US Allopathic Medical Schools Research Articles

Understanding motivations behind medical student involvement in COVID-19 pandemic relief efforts

BackgroundAlthough students were removed from patient-facing settings at the beginning of the COVID-19 pandemic due to concerns of burdening teaching physicians and depleting personal protective equipment, some leaders suggest students can be effectively utilized when personnel resources may be scarce. There have been narrative discussions surrounding medical student involvement, but no studies exploring the attitudes of these students. The authors aim to quantify the degree to which factors influenced a medical student’s decision to or to not volunteer during the pandemic and to characterize medical students’ attitudes towards medical professionals’ duty to serve in a pandemic.MethodsThe authors developed and tested a secure web-based survey before distribution to students at 23 different US allopathic medical schools that did not graduate medical students early to aid in pandemic efforts between April and June 2020. Of the 599 students who completed the survey, 65.5% self-identified as female and were on average 25.94 years old (SD = 2.5). Multiple comparisons were made based on volunteer status. Ordinal scale questions were compared with the Mann Whitney U test, and the Chi-Squared test was used for categorical variables using R version 3.62.Results67.6% of students volunteered in pandemic relief activities and a majority of those students volunteered in non-patient-facing roles. Community service, new skills, and time commitment were top 3 influencing factors for students who volunteered, while risk to other, time commitment, and risk to self were top 3 influencing factors for students who chose not to volunteer. Compared to other specialties, students interested in primary care specialties agreed to a greater degree that physicians have a duty to serve in pandemic relief efforts.ConclusionsMedical students who volunteered cited self-serving factors and altruistic values as significant motivators. Students who did not volunteer were significantly more concerned with risks of COVID-19 exposure. However, medical students in general agreed that students should be allowed to volunteer in COVID-19 related relief efforts. As large areas of the United States continue to experience increases in COVID-19 cases, institutions should involve medical students in balancing the level of acceptable risk with the educational benefits.

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Assessing the Impact of Diverse Approaches of Promoting Virtual Radiation Oncology Educational Content to Medical Students

Association of the COVID-19 Pandemic With Medical School Diversity Pathway Programs

Medical school pathway programs are a strategy to increase the diversity of the physician workforce. The COVID-19 pandemic may have negatively affected pathway programs, further challenging efforts to increase diversity. To describe the changes in medical school pathway programs during the COVID-19 pandemic and identify methods for sustaining and supporting these programs during and after the pandemic. A survey study using an exploratory sequential mixed-method design was conducted from January 4 to August 3, 2021. Semistructured interviews with a sample of medical school pathway program administrators and academic leaders of US allopathic and osteopathic medical school diversity pathway programs identified themes and patterns of change to pathway programs since the onset of the pandemic compared with previous years. These themes were used to develop a survey that was sent to medical schools to assess the association between COVID-19 and their programs. The association between the COVID-19 pandemic and medical school diversity pathway programs was explored using interview and survey data assessing respondent characteristics; changes in the scope, size, and funding of programs in 2020 compared with previous years; and respondents' perceptions of future needs for pathway programs. Twelve program administrators and academic leaders were interviewed. Interviews revealed challenges and benefits of virtual programming in engaging and reaching students and speakers, the value of community partnerships to sustaining programming, and the importance of psychosocial support to mediating students' mental health challenges due to COVID-19 and remote learning. Of 198 schools surveyed in the quantitative phase, 112 responded (56.6%), 106 (94.6%) of which had been sponsoring or assisting with pathway programs during the COVID-19 pandemic. Forty-two respondents (39.6%) had reduced pathway programs since the onset of the COVID-19 pandemic compared with the previous year. Program cancellations were more likely to be noted in elementary school-aged (50.0% decrease in programming; P = .01) and middle school-aged (32.6%; P = .02) students compared with older groups. In this survey study, schools indicated that pathway programs were disrupted by COVID-19. Ongoing and flexible supports may be needed to sustain these programs. These findings are timely given recent investments in equity-focused programs to diversify the health workforce.

Step 1 is Pass/Fail, Now What? Can Clinical Clerkship Grades be Used as a Reliable Metric to Screen General Surgery Residency Applicants?

