US Medical Schools Research Articles

Prevalence of visual art education in medical school curricula: a national survey of US medical schools

ABSTRACT Background: The Association of American Medical Colleges (AAMC) has recommended integrating medically-relevant arts and humanities curricula into medical student education in order promote physician skills development. An analysis of the state of existing visual arts-based medical school pedagogies was conducted to inform future implementation strategies. Methodology: An electronic survey was distributed to representatives of US medical schools to describe the prevalence and characteristics of visual arts-based medical school curricula. Official courses, informal events, cross-registration opportunities, and established art museum partnerships were assessed. Results: Survey response rates were 65% for US allopathic medical schools and 56% for osteopathic medical schools. A majority (79%) of responding institutions incorporate or support medical student art experiences in some format. Thirty-one percent (n = 36) of schools offer stand-alone humanities courses using visual arts. These were primarily allopathic programs (n = 35; 37% of allopathic programs) and only one responding osteopathic program (n = 1; 5% of osteopathic programs). Schools without dedicated courses are less likely to report other curricular and extracurricular visual arts engagement. Most visual art medical courses are offered at medical schools located in the Northeastern United States. Conclusions: Many but not all medical schools are incorporating the visual arts into their medical education curriculum. Opportunities to promote increased uptake, more effective implementation, and collaboration strategies for the AAMC recommendations are proposed.

Measuring the development of a medical professional identity through medical school

Purpose The Professional Identity Essay (PIE) is a theory and evidence-based Medical Professional Identity Formation (MPIF) measure. We describe trajectories of PIE-measured MPIF over a 4-year US medical school curriculum. Methods Students write PIEs at medical school orientation, clinical clerkships orientation, and post-advanced (near graduation) clerkship. A trained evaluator assigns an overall stage score to narrative responses to nine PIE prompts (inter-rater ICC 0.83, 95% CI [0.57 − 0.96], intra-rater ICC 0.85). Distribution of PIE stage scores across time points were analyzed in the aggregate and individual students were classified as Increase, Stable (no score change) or Decrease based on the trajectories of PIE stage scores over time. Results 202 students completed 592 PIEs from 2018-2023. There was a significant change in the proportion of PIEs in stages over time (X2 84.40, p < 0.001), 47% (n = 95) students were categorized in the Increase trajectory, 45.5% (n = 92) as Stable and 7.4% (n = 15) as Decrease. Older age and time-predicted stage scores change within trajectories (p < 0.05). Conclusions Medical students’ PIE stage scores increase over time with three distinctive trajectories. Further study is needed to explore the utility of this method for formative assessment, program evaluation, and MPIF research.

Strategies for Structuring Health Systems Science Curriculum in the Korean Medical Education: A Study Based on an Analysis of the Domestic Status of Health Systems Science Education and Case Studies of US Medical Schools

Health systems science (HSS) is recognized as the third pillar of medical education. alongside basic and clinical sciences. Today’s physicians must also be systems thinkers who are able to discern how social, economic, environmental, and technological forces influence clinical decision-making. This study aimed to propose strategies for structuring an HSS curriculum that is tailored to the Korean healthcare and medical education context. First, the authors of this study conducted a survey to identify the present curricular contents of HSS related education at Korean medical schools. Second, a needs assessment was performed to determine the necessity of HSS competencies, as well as the prerequisites for the seamless integration of HSS into the existing curriculum. Third, literature reviews on HSS education at 14 US medical schools and expert consultations was conducted. We would like to propose a set of strategic approaches, classified into two levels: comprehensive and partial restructuring of the current medical curriculum to incorporate HSS. The partial restructuring approach entails a gradual, incremental incorporation of HSS content, while maintaining the current curricular structure. In contrast, a complete overhaul of the curriculum may be ideal to build HSS as the third pillar of medical education, but its feasibility remains relatively limited. The partial reorganization approach, however, has the advantage of being highly feasible. Collaborative efforts between professors and students are imperative to collectively devise effective methods for the seamless integration of HSS into the existing curriculum.

