these should be evaluated in tandem with increased difficulties for the interviewers.

The Current State of Pediatric and Adolescent Gynecology Residency Training in Canada: A Needs Assessment From Program Directors.

To perform a needs assessment to determine whether a mandatory Pediatric and Adolescent Gynecology (PAG) training experience in each Obstetrics and Gynecology (ObGyn) residency program in Canada is required and feasible. This was a comparative descriptive design in which the 16 ObGyn Residency Program Directors (PD) in Canada were asked to undergo a 20-minute structured phone interview. These interviews were recorded, and explored how PAG and Reproductive Endocrinology (RE) objectives are met in each program, the PD's awareness of PAG opportunities in North America, and the feasibility of a mandatory training experience. This project is Research Ethics Board (REB) approved. Of 16 PDs, 12 gave consent and completed the phone interview. There is at least 1 PAG-trained ObGyn per institution, with a wide variety of clinical and academic experiences in PAG for residents between residency programs. There is much overlap among PAG and RE. All PDs interviewed believe that PAG training is important and should be mandatory; however, many feel that they lack the resources to implement a PAG mandatory training experience and that many barriers to such a curriculum exist. PAG training experiences should be mandatory in all ObGyn training programs, according to participating PDs. PAG providers were identified at all the participating residency programs, and efforts should be made to support these providers in delivering the educational PAG content to ObGyn residents so the residents can become competent in the care of young women and children. PDs should be provided with the available PAG resources and resident elective opportunities.

Stakeholder Perspectives on Limiting Residency Applications and Interviews in Obstetrics and Gynecology

Application inflation in the current residency application process leads to congestion, inefficiency, and perceptions of inequity. The authors aimed to assess the interest of key stakeholders on the topic of capping applications and interviews, and their perceptions regarding equity of the process. An anonymous survey was electronically distributed in March 2021 to Obstetrics and Gynecology (OBGYN) residency applicants, clerkship directors, program directors, and student affairs deans after the submission of the rank order list for the 2021 application cycle and prior to the release of final Match results. Participants answered questions regarding the perceived equity of the current process (no limits on applications submitted or interviews completed) compared with limiting the number of applications and interviews students could submit or complete. Respondents supporting caps reported the number they considered a reasonable cap for applications and interviews. Associations between the profiles of applicants and program directors and their interest in application and interview caps were explored using chi-squared tests for non-parametric statistics and t-tests for normally distributed interval data. The University of Michigan determined the study exempt from IRB review. The overall response rate was 36.0% (1167/3243), including 34.0% of applicants (879/2579), 50.3% of program directors (143/284), 41.8% of clerkship directors (94/225) and 32.9% of student affairs deans (51/155). All groups reported application caps for either all applicants or the most competitive applicants to be more equitable than the current process, and suggested a median application cap ranging from 25 (clerkship directors and program directors) to 40 (applicants). All groups also believed interview caps to be more equitable than the current process, and suggested a median interview cap ranging from 12 (clerkship directors) to 15 (applicants, program directors, and student affairs deans). Stakeholders in the OBGYN application process consider caps to applications and interviews a promising means to improve equity in the Match.

Assessing nephrology competence in general paediatrics-A survey of general paediatricians, paediatric nephrologists, residents, and program directors.