IntroductionFor decades, the three-digit United States Medical Licensing Exam Step 1 score has been used to competitively evaluate and compare candidates during the residency application process. Starting in 2022, however, all Step 1 scores will be converted to pass/fail. A different quantitative measure will likely gain importance in its stead, one such being clerkship performance grades. This study aims to determine the consistency of class rank and distribution of clerkship grades reported by medical schools for applicants to a general surgery program. MethodsCandidates’ Medical Student Performance Evaluation letters from 141 unique US allopathic medical schools were reviewed for student overall class rank, the number of grading tiers in each clerkship, and the percent achieving honors criteria in each clerkship from the 2020 application cycle. Comparative analysis was performed by region and medical school prestige. ResultsMost medical schools rank students using a four-tier system (e.g., fail, pass, high pass, and honors). A third of schools do not provide an overall class rank of students (34.7% of schools); this was most prevalent in the Northeast and Western regions. Schools in the Central US more often rank their students in five tiers compared to the South (P < 0.01). The percent of students that achieve the highest grading tier varies across the core clerkships (mean 37.1%, range 6.5%-78%); an average of 34.5% of students meet the highest honors tier in their Surgery clerkship. Students at US News and World Report Top 20 medical schools are more likely to receive the highest honors tier, across all core clerkships and overall class rank, than students at schools outside the Top 20 (P < 0.05). ConclusionsIn the absence of the United States Medical Licensing Exam Step 1 score, the variability in clerkship grading tiers and overall class rank will likely pose a challenge to residency programs’ ability to stratify desirable applicants. Further transparency and standardization may be required to compare students objectively and fairly from medical schools across the country.

Cost of the Otolaryngology Residency Application Process: Comparison With Other Specialties and Equity Implications.

ObjectiveThis study aims to assess trends in applicant-reported costs of the otolaryngology residency application process between 2019 and 2021 and evaluate the impact of application costs on number of interview offers.Study DesignCross-sectional study.SettingUS allopathic and osteopathic medical schools.MethodsSurvey data from applicants were obtained from the Texas STAR database (Seeking Transparency in Application to Residency) for the years 2019 to 2021. Outcomes included total cost, interview cost, other costs, application fees, and number of interview offers. Simple and multivariable linear regression was used to identify novel predictors of cost and assess the correlation between cost and interview offers.ResultsAmong 363 otolaryngology applicants, there was a 74% reduction in total costs and a 97% reduction in interview costs in the 2021 cycle vs the 2020 cycle. Significant predictors of total cost among otolaryngology applicants included the number of away rotations (P < .01), the number of research experiences (P = .04), and couples matching (P < .01). During the 2019 and 2020 application cycles, there was a significant association between applicant-reported total spending and number of otolaryngology interview offers (P < .01), which was not present during the 2021 cycle (P = .35).ConclusionNumber of otolaryngology interview offers appears to be directly correlated with applicant-reported total costs regardless of number of applications or interviews attended, which may be a source of inequality in the application process. There was a drastic reduction in total costs, interview costs, and other costs during the COVID-19 pandemic, which was likely driven by virtual interviewing and the absence of away rotations.

Impact of Medical Student Disciplinary Actions on the United States National Resident Match.

Introduction: Each year, the United States National Resident Matching Program describes the relative importance of a number of factors in the residency match for each speciality. However, the impact of disciplinary actions taken by a school when a student fails to meet certain expectations is not specifically evaluated but may have a major impact on a physician’s future performance.Methods: This study used electronic surveys sent to deans of medical education and residency program directors (PDs) to assess the way disciplinary actions are used at US allopathic medical schools, and the perceived implications of those actions on the residency match.Results: Thirty-three deans and 158 PDs participated (response rates of 26% and 22%, respectively). The median percentage of students put on probation each year as a function of class size was 3.3% (interquartile range [IQR] 2% to 6%). Three institutions reported putting greater than 10% of their students on probation each year and one institution reported putting 22% of their students on probation each year. A student's risk of failing to match was thought to be very or extremely likely (to deans and PDs, respectively) if there was a history of failed coursework (18.8% and 41.2%, p = 0.017), academic probation (34.4% and 67.1%, p = 0.009), or professionalism probation (78.1% and 83.9%, p = 0.016). The differences between each of the above types of disciplinary action’s impact on the likelihood of interviewing (p < 0.001) and risk of failure to match (p < 0.001) were also significant among both groups.Conclusion: Significant variability exists in the use and reporting of disciplinary actions at US medical schools. A history of these adverse actions, even if successfully remediated, was thought to negatively impact a student’s likelihood to interview and match. Greater standardization in the use and reporting of disciplinary actions would be appropriate to ensure equitable treatment of students nationwide.

