United States Medical Schools Research Articles

There and Back Again: A Forty-Year Perspective on Physician Nutrition Education

Medical education faces an urgent need for evidence-based physician nutrition education. Since the publication of the 1985 National Academies report “Nutrition Education in the United States Medical Schools,” little has changed. Although several key efforts sought to increase nutrition content in undergraduate medical education over the past 40 y, most medical schools still fail to include the recommended minimum of 25 h of nutrition training. Without foundational concepts of nutrition in undergraduate medical education, graduate medical education unsurprisingly falls short of meeting patient needs for nutritional guidance in clinical practice. Meanwhile, diet-sensitive chronic diseases continue to escalate, although largely preventable and treatable by nutritional therapies and dietary lifestyle changes. Fortunately, recent recognition and adoption of Food is Medicine programs across the country increasingly connect patients with healthy food resources and nutrition education as core to their medical care, and physicians must be equipped to lead these efforts alongside their dietitian colleagues. Filling the gap in nutrition training will require an innovative and interprofessional approach that pairs nutrition with personal wellness, interprofessional practice, and community service learning. The intersectional benefits of connecting these domains will help prepare future physicians to address the social, behavioral, and lifestyle determinants of health in a way that recognizes nourishing food access as a core part of clinical practice. There are numerous strategies to integrate nutrition into education pathways, including didactic and experiential learning. Culinary medicine, an evidence-based field combining the culinary arts with nutritional science and medicine, is 1 promising educational framework with a hands-on, interprofessional approach that emphasizes community engagement. Advancing the critical need for widespread adoption of nutrition education for physicians will require support and engagement across societal stakeholders, including co-leadership from registered dietitian nutritionists, health system and payor reform, and opportunities for clinical innovation that bring this essential field to frontline patient care.

Racial and Ethnic Disparities in Situational Judgment Testing Among Applicants to an Anesthesiology Residency Program

Background The Computer-Based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgment test (SJT) that assesses noncognitive skills like professionalism, communication, and empathy. There are no reports of the effects of race/ethnicity and sex on CASPer scores among residency applicants. Objective We examined the effects of race/ethnicity, sex, and United States vs international medical school attendance on CASPer performance. Methods Our anesthesiology residency program required all applicants for the 2021-2022 Match cycle to complete an online video and text-based SJT (CASPer). We compared these results, reported as z-scores, with self-identified race/ethnicity, sex, United States vs international medical school attendance, and United States Medical Licensing Examination (USMLE) Step 1 scores. Results Of the 1245 applicants who completed CASPer, 783 identified as male. The racial/ethnic distribution was 512 White, 412 Asian, 106 Black, 126 Hispanic, and 89 Other/No Answer. CASPer z-scores did not differ by sex. White candidates scored higher than Black (0.18 vs -0.57, P<.001) and Hispanic (0.18 vs -0.52, P<.001) candidates. Applicants attending US medical schools scored higher than those attending international medical schools (z-scores: 0.15 vs -0.68, P<.001). There was no correlation between CASPer z-scores and USMLE Step 1 scores. Conclusions Our results suggest that CASPer scores favor White applicants over Black and Hispanic ones and applicants attending US medical schools over those attending international medical schools.

Professors of racial medicine: imperialism and race in nineteenth-century United States medical schools.

This article examines some of the racist features of nineteenth-century medical school curricula in the United States and the imperial networks necessary to acquire the data and specimens that underpinned this part of medical education, which established hierarchies between human races and their relationship to the natural environment. It shows how, in a world increasingly linked by trade and colonialism, medical schools were founded in the United States and grew as the country developed its own imperial ambitions. Taking advantage of the global reach of empires, a number of medical professors in different states, such as Daniel Drake, Josiah Nott and John Collins Warren, who donated his anatomical collection to Harvard Medical School on his retirement in 1847, began to develop racial theories that naturalised slavery and emerging imperialism as part of their medical teaching.

