US Medical Licensing Research Articles

May the Interview Be With You: Signal Your Preferences.

May the Interview Be With You: Signal Your Preferences.

Differences in Medical Students' Academic Performance between a Pass/Fail and Tiered Grading System.

Medical school implementation of a pass/fail grading system offers the opportunity for a reduction in student stress and anxiety and the creation of a less competitive environment, leading to an improvement in overall well-being. Some critics of a pass/fail system have raised concerns of a decrement in academic performance. The purpose of this research project was to determine whether medical students at the Medical College of Georgia experienced a significant change in academic performance when graded using a pass/fail grading system rather than a tiered grading system in the year 1 curriculum. This retrospective cohort study included a convenience sample of two cohorts of students: the first had tiered grading in the first year of medical school (classes of 2015 and 2016; n = 389) and the second cohort had pass/fail grading in the first year of medical school (classes of 2017 and 2018; n=385). Students' undergraduate grade point average and Medical College Admission Test scores in the two cohorts were compared. The first- and second-year averages and comprehensive finals, and the US Medical Licensing Examination step 1 scores were compared. Mann-Whitney U tests were calculated to compare the cohorts' grades. Overall, both cohorts performed similarly in the first and second year of medical school and on US Medical Licensing Examination step 1; however, there were a few unimportant but statistically significant differences of 1 to 2 points on a 100-point scale. In a few instances, the pass/fail cohort performed slightly better and in others, slightly worse. Overall academic performance was similar. The potential for an enhanced learning environment associated with pass/fail grading does not create an important decrement in academic performance.

Association of Clinical Specialty With Symptoms of Burnout and Career Choice Regret Among US Resident Physicians

Burnout among physicians is common and has been associated with medical errors and lapses in professionalism. It is unknown whether rates for symptoms of burnout among resident physicians vary by clinical specialty and if individual factors measured during medical school relate to the risk of burnout and career choice regret during residency. To explore factors associated with symptoms of burnout and career choice regret during residency. Prospective cohort study of 4732 US resident physicians. First-year medical students were enrolled between October 2010 and January 2011 and completed the baseline questionnaire. Participants were invited to respond to 2 questionnaires; one during year 4 of medical school (January-March 2014) and the other during the second year of residency (spring of 2016). The last follow-up was on July 31, 2016. Clinical specialty, demographic characteristics, educational debt, US Medical Licensing Examination Step 1 score, and reported levels of anxiety, empathy, and social support during medical school. Prevalence during second year of residency of reported symptoms of burnout measured by 2 single-item measures (adapted from the Maslach Burnout Inventory) and an additional item that evaluated career choice regret (defined as whether, if able to revisit career choice, the resident would choose to become a physician again). Among 4696 resident physicians, 3588 (76.4%) completed the questionnaire during the second year of residency (median age, 29 [interquartile range, 28.0-31.0] years in 2016; 1822 [50.9%] were women). Symptoms of burnout were reported by 1615 of 3574 resident physicians (45.2%; 95% CI, 43.6% to 46.8%). Career choice regret was reported by 502 of 3571 resident physicians (14.1%; 95% CI, 12.9% to 15.2%). In a multivariable analysis, training in urology, neurology, emergency medicine, and general surgery were associated with higher relative risks (RRs) of reported symptoms of burnout (range of RRs, 1.24 to 1.48) relative to training in internal medicine. Characteristics associated with higher risk of reported symptoms of burnout included female sex (RR, 1.17 [95% CI, 1.07 to 1.28]; risk difference [RD], 7.2% [95% CI, 3.1% to 11.3%]) and higher reported levels of anxiety during medical school (RR, 1.08 per 1-point increase [95% CI, 1.06 to 1.11]; RD, 1.8% per 1-point increase [95% CI, 1.6% to 2.0%]). A higher reported level of empathy during medical school was associated with a lower risk of reported symptoms of burnout during residency (RR, 0.99 per 1-point increase [95% CI, 0.99 to 0.99]; RD, -0.5% per 1-point increase [95% CI, -0.6% to -0.3%]). Reported symptoms of burnout (RR, 3.20 [95% CI, 2.58 to 3.82]; RD, 15.0% [95% CI, 12.8% to 17.3%]) and clinical specialty (range of RRs, 1.66 to 2.60) were both significantly associated with career choice regret. Among US resident physicians, symptoms of burnout and career choice regret were prevalent, but varied substantially by clinical specialty. Further research is needed to better understand these differences and to address these issues.