Cataloging formal medical student surgical funding opportunities: A retrospective characterization

Representation of female surgical residents has slowly increased, but underrepresented in medicine (URiM) representation remains disappointingly low. National residency matching reports suggest that meaningful research experience improves surgical residency match success - therefore, formal funding opportunities and early mentorship for URiM medical students. In this study, we catalog medical student (MS) funding opportunities (funding type, eligibility by year, mission, compensation, length of commitment, number of awardees, and dollar investment amount per student) from 7 surgical departments (general surgery, thoracic surgery, vascular surgery, plastic surgery, otorhinolaryngology, orthopedic surgery, neurosurgery) within 196 US medical schools and 20 professional surgical educational organizations through manually searching web pages. We recorded 146 surgical funding opportunities from medical school surgical departments and 16 surgical funding opportunities from professional organizations. Overall, we find that medical institutions' surgical departments and professional surgical educational organizations may not be effectively utilizing recruitment strategies in MS funding opportunities.

Listen Before You Auscultate: An Active-Learning Approach to Bedside Cardiac Assessment.

Bedside cardiac assessment (BCA) is deficient across a spectrum of noncardiology trainees. Learners not taught BCA well may become instructors who do not teach well, creating a self-perpetuating problem. To improve BCA teaching and learning, we developed a high-quality, patient-centered curriculum for medicine clerkship students that could be flexibly implemented and accessible to other health professions learners. With a constructivist perspective, we aligned learning goals, activities, and assessments. The curriculum used a "listen before you auscultate" framework, capturing patient history as context for a six-step, systematic approach. In the flipped classroom, short videos and practice questions preceded two 1-hour class activities that integrated diagnostic reasoning, pathophysiology, physical diagnosis, and reflection. Activities included case discussions, jugular venous pressure evaluation, heart sound competitions, and simulated conversations with patients. Two hundred sixty-eight students at four US and international medical schools participated. We incorporated feedback, performed thematic analysis, and assessed learners' confidence and knowledge. Low posttest data capture limited quantitative results. Students reported increased confidence in BCA ability. Knowledge increased in both BCA and control groups. Thematic analysis suggested instructional design strategies were effective and peer encounters, skills practice, and encounters with educators were meaningful. The curriculum supported active learning of day-to-day clinical competencies and promoted professional identity formation alongside BCA ability. Feedback and increased confidence on the late-clerkship posttest suggested durable learning. We recommend approaches to confirm this and other elements of knowledge, skill acquisition, or behaviors and are surveying impacts on professional identity formation-related constructs.

What Do Pediatric Subinterns Say About Their Learning and Assessment? A Qualitative Analysis of Individual Learning Plans

ObjectiveTo perform a qualitative content analysis of learning and assessment strategies that pediatric subinterns describe in Individualized Learning Plans (ILPs) and to explore barriers and facilitators to their learning. MethodsWe analyzed ILPs from medical students enrolled in pediatric subinternships at 10 US medical schools that utilized a standardized curriculum and were recruited to reflect diversity in geographic location, funding, and enrollment. Students used an ILP to record 3 or more selected learning objectives, rationale for selection, and reflection on learning and assessment strategies. Investigators used the constant comparative method to perform a content analysis of the ILPs, grouping codes into themes, and verifying relationships between codes within themes. ResultsTwo hundred and four ILPs that included student reflections on 850 learning objectives were analyzed. Content was analyzed in 5 categories: rationale for selecting objectives, learning strategies, assessment strategies, challenges to learning, and facilitators of learning. Students showed strong commitment to individualized, self-directed learning, developed a wide range of creative learning strategies, and relied heavily on self-reflection to assess their progress. The learning environment both helped and hindered students’ ability to make and assess progress on their selected learning objectives. ConclusionsThrough ILP-guided reflection and a formal curriculum, students can choose well-justified learning objectives and demonstrate resourcefulness and independence in developing self-directed learning and assessment strategies. The strategies that students identified in this study provide a menu of learning and assessment options for subinterns. Identified challenges and facilitators of learning provide guidance for educators who seek to enhance the clinical learning environment.