Technology Literacy in Undergraduate Medical Education: Review and Survey of the US Medical School Innovation and Technology Programs

BackgroundModern innovations, like machine learning, genomics, and digital health, are being integrated into medical practice at a rapid pace. Physicians in training receive little exposure to the implications, drawbacks, and methodologies of upcoming technologies prior to their deployment. As a result, there is an increasing need for the incorporation of innovation and technology (I&T) training, starting in medical school.ObjectiveWe aimed to identify and describe curricular and extracurricular opportunities for innovation in medical technology in US undergraduate medical education to highlight challenges and develop insights for future directions of program development.MethodsA review of publicly available I&T program information on the official websites of US allopathic medical schools was conducted in June 2020. Programs were categorized by structure and implementation. The geographic distribution of these categories across US regions was analyzed. A survey was administered to school-affiliated student organizations with a focus on I&T and publicly available contact information. The data collected included the founding year, thematic focus, target audience, activities offered, and participant turnout rate.ResultsA total of 103 I&T opportunities at 69 distinct Liaison Committee on Medical Education–accredited medical schools were identified and characterized into the following six categories: (1) integrative 4-year curricula, (2) facilitated doctor of medicine/master of science dual degree programs in a related field, (3) interdisciplinary collaborations, (4) areas of concentration, (5) preclinical electives, and (6) student-run clubs. The presence of interdisciplinary collaboration is significantly associated with the presence of student-led initiatives (P=.001). “Starting and running a business in healthcare” and “medical devices” were the most popular thematic focuses of student-led I&T groups, representing 87% (13/15) and 80% (12/15) of respondents, respectively. “Career pathways exploration for students” was the only type of activity that was significantly associated with a high event turnout rate of >26 students per event (P=.03).ConclusionsExisting school-led and student-driven opportunities in medical I&T indicate growing national interest and reflect challenges in implementation. The greater visibility of opportunities, collaboration among schools, and development of a centralized network can be considered to better prepare students for the changing landscape of medical practice.

Evaluating the Current State of Ergonomics Education Offered to Students in US Medical Students.

The high rate of work-related musculoskeletal disorders (WMSD) among surgeons is well-documented and found to factor into medical students' interest in surgical specialties. Ergonomic techniques can reduce musculoskeletal pain in surgeons. Access to ergonomics education in residency is minimal and the ergonomics education offered in medical school has not been characterized. An anonymous, online survey was distributed to 210 administrators in medical education and curriculum at all accredited US allopathic medical schools. They were asked about their knowledge of ergonomics, assessment of potential benefits of ergonomics education to their students, and the ergonomics education offered at their institution. A total of 71 surveys were completed (33.8% response rate). 82% of schools reported familiarity with the study of ergonomics and 81% thought it would be beneficial to the future careers of their students to receive ergonomics education. Respondents estimated 43% of surgeons experience WMSDs and those that did not think ergonomics education would be beneficial to their students' future careers had a statistically significantly lower estimate of WMSD burden amongst practicing surgeons. Only one respondent reported that students at their institution receive greater than three hours of ergonomics education, while 98% reported their students will receive less than three hours. Considering this, 81% of respondents reported that students do have access to other resources that encourage ergonomic practices, such as gym access, yoga classes, and surgical simulation labs. Medical schools should increase access to ergonomics education and integrate it into their curriculum as early as possible.