Evaluation of patient health outcomes of a student-run free clinic in East Harlem

BackgroundMost United States medical schools have affiliated student-run free clinics, but the quality of services provided in such contexts compared to national metrics is unknown. This study determines whether a student-run, attending-supervised free clinic servicing a low-income and minority race patient population in New York City can meet national metrics of care.MethodsThrough chart review from January 1, 2020 to December 31, 2020, patient outcomes and service utilization in the Healthcare Effectiveness Data and Information Set were examined and compared to national rates of patients using Medicaid HMO or Medicare. Patients are ≥ 21 years of age, residents of East Harlem, and ineligible for health insurance because of legal residency requirements. The majority identify as Hispanic and speak Spanish as their primary language. All patients who were seen in the clinic during the 2020 calendar year were included. The primary study outcome is the number of Healthcare Effectiveness Data and Information Set measures in which patients, seen in a student-run free clinic, meet or exceed national comparisons.ResultsThe healthcare outcomes of 238 patients, mean age 47.8 years and 54.6% female, were examined in 18 Healthcare Effectiveness Data and Information Set measures. The student-run free clinic met or exceeded national metrics in 16 out of 18 categories.ConclusionsThe student-run free clinic met or exceeded the national standard of care according to national metrics. Evidence-based priorities have been clarified for future improvement. Other student-run free clinics should similarly evaluate the quality of their services.

Post-COVID Analysis of Which U.S. Medical Schools Produce the Most Neurosurgery Residents: 2021–2023 in Review

ObjectiveThe process surrounding application to the national residency matching program changed drastically because of COVID. Virtual interviews, pre-interview zoom socials, and limitations on sub-internships are major changes that applicants worldwide have had to overcome. The available literature does not reflect the impact of major changes to the interview process. Here, we examine the neurosurgery resident cohort from 2021-2023 to investigate differences between United States medical schools pre- and post-COVID. MethodsA database was constructed reporting the number of students matched to neurosurgery for U.S. medical schools (MD and DO) from 2021-2023. Percentage of total graduates matched to neurosurgery was calculated and institutions were ranked by this metric. This rank was compared to the rank reported by Antar et al in 2021. Variables were compared across the pre- and post-COVID cohorts. ResultsCase Western, Johns Hopkins, Mayo Clinic, Vanderbilt, University of Illinois and University of California San Francisco produced the most neurosurgical residents as a percentage of total graduates. There was a statistically significant difference in the post-COVID cohort between medical schools with a home program vs those without. For the top 20 ranked U.S. News medical schools, there was a statistically insignificant increase in the number of graduates matched to neurosurgery ConclusionsWith the data provided, there have not been many significant changes in which medical schools produce the most neurosurgery residents since COVID changes were implemented. The playing field has remained relatively the same in the setting of major changes that were made.

Gender parity in neurosurgery residencies: an analysis.

The number of women graduating from United States medical schools has reached parity with that of men. However, persistent inequalities and barriers have slowed the pace toward equity in application and representation in neurosurgery residency despite initiatives to increase female representation. The objective of the present study was to assess the advancement of gender parity within neurosurgery residency programs. Additionally, the study aimed to analyze the pipeline dynamics by investigating the effects of attrition on women in neurosurgery, as well as exploring the patterns of female applications to neurosurgery residency programs versus other surgical specialties. Data on the number of active female neurosurgery residents and female applicants to neurosurgery were collected from the Accreditation Council for Graduate Medical Education Data Resource Book from 2007 to 2021 and Electronic Residency Application Service from 2014 to 2022. Linear regression analysis was used to predict the percent of active female residents based on academic year (AY). A Pearson chi-square test was used to determine the odds of a female applying to neurosurgery. The percent of active female residents in neurosurgery increased from 11.0% in 2007 to 21.8% in 2021. Bivariate linear regression analysis using AY as a predictor of the percent of active females showed a statistically significant correlation. On average, the percent of active female residents increased by 0.65% per year. If trends persist, parity for females in neurosurgery will not be reached until 2069. Linear regression analysis of the overall rate of attrition in neurosurgery as a predictor of the percent of active female residents revealed that for every 1% increase in the rate of attrition, the percent of active female residents decreased by 2.91% (p = 0.001). The percent of female applicants to neurosurgery increased from 19.6% in 2014 to 29.8% in 2022 (p = 0.009), yet the odds of a female applying to neurosurgery remain low. Neurosurgery continues to struggle with the recruitment of female medical students even as parity has been reached for female medical school matriculants. Greater effort is needed to recruit and retain female applicants to neurosurgery, including increased transparency in match and attrition metrics.

Promotion Criteria for Medical Educators: Are We Climbing a Ladder with Invisible Rungs?

