Senior Year Of Medical School Research Articles

Impact of Virtual Interviewing on Time and Financial Costs for NRMP© Applicants: Did Regional Campus Students Save More?

Background and Objectives: The sudden change from in-person to remote interviews by the National Residency Matching Program© (NRMP©) in 2020 was expected to result in significant financial and time savings for applicants. This project aimed to compare savings before and after the 2020-2021 interviewing season reported by students graduating from our institution’s regional and main campuses. Methods: Data were collected over a six-year period at a Midwestern medical school. Each year, approximately 120 main campus and 75 regional campus students are surveyed regarding specialty choice, number of applications and interviews, time, and expenses to complete the NRMP. Chi-square and t-tests were used to determine statistical differences by campus and by specialty in savings during the 2020-21 interviewing season compared to the previous five years. Results: Data were provided by 957 students. The response rates were 81.5% (regional) and 82% (main campus). Compared to the previous five years, in 2021 main campus students saved $3,990 (79.9%) and regional campus students saved $2,789 (77.1%). The previous highly significant differences in expenses between campuses ($1,386 ± $243) dropped to $185 (p = 0.3). On both campuses, applicants to non-primary care specialties saved more than their classmates applying to primary care. The largest average saving was reported by non-primary care applicants on the main campus ($4,207) and the smallest by regional applicants to primary care ($2,328). Main campus applicants reported saving 13.1 and regional campus 15.4 days interviewing in 2021. The smallest average time saving was reported by main campus applicants to non-primary care (12.7 days) and the largest (16.2 days) by regional campus applicants to primary care. No significant changes occurred in number of applications, interviews, or Match outcomes in 2021 compared to previous years. Conclusion: Prior to 2021, students from our institution’s regional campus reported lower costs and similar interviewing time than their peers on the main campus. Cost and time were significantly decreased in 2021 for both regional and main campus students applying to any specialty and differences between campuses reduced to non-significant levels. The number of applications, completed interviews, and Match outcomes remained similar to previous years. Changes to the NRMP© incorporating remote interviewing may reduce applicant costs by 80% and provide up to two weeks of available curricular time in the senior year of medical school.

Stigma Among Chinese Medical Students Toward Individuals With Mental Illness.

The current study aimed to examine medical students' attitudes toward individuals with mental illness. Stratified cluster sampling was used to survey 735 Chinese medical students from three medical universities in Shandong, China. Participants completed the Perceived Devaluation and Discrimination Scale (PDD). Scores on the devaluation subscale items (mean = 2.80, SD = 0.59) were lower than the midpoint score (i.e., 3) (p < 0.001), and scores on the discrimination subscale items (mean = 3.20, SD = 0.52) were higher than the midpoint score (p < 0.001). Higher scores indicated more negative attitudes toward individuals with mental illness. Significant gender differences were found in the discrimination subscale scores and total PDD scores, with lower scores in men compared with women. Compared with medical students in other years, students in their senior year of medical school had the lowest scores on the discrimination subscale. Students may benefit from increased education regarding psychology and psychiatry and by having more contact with individuals with mental illness. [Journal of Psychosocial Nursing and Mental Health Services, 58(2), 27-31.].

The JeffSTARS Advocacy and Community Partnership Elective: A Closer Look at Child Health Advocacy in Action

Advocacy and service-learning increasingly are being incorporated into medical education and residency training. The Jefferson Service Training in Advocacy for Residents and Students (JeffSTARS) curriculum is an educational program for Thomas Jefferson University and Nemours trainees. The JeffSTARS Advocacy and Community Partnership Elective is one of two core components of the larger curriculum. The elective is a monthlong rotation that provides trainees in their senior year of medical school or residency training the opportunity to learn about health advocacy in depth. Trainees develop a basic understanding of social determinants of health, learn about health policy, participate in legislative office visits, and work directly with community agencies on a mutually agreeable project. The elective provides advocacy training to self-selected trainees from area medical schools and residency programs to develop a cadre of physicians empowered to advocate for child health. JeffSTARS has advanced the field of child health advocacy locally by forging new partnerships and building a network of experts, agencies, and academic institutions. After this experience, trainees realize that their health expertise is very valuable to health advocacy and policy development. JeffSTARS is recognized nationally as one of a growing number of advocacy training programs for students and residents, with trainees presenting selected projects at national meetings. Teaching advocacy has raised awareness about social determinants of health, community resources, and the medical home. One of the many benefits of the elective has been to strengthen the skills and expertise of trainees and faculty members alike.