Perceptions on Burnout and the Medical School Learning Environment of Medical Students Who Are Underrepresented in Medicine

Burnout is a highly prevalent issue among medical trainees, but there has been limited research characterizing burnout specifically among medical students from groups who are underrepresented in medicine (URIM). To assess the association between components of the medical school learning environment and burnout among medical students who are URIM vs those who are not. This retrospective cross-sectional survey study evaluated responses of allopathic medical students graduating from all US allopathic medical schools in 2016 and 2017 to the American Medical Colleges Graduation Questionnaire. Analysis was completed between December 1, 2019, and July 1, 2020. Self-identification as a medical student who is URIM. Self-reported measures of medical student overall, disengagement, and exhaustion-related burnout using the Oldenburg Burnout Inventory for Medical Students. The American Medical Colleges Graduation Questionnaire had an 81% response rate, yielding 26 567 complete participant responses that were included the analysis. A total of 13 645 individuals (51.4%) were male, and 3947 (14.9%) identified as URIM (ie, Alaska Native, Black, Hispanic/Latinx, Native American, and/or Pacific Islander). Medical students who are URIM reported modestly higher levels of exhaustion-related burnout (mean [SD], 11.84 [3.62] vs 11.48 [3.61]; P < .001) and modestly lower mean burnout scores associated with disengagement (mean [SD], 9.24 [3.56] vs 9.36 [3.58]; P = .047). Medical students who are URIM also reported marginally less favorable student-faculty interactions in the learning environment (mean [SD], 14.09 [3.45] vs 14.29 [3.35]; P < .001). Medical students who are URIM were more likely to be in the top quartile of those who experienced exhaustion-related burnout (odds ratio, 1.19 [95% CI, 1.09-1.29]) but less likely to be in the top quartile for disengagement (odds ratio, 0.87 [95% CI, 0.80-0.94]). Regardless of URIM status, those who reported learning environment scores in the bottom quartile were more likely to experience higher rates of burnout as were those who experienced at least 1 episode of discrimination. This survey study found that medical students who are URIM had a higher risk for exhaustion-related burnout. This burnout is likely multifactorial and could represent a resiliency or survival bias, the burden of increased responsibility, and/or recurrent discrimination. The learning environment can play a key role in mitigating burnout in both medical students who are URIM and those who are not and is deserving of further research.

Teaching About Intergenerational Dynamics: An Exploratory Study of Perceptions and Prevalence in US Medical Schools.

PurposePrior studies suggest a role for promoting recognition of generational differences as a part of workplace ethics. To our knowledge, there is no published comprehensive analysis demonstrating how commonly or by what methods intergenerational dynamics are taught as structured coursework in medical school curricula. To address this gap, we carried out a survey of curriculum leaders of US medical schools to assess the current practices and attitudes toward content related to generational differences in medical school coursework.MethodsA survey consisting of 23 closed- and open-ended questions that aimed to assess the presence, characteristics, and attitudes of participants towards intergenerational dynamics in medical school coursework was disseminated via email. Curriculum deans at 154 allopathic medical schools were invited to complete the survey and sent one reminder email. Quantitative responses were descriptively analyzed, and qualitative responses were thematically analyzed.ResultsThe response rate was 38.3%, with the majority (58%) of responding institutions stating that their curriculum did not include coursework on intergenerational dynamics. When taught, the most frequent method of instruction was small-group activities. Most stated that the educational content for intergenerational dynamics has been part of their curriculum for fewer than five years. In total, 34% of respondents agreed that some form of education about intergenerational dynamics should be required during medical education as they felt that content could improve cultural competence. Those that were less supportive of inclusion of intergenerational material stated concerns about stereotyping and the value of generational descriptions.ConclusionOur findings show a heterogeneity of responses on the perceptions and practice of curriculum leaders regarding inclusion of content related to intergenerational differences in medical school education. In summary, we present the first work assessing current practices and attitudes toward content related to the inclusion of material on intergenerational dynamics in undergraduate medical education in US allopathic medical schools.

How Did Coronavirus-19 Impact the Expenses for Medical Students Applying to an Orthopaedic Surgery Residency in 2020 to 2021?