ObjectiveIn 2006 the Association of American Medical Colleges recommended standardization of documentation of the contributions of medical educators and guidelines for their academic promotion. The authors characterized current United States (US) medical school promotion guidelines for medical educators. MethodsAuthors collected publicly available data from medical school promotion websites from March through July 2022 after determining categories by traditional-set domains as well as peer-reviewed standards. Extracted data were analyzed using descriptive and inferential statistics, and frequencies were calculated for nominal and categorical data. ResultsOf 155 medical schools identified, promotion criteria were publicly available for 143 (92%) schools. Ninety-one (64%) schools identified a distinct educator track. Of those with a defined educator track, 44 (48%) schools consider workshops or other media when evaluating candidates for promotion, and only 52 (57%) of schools with a specified educational track require additional documentation of teaching or education as part of their promotion process. Notably, 34 (37%) of the 91 schools with an educator track specifically require an Educational Portfolio, compared to 27 (52%) of the 52 schools that do not have a specific educator track for promotion. ConclusionThis study describes the current lack of clarity and consistency of the promotion criteria for medical educators and indicates that the guidelines proposed by the Association of American Medical Colleges over 15 years ago have not been widely adopted. These data amplify previous calls for a more objective set of criteria for evaluating and recognizing the contributions of medical educators.

Are Medical School Curricula Adapting With Their Students? A Survey on How Medical Students Study and How it Relates to USMLE Step 1 Scores.

Over the years, medical schools have evolved their curricula in response to the medical field, faculty, and students. The current study aims to examine how medical students study, what resources they most commonly use, and how it relates to United States Medical Licensing Examination (USMLE) Step 1 scores. A cross-sectional survey study of United States medical students was distributed via social media, GroupMe school chats, and school listservs from September 8, 2020, to December 12, 2020. The survey gathered data including, demographic and school information, resources students, time spent using each resource, and USMLE Step 1 scores. The survey was completed by 560 students from 102 different United States medical schools. Study guides as online resources (83.2%) were mostly used, lecture (82.5%), Anki (spaced repetition flashcards, 68.3%), and school-organized sessions (workshops, labs, and small groups) (60.7%). Of the students surveyed, 90% attended schools with a recorded lecture option. Only 54% of these students watched their lectures live. When watched online, the average watching speed was 1.75 ± 0.4× with a mode of 2× speed. In examining different medical school styles, schools with a 1.5-year preclinical curriculum had higher USMLE Step 1 scores (244.5 ± 15.6 vs 236.9 ± 16.2, P-score = .024) compared to schools that did not (1- or 2-year preclinical curriculum). Medical students seem to be using third-party resources in addition to their medical school curriculums. Because students are already broadly using these, medical schools could allow their curriculums to reference, require, or complement third-party online resources. Additionally, because of their increased cost, medical schools could consider ways to alleviate the cost on medical students as a means of equitable support. Lastly, Step 1 scores significantly correlated with schools with a 1.5-year preclinical curriculum, although the exact reasoning for this remains uncertain.

Opioid Overdose Recognition: A Survey of Perceived Preparedness and Desire for Curricular Integration Among Current US Medical Students.

Opioid overdose deaths remain a major health issue in the United States (US). As future physicians, medical students must receive comprehensive training to recognize and manage opioid overdoses. This study aimed to highlight training gaps at the medical student level and understand students' attitudes toward patients with opioid use disorder (OUD). We assessed baseline knowledge of and attitudes toward the management of opioid overdoses and naloxone administration among medical students in the US. Two validated survey tools (Opioid Overdose Knowledge Scale and Opioid Overdose Attitude Scale) were administered to medical students training at accredited institutions along with supplemental questions measuring knowledge and attitudes towards opioid overdose management, naloxone administration, and prior training. The final sample had N = 73 participants from US medical schools with a mean age of 25.3 (range of 22-37): 72.6% of respondents were female. Although most respondents reported personal/professional experience with OUD before medical school, they expressed interest in additional training. Knowledge surrounding opioid overdoses increased insignificantly over the 4 years of medical school. However, there was a significant increase in both perceived competence in overdose recognition/management and in concerns about intervening from the first to fourth year of medical school. Female respondents had significantly lower perceived competence and readiness to intervene sub-scores than male counterparts; however, there was no significant difference in overall attitude and knowledge scores when stratified by sex. Incorporating opioid overdose prevention training (OOPT) into early medical education was favorable among respondents, who expressed an overwhelming interest in learning and supporting patients with OUD. Given the ongoing opioid crisis, medical students are ideally placed to identify and manage opioid overdoses. Medical students are ready to receive this training, thus strengthening the argument for OOPT integration into early medical student curricula.