US medical school curriculum on opioid use disorder—a topic review of current curricular research and evaluation of winning student-designed opioid curricula for the 2021 Coalition on Physician Education in Substance Use Disorders curricular competition

The opioid crisis in the US severely affected and continues to affect population's health. The opioid crisis was in part fueled by inadequate pain management, which is in part due to the inadequate education in both pain and opioid use disorder (OUD) for health care professionals. In 2021, the Coalition on Physician Education in Substance Use Disorders (COPE) organized a curricular competition soliciting US medical students-designed OUD-related curricula. Twelve winning curricula were identified. Here, we first conducted a topic review regarding current US medical school OUD curricula. Then we evaluated the COPE winning curricula and compared them to the curricula identified in the topic review. For the topic review, ten relevant databases were searched up to December 31, 2021 using a combination of pre-determined keywords. Total of 25 peer-reviewed articles were selected based on the pre-determined criteria, which included 5 articles describing opioid curricular development at the state level (AZ, CA, MA, PA, and RI), 17 research articles evaluating a curriculum developed in a single institution, 2 literature reviews, and 1 article detailing curricular development and validation processes in a single institution. Although vary in organizations and formats, state-level curricula were comprehensive and could be adopted by other states or institutions with necessary local issue-based modifications. Faculty development and critical resources were major challenges for curricular implementation. The 17 research articles exhibited good scientific quality (Medical Education Research Study Quality Instrument (MERSQI) score = 11.94 ± 2.33 (maximal score = 18)). All research articles reported to some extent, the success of respective curriculum, in improving students' knowledge in and/or attitude towards OUD, based on primarily pre- and post- comparisons. Compared to these published curricula, winning students-designed curricula had more specific focuses, diverse learning activities, and varieties in assessment methods. For all curricula, long-term evaluations were lacking. Except for the state level curricula, majority of the other curricula did not emphasize specifically on chronic pain education or the biopsychosocial approach. Interprofessional education approach was also lacking. Our topic review and curricular evaluation highlighted the needs for integrating OUD and chronic pain medical curricula, developing long-term assessment tools, and more OUD curriculum research overall.

Policies to Support Lactation at Highly Ranked US Medical Schools

This cross-sectional study analyzes lactation support policies at the top 50 US schools of medicine.

Ophthalmology Faculty Diversity Trends in the US

Enhancing the diversity of ophthalmologists can potentially contribute to diminishing disparities in eye care. To investigate longitudinal trends in the representation of individuals underrepresented in medicine (URiM) and women among ophthalmology faculty compared with other specialties and to assess disparities between ophthalmology faculty demographic characteristics and the US population. In this cross-sectional study, a comprehensive analysis of Association of American Medical Colleges Faculty Roster data between 2000 and 2021 was conducted, using data from the US Medical School Faculty report on 56 438 ophthalmology faculty members. The data set was used to differentiate ophthalmology faculty members by gender, rank, and designation as a URiM individual. Outcome measures included changes in URiM and non-URiM faculty proportions, faculty rank, gender, department chair positions, and the US population between 2000 and 2021. A total of 56 438 ophthalmology faculty members (37 511 men [66.5%]) were included in the study. The number of ophthalmology faculty increased from 1820 in 2000 to 3151 in 2021. Across all years, URiM female faculty represented 3.1% of ophthalmologists (1733 of 56 438), while URiM men accounted for 3.5% (1983 of 56 438). Overall, non-URiM men constituted 63.0% of ophthalmologists (35 528 of 56 438), and non-URiM women accounted for 30.5% (17 194 of 56 438). The proportion of URiM male faculty remained stable from 2000 to 2021 (63 of 1820 [3.5%] vs 104 of 3151 [3.3%]), with a small increase in URiM women faculty at junior faculty positions (2000, 40 of 1820 [2.2%]; 2021, 129 of 3151 [4.1%]; difference, 1.9% [95% CI, 0.9%-2.9%]). Proportions of non-URiM men decreased from 71.2% (1295 of 1820) in 2000 to 55.3% (1743 of 3151) in 2021 (difference, 15.8% [95% CI, 13.1%-18.6%]) and proportions of non-URiM women increased from 23.2% (422 of 1820) in 2000 to 37.3% (1175 of 3151) in 2021 (difference, 14.1% [95% CI, 11.5%-16.7%]). In terms of faculty rank, there were increases in representation of women from 2000 to 2021 at assistant professor (from 11.2% [203 of 1819] to 19.7% [622 of 3165]; difference, 8.5% [95% CI, 6.5%-10.5%]), associate professor (from 4.6% [83 of 1819] to 8.6% [271 of 3165]; difference, 4.0% [95% CI, 2.6%-5.4%]), and professor levels (from 2.8% [51 of 1819] to 7.1% [223 of 3165]; difference, 4.3% [95% CI, 3.9%-6.1%]). URiM representation remained stable at most ranks. Compared with other specialties, ophthalmology had among the lowest percentage change in URiM faculty. The expansion of ophthalmology's URiM faculty representation was less than one-third that of the diverse US population. These findings highlight substantial growth in ophthalmology faculty and an increase in women's representation across several faculty ranks. However, URiM representation has remained largely unchanged, despite an increase at the associate professor level. This finding emphasizes the need for continued efforts to enhance diversity in academic ophthalmology.