Education Research: Resident education through adult learning in neurology: Implementation and impact.

To enhance residency education by implementing the 6 principles of adult learning theory (ALT) in a large academic neurology residency program. We implemented a set of curricular interventions aimed at Resident Education through Adult Learning in Neurology (REAL Neurology), in a large, academic neurology residency program. Interventions included didactic reform, increasing resident-as-teacher activities, and enhancing residents' interaction. The primary outcome was the change in mean Residency In-service Training Examination (RITE) percentile between the preintervention and postintervention cohorts, adjusting for US Medical Licensing Examination step 1 and 2 score. Other analysis included evaluating the effect of the duration of intervention exposure on outcome and evaluating the intervention effect on the proportion of advanced performers. A total of 134 RITE score reports were evaluated (87 preintervention and 47 postintervention). The mean RITE score percentile postintervention was 11.7 points higher than preintervention (adjusted, longitudinal analysis: fit linear mixed model, p < 0.0001). Postgraduate year 3 learners who had 1 and 2 years of exposure scored 13.4 and 18.9 points higher than those with no exposure at all, respectively (analysis of covariance, p = 0.04). The adjusted odds of better performance with REAL Neurology was 5.77 (ordinal logistic regression, 95% confidence interval 2.37-14.07, p < 0.05). This study evaluated the efficacy and feasibility of an ALT-based curricular program in neurology education. The results show robust and sustainable benefit for residents in training without imposing a financial or logistical burden on programs. REAL Neurology could serve as a model for curricular reform in other programs across subspecialties.

Musculoskeletal Education in Medical Schools: A Survey of Allopathic and Osteopathic Medical Students

Background:Musculoskeletal (MSK) disorders are one of the most common causes of disability and emergency department and physician visits in the United States. However, there is very little consistency in how physicians in training are prepared to treat MSK disorders. On the basis of published reports, medical school graduates have a relative lack of cognitive mastery in MSK medicine, even with the recent increase in instruction. This study sought to compare MSK education at an allopathic medical school with that at an osteopathic medical school.Methods:An anonymous survey of students in medical school graduate years 2, 3, and 4 at Michigan State University College of Human Medicine (allopathic) and College of Osteopathic Medicine (osteopathic) was conducted. Questions were structured into three main categories: demographic information, content of the current MSK curriculum, and opinions regarding importance, instruction, and assessment of MSK education.Results:As of 2010, 83% of medical schools require MSK courses because of the United States Bone and Joint Initiative to incorporate such coursework into core curriculum. Yet only 54% of surveyed students thought that their MSK education was adequate. A greater portion of osteopathic students (57.1%) compared with allopathic students (26.8%) thought that their MSK curriculum is adequate, and as a consequence, 36.6% of allopathic students thought that they were inadequately prepared for the MSK content of US medical licensing examinations compared with 8.1% of osteopathic students. Further curriculum development and improvement is needed to advance physicians' abilities to address and treat MSK disorders. Medical students surveyed feel that this goal can be accomplished by emphasizing MSK education in third and fourth years of medical school.Conclusion:These findings highlight differences in MSK education between an allopathic and osteopathic medical school. Further standardization of the curriculum in medical schools may help improve the quality of teaching student comfort levels of new physicians.Level of Evidence:Level III

Improving Underrepresented Minority in Medicine Representation in Medical School.