Orthopaedic surgery is one of the most competitive specialties for residency applicants. For the 2021 residency match, the coronavirus-19 pandemic introduced complexity for programs and applicants because away rotations were limited and in-person interviews were cancelled. This may have changed the landscape in terms of expenses for candidates in important ways, but this topic has been insufficiently studied. Given that in 2021, students did not attend away rotations and all interviews were held virtually, we asked (1) What were the financial savings associated with this change? (2) Was medical school geographic region associated with differences in expenses when applying to residency? A retrospective, cross-sectional analysis of the 2020 and 2021 Texas Seeking Transparency in Application to Residency Dashboard database was performed. The data were derived from an online survey of a nationwide pool of applicants from 87% (123 of 141) of US allopathic medical schools upon conclusion of the match. The response percentage was 29% (521 of 1794). We believe this nationwide dataset represents the largest and most current data for this applicant group. Responses from applicants applying to orthopaedic surgery residency in the year before the COVID-19 pandemic application changes (2020) and during COVID-19 (2021) were queried and compared. After the orthopaedic surgery match, the database was evaluated for individual (application costs, away rotation expenses, and interview expenses) and total expenses for medical school seniors applying to orthopaedic surgery residency. Applicant characteristics were compared between application cycles. The 2020 to 2021 Texas Seeking Transparency in Application to Residency Dashboard database had 521 responses (n = 263 in 2020 and n = 258 in 2021) from applicants applying to orthopaedic surgery residency. Demographic and applicant characteristics were comparable between application cycles. Median expenses are reported with percentile distributions and geographic comparisons. A Mann-Whitney U test or Kruskal-Wallis H test was used to determine whether there were statistically significant differences in expenses between years and between medical school regions at a p value threshold of < 0.05. For all applicants, the median total expenses (USD 7250 versus USD 2250), application costs (USD 2250 versus USD 1750), away rotation expenses (USD 2750 versus USD 250), and interview expenses (USD 2250 versus USD 75) declined in 2021 compared with 2020 (all p < 0.001). The median total savings in expenses for all applicants in 2021 compared with 2020 was USD 5000. In 2021, median total expenses were lower in all geographic regions with the greatest savings from applicants in the West (USD 6000); in addition, the difference in median total expenses between the geographic region with the highest total expenses and the lowest total expenses was lower in the pandemic year than it was in the year prior (USD 1000 versus USD 1500; p < 0.001). In 2021, there were differences in total expenses between the Northeast (USD 1750), West (USD 1750), and Central (USD 2750) regions (p < 0.001). From 2020 to 2021, only application fees from Northeast applicants differed (USD 2250 versus USD 1250; p < 0.001). In 2020, interview expenses were not different between all regions (USD 2250 Northeast and West versus USD 2750 Central and South; p = 0.19); similarly in 2021, interview expenses were similar between all regions (USD 75 versus USD 75; p = 0.82). Finally, in 2020, Northeast (USD 3250) and Western (USD 3250) applicants spent more for away rotations than Southern (USD 2750) and Central (USD 2250) applicants (p = 0.01). In 2021, applicants from schools in the South (USD 250) and Central (USD 250) regions spent more than their counterparts (USD 0; p = 0.028). In the COVID-19 application cycle, the median expenditures of orthopaedic residency candidates were USD 5000 lower than they were in the previous year; the difference can be attributed to the use of virtual interviews and the lack of away rotations. There are geographic implications, with applicants from Western United States medical schools potentially saving the most. Despite the financial savings during the 2021 match, further study related to the long-term success of the current application process (both for applicants and programs) is needed. The recommendation in May 2020 by the AOA Council of Orthopaedic Residency Directors (CORD) to limit the number of applications submitted by candidates with USMLE Step 1 scores greater than 235 did not result in any considerable decline in applications submitted or expenses. A better understanding of how differences in these expenses may influence our specialty's ability to attract socioeconomically diverse candidates would be important, and we need to explore perceived and actual financial obstacles to obtaining this diversity in the application process. Finally, avenues should be explored by program directors and chairpersons to reduce the expenses of the traditional application process while maintaining recruitment of top candidates. Level IV, economic analysis.