The prevalence and cost of medical student visiting rotations.

BackgroundPerformance on visiting rotations during the senior year of medical school is consistently cited by residency program directors as a critical factor in selecting residents. Nevertheless, the frequency with which visiting rotations are undertaken and the associated financial costs they impose have not been systematically examined.MethodUnder the auspices of the Electronic Residency Application Service, a survey was sent in March 2015 to all U.S. applicants for residency programs in the 2014-15 academic year. Students were asked how many visiting rotations they performed; the estimated cost of performing each rotation; their perception of their educational value and primary motivation for performing them; and the Match outcome of their residency application.ResultsThe survey was completed by 2817 applicants, yielding a response rate of 11.3 %. 1898 applicants (67.4 %) performed visiting rotations: 647 applicants (30.0 %) performed one; 640 (22.7 %) performed two; 322 (11.4 %) performed three; and 289 (10.3 %) reported four or more. When accounting for potential response bias, the true prevalence of away rotators was estimated to be 58.7 % of all fourth-year medical students (95 % CI 54.0–63.4 %). The mean number of rotations for participating students was 2.1. Most students performed rotations equally as an audition for residency placement and for education, with some of the more competitive subspecialties reporting more of an audition experience. The mean estimated cost for performing a single rotation was $958. Thirty-six percent of applicants reported matching at an institution where they had rotated, either their home institution or one at which a visiting rotation was performed.ConclusionsVisiting rotations are prevalent, expensive, and only partly educational. As such, these rotations may impede optimal use of the senior year of medical school and limited student financial resources.

Harold E. Lebovitz, MD: Legendary Diabetologist.

Harold (Hal) Lebovitz turned 85 years old in October 2016. You wouldn’t know it from his travel schedule. He seems to go to India, or somewhere equally far, at least once a month. Despite long travels, he always shows up looking very perky and full of energy. In Harold’s case, some people will drive as much as 500 miles to attend his presentations, and as one physician commented, “Oh, yes, Harold Lebovitz is the greatest. I would go any distance to hear him speak.” And, in speaking, he has always adjusted his presentation to fit exactly to the time allocated without apparently looking at his watch. His array of topics spans all of diabetes and is always quite up to date. Harold Emil Lebovitz was born in Pittsburgh, PA, on 13 October 1931 to David (Dave) and Frieda Pachman Lebovitz. Harold’s father, Dave, had wanted to be a physician, but his parents told Dave he could never support a family as a physician, so he became a pharmacist. Dave opened Lawrenceville Drugs in Pittsburgh. The family lived above the store and Harold and his older brother, Al, as teenagers and while in college, worked there as soda jerks and helped fill prescriptions. All three of the brothers became physicians: Al, now deceased, was a psychiatrist; Harold is an endocrinologist; and Philip, the youngest, is a cardiologist. Dave continued to work actively as a pharmacist, even after selling his store and moving to Florida, only retiring at age 86. Harold Lebovitz at college graduation Harold as a young faculty member Harold received his undergraduate and medical degrees, in 1952 and 1956, respectively, from the University of Pittsburgh. During his senior year of medical school, he was a Lederle Research Student Fellow in Pathology. He also served as president of Alpha Omega …