Global Trends and Hotspots of Minimally Invasive Surgery in Lumbar Spinal Stenosis: A Bibliometric Analysis.

The popularity of minimally invasive surgery for lumbar spinal stenosis (LSS) has been steadily increasing worldwide. This study aims to conduct a comprehensive bibliometric analysis to identify global trends and hotspots in the research related to this surgical approach. Select articles related to the field that were retrieved from the Web of Science Core Collection (WoSCC) between January 1, 1993 and December 31, 2022. Visualization of networks and in-depth bibliometric analyses, including the number of publications, countries/regions, institutions, journals, authors, keywords, and references, were conducted using VOSviewer and CiteSpace software. A total of 1197 papers were identified over a three-decade period, with the highest production year being 2022, which saw 171 papers published. The most prolific countries/regions were the United States (279) and Harvard Medical School (59). Among journals, Spine (3289 citations) was the most cited, while World Neurosurgery (98 publications) had the highest number of publications. Lewandrowski, Kai-Uwe (29 publications) wrote the most articles, and Ahn, Y (239 citations) ranked first among cited authors. The most frequently used keyword was "discectomy", but recent years have shown a strong emergence of keywords such as "microendoscopic decompressive laminotomy", "foraminotomy" and "classification". The United States and China have emerged as leaders in the field of minimally invasive surgery for LSS. Endoscopic spinal surgery is recognized as a critical approach, with ongoing research focused on indications, potential complications, minimally invasive anatomical approaches, and outcomes. Furthermore, there is a strong emphasis on optimizing the surgical process, which has become a trending and hot spot in current research. The improvement of surgical techniques is at the forefront of advancements in this field.

Pathology teaching in different undergraduate medical curricula within and outside the United States: a pilot study

Pathology education is taught using different curricula in the United States (USA) and abroad. We evaluate and compare the hours spent in different forms of pathology teaching such as lectures, team-based learning (TBL), problem-based learning (PBL), and other methods taught in general and systemic pathology amongst different medical schools within the USA and outside the USA. The total number of lecture hours taught in general and systemic pathology combined was greater in outside schools than within the USA (141 h vs 97.8 h, respectively). Three subjects in general pathology and six subjects in systemic pathology had a significantly greater lecture hours in outside medical schools. The greatest difference was the hours spent in labs were longer for both general and systems pathology in schools outside the USA. The overall utilization of PBL in general and systemic pathology teaching combined was much greater outside the USA compared to within the USA (average overall hours PBL – 97.2 outside vs 16.5 in the USA), however, the reverse was observed for using TBL (average overall hours TBL – 59.5 outside vs 84.5 in USA). Average hours used with other methods of teaching was also greater in outside medical schools compared to USA medical schools (80.8 h vs 44 h, respectively). Pathology teaching in both general and systemic pathology has more extensive lecture hours, laboratory hours, PBL, and other methods of teaching pathology in outside medical schools with different curricula than USA medical schools. TBL is utilized more extensively in USA medical schools.

Association of applicant demographic factors with medical school acceptance

BackgroundMedical school acceptance rates in the United States (US) have been lower for applicants who identify as Underrepresented-in-Medicine (UiM) compared to non-UiM applicants. The gap between UiM and no-UiM groups is narrowing in recent years. Less well-studied are associations of acceptance decisions with family income and parental education. This study’s purpose is to evaluate the relationships between medical school acceptance and family income, parental education status, racial/ethnic background, Grade Point Average (GPA), Medical College Admission Test (MCAT) score, and participation in extracurricular activities.MethodsThis is a cross-sectional study of first-time US medical school applicants between 2017 and 2020. Acceptance rates for first-time applicants were calculated for first-generation (FG), low-income (LI), and UiM applicants. Associations of these attributes with MCAT scores, science GPAs, and seven categories of extracurricular activities were evaluated. Regression analyses estimated associations between acceptance to medical school with all variables with and without interaction terms (FG*URM, LI*URM, FG*LI).ResultsThe overall acceptance rate for first-time applicants from 2017–2020 was 45.3%. The acceptance rates among FG, LI and UiM applicants were 37.9%, 39.6% and 44.2%, respectively. In univariable logistic regression analyses, acceptance was negatively associated with being FG (OR: 0.68, CI: 0.67–0.70), LI (OR: 0.70, CI: 0.69–0.72), and UiM (OR: 0.95, CI: 0.93–0.97). In multivariable regression, acceptance was most strongly associated with science GPA (OR: 7.15, CI: 6.78–7.54 for the highest quintile) and UiM (OR: 5.56, CI: 5.48–5.93) status and MCAT score (OR: 1.19, CI: 1.18–1.19), FG (OR: 1.14, CI: 1.10–1.18), and most extracurricular activities. Including interaction terms revealed a negative association between acceptance and LI (OR:0.90, CI: 0.87–0.94) and FG was no longer significant (OR:1.10, CI:0.96–1.08).ConclusionsCollectively these results suggest medical school admissions committees may be relying on holistic admission practices. While MCAT and GPA scores continue to predict acceptance, individuals from racially and ethnically UiM backgrounds have favorable odds of acceptance when controlling for MCAT and GPA. However, these positive associations were not seen for low-income and first-generation applicants. Additional preparation for college and the MCAT for these latter groups may help further diversify the medical profession.