Characteristics of Successful Integrated Plastic Surgery Applicants from US Allopathic Medical Schools without a Home Integrated Program

Integrated plastic surgery (PS) is one of the most competitive residency programs, but current literature lacks data specific to matched applicants from medical schools without home integrated PS residency programs (NHP). Therefore, there is a need to examine this specific demographic of applicants to identify key factors that led to a successful match. An anonymous survey was sent to PS residents who graduated from US allopathic medical schools with NHP. Survey questions focused on applicants' objective statistics (USMLE scores, research experiences, etc.), as well as various other factors, including access to resources and letters of recommendation. All US-based integrated plastic surgery residency programs. PGY-1 through PGY-6 integrated PS residents who graduated from US allopathic medical schools with NHP. The survey was distributed to 178 NHP residents from May to June of 2021, achieving a 55.1% response rate. Thirty-seven percent attended an institution with an independent, but not integrated, residency program. Average USMLE Step 1 and 2 scores were 248 ± 10.1 and 256 ± 9.7, respectively. Respondents reported having 9.8 ± 9.5 abstracts, presentations, and publications listed on their residency applications. NHP applicants had an average of 1.5 letters of recommendation written by away rotation faculty. Forty-five percent reported accessing resources at institutions with home integrated residency programs (HP), 55.6% of whom "strongly agreed" or "agreed" that this significantly helped in matching. The USMLE Step scores and research experiences of NHP residents are similar to those which are reported among all matched applicants nationally. NHP respondents optimized their success by utilizing plastic surgery-related resources at their own institutions, while often seeking resources at other institutions.

Student Substance Use Policies in US Allopathic Medical Schools

This quality improvement study examines US allopathic medical schools’ student handbook policies on substance use and assesses their adherence to current Association of American Medical Colleges guidelines.

Community and Academic Physicians Working Together in Integrated Health CareSystems.

ObjectiveTo examine best practices and policies for effectively merging community and academic physicians in integrated health care systems.MethodsDeans of US allopathic medical schools were systematically interviewed between February and June 2017 regarding growth in their faculty practice plan (FPP), including logistics and best practices for integration of community physicians.ResultsThe survey was completed by 107 of 143 (74.8) of US medical school deans approached. Of these institutions, 73 met criteria for final analysis (research-based medical schools with FPPs of >300 physicians). Most academic medical center–based FPPs have increased in size over the last 5 years, with further growth anticipated via adding community physicians (85%). Because of disparate practice locations, integration of community and academic physicians has been slow. When fully integrated, community physicians predominantly have a clinical role with productivity incentives. Deans report that cultural issues must be addressed to avoid conflict. Consensus exists that transparent clinical work requirements for all FPP members, clearly defined productivity incentives, additional promotion tracks, and early involvement of department chairs and other leaders enhances trust and creates better synergy among all physician providers.ConclusionFindings from this study should help guide FPPs, academic medical center leaders, chief medical officers, and professional and trade organizations in working toward positive physician synergy in consolidated health care organizations. Work and cultural considerations must be addressed to honor distinct talents of each physician group, facilitating smooth transition from disparate groups to healthy synergy.

Native Hawaiian and Other Pacific Islander Representation Among US Allopathic Medical Schools, Residency Programs, and Faculty Physicians

Native Hawaiian and Other Pacific Islander Representation Among US Allopathic Medical Schools, Residency Programs, and Faculty Physicians

Predicting United States Medical Licensing Examination Step 2 Clinical Knowledge Scores from Previous Academic Performance Measures within a Longitudinal Interleaved Curriculum.