Despite the efforts of various leading organizations in medical education, representation of black students in US medical schools has declined since the mid-1990s. The Florida State University College of Medicine (FSUCOM) has undertaken efforts to increase black and other underrepresented minority in medicine (URMM) representation in medical school through the Bridge to Clinical Medicine Program. This program is described and analyzed by the authors. Demographic information, Medical College Admission Test scores, undergraduate grade point average, US Medical Licensing Examination (USMLE) scores (Steps 1 and 2), residency match information, and current practice location from 2006 to 2015 were collected from the FSUCOM. Data were analyzed using SAS and linear regression analyses were performed, comparing Bridge students with the College of Medicine and national averages. Sixty percent of Bridge students were black, 21% were other URMM, and the remainder were non-URMM. Black Bridge students scored 7.4 points lower on their Medical College Admission Test, and other-URMM Bridge students scored 6.0 points lower (P < 0.0001) than their non-URMM non-Bridge classmates. Black Bridge students also started with a grade point average that was 0.28 points lower than their non-URMM non-Bridge counterparts, but there was no statistical difference for other-URMM Bridge students. Black students, regardless of Bridge participation, were less likely to pass USMLE Step 1 when compared with non-URMM classmates (P < 0.0001). For USMLE Step 2, however, there were no significant differences in passing rates for Bridge students compared with non-Bridge students. The FSUCOM Bridge program has not only increased its URMM enrollment but it also has effectively doubled the number of black students in its medical college. Other universities could produce similar results using the program outlined in this article.

A progressive three-phase innovation to medical education in the United States

ABSTRACTThe practice of medicine has changed greatly over the past 100 years, yet the structure of undergraduate medical education has evolved very little. Many schools have modified their curricula to incorporate problem-based learning and organ systems-based curricula, but few schools have adequately addressed rising tuition costs. Undergraduate medical education has become cost-prohibitive for students interested in primary care. In the meanwhile, the concept of a separate dedicated intern year is outdated and mired in waste despite remaining a requirement for several hospital-based and surgical specialties. Described here is an innovative approach to medical education which reduces tuition costs and maximizes efficiency, based on principals already employed by several schools. This integrated curriculum, first suggested by the author in 2010, keeps the current USMLE system in place, exposes medical students to patient care earlier, expands and incorporates the ‘intern’ year into a four-year medical training program, provides more time for students to decide on a specialty, and allows residency programs to acquire fully-licensed practitioners with greater clinical experience than the status quo.Abbreviations: MCAT: Medical college admission test; USMLE: US medical licensing examination

Evaluation of Validity Evidence for Personality, Emotional Intelligence, and Situational Judgment Tests to Identify Successful Residents

The ability to identify candidates who will thrive and successfully complete their residency is especially critical for general surgery programs. To assess the extent to which 3 screening tools used extensively in industrial selection settings-emotional intelligence (EQ), personality profiles, and situational judgment tests (SJTs)-could identify successful surgery residents. In this analysis, personality profiles, EQ assessments, and SJTs were administered from July through August 2015 to 51 postgraduate year 1 through 5 general surgery residents in a large general surgery residency program. Associations between these variables and residency performance were investigated through correlation and hierarchical regression analyses. Completion of EQ, personality profiles, and SJT assessments. Performance in residency as measured by a comprehensive performance metric. A score of zero represented a resident whose performance was consistent with that of their respective cohort's performance; below zero, worse performance; and greater than zero, better performance. Of the 61 eligible residents, 51 (84%) chose to participate and 22 (43%) were women. US Medical Licensing Examination Step 1 (USMLE1), but not USMLE2, emerged as a significant factor (t2,49 = 1.98; β = 0.30; P = .03) associated with overall performance. Neither EQ facets nor overall EQ offered significant incremental validity over USMLE1 scores. Inclusion of the personality factors did not significantly alter the test statistic and did not explain any additional portion of the variance. By contrast, inclusion of SJT scores accounted for 15% more of the variance than USMLE1 scores alone, resulting in a total of 25% of the variance explained by both USMLE1 and SJT scores (F2,57 = 7.47; P = .002). Both USMLE1 (t = 2.21; P = .03) and SJT scores (t = 2.97; P = .005) were significantly associated with overall resident performance. This study found little support for the use of EQ assessment and only weak support for some distinct personality factors (ie, agreeableness, extraversion, and independence) in surgery resident selection. Performance on the SJT was associated with overall resident performance more than traditional cognitive measures (ie, USMLE scores). These data support further exploration of these 2 screening assessments on a larger scale across specialties and institutions.