Scholarly Productivity of US Medical Schools Before and During the COVID-19 Pandemic.

The coronavirus disease 2019 pandemic profoundly disrupted scientific research but was accompanied by a rapid increase in biomedical research focused on this new disease. We aimed to study how the academic productivity of US medical schools changed during the pandemic and what structural characteristics of medical schools were associated with trends in scholarly publication. Annual totals of publications for each US Doctor of Medicine-granting medical school were extracted for 2019 to 2021 from the Scopus database, and schools were categorized a priori as experiencing a sustained increase in publications, a transient increase in publications, or no increase in publications. Bivariate tests compared school characteristics among these three groups. Of 139 Doctor of Medicine-granting medical schools, 79% experienced sustained growth in publications from 2019 to 2021, 6% experienced transient growth, and 14% experienced no growth. Sustained growth in publications was associated with being affiliated with a research-intensive university, larger faculty size, the presence of an Emergency Medicine residency, having higher baseline National Institutes of Health funding, and experiencing higher coronavirus disease 2019 infection rates in the local community during the early months of the pandemic. Among predominantly White institutions, a higher diversity of female faculty was associated with a higher likelihood of experiencing transient rather than sustained growth in publications. Our results demonstrate that scientific output increased during the pandemic at most medical schools, despite significant barriers to research experienced by individual investigators. Further attention is needed to enhance equity in research opportunities, considering diverging trends in productivity between more- and less-advantaged schools, however.

Assessing the Finances of Applying to Surgical Residency in 2019-2020: A US Nationwide Surgical Specialties Comparison.

Background The costs of applying to residency programs may affect which students choose to apply to a specialty, yet few studies have compared expenses of applying to different surgical specialties. Objective To compare individual and total expenses for applicants applying to 5 US surgical specialties during an in-person interview and recruitment period. Methods Post-match survey data from 2019-2020, from senior applicants of 123 of 141 (87.2%) US medical schools, to orthopaedic surgery (OS), neurological surgery (NS), urology (UR), plastic surgery (PS), otolaryngology (OTO) programs, was analyzed for applicant characteristics and mean application, away rotation, interview, and total expenses. Kruskal-Wallis H tests compared differences in costs between specialties. P values <.05 were significant. Results The survey data included 1136 applicants, representing a response rate of 27%, with 459 applicants to OS, 121 to NS, 191 to UR, 117 to PS, and 248 to OTO. Mean application costs were different among the specialties: OS, $1,990; NS, $1,711; UR, $1,570; PS, $1,638; and OTO, $1,612 (P≤.003). Mean interview expenses also differed: OS, $3,129; NS, $6,400; UR, $3,915; PS, $5,486; and OTO, $3,540 (P≤.001) as well as away rotation expenses: OS, $3,182; NS, $3,840; UR, $2,640; PS, $4,074; and OTO, $2,437 (P≤.029). Mean total costs were high and differed among specialties: OS, $8,205; NS, $11,882; UR, $8,207; PS, $10,845; and OTO, $7,516 (P≤.029). Conclusions Applying to surgical residencies in the pre-pandemic era was expensive, with mean costs over $10,000 for NS and PS. The largest contribution to total costs were interview expenses.