Empowering Fourth-Year Medical Students

In this issue of Academic Medicine, Wolf et al explore the purposes and value of the senior year of medical school as viewed by graduating students at their institution. Using data from student focus groups and questionnaires, they report that students all found there to be significant value in but identified different purposes for the fourth year. The authors of this commentary believe that study adds to the discussion of fourth-year curriculum reform an important voice that has been lacking—that of students.Previous articles focusing on the perceived lack of clarity of educational purpose in the senior year curriculum have reflected a faculty perspective and have led some to call for increasing the structure of, decreasing the elective time in, or even completely eliminating the fourth year. In this commentary, the authors ask for a pause in this debate to consider the implications of the student perspective as well as important trends in the medical education continuum that affect the senior student (e.g., milestones that will set new expectations for first-year residents, increasing pressure associated with matching to a residency). They propose that providing students with time for career exploration and for focusing on areas of interest would allow them to individualize their preparation for residency and to be more sure of their career choices. They share the University of Washington School of Medicine’s planned new fourth-year approach as an example of a flexible, individualized senior year curriculum.

Lucien E. Morris, MD, Aqualumnus, Inventor, Academic and Historian

Lucien E. Morris, MD, Aqualumnus, Inventor, Academic and Historian

Development, implementation and evaluation of a fourth-year medical school elective course in clinical microbiology using case-based vignettes

Knowledge of clinical microbiology is an integral component in the management of patients with infectious diseases. Clinical microbiologists validate, implement and ensure quality control of all the tests and cultures performed in the clinical microbiology laboratory servicing hospitals and outpatient clinics. Typically, microbiology is taught to medical students by basic science microbiologists or infectious diseases physicians with minimal input from clinical laboratory specialists. Emory University School of Medicine implemented a course in the final month of the senior year of medical school to ensure that students are ready for postgraduate residency. As part of this course and emphasizing the Systems-Based Practice core competency of the Accreditation Council for Graduate Medical Education (Gregory et al., 2009), one full day was allotted to the Department of Pathology and Laboratory Medicine. During this ‘Laboratory Medicine Experience’, students toured different hospital clinical laboratories and solved cases designed to stimulate discussions that emphasized laboratory medicine fundamentals as delineated by the Academy of Clinical Laboratory Physicians and Scientists (Smith et al., 2010; Molinaro et al., 2012). Using case-based learning (Srinivasan et al., 2007), an additional 4 h elective in clinical microbiology was offered 1 day after the ‘Laboratory Medicine Experience’.

Orthopaedic Residency: How Do You Know When the “Cake is Done?”