Editorial introductions

Current Opinion in Organ Transplantation was launched in 1996. It is part of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of organ transplantation is divided into 18 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Parsia A. VagefiParsia A. VagefiParsia A. Vagefi, MD, is the Associate Surgical Director of Liver Transplantation and the Surgical Director of Living Donor Liver Transplantation at Massachusetts General Hospital. In addition, Dr Vagefi is an Associate Professor of Surgery at Harvard Medical School. Dr Vagefi graduated with a BA in Biology from Johns Hopkins University, followed by medical school at Yale. During medical school, Dr Vagefi was a Howard Hughes Medical Institute Research Fellow at the Transplantation Biology Research Center with Dr David H. Sachs where he investigated large animal models of allotransplantation and xenotransplantation. Dr Vagefi completed his general surgery residency at the Massachusetts General Hospital, followed by an abdominal transplant surgery fellowship at the University of California, San Francisco, where he received the ASTS Novartis Fellowship in Transplantation Award. Dr Vagefi's clinical expertise is in adult and pediatric liver transplantation (including split-liver and living donor liver transplantation) and complex hepatobiliary surgery. Dr Vagefi is a Senior Investigator at the Center for Transplantation Sciences, with a research focus on a pre-clinical model of pig-to-baboon liver xenotransplantation, having now achieved the world's longest survival in pig-to-primate liver xenotransplantation utilizing a novel regimen of co-stimulation blockade combined with coagulation factor infusion. Peter FriendPeter FriendPeter Friend obtained his medical degree (MB BChir) from the University of Cambridge (Magdalene College). He is a Fellow of the Royal College of Surgeons (Eng) and has a doctoral degree (MD) from the University of Cambridge. After specialist training, he spent a year as Assistant Visiting Professor of Surgery, Indiana University, USA, initiating the Indiana liver transplant programme. In 1989, he returned to the UK as Lecturer in Surgery (Honorary Consultant Surgeon), University of Cambridge; he was also Fellow and Director of Studies in Medicine, Magdalene College, Cambridge. In 1999, he was appointed as Professor of Transplantation, University of Oxford (Honorary Consultant Surgeon); he is also Director of the Oxford Transplant Centre and Fellow of Green Templeton College. Peter Friend's clinical commitments include organ transplantation (kidney, pancreas, intestine) and hepatobiliary surgery. He heads a translational research group focusing on organ perfusion (liver/kidney), novel immunosuppressive strategies and pancreas transplantation. He is author of more than 200 scientific papers on clinical transplantation, immunosuppression, monoclonal antibodies, xenotransplantation, and liver perfusion. He is the Royal College of Surgeons national specialist lead for transplantation research. He is a past-President of the British Transplantation Society. Kathy Lee CoffmanKathy Lee CoffmanDr Kathy Coffman is an attending psychiatrist at the Cleveland Clinic Foundation, USA. She attended Wayne State School of Medicine, did an internship in Internal Medicine at Michael Reese Hospital in Chicago, and a psychiatry residency at the University of Chicago. She also did a two-year fellowship in Consultation Liaison Psychiatry at the University of Michigan. She is board certified in addiction psychiatry, geriatric psychiatry and psychosomatic medicine. She has been involved with the field of transplant psychiatry since her residency over the last twenty years. Dr Coffman's research interests include maintaining sobriety in alcoholic liver transplant recipients, HIV, and psychological issues in lung disease. She is a current member of the psychiatry committee for the National Board of Psychiatry and Neurology for development of test questions for the US Medical Licensing Examination. She has been involved in grant review for the National Institutes of Mental Health, and has been a reviewer for Psychomatics and other journals.

US Medical Licensing Examination Step 2 Clinical Knowledge Score in Dermatology Resident Selection

This survey analysis assesses the use of USMLE Step 2 CK scores in resident selection in US dermatology residency programs.