Advising Orthopaedic Hopefuls in the Wake of a Pass/Fail US Medical Licensing Examination Step 1: A Proposed Method for Predicting US Medical Licensing Examination Step 2 Clinical Knowledge Outcomes.

Matching into orthopaedic residency has become difficult, and the US Medical Licensing Examination Step 1 transition to pass/fail scoring has complicated the process. Advisors' ability to mentor students has decreased, and program directors may rely on Step 2 Clinical Knowledge (CK) scores in selecting which candidates to interview. This study aims to offer a method to predict Step 2 CK outcomes based on preadmission and preclinical performance. The study investigated 486 students from a US medical school who enrolled in 2017 and 2018. Data on demographics, preadmission, and preclinical performance were collected. Before model creation, it was found that sex, Medical College Admission Test scores, Comprehensive Basic Science Examination performance, and preclinical curriculum performance produced optimal models. Multivariate ordinal logistic regression models were built to predict probabilities of four outcome levels of Step 2 CK: <235, 235 to 249, 250 to 265, and >265. Finally, nomograms were created to visualize probability calculations. Each model's odds ratios revealed that female sex, higher MCAT scores, and better Comprehensive Basic Science Examination and preclinical performance were associated with an increased likelihood of being in higher Step 2 CK scoring groups. Preclinical performance had a profound effect, especially for those in the top 1/3. Models were successful in assigning higher probabilities to students in higher Step 2 CK scoring groups in more than 80% of instances. Nomograms presented provide examples of how to apply these models to an individual student. This study presents a novel method for predicting probabilities of Step 2 CK outcomes that can be used to mentor students at a time point when Step 1 previously filled this role. It may assist in identifying orthopaedic hopefuls at risk of performing poorly on Step 2 CK and can foster the development of individualized guidance and mitigation strategies.

The Anesthesiology Physician-Scientist Pipeline: Current Status and Recommendations for Future Growth-An Initiative of the Anesthesia Research Council.

The limited number and diversity of resident physicians pursuing careers as physician-scientists in medicine has been a concern for many decades. The Anesthesia Research Council aimed to address the status of the anesthesiology physician-scientist pipeline, benchmarked against other medical specialties, and to develop strategic recommendations to sustain and expand the number and diversity of anesthesiology physician-scientists. The working group analyzed data from the Association of American Medical Colleges and the National Resident Matching Program to characterize the diversity and number of research-oriented residents from US and international allopathic medical schools entering 11 medical specialties from 2009 to 2019. Two surveys were developed to assess the research culture of anesthesiology departments. National Institutes of Health (NIH) funding information awarded to anesthesiology physician-scientists and departments was collected from NIH RePORTER and the Blue Ridge Medical Institute. Anesthesiology ranked eighth to tenth place of 11 medical specialties in the percent of "research-oriented" entering residents, defined as those with advanced degrees (Master's or PhDs) in addition to the MD degree or having published at least 3 research publications before residency. Anesthesiology ranked eighth of 11 specialties in the percent of entering residents who were women but ranked fourth of 11 specialties in the percent of entering residents who self-identified as belonging to an underrepresented group in medicine. There has been a 72% increase in both the total NIH funding awarded to anesthesiology departments and the number of NIH K-series mentored training grants (eg, K08 and K23) awarded to anesthesiology physician-scientists between 2015 and 2020. Recommendations for expanding the size and diversity of the anesthesiology physician-scientist pipeline included (1) developing strategies to increase the number of research intensive anesthesiology departments; (2) unifying the diverse programs among academic anesthesiology foundations and societies that seek to grow research in the specialty; (3) adjusting American Society of Anesthesiologists metrics of success to include the number of anesthesiology physician-scientists with extramural research support; (4) increasing the number of mentored awards from Foundation of Anesthesia Education and Research (FAER) and International Anesthesia Research Society (IARS); (5) supporting an organized and concerted effort to inform research-oriented medical students of the diverse research opportunities within anesthesiology should include the specialty being represented at the annual meetings of Medical Scientist Training Program (MSTP) students and the American Physician Scientist Association, as well as in institutional MSTP programs. The medical specialty of anesthesiology is defined by new discoveries and contributions to perioperative medicine which will only be sustained by a robust pipeline of anesthesiology physician-scientists.