When should you take the cake out of the oven? The correct, if somewhat glib, answer is, “When it is done.” In everyday practice, however, pastry chefs do not test the cooking batter every minute. Rather, the benefit of experience is translated into simple rules, such as, “Bake at 375° for 45 minutes.” When should residents be allowed to graduate? The correct answer is a variation: “When they are done,” meaning when they are ready for independent practice. And here, too, we do not test for completion continuously, but rather follow the cake-baking rule: apply a certain intensity and duration of training, and confirm “doneness” at the end. Even amateur bakers realize that when using an oven that does not get hot enough, the cake must stay in the heat a little bit longer. Yet similar logic has not been applied to residency training; specifically, there has been an 80-hour limit on the resident workweek, but the duration of residency training has not increased. It seems to me that if we cut back the number of hours residents can work each week, and we do not increase the total number of weeks worked, we risk truncating the educational experience. This truncation is probably not a 50% reduction (for only in the ”Days of the Giants” did residents routinely work 160 hours per week), but 10% is not an unreasonable estimate. Add to that the inefficiencies of more frequent patient hand-offs, and I would bet that residents’ traditional clinical experiences have been effectively abbreviated by 6 months or more. We can teach a lot of orthopaedics in 6 months. The question of why the work restriction rules were not immediately coupled with an extension of the duration of residency has a few possible answers. Cynics would say that this was just one of the many ramifications of the work-restriction rules that were not well thought out. A more neutral position holds that longer residencies would be better in the abstract, but there is no money to fund them. Or perhaps residency programs were unnecessarily long to begin with, and this shortening simply cut them down to proper size—recall that orthopaedic residency was, for most of its history, only 3 years long, following 2 years of general surgery. Whatever the explanation, we still are left with a key question: What should we do now to best adapt to a de facto, abbreviated course of training? One simple step would be to insist that future orthopaedic residents learn as much as they can before they even begin residency, and they demonstrate proficiency as a requirement for admission. Specifically, any aspect of orthopaedic surgery education that can be taught in medical school should be taught there; by doing so, we free up more time for things that can only be taught in residency. For example, why not insist that all students interested in our field take an advanced anatomy examination? At the same time, why not insist that all applicants complete subinternships in surgical intensive care, emergency medicine, and musculoskeletal radiology? It is not like the senior year of medical school is overly-rigorous as it is. Orthopaedics remains a very popular career choice among students, and we can increase the entrance requirements without creating a shortage of qualified applicants. Beyond that, we must selectively lengthen residency for those residents who need it. In turn, we need to enhance the power of program directors to identify and hold back from graduation those residents who, while not failing per se, are simply not ready to graduate. Further, this power must be paired with a program that supports those residents who are not ready to be released. Currently, hospitals are reimbursed by the federal government for residents’ salaries but only for the first 5 years of training. When a program currently decides that it must retain a resident for more training, it must pay for this extra year— a substantial cost. This strong incentive for programs to graduate “marginal” residents must be removed. Training residents is not exactly like baking a cake, though they do have some elements in common, apart from cracking, whipping, and beating. To graduate the best possible residents, or bake the best possible cake, one must start with the best possible ingredients and allow the expert “chefs” enough discretion to get the job done correctly.

Evaluating an Interdisciplinary, Multicultural, Innovative, and Required Palliative Care Medical Student Course (747)

1.Examine the level of education medical schools provide in the field of Palliative and end-of-life care as part of their curricula to their medical students.2.Evaluate the impact of a required course in Palliative Care for fourth year medical students as it pertains to change in knowledge and attitudes. Palliative Care (PC) education at U.S. medical schools has significantly increased over the past decade, with greater than 90% of U.S. schools providing medical students (MS) with established curricula of various durations. Positive outcomes might include MS’ improved overall knowledge and enhanced level of comfort with end-of-life issues and decision making. To examine the effectiveness of a required curriculum in PC education received by MS at a U.S. medical school. An eight-hour required course in PC was delivered to all fourth-year MS locally, to complete 30 hours of PC instruction throughout medical school education. Curriculum included key aspects of PC such as family meetings, complex symptom management, and end-of-life care. Pre/post-tests in knowledge and attitudes focused on:1.Opioid use to control symptoms2.Provider expertise with hospice referral, and3.When to shift from curative to comfort-care approach. N = 203. MS level of comfort (LOC) increased from 61.1% to 90.6% when prescribing opiod analgesics; MS LOC increased from 53.7% to 89.3% with knowing when it is time to refer a patient to home hospice care; and MS LOC increased from 46.8% to 89.3% on when to recommend a shift in treatment goals from curative medical care to a comfort-care approach. Additionally, overall knowledge test and attitudes towards PC patients significantly increased. Pre vs. post-test P-value <0.0001 for all assessments. The PC educational intervention significantly improved PC knowledge, attitude, and comfort level. A required PC curriculum positively impacts a students' knowledge and level of comfort in dealing with PC patients, even in senior year of medical school.