Development of Statistical Models to Predict Medical Student Performance on the USMLE Step 1 as a Catalyst for Deployment of Student Services

The purpose of this study was to explore whether useful regression models could be developed to predict student performance on the US Medical Licensing Examination (USMLE) Step 1, using pre-matriculation data and student performance outcomes available as early in the curriculum as possible. Additionally, we sought to determine if we could establish a model by which we could identify students who may need supplemental instruction early in the curriculum. Regression modeling revealed that a fairly strong predictive relationship exists when combining certain internally developed summative assessments and the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) with pre-matriculation variables. However, in our best regression model, > 40% of the overall variance in Step 1 scores could not be explained by the model. As a consequence, we propose using this type of modeling to facilitate timely deployment of student services to support individual students who are struggling. Future studies will focus on understanding what additional human factors fill this gap including student motivation, affect, and the factors that help students become “expert learners” (e.g., interactions with senior students, identification of test preparation materials).

United States Medical Licensing Examination and American Board of Pediatrics Certification Examination Results: Does the Residency Program Contribute to Trainee Achievement

To determine whether training site or prior examinee performance on the US Medical Licensing Examination (USMLE) step 1 and step 2 might predict pass rates on the American Board of Pediatrics (ABP) certifying examination. Data from graduates of pediatric residency programs completing the ABP certifying examination between 2009 and 2013 were obtained. For each, results of the initial ABP certifying examination were obtained, as well as results on National Board of Medical Examiners (NBME) step 1 and step 2 examinations. Hierarchical linear modeling was used to nest first-time ABP results within training programs to isolate program contribution to ABP results while controlling for USMLE step 1 and step 2 scores. Stepwise linear regression was then used to determine which of these examinations was a better predictor of ABP results. A total of 1110 graduates of 15 programs had complete testing results and were subject to analysis. Mean ABP scores for these programs ranged from 186.13 to 214.32. The hierarchical linear model suggested that the interaction of step 1 and 2 scores predicted ABP performance (F[1,1007.70] = 6.44, P = .011). By conducting a multilevel model by training program, both USMLE step examinations predicted first-time ABP results (b = .002, t = 2.54, P = .011). Linear regression analyses indicated that step 2 results were a better predictor of ABP performance than step 1 or a combination of the two USMLE scores. Performance on the USMLE examinations, especially step 2, predicts performance on the ABP certifying examination. The contribution of training site to ABP performance was statistically significant, though contributed modestly to the effect compared with prior USMLE scores.

Racial Disparities in Medical Student Membership in the Alpha Omega Alpha Honor Society

Previous studies have found racial and ethnic inequities in the receipt of academic awards, such as promotions and National Institutes of Health research funding, among academic medical center faculty. Few data exist about similar racial/ethnic disparities at the level of undergraduate medical education. To examine the association between medical student race/ethnicity and induction into the Alpha Omega Alpha (AΩA) honor society. This study analyzed data from the Electronic Residency Application Service, the official service used by US medical students to apply to residency programs. A total of 4655 US medical students from 123 allopathic US medical schools who applied to 12 distinct residency programs associated with one academic health center in the 2014 to 2015 academic year were studied. Membership in the AΩA society among black, white, Hispanic, and Asian medical students. A total of 4655 unique applications were analyzed in the study (median age, 26 years; 2133 women [45.8%]). Overall, self-reported race/ethnicity in our sample was 2605 (56.0%) white (691 [71.5%] of AΩA applicants were white), 276 (5.9%) black (7 [0.7%] AΩA), 186 (4.0%) Hispanic (27 [2.8%] AΩA), and 1170 (25.1%) Asian (168 [17.4%] AΩA). After controlling for US Medical Licensing Examination Step 1 scores, research productivity, community service, leadership activity, and Gold Humanism membership, the study found that black (adjusted odds ratio [aOR], 0.16; 95% CI, 0.07-0.37) and Asian (aOR, 0.52; 95% CI, 0.42-0.65) medical students remained less likely to be AΩA members than white medical students. No statistically significant difference was found in AΩA membership between white and Hispanic medical students (aOR, 0.79; 99% CI, 0.45-1.37) in the adjusted model. Black and Asian medical students were less likely than their white counterparts to be members of AΩA, which may reflect bias in selection. In turn, AΩA membership selection may affect future opportunities for minority medical students.