Bibliometric analysis of residual cardiovascular risk: trends and frontiers.

The presence of residual cardiovascular risk is an important cause of cardiovascular events. Despite the significant advances in our understanding of residual cardiovascular risk, a comprehensive analysis through bibliometrics has not been performed to date. Our objective is to conduct bibliometric studies to analyze and visualize the current research hotspots and trends related to residual cardiovascular risk. This will aid in understanding the future directions of both basic and clinical research in this area. The literature was obtained from the Web of Science Core Collection database. The literature search date was September 28, 2022. Bibliometric indicators were analyzed using CiteSpace, VOSviewer, Bibliometrix (an R package), and Microsoft Excel. A total of 1167 papers were included, and the number of publications is increasing rapidly in recent years. The United States and Harvard Medical School are the leading country and institution, respectively, in the study of residual cardiovascular risk. Ridker PM and Boden WE are outstanding investigators in this field. According to our research results, the New England Journal of Medicine is the most influential journal in the field of residual cardiovascular risk, whereas Atherosclerosis boasts the highest number of publications on this topic. Analysis of keywords and landmark literature identified current research hotspots including complications of residual cardiovascular risk, risk factors, and pharmacological prevention strategies. In recent times, global attention toward residual cardiovascular risk has significantly increased. Current research is focused on comprehensive lipid-lowering, residual inflammation risk, and dual-pathway inhibition strategies. Future efforts should emphasize strengthening international communication and cooperation to promote the comprehensive evaluation and management of residual cardiovascular risk.

Eat to Treat: The Methods and Assessments of a Culinary Medicine Seminar for Future Physicians and Practicing Clinicians.

Nutrition-associated chronic disease is an epidemic in the United States (US), yet most medical schools lack adequate nutrition education. We developed a six-session culinary medicine (CM) seminar entitled "Eat to Treat: A Nutrition Course for Future Clinicians" that teaches culinary skills, nutrition science, and counseling techniques to improve clinical nutrition management. The seminar was offered in-person to first-year medical students in a medical school-based teaching kitchen from 2017 to 2019. A virtual three-session course was also offered to practicing clinicians in 2020. Voluntary self-efficacy questionnaires were collected at the beginning of the first and last sessions of the student seminar, and paired t-tests determined the course's effect on survey items. A total of 53 first-year medical students attended the program over five semesters, and 39 students (73.6%) completed both surveys. All except one measure of self-efficacy were significantly higher at session 6 than session 1 (p < 0.05). A post-course survey was utilized for the clinician seminar and of the 31 participants, 14 completed the surveys; 93% and 86% of respondents agreed the course was clinically relevant and improved their confidence, respectively. We developed a CM curriculum that improved nutrition knowledge and confidence among a professionally diverse cohort and may represent a scalable education model to improve nutrition education in US medical schools.