Impact of parental status on US medical student specialty selection.

Medical training occurs during peak childbearing years for most medical students. Many factors influence specialty selection. The aims of this study were (i) to determine whether being a parent is a major deciding factor when picking a specialty and (ii) whether parents are more drawn to family-friendly specialties than non-parents. The authors performed a multicenter web-based survey study of medical students enrolled in Oregon Health and Science University, Dartmouth's Geisel School of Medicine, and University of Michigan Medical School. The 27-item instrument assessed parenthood status, specialty preference, specialty perceptions, and factors influencing specialty choice. A total of 537 out of 2236 (24.0%) students responded. Among respondents, 59 (10.9%) were current or expecting parents. The majority (359, 66.8%) were female and 24-35 years old (430, 80.1%). Of the students who were parents or expecting, 30 (50.9%) were female, and the majority (55, 93.2%) were partnered. Top specialties preferred by both parents and non-parents were family medicine, emergency medicine, obstetrics and gynecology (OB/GYN), internal medicine, psychiatry, and pediatrics. Specialties rated most family-friendly included family medicine, dermatology, pediatrics, psychiatry, radiology, emergency medicine, and pathology. The specialties rated least family-friendly were surgery, neurosurgery, orthopedic surgery, plastic surgery, and OB/GYN. These rankings were the same between groups. Passion for the field, culture of the specialty, and quality of life were the top three factors students considered when choosing a specialty. Being a parent or future parent ranked more highly for parents than non-parents, but was not in the top three factors for either group. US Medical School parents report that being a parent influenced their medical specialty choice "strongly" or "very strongly." However, being a parent was not weighed as heavily as passion for the field, culture of the specialty, and quality of life. These student-parents are entering perceived "non-family friendly" specialties at similar rates as their peers. US Medical school training and simultaneous parenting is daunting, yet student parents are putting their passion first when making a career choice. They must be supported.

Key factors for residency interview selection from the National Resident Matching Program: analysis of residency Program Director surveys, 2016-2020.

As the number of medical school graduates continues to outpace the available residency training positions, applying for residency in the United States has become a highly competitive process, often associated with a low rate of selection and invitation for interview. The National Resident Matching Program (NRMP) Program Director survey provides data assessing factors considered by Program Directors (PD) in selecting and inviting candidates for interview. Assessing the evolution of these factors over time is efficacious to inform and guide prospective applicants toward improving preparation for residency application. We aim to synthesize NRMP data showing factors that PDs reported and rated as important in their decision to select and invite applicants for interview. Data from residency PD surveys from 2008 to 2021were accessed, but after applying inclusion/exclusion criteria, only the data from 2016 to 2020 were reviewed and analyzed. The NRMP survey reports provided two metrics that characterized PDs' evaluation of the residency factors for interview, namely, "percent citing factor" and "average rating" on a 0 to 5 Likert-type scale. These two metrics were combined into an aggregate measure of importance (AI), and another measure of relative importance (RI) was constructed from normalizing the AI of each individual factor to the sum of the AI within each survey year. The top ranked factors were United States Medical Licensing Examination (USMLE) Step 1/Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 1, Letter of Recommendation (LOR) in the specialty, Medical Student Performance Evaluation (MSPE/Dean's Letter), and USMLE Step 2 Clinical Knowledge (CK)/COMLEX Level 2 Cognitive Exam (CE) score, any failed attempt in USMLE/COMLEX, and perceived commitment to specialty. Factors rising in importance were Audition Elective/Rotation Within Your Department, Personal Statement (PS), Perceived Commitment to Specialty, Perceived Interest in Program, LOR in the Specialty, Other Life Experience, and Personal Prior Knowledge of the Applicant. Factors with declining importance were Interest in Academic Career, Awards or Special Honors in Basic Sciences, Graduate of Highly Regarded US Medical School, Awards or Special Honors in Clinical Clerkships, Lack of Gaps in Medical Education, Awards or Special Honors in Clerkship in Desired Specialty, and Consistency of Grades. Compared to the 2021PD survey, our findings show continued predictive consistency, particularly related to specialty and program commitment. The factors identified for the selection of medical school graduates for interview into a residency program reveal that PDs move toward a more integrated approach. Specifically, PDs are placing increasing emphasis on factors that border on subjective qualities more so than the more traditional, quantitative, and objective metrics. Medical students and educators need to continually apprise themselves of the NRMP data to inform students' preparation endeavors throughout medical school to strengthen their application portfolios and enhance their competitiveness for the matching process.