How to Win an Argument About the Senior Year of Medical School

How to Win an Argument About the Senior Year of Medical School

Making a Complete Orthopod

To the Editor.— Your recent publication Principles for Graduate Medical 1 was of great interest. Although many of the principles seem to reflect common sense, some are not in current practice. Principle 10, Education in the broad field of medicine, is specifically a problem within orthopedic surgery. Since the general demise of the rotating internship, it is clear that the clinical education of physicians entering the field of orthopedic surgery is not consistent with the goal of providing a broad clinical experience prior to specialty education. Obtaining an orthopedic surgery residency is extremely competitive. It is unusual for an individual to be considered highly for a residency spot without some extraordinary qualification. This usually consists of time spent in orthopedic electives in the junior or senior year of medical school. This experience allows the individual to acquire a recommendation from a qualified orthopedic educator. This type of experience is

Fifth year of residency versus fourth year of medical school and residency

I have suggested that residency programs in Obstetrics and Gynecology have a number of deficits with a major one being insufficient education in the full spectrum of the specialty. Specifically, there are inadequate ambulatory care, inadequate case volume, inadequate instruction in pelvic surgery, and inadequate instruction in a number of other areas such as practice management, ethics, etc. I proposed a fifth year of residency to provide enough time for each of these areas to be covered. There is an alternative that may be achievable. First, it is unlikely the Accreditation Committee for Graduate Medical Education will agree to an increase in the length of any residencies. Pathology made such a change a few years ago and incurred the attention of all involved. It is equally unlikely that the funding necessary for such an increase will be available. It would probably require that each program cut its annual resident complement by 20% to be able to pay for the 20% increase in years. Even cutting the number of residents will not solve all of the money problems because salary goes up in the fifth year and fringe benefits go up proportionately. Such an increase by reducing numbers per year also impinges on service versus education and, in many programs, would not accomplish the goals desired. It would be difficult to recruit to Obstetrics and Gynecology if we add a year. I have had a number of queries from concerned candidates this year. For many students the senior year of medical school is a hodge-podge of electives. They have no guidance in too many schools and are allowed to take almost anything they want. Some elect for easy rotations; others choose hard ones. The end result is a senior year that is poorly structured for entry into our discipline. I propose that we mandate a change in the senior year of medical school. This is possible even though other

AMA—Fellowship and Residency Electronic Interactive Database Access (AMA-FREIDA):

Over the past several years, medical educators and students have been expressing increasing concern about the selection process for graduate medical education programs. The senior year of medical school is a period of intense pressure when medical students must choose a specialty, select a graduate program, and, in some cases, rehearse an internship.1Residents who have experienced that process have stated that they did not have enough information to make an informed choice.1-3 Students seek information about graduate medical education programs from a variety of sources. However, 52% of residents in one study said they did not have available the information they needed to make a decision about a graduate medical education program.4One study found theDirectory of Graduate Medical Education Programsto be the single most important source of information.3Another study found that residents consider published information to be the most important source,

The Stability of Early Specialty Preferences Among US Medical School Graduates in 1983

Medical graduates in 1983 were in preclinical training when the Graduate Medical Education National Advisory Committee forecast a surplus of 70,000 physicians by 1990. Among the problems identified was the nuclear role of medical schools in affecting specialty choices. To understand this role further, the current study determined the stability and evolution of specialty preferences between the time of the Medical College Admission Test and the senior year of medical school. The study included 10,321 US medical school graduates in 1983. Eighty percent changed their specialty preference during this interval, demonstrating the substantial effects that medical schools have on specialty selection. The stability of early preferences ranged from 41% to 1%. Interest in primary care specialties declined among both men and women; interest in specialty care and supporting services increased during this five-year longitudinal study. These findings parallel shifts away from primary care among US medical school graduates in 1978 and 1983.

The Quality and Influence of JAMA

<h3>To the Editor.</h3> —In my senior year of medical school, one professor devoted an hour or so of each class to the matter of education beyond medical school; he recommended that each of us subscribe to a general medical journal from that point to the end of our days in medicine. We should not limit ourselves to reading within our areas of special interest, but rather we should keep informed generally in medicine. Among the general medical journals my professor mentioned were<i>The Lancet, New England Journal of Medicine</i>, and<i>JAMA</i>. This was in 1960. Not being a surgically decisive person, I chose not to select one of these diverse journals but to read all three, and have done so, missing nary a week, since my commencement in 1960. It is my impression that these general medical journals are like people. They have their ups and downs. To base things