Neurosurgery Clerkships in United States Medical Schools: A Survey of Doctor of Medicine–Granting and Doctor of Osteopathic Medicine–Granting Schools

Exposure to neurosurgery is important for knowledge of neurosurgical conditions that physicians may encounter. The current status of neurosurgery nonsubinternship clerkships in the United States is unknown; this study determined the availability and format of non-subinternship neurosurgery clerkships in DO (Doctor of Osteopathic Medicine)-granting and MD (Doctor of Medicine)-granting U.S. medical schools. Association of American Medical Colleges and American Association of Colleges of Osteopathic Medicine websites were used to obtain contact information for all U.S. medical schools. Respondents were asked whether their school offered a non-subinternship neurosurgery clerkship, if it was required, clerkship length, and whether the clerkship was embedded in another clerkship. Nonsubinternship clerkships/electives/selectives were defined as an exploratory neurosurgery rotation. For nonresponding schools, data were collected from school websites. Data were obtained for 180/199 U.S. medical schools; 142 (79%) provided neurosurgery non-subinternships, including 125/150 (83.3%) MD-granting and 17/30 (57%) DO-granting schools. Four MD-granting schools (2.8%) required the clerkship; 87/142 (61%) offered a stand-alone clerkship, 34/142 (24%) an embedded clerkship, and 21/142 (15%) offered both. In total, 200 clerkships were offered across 142 schools. Most were either >1-2 weeks or >3-4 weeks (69/200, 35% and 89/200, 45%, respectively). Most U.S. medical schools provide elective neurosurgery non-subinternships. Fewer, although still a majority, of DO-granting schools offer a neurosurgery non-subinternship compared with MD-granting schools.

The Changing Landscape of the Preclinical Medical School Curriculum: Results from a Nationwide Survey of United States Medical School Curriculum Deans

The Changing Landscape of the Preclinical Medical School Curriculum: Results from a Nationwide Survey of United States Medical School Curriculum Deans

Survey of ASCO Sponsored Oncology Interest Groups in the United States Assessing Medical Student Perceptions of Education in Radiation Oncology and Future Employment Prospects

Over the last five years, applications to radiation oncology residency programs among graduates of medical schools in the United States (US) have declined by nearly 50% with a corresponding increase in unfilled positions in the National Resident Matching Program. This has led to ongoing concern regarding the future of the radiation oncology workforce and speculation regarding contributing factors. There are no published data substantiating medical student viewpoints on these issues. To better understand medical student perceptions of oncology specialties (medical oncology (MO), radiation oncology (RO), and surgical oncology/surgical subspecialties (SO)) and factors contributing to their career choices, we conducted a survey among oncology interest groups sponsored by the American Society of Clinical Oncology (ASCO). Survey content emphasized relative impressions of oncology specialties, exposure to these fields during medical school, and perceptions of future employment prospects. An IRB-approved thirty-item questionnaire was distributed electronically via SurveyMonkey to US medical student members of ASCO sponsored interest groups. Participation was optional at the institutional and individual level and responses anonymous. Chi square test or Fisher's exact test was used to compare categorical variables. Two-hundred seventy-nine students completed the survey (37% male, 62% female; 42% White, 40% Asian, 18% underrepresented minorities). Students report receiving less exposure to radiation oncology during medical school: 19% report RO is not included in their curriculum vs. 4% for MO (p<0.01); 77% report receiving lectures from MO faculty, 33% from RO, and 41% from SO (p <0.01); 41% were encouraged to consider RO as a specialty, compared to 62 % for MO and 42% for SO (p < 0.01); 45% report having a clear understanding of role of MO in oncology care vs. only 25% for RO and 38% for SO (p<0.01); 41% saw MO as leaders of the multidisciplinary cancer team, 1 % for RO, and 2% for SO, 47% felt all played equal roles (p<0.01). Students have more negative perceptions of future career prospects for RO: 81% feel that job prospects for MO are strong, 55% for RO and 73% for SO (p<0.01); 54% feel strongly that jobs are available in desirable geographic locations for MO, 36% for RO, 48% for SO (p<0.01); 27% of students report concerns about the future viability of RO, 10% for MO, and 11% for SO (p<0.01). Compared to other oncology specialties, students have less exposure to RO, less understanding of the role of RO in multidisciplinary cancer care, and more pessimism about the future job market/specialty viability. These are likely contributing factors to declining interest in RO among graduates of US medical schools. Current radiation oncologists should increase efforts to improve medical student interest and understanding of RO.