Does Geographic Region of Away Rotations Predict Otolaryngology Match Outcomes?

To assess whether the geographic region where medical students complete an away rotation predicts the same site, region-specific, or overall interview offers and match success in otolaryngology. Cross-sectional. US medical schools. We queried the Texas Seeking Transparency in Application to Residency database to analyze outcomes of otolaryngology applicants during the 2018 to 2020 and 2022 match cycles. Outcomes included a number of interviews offered, geographic location of interviews, and match results, including region-specific and overall match success rate. Of 455 otolaryngology applicants, 402 (90.3%) completed an away rotation. Among these, 368 (91.8%) were offered an interview and 124 (30.9%) matched to the program where they completed an away rotation. Applicants who completed away rotations outside their home region received more interview offers from that region than those who did not (Northeast: 4.2 vs 2.9; South: 4.3 vs 3.0; Central: 4.8 vs 3.0; West: 3.8 vs 1.6, P < .01 for all). Completing a remote away rotation increased the odds of receiving an interview from and matching within that region. After excluding programs where an away rotation was completed, a remote away rotation increased the odds of receiving an interview in the central and western regions (Central: odds ratio [OR]: 1.2 [1.1, 1.5]); West OR: 1.9 [1.7, 2.2]; and the odds of matching in the western region (OR: 2.9 [1.2, 7.4], all P < .01). Away rotations are associated with increased odds of interviewing and matching at that away program, with possible associations across the region, most evident for the West coast.

Electronic health records and clinical documentation in medical residency programs: preparing residents to become master clinicians.

The ubiquity of electronic health records (EHRs) has made incorporating EHRs into medical practice an essential component of resident's training. Patient encounters, an important element of practice, are impacted by EHRs through factors that include increasing documentation requirements. This research sheds light on the role of EHRs on resident clinical skills development with emphasis on their role in patient encounters. We conducted qualitative semistructured interviews with 32 residents and 13 clinic personnel at an internal medicine residency program in a western US medical school focusing on the resident's clinic rotation. Residents were learning to use the EHR to support and enhance their patient encounters, but one factor making that more challenging for many was the need to address quality measures. Quality measures could shift attention away from the primary reason for the encounter and addressing them consumed time that could have been spent diagnosing and treating the patient's chief complaint. A willingness to learn on-the-job by asking questions was important for resident development in using the EHR to support their work and improve their clinical skills. Creating a culture where residents seek guidance on how to use the EHR and incorporate it into their work will support residents on their journey to become master clinicians. Shifting some documentation to the patient and other clinicians may also be necessary to keep from overburdening residents. Residency programs must support residents as they develop their clinical skills to practice in a world where EHRs are ubiquitous.

The mitigated carbon emissions of transitioning to virtual medical school and residency interviews: A survey-based study.