Aesthetic Surgery Fellowship Selection Criteria: A National Fellowship Director Survey.

Desirable candidate characteristics for aesthetic surgery fellowship applicants remain unknown because of a lack of data in the literature. This study aims to identify the criteria used to select applicants for aesthetic surgery fellowship in the United States. A 38-question survey was sent in April 2015 to all directors of fellowships endorsed by the American Society for Aesthetic Plastic Surgery (n = 20) in the United States. The survey investigated various factors including residency training and fellowship interview. A 5-point Likert scale was used to grade 33 influential factors from 1 ("not at all important") to 5 ("essential"); a separate 5-point Likert scale was used for 5 controversial factors from 1 ("very negative impact") to 5 ("very positive impact"). Sixty-five percent (13 out of 20) of directors responsed. The most important factors were letters of recommendation by well-established plastic surgeons (4.6 ± 0.7), interpersonal skills (4.5 ± 0.8), overall interview performance (4.5 ± 0.7), professionalism and ethics (4.4 ± 1.0), and letters of recommendation by aesthetic surgeons (4.4 ± 1.2). The least important factors were Alpha Omega Alpha Honor Medical Society membership (1.8 ± 0.6), postgraduate degrees (1.9 ± 0.9), US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK)/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Cognitive Evaluation and USMLE/COMLEX Step 3 score (1.9 ± 0.9), and research fellowships (2.0 ± 0.6). This study provides data on the aesthetic surgery fellowship directors' perceptions about the criteria important for applicant selection. We trust that fellowship directors, residency programs, and applicants find this data useful as they prepare for the aesthetic surgery fellowship match.

Fourth-Year Medical School Course Load and Success as a Medical Intern.

The fourth year of medical school has come under recent scrutiny for its lack of structure, cost- and time-effectiveness, and quality of education it provides. Some have advocated for increasing clinical burden in the fourth year, while others have suggested it be abolished. To assess the relationship between fourth-year course load and success during internship. We reviewed transcripts of 78 internal medicine interns from 2011-2013 and compared the number of intensive courses (defined as subinternships, intensive care, surgical clerkships, and emergency medicine rotations) with multi-source performance evaluations from the internship. We assessed relative risk (RR) and 95% confidence interval (CI) of achieving excellent scores according to the number of intensive courses taken, using generalized estimating equations, adjusting for demographics, US Medical Licensing Examination (USMLE) Step 1 board scores, and other measures of medical school performance. For each additional intensive course taken, the RR of obtaining an excellent score per intensive course was 1.05 (95% CI 1.03-1.07, P < .001), whereas the RR per nonintensive course taken was 0.99 (95% CI 0.98-1.00, P = .03). An association of intensive course work with increased risk of excellent performance was seen across multiple clinical competencies, including medical knowledge (RR 1.08, 95% CI 1.04-1.11); patient care (RR 1.07, 95% CI 1.04-1.10); and practice-based learning (RR 1.05, 95% CI 1.03-1.09). For this single institution's cohort of medical interns, increased exposure to intensive course work during the fourth year of medical school was associated with better clinical evaluations during internship.

Factors Associated with Performance in an Internal Medicine Clerkship

The purpose of this retrospective study was to examine the relationship between demographic and educational variables and student performance on an internal medicine (IM) clerkship in order to target areas for educational intervention and potential early remediation. This study examined data associated with third-year medical student performance (N = 505) during the IM clerkship at Baylor Scott & White, Temple/Texas A&M Health Science Center College of Medicine from 2005 to 2011. Multiple regression analysis (N = 341) showed that a model containing the following variables was significantly associated with scores on the National Board of Medical Examiners (NBME) subject exam, accounting for 46.5% of the variance: Objective Structured Clinical Exam (OSCE), Medical College Admissions Test (MCAT), US Medical Licensing Exam (USMLE) Step 1, second-year grade point average (GPA), and clinical evaluation. A model containing USMLE Step 1, clinical evaluation, and NBME was significantly associated with OSCE score, accounting for 30% of the variance. Additionally, a model containing age, MCAT score, undergraduate GPA, NBME subject exam score, and OSCE was significantly associated with clinical evaluation score, accounting for 22% of score variance. Age accounted for the most unique variance in clinical evaluation score. Gender and IM interest group were not significantly associated with any outcome variable. In conclusion, in contrast to previous studies in the field, we did not find a significant association between undergraduate GPA and NBME score. Our findings supply further evidence that the OSCE, typically believed to be a clinical performance exam, actually assesses a broader set of domains. Interest group membership did not confer any academic benefit to medical students in IM clerkships in our study.