The objective of this study was to identify nephrology topics of lowest perceived competency and importance for general paediatricians. Surveys were distributed to general paediatricians, paediatric residents, paediatric residency program directors, and paediatric nephrologists. Perceived importance and competence were rated on a 5-point Likert scale. Means and 95% confidence intervals were calculated. Mean perceived competency from general paediatricians across all nephrology domains was 3.0, 95%CI (2.9 to 3.1) and mean importance was 3.2, 95%CI (3.1 to 3.3). Domains scoring below the means for competence and importance, respectively were kidney stones (2.5, 95%CI [2.2 to 2.7]) and 2.6, 95%CI [2.3 to 2.8]), acute kidney injury (2.5, 95%CI [2.2 to 2.8] and 2.4, 95%CI [2.1 to 2.8]), chronic kidney disease (1.9, 95%CI [1.7 to 2.2] and 2.1, 95%CI [1.8 to 2.4]), tubular disorders (1.8, 95%CI [1.6 to 2.0] and 2.0, 95%CI [1.8 to 2.3]), and kidney transplant (1.6, 95%CI [1.4 to 1.8] and 1.7, 95%CI [1.4 to 1.9]). Residents, program directors, and paediatric nephrologists agreed that stones, chronic kidney disease, tubular disorders, and transplant were of lower importance. However, acute kidney injury was the domain with the largest discrepancy in perceived importance between residents (4.4, 95%CI [4.2 to 4.6]), nephrologists (4.2, 95%CI [3.8 to 4.6]), and program directors (4.2, 95%CI [3.7 to 4.7]) compared to general paediatricians ([2.4, 95%CI [2.1 to 2.8]; P<0.05). Paediatricians did not believe acute kidney injury was important to their practice, despite expert opinion and evidence of long-term consequences. Educational interventions must address deficits in crucial domains of renal health in paediatrics.

The PASS Course: Practical Anatomy and Surgical Skills Course as a Pragmatic Primer for Senior Medical Students Pursuing Surgical Residency.

The senior year of undergraduate medical education has been scrutinized for lacking emphasis from educators and value for students. Surgical residency program directors and medical students have reported different sets of perceived weaknesses as surgical trainees enter residency. With this in mind, we developed a novel rotation for senior medical students pursuing surgical residency. The rotation incorporates practical didactics, robust skill and simulation training, and an enriching anatomy experience that entails dissections and operations on embalmed and fresh tissue cadavers. To our knowledge, this is the first reported formal training experience for medical students that involves working with fresh tissue cadavers, which have been described as effective models for live human tissue in the operating room. We describe our multifaceted curriculum in detail, discuss its organization, and elaborate on its potential value. We also provide detailed explanations of the curriculum components so that other surgical educators may consider adopting them.

Traits and Attributes of a Successful Physical Therapy Resident: A Delphi Study

Introduction. Given the limited number of positions in physical therapy (PT) residency programs, it is important to select individuals who are most likely to succeed. The purpose of the study is to obtain consensus from residency program directors regarding 1) the traits and/or characteristics that are likely to result in a successful residency experience, 2) how success in residency education is defined, and 3) what do programs aspire their residency graduates to accomplish professionally. Review of the Literature: Limited evidence exists that explores the qualities, skills, traits, or experiences that contribute to a successful PT resident or whether the current application process is able to identify these traits. Subjects: The residency directors of 246 American Board of Physical Therapy Residency and Fellowship Education-accredited programs were invited via email. One hundred nine (44.67%) residency program directors participated. Methods: Using the Delphi study design, consensus was reached after round 3 of the survey. Results: Five traits/characteristics, 9 characteristics/achievements of a successful residency graduate, and 4 postresidency aspirations reached consensus as “absolutely essential,” and 1 outcome measure reached consensus as “very useful.” Discussion/Conclusion: Residency programs may look to modify 1) their application/selection processes to identify applicants who possess desirable traits/characteristics and 2) their criteria for successful completion. Entry-level PT programs may use this information to guide what skills/traits are needed to prepare graduates for postprofessional experiences.

Gynecologic Surgery and Obstetrics Leadership Roles in Academic Military Treatment Facilities by Subspecialty and Gender.

Gender distribution in academic ob-gyn leadership positions has previously been examined in the civilian sector, but not in military medicine. To characterize the distribution of department-level leadership positions by gender and subspecialty in academic military facilities in comparison to those reported in the civilian sector. This is an observational cross-sectional study. We queried military obstetrics and gynecology (ob-gyn) specialty consultants, for title and gender of personnel assigned to academic military treatment facilities. Roles were characterized by gender and subspecialty, and the proportion of female leaders was compared to published civilian leadership data. Women comprised 25% of Department Chairs, 45% of Assistant Chairs, and 42% of Division Directors. In educational leadership roles, women comprised 25% of Residency Program Directors, 0% of Fellowship Directors, and 62% of medical Student Clerkship Directors. Female department chairs were most often uro-gynecologists (44%) followed by specialists in ob-gyn (37%). Most female residency program directors were specialists in general obstetrics and gynecology. The proportion of women in leadership roles in military departments was not different than in the civilian sector. In contrast to civilian academic leadership positions, Department Chairs were most likely to be uro-gynecologists. Similar to civilian programs, women remain underrepresented as chairs, Assistant Chairs, Fellowship Directors, and Division Directors and similarly represented as Residency Program Directors. Despite a smaller pool of women available to fill academic leadership positions in military ob-gyn departments, the proportion of women in leadership roles reaches parity with the civilian sector. This suggests that a greater proportion of women rise to leadership positions in military academic ob-gyn departments than in the civilian sector.