Factors used by program directors to select residents

A national, stratified random sample of 405 graduate medical education program directors was surveyed on the way they selected their residents. The results from the 237 respondents reaffirm earlier studies which found that the interview was the most important selection variable. The results indicate that the recent increase in competition for residency positions has increased the importance of academic variables. For example, 86 percent of the respondents stated that they would not rank a candidate who had not passed the National Board of Medical Examiners Part I examination. Because 86 percent also stated that they give preference in ranking students to those who have done well in an elective at their hospitals, the senior year of medical school may be used as a "residency chase" rather than for the general professional education of the physician.

Dermatology Resident Matching Program

<h3>To the Editor.—</h3> I have read with interest your editorial entitled "A National Resident Matching Program for Dermatology" in the August 1981Archives(117:457-459). As one who has recently participated in this new matching program, I would like to point out several related problems in this program and a proposed solution. The editorial states that it is possible to conduct simultaneous interviews for G-1 and G-2 positions for those persons committed to dermatology while presumably still in their senior year of medical school. This is impossible in most situations, as G-1 (internship) interviews are generally held in September through December, while G-2 (residency) interviews for dermatology, with few exceptions, are not held until at least March of the following year. This inconvenience causes applicants who are still in medical school to double both their expenses and time involved in the interviewing process. Another problem with the new matching program is

Radiology and new curriculum.

The awareness that the medical profession faces an increasing number of problems in the future has led to the formation of many committees and commissions to explore possible solutions. Outstanding among the reports are two in which Lowell T. Coggeshall, M.D., and John S. Millis, Ph.D., made several recommendations designed to improve medical education and training for medical specialties. It is accepted by all radiologists that the problems facing their specialty are as grave as if not more so than those of other physicians. The well known NACOR Report (Radiology 87∶ 957, 1966) was prepared by a Committee chaired by Russell Morgan, M.D. At the present time a “Survey of Academic Radiology” is being conducted by a special committee chaired by Joseph C. Hinsey, M.D. When completed, this report will be presented jointly to the Division of Medical Sciences of the National Research Council and the American Board of Radiology. Most radiologists believe that perhaps the greatest problem facing their specialty is the sparsity of young physicians being trained in Radiology. What is the best source of candidates for Radiology residencies? Does it vary with geographic location? The following discussion presents what may be a partial solution, worked out by the staff of the Medical College of Virginia. The education of the radiologist could well be divided into three phases: the predoctoral or Medical School, the postdoctoral or Intern and Residency years; and Continuation Education. While it is true that some of the residents in Radiology are obtained during their intern years or occasionally transfer from another specialty or from general practice, it is our opinion that the best source of future radiologists is found in the predoctoral period of training. The Millis report proposed abolishing the internship as we know it and including this year of postdoctoral training into the residency requirements of a specialty board. Many radiologists, however, object to the idea of abolishing the internship. Among their reasons is the feeling that it is in this period that many candidates for residencies in Radiology make their decision. On the other hand, residents in Radiology are being appointed earlier and earlier, and it is now common practice to give a candidate an appointment as a resident in Radiology during his senior year of Medical School or in the first or second month of his internship. After several years of planning, our institution embarked in 1964 upon what was called a “new curriculum.” The June 1968 graduates will be the first to have spent their entire period of predoctoral training in this course. This new curriculum should probably not be called “core,” inasmuch as it has not shortened the period of training or exemplified the system or block method of teaching throughout the entire four-year period.

Attitudes of medical residents toward the dying patient in a general hospital.

This report examines the reactions of 120 medical residents to terminal illness. It also explores their own feelings about death and their frustration when faced with a dying patient: “If I cannot cure, what is there left for me to do?” It is recommended that the problems of management of the dying patient be given special attention in the senior year of medical school. The ability to recognize his own psychologic feelings about death helps the young physician to be a better doctor.