BackgroundUnited States Medical Licensing Examination (USMLE) Step 1 is a common metric looked at by residency programs to determine invitations for candidates to interview. However, USMLE Step 2 Clinical Knowledge (CK) has also been an important factor for selecting applicants to interview and plays a significant role during applicant selection. This study aims to identify academic performance measures that correlate with USMLE Step 2 CK scores and to develop a model to predict USMLE Step 2 CK scores using previous academic measures from the first two cohorts in the longitudinal interleaved clerkship (LInC) at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas (KSOM).SettingThe KSOM is a newly accredited US allopathic medical school that accepted its first class in 2017. At KSOM, a LInC model is used in the primary clinical year. In this model, rotations are two weeks in duration before moving on to the next specialty. Students complete the National Board of Medical Examiners (NBME) subject examinations in all six specialties in one week at the midpoint and the end of the LInC. Students who passed an exam at the midpoint can opt out of that exam at the end as the higher of the two exam scores is recorded. However, most students choose to take all the exams again to improve their scores and prepare for USMLE Step 2 CK.MethodologyAcademic performance measures were gathered from the class of 2021 and 2022 (n = 101) including undergraduate grade point average (GPA), undergraduate science GPA, medical college admission test score, USMLE Step 1 score, NBME clinical subject exam scores, and USMLE Step 2 CK scores. Pearson correlations were run between the performance variables and USMLE Step 2 CK scores to measure influence variables individually, then a regression model measured impacts of variables together.ResultsAll variables except undergraduate science GPA significantly correlated with USMLE Step 2 CK score. USMLE Step 1 had the strongest correlation (r = 0.752, p < 0.001). The regression model had an R of 0.859 with the internal medicine subject exam showing the highest beta coefficient (0.327, p < 0.001).ConclusionsThis study determined that USMLE Step 2 CK scores can be effectively predicted using available performance measures. With USMLE Step 1 becoming pass/fail in January 2022, the importance of USMLE Step 2 CK as a screening tool in the residency application process will likely increase. This study was conducted within a LInC curriculum and may have limited value in the prediction of scores within other clinical year curricula.

Analysis of American Medical Students' Knowledge of Physical Activity Recommendations.

The benefits of physical activity (PA) are widely recognized; American medical schools have begun to emphasize PA, but the effectiveness of these changes is unclear. We performed a cross-sectional analysis of medical students enrolled in US osteopathic and allopathic medical schools between August 2019 and May 2020. All participants completed an electronic survey about PA instruction across the 4 years of medical school. Objective information including hours and format of PA instruction was collected. Subjectively, participants reported their relative comfort discussing various aspects of PA education with patients. A total of 480 medical students completed the survey, representing 82 of the 192 US medical schools (69 allopathic, 13 osteopathic). Students are more comfortable discussing overall exercise benefits than exercise testing, exercise prescription, and exercise physiology (P<.0001). They also report more exposure to general PA guidelines related to overall PA duration than strength training (P<.0001). Students at allopathic and osteopathic schools reported similar outcomes regarding PA education, while students with class sizes under 200 reported increased familiarity with National Physical Activity Guidelines regarding PA duration (P<.0001) and strength training (P=.01). Despite recent efforts to improve PA education in medical school, students feel unprepared to apply their knowledge in a clinical setting and remain unaware of national PA guidelines. Future studies should determine how to practically integrate PA education longitudinally into curricula to change PA education from an afterthought to an essential component of medical school education.

Costs of a Train-the-Trainer Program to Teach Primary Care Faculty Mental Health Care.

Mental health care must improve in this country. With the worsening shortage of psychiatrists and other mental health professionals, the next generation of physicians in primary care will need to be better trained in mental health care. We estimate the direct cost of implementing an evidence-based Train-the-Trainer (3T) program to disseminate mental health training to allopathic medical school faculty; once trained, faculty can teach a much-enhanced curriculum of mental health care to medical students and residents. A combination of published standardized unit costs and an activity-based costing approach is used to estimate the direct costs (labor and nonlabor) for implementing the 3T program. The estimated direct cost of implementing the 3T program at one prototypical school, including the 12-month start-up period (1.1 million) and 18-month rollout period (8.6 million), is ∼9.7 million dollars. Successfully adopted in all US allopathic medical schools, the 3T program will provide over 3800 attitudinally competent and mental health skills-qualified primary care faculty members. They would then be available to train nearly 100,000 medical students per year and 55,000 primary care residents to be as competent in basic mental health care as in medical care. This 3T program will begin to meet the needs each year for the millions of adults with major mental disorders that now are largely unrecognized and untreated.