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Diversity and Facing Discrimination in Family Medicine Residencies: A CERA Survey of Program Directors.

Increasing the number of underrepresented minorities in medicine (URM) has the potential to improve access and quality of care and reduce health inequities for diverse populations. Having a diverse workforce in residency programs necessitates structures in place for support, training, and addressing racism and discrimination. This study examines reports of discrimination and training initiatives to increase diversity and address discrimination and unconscious bias in family medicine residency programs nationally. This survey was part of the Council of Academic Family Medicine Educational Research Alliance (CERA) 2018 national survey of family medicine residency program directors. Questions addressed the presence of reported discrimination, residency program training about discrimination and bias, and admissions practices concerning physician workforce diversity. We performed univariate and bivariate analyses on CERA survey response data. We received 272 responses to the diversity survey items within the CERA program director survey from 522 possible residency director respondents, yielding a response rate of 52.1%. The majority of residency programs (78%) offer training for faculty and/or residents in unconscious/implicit bias and systemic/institutional racism. A minority of program directors report discrimination in the residency environment, most often reported by patients (13.2%) and staff (7.2%) and least often by faculty (3.3%), with most common reasons for discrimination noted as language or race/skin color. Most family medicine residency program directors report initiatives to address diversity in the workforce. Research is needed to develop best practices to ensure continued improvement in workforce diversity and racial climate that will enhance the quality of care and access for underserved populations.

Maternity Care Tracks at US Family Medicine Residency Programs.

The number of family physicians providing maternity care continues to decline, jeopardizing access to needed care for underserved populations. Accreditation changes in 2014 provided an opportunity to create family medicine residency maternity care tracks, providing comprehensive maternity care training only for interested residents. We examined the relationship between maternity care tracks and residents' educational experiences and postgraduate practice. We included questions on maternity care tracks in an omnibus survey of family medicine residency program directors (PDs). We divided respondent programs into three categories: "Track," "No Track Needed," and "No Track." We compared these program types by their characteristics, number of resident deliveries, and number of graduates practicing maternity care. The survey response rate was 40%. Of the responding PDs, 79 (32%) represented Track programs, 55 (22%) No Track Needed programs, and 94 (38%) No Track programs. Residents in a track attended more deliveries than those not in a track (at Track programs) and those at No Track Needed and No Track programs. No Track Needed programs reported the highest proportion of graduates accepting positions providing inpatient maternity care in 2019 (21%), followed by Track programs (17%) and No Track programs (5%; P&lt;.001). Where universal robust maternity care education is not feasible, maternity care tracks are an excellent alternative to provide maternity care training and produce graduates who will practice maternity care. Programs that cannot offer adequate experience to achieve competence in inpatient maternity care may consider instituting a maternity care track.

A Qualitative Preceptor Development Needs Assessment to Inform Program Design and Effectiveness

Objective. To assess preceptor teaching challenges and development programming design preferences through a qualitative needs assessment of Doctor of Pharmacy student and resident preceptors.Methods. In 2018, 148 experiential education stakeholders across North Carolina (eg, preceptors, residency program directors, experiential faculty administrators, and practice site administrators) were invited to participate in a 60-minute semi-structured interview as part of a broad preceptor development needs assessment. Interview questions focused on: precepting challenges, positive and negative features of development programs, and preferences for program design. Interview transcripts were coded using thematic analysis.Results. Forty-two participants completed interviews, including preceptors from various rotation types, residency program directors, experiential faculty administrators, and institution administrators. Participants identified numerous teaching challenges related to learners, preceptors, and institutional level factors. Participants often noted there was inadequate time, resources, and support to effectively teach. Desirable preceptor development program features included practical strategies, collaboration with preceptors, delivery by education and practice experts, and topics specific to precepting experience. Participants identified live, on-demand, and webinar formats as acceptable if collaboration and engagement were included. Participants also desired unique training opportunities such as online platforms, coaching programs, and simulated learning environments.Conclusion. Preceptors for pharmacy students and residents face numerous challenges and require sufficient time, support, and resources to develop their skills. Participants requested training that included on-demand, frequent sessions delivered through various modalities, collaboration opportunities, a choice in topics and delivery formats, and sessions from educational and practice experts.