The medical humanities at United States medical schools: a mixed method analysis of publicly assessable information on 31 schools

IntroductionThere have been increasing efforts to integrate the arts and humanities into medical education, particularly during undergraduate medical education (UME). Previous studies, however, have focused on courses and curricular programming without rigorous characterization of the associated paracurricular environment or infrastructure enabling or facilitating these offerings.MethodsTo assess opportunities for students to engage the arts and humanities during their medical education as well as the institutional resources to support those opportunities, we developed the Humanities and Arts Programming Scale (HARPS): an 18-point scale involving eight sub-domains (Infrastructure, Curricular Opportunities, Extracurricular Engagement, Opportunities for Immersion, Faculty Engagement, Staff Support, Student Groups, and Scholarship). This scale was used to evaluate the top-31 ranked United States medical schools as determined by US News and World Report’s (USWNR) Medical School Research Rankings using information derived from public-facing, online information.ResultsMean cumulative HARPS score was 11.26, with a median score of 12, a standard deviation of 4.32 and a score range of 3–17. Neither USWNR ranking nor private/public institution status were associated with the cumulative score (p = 0.121, p = 0.739). 52% of institutions surveyed had a humanities-focused center/division with more than 70% of the schools having significant (> 5) faculty engaged in the medical humanities. 65% of schools offered 10 or more paracurricular medical humanities events annually, while 68% of the institutions had more than 5 medical humanities student organizations. While elective, non-credit courses are available, only 3 schools required instruction in the arts and humanities, and comprehensive immersive experiences in the medical humanities were present in only 29% of the schools.ConclusionsAlthough there is a significant presence of the medical humanities in UME, there is a need for integration of the arts and humanities into required UME curricula and into immersive pathways for engaging the medical humanities.

The Significance of Physical Activity Education: A Survey of Medical Students

Introduction Less than 20% of US adults meet physical activity (PA) recommendations, yet few physicians provide consistent PA counseling. There is limited research on the state of education of PA counseling in medical school curricula. The purpose of this study was to analyze medical students’ perspectives on the current state and perceived quality of PA education in medical school. Methods An online survey was administered to the students of nine United States medical schools in January 2021. Descriptive statistics were used to analyze results. Results Of 5500 invited students, 1182 (21.5%) responded. Only 8% of students received any formal training on PA counseling for patient or self-use throughout their medical education. The majority (64% and 85%, respectively) of respondents felt that both learning more about the benefits of PA and gaining more practical skills in counseling on PA should be requirements to graduate. Students across all medical school years agreed that formal training on patient counseling for PA should be taught more in-depth. Conclusions Medical students believe that PA and exercise physiology should comprise more of medical education curricula. Such training may equip students with the tools they believe they need to adequately treat patients effectively throughout their careers.

Survey Study of Clerkship Curriculum on Learner's Choice to Pursue Surgery: Positive Impact of Extracurricular Opportunities

Prior studies have focused on the role of the learning environment on students' decisions to pursue surgery, but few have analyzed the impact of the clerkship curriculum. This study assessed surgical clerkship curricula across United States (US) medical schools and their impact on students' likelihood of pursuing a surgical residency. A cross-sectional survey was developed to assess surgery clerkship characteristics. Questions included clerkship duration, number of offered and required surgical services, method of service assignment, and number of advanced clinical electives (e.g., fourth-year sub-internships) and additional surgical clinical opportunities (e.g., surgical elective rotations). Survey results were merged by the Association of American Medical Colleges with the percentages of students who matched into a surgical specialty. Linear regression models estimated the association of covariates with the percentage of students who (1) matched in surgical specialties, (2) were interested in surgery at medical school matriculation and ultimately matched into surgical residency (retention rate), and (3) were not interested in surgery at medical school matriculation but ultimately matched into surgical residency (recruitment rate). The survey was distributed to clerkship directors and coordinators at 66 medical schools through the Association for Surgical Education (ASE) from 5/1/2021 to 8/1/2021. All US medical schools in the ASE. A total of 21 medical schools responded (34.8% response rate). The overall retention rate was 36.4%, and the overall recruitment rate was 25.0%. Clerkships were 4 to 12 weeks. In 81% of programs, students submitted preferences and were assigned services. The percentage of students applying to surgical specialties was not associated with clerkship duration (p=0.79) or the number of required services (p=0.15), subspecialty services offered (p=0.33), or advanced clinical electives (p=0.24) but was associated with a program's having additional surgical clinical opportunities (p=0.02). Most of these factors were not associated with retention or recruitment rates. Offering more extracurricular surgical clinical opportunities was associated with having more students pursue surgical careers. Though limited by a relatively small sample size, our findings suggest that having shorter clerkships or limited subspecialty offerings may not have a significant influence on students' career choices.