Current State of the Medical Student Performance Evaluation: A Tool for Reflection for Residency Programs.

The Medical Student Performance Evaluation (MSPE) provides important information to residency programs. Despite recent recommendations for standardization, it is not clear how much variation exists in MSPE content among schools. We describe the current section content of the MSPE in US allopathic medical schools, with a particular focus on variations in the presentation of student performance. A representative MSPE was obtained from 95.3% (143 of 150) of allopathic US medical schools through residency applications to the Zucker School of Medicine at Hofstra/Northwell in select programs for the 2019-2020 academic year. A manual data abstraction tool was piloted in 2018-2019. After training, it was used to code all portions of the MSPE in this study. The results were analyzed, and descriptive statistics were reported. In preclinical years, 30.8% of MSPEs reported data regarding performance of students beyond achieving "passes" in a pass/fail curriculum. Only half referenced performance in the fourth year including electives, acting internships, or both. About two-thirds of schools included an overall descriptor of comparative performance in the final paragraph. Among these schools, a majority provided adjectives such as "outstanding/excellent/very good/good," while one-quarter reported numerical data categories. Regarding clerkship grades, there were numerous nomenclature systems used. This analysis demonstrates the existence of extreme variability in the content of MSPEs submitted by US allopathic medical schools in the 2019-2020 cycle, including the components and nomenclature of grades and descriptors of comparative performance, display of data, and inclusion of data across all years of the medical education program.

Association Between Sexual Orientation, Mistreatment, and Burnout Among US Medical Students

Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. To evaluate whether medical student burnout differs by sexual orientation and whether this association is mediated by experiences of mistreatment. This cross-sectional study surveyed US medical students graduating from Association of American Medical Colleges (AAMC)-accredited US allopathic medical schools who responded to the AAMC graduation questionnaire in 2016 and 2017. Statistical analyses were performed from March 15, 2019, to July 2, 2020, and from November 20 to December 9, 2020. Burnout was measured using the Oldenburg Burnout Inventory for Medical Students, and sexual orientation was categorized as either heterosexual or lesbian, gay, or bisexual (LGB). Logistic regression models were constructed to evaluate the association between sexual orientation and experiencing burnout (defined as being in the top quartile of exhaustion and disengagement burnout dimensions) and to test the mediating association of mistreatment. From 2016 to 2017, 30 651 students completed the AAMC Graduation Questionnaire, and 26 123 responses were analyzed. Most respondents were younger than 30 years (82.9%) and White (60.3%). A total of 13 470 respondents (51.6%) were male, and 5.4% identified as LGB. Compared with heterosexual students, a greater proportion of LGB students reported experiencing mistreatment in all categories, including humiliation (27.0% LGB students vs 20.7% heterosexual students; P < .001), mistreatment not specific to identity (17.0% vs 10.3%; P < .001), and mistreatment specific to gender (27.3% vs 17.9%; P < .001), race/ethnicity (11.9% vs 8.6%; P < .001), and sexual orientation (23.3% vs 1.0%; P < .001). Being LGB was associated with increased odds of burnout (adjusted odds ratio, 1.63 [95% CI, 1.41-1.89]); this association persisted but was attenuated after adjusting for mistreatment (odds ratio, 1.36 [95% CI, 1.16-1.60]). The odds of burnout increased in a dose-response manner with mistreatment intensity. Lesbian, gay, or bisexual students reporting higher mistreatment specific to sexual orientation had and 8-fold higher predicted probability of burnout compared with heterosexual students (19.8% [95% CI, 8.3%-31.4%] vs 2.3% [95% CI, 0.2%-4.5%]; P < .001). Mediation analysis showed that mistreatment accounts for 31% of the total association of LGB sexual orientation with overall burnout (P < .001). This study suggests that LGB medical students are more likely than their heterosexual peers to experience burnout, an association that is partly mediated by mistreatment. Further work is needed to ensure that medical schools offer safe and inclusive learning environments for LGB medical students.