Plastic Surgery In-training Exam Scores Correlate with US Medical Licensing Exam Step 1 and 2 Scores

Plastic Surgery In-training Exam Scores Correlate with US Medical Licensing Exam Step 1 and 2 Scores

Revisiting 'The effect of assessments and examinations on the learning of medical students'.

Revisiting 'The effect of assessments and examinations on the learning of medical students'.

A Symposium-Based Self-Directed Learning Approach to Teaching Medical Cell Biology to Medical Students

The Commonwealth Medical College has used a variety of self-directed learning pedagogies to promote the student’s performance and knowledge retention since its inception in 2009. Based on this goal, a Cell Biology Symposium was designed to allow students to present medical cell biology concepts to their peers. It was believed that by utilizing a team-based learning strategy, this would enhance the students’ learning. This is a study that describes how well medical students mastered medical cell biology concepts in a classroom lecture-based format versus a peer-teaching format arranged as a Medical Cell Biology Symposium. We analyzed the list of cell biology concepts that medical students were required to understand according to guidelines published by the 2009 US Medical Licensing Examination (USMLE) Step 1 Content Description and General Information (2008) and chose eight appropriate subjects and associated diseases that would cover these concepts. The 65 students in the 2009 class were assigned to teams and given faculty selected papers. Their goal was a PowerPoint presentation to their fellow students, designed on updating the class on the changes in medical knowledge since their assigned paper was published, including associated learning objectives and an annotated bibliography. We analyzed a student-derived, take-home test and a multiple-choice test given to the subsequent class of 2010, also composed of 65 students. As expected, scores for the open-book take-home test were much higher than the scores in a closed-book, multiple-choice examination given in the subsequent year. Our data indicate that satisfaction with an activity does not necessarily correlate with knowledge of this subject area in test performance and that this type of self-directed learning activity is an excellent way to deliver cell biology content to medical students. The real value of the Cell Biology Symposium may lie more in improving student skills in communication, problem solving, leadership, and working together as a team. These skills will be at least as important to the future success of our medical students as their mastery of the basic science, in this case cell biology, associated with the practice of medicine.

Physician Migration: Experience of International Medical Graduates in the USA

The purpose of this study was to explore the experience of foreign-born international medical graduates (IMGs) in the USA. Few studies describe IMG experiences in attaining medical licensure in the USA at each step of the process. Furthermore, little is known about IMGs who choose not to become a licensed physician or were unsuccessful in doing so. In this study, 20 foreign-born IMGs, 16 practicing IMGs and 4 non-licensed physician IMGs, participated in a 1-h semi-structured face-to-face interview between September 2013 and April 2014. Participants were from North America (Canada), Latin America, South Asia, East Asia, Europe, the Middle East, or Sub-Saharan Africa. Interviews were transcribed. Two of the authors conducted initial analysis of each interview separately. Four primary themes emerged based on the data analysis: (1) barriers to physician careers include the immigration process, years since graduating from medical school, language and culture, and cost and time; (2) positive factors to support physician careers include networking and research experience; (3) factors that positively or negatively affect IMGs seeking physician careers such as the education system in a home country and family; and (4) non-physician careers. In order to develop multiple pathways to utilize IMGs in the US healthcare system, future research examining the following areas is necessary: (1) support systems for IMGs who are taking the US Medical Licensing Exam (USMLE) or applying for a residency position and (2) the experience of IMGs who are not certified physicians in the USA.