Prior to COVID, thousands of medical school and residency applicants traversed their countries for in-person interviews each year. However, data on the greenhouse gas emissions from in-person interviews is limited. This study estimated greenhouse gas emissions associated with in-person medical school and residency interviews and explored applicant interview structure preferences. From March to June 2022, we developed and distributed a nine-question, website-based survey to collect information on applicant virtual interview schedule, demographics and preference for future interview format. We calculated theoretical emissions for all interviews requiring air travel and performed a content analysis of interview preference explanations. We received responses from 258 first-year and 253 fourth-year medical students at 26 allopathic US medical schools who interviewed virtually in 2020-2021 and 2021-2022, respectively. Residency applicants participating in the study were interviewed at a mean of 15.3 programs (SD 5.4) and had mean theoretical emissions of 4.31 tons CO2 eq. Medical school applicants participating in the study were interviewed at a mean of 6.9 programs and had mean theoretical emissions of 2.19 tons CO2 eq. Ninety percent of medical school applicants and 91% of residency applicants participating in the study expressed a preference for hybrid or virtual interviews going forward. In-person medical training interviews have significant greenhouse gas emissions. Virtual and hybrid alternatives have a high degree of acceptability among applicants.

Changing Faces: Factors Associated with the Intention to Pursue Plastic Surgery and Practice in Underserved Areas.

De-identified data for US medical school graduates were obtained from the Association of American Medical Colleges for students who matriculated in academic years 2007-2008 and 2011-2012. Data collected included self-reported demographic and future practice intentions. Multivariate analysis was conducted to determine indicators of students' interest in plastic surgery, and their intention to practice in underserved areas. Of the 57,307 graduating US medical students in our cohort who completed the Graduation Questionnaire, 532 (0.9%) reported an intention to pursue plastic surgery. Hispanic [adjusted odds ratio (aOR): 1.45; 95% confidence interval (95% CI), 1.07-1.98] and multiracial (aOR: 1.59; 95% CI, 1.03-2.45) students were more likely to pursue plastic surgery compared with other surgical specialties. Among students interested in plastic surgery, compared with non-Hispanic White students, Black (aOR: 6.15; 95% CI, 1.96-19.26) students were more likely to report intention to practice in underserved areas. Students with community-engagement experiences were more likely to report intention to practice in underserved areas. Diversity among medical trainees pursuing plastic and reconstructive surgery is critical for maintaining and expanding plastic surgery services rendered in underserved areas. These findings suggest that student demographics and experiences with community-engagement experiences are positive indicators of practicing in underserved communities.

Evaluating the Impact of the Novel Geographic Preferences Section on Interview Rate and Residency Match Outcomes.

The American Association of Medical Colleges trialed residency application initiatives including geographic preferences and preference signals in 2022. To assess the impact of geographic preferences on application outcomes during the 2022 residency match year. Cross-sectional. Applicants to categorical and preliminary internal medicine during the 2022 application cycle who completed the Texas Seeking Transparency in Applications to Residency survey. The primary outcome was interview rate (interview offers/total applications) and whether an application resulted in a match. The key dependent variables were geographic preferences and program-specific preference signals. We also assessed differences in utilization of geographic preferences between specialties. A total of 970 applicants into categorical (n = 884) and preliminary (n = 86) internal medicine were included in our study. A total of 704 (72.6%) applicants submitted at least one geographic preference and 424 (43.7%) submitted three preferences. On average, applicants who submitted a geographic preference had a higher interview rate than those who did not (46.0% vs. 41.8%). Applications submitted with both a preference signal and geographic preference were significantly more likely to receive an interview offer (OR: 3.2, p < 0.01) and match (OR: 6.4, p < 0.01) than applications with neither a preference signal nor a geographic preference. Geographic preferences were associated with an increase in the odds of an application receiving an interview offer, even in the setting of a preference signal (OR: 1.4, p < 0.01). Both preference signals and geographic preferences have significant associations with odds of an application receiving an interview and matching for both categorical and preliminary internal medicine applicants. This study can be used to inform applicants, advisors, and programs how novel application strategies can affect important application outcomes for US medical school graduates. As more specialties pilot alternative processes, it will be important to study all application outcomes among varying applicant populations.