Residency Program Director Perceptions of Resident Performance Between Graduates of Medical Schools With Pass/Fail Versus Tiered Grading System for Clinical Clerkships: A Meta-Analysis.

Purpose: The variability and imprecision of clerkship grading raise concerns for program directors (PDs) during applicant selection. 1 Although the majority of medical schools have adopted pass/fail (P/F) preclinical grading, only 12 schools formally use P/F grading for clerkships. 2 Additionally, per Liaison Committee on Medical Education recommendations, events such as Hurricane Katrina and the COVID-19 pandemic have led additional schools to adopt P/F clerkship grading temporarily. 3 Moreover, the rise in studies describing student- and institutional-level disparities in clerkship grading has tasked medical education personnel with weighing the fairness and risk of disparities as well as the potential benefits of tiered grading. 1,4 With the continued paucity of literature examining P/F grading in core clerkships, 5 we conducted a meta-analysis of studies comparing PDs’ perceptions of residency performance among residents from schools using P/F versus tiered clerkship grading systems. Approach/Methods: Embase, PubMed, and Scopus were searched since inception through October 2020, and hand searches were performed of the retrieved reference lists. No study or language restrictions were applied. Studies exploring P/F clerkship in the context of a cohort of PD assessments were included, and the CLARITY risk of bias was used. Reviewers assessed study characteristics, overall resident performance, learning ability, work habits, work products, educational assessments, and PD’s personal evaluation (worse: 0 to best: 100), and were assessed using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. To account for different survey and grading metrics, adjusted standard difference in means were used. Main outcomes and measures were program director ratings of residents from U.S. medical schools using tiered versus P/F clerkship grading. Results/Outcomes: From 4,931 studies screened, we identified 6 eligible studies (3 cohort, 3 surveys; 6 low risk of bias) with 2,118 participants. From 31 accredited medical specialties, 7 specialties were represented with a median response rate of 81.0% (95% CI, 49.0–100.0). Reported as means, there was no difference in PD preference for residents from P/F or tiered grading system throughout residency training (37.0% Tiered; 95% CI, 0–100, P > .05). Adjusted scaled scores utilizing mean difference from an equal variance model from PDs showed overall performance (5.5; 95% CI, –1.9 to 12.9), learning ability (2.7; 95% CI, 0–5.4), work habits (2.9; 95% CI, 0–5.8), personal evaluations (–1.6; 95% CI, –3.8 to 0.6) and educational evaluation (1.7; 95% CI, –0.8 to 4.3) of residents from tiered clerkship grading systems were not statistically significant (P > .05) from P/F residents. However, there was a difference in work products produced (6.8; 95% CI, 1.4–12.2, P < .0001). Meta-regression standard difference in means revealed that there is no difference in tiered applicant’s overall performance in residency compared with P/F applicants (0.0001 fixed, P = .98; –0.0047 random, P = .81) Discussion: Clerkship performance has often been used as a metric to assess medical student preparedness for residency. 1,2 While PDs reported that residents from medical schools using P/F clerkship gradings tended to perform slightly lower on average, these results were not statistically significant. In addition, PDs did not generally prefer applicants from tiered medical schools. Given the continued expansion of P/F grading in medical school curricula, our findings allow for early discussion regarding the implications of P/F clerkship grading and its anticipated reception by stakeholders. Significance: In our cohort, there appears to be no perceived difference in resident performance based on clerkship grading system. This study provides further impetus for discussion of wider adoption of P/F grading in clinical clerkships.