US Seniors Research Articles

State of the Otolaryngology Match: Has Competition Increased since the Early Match?

Objectives: Demonstrate increasing demand of medical students applying to otolaryngology and decreasing supply of available residency training positions after the shift from an early match to conventional matching process. Demonstrate increasing United States Medical Licensing Examination (USMLE) Step I scores among matched otolaryngology applicants over time. Methods: Matching statistics were obtained for first year residency positions through the National Residency Matching Program from 1998 to 2013. Matching statistics were obtained for otolaryngology residency positions through the San Francisco Match from 1998 to 2005. Univariate cross-sectional analysis was performed with a P value of .05 determined as significant. Results: Comparing the early match time period to the conventional match time period, there was an increase in otolaryngology resident applicants overall ( P = .002) and US senior otolaryngology applicants (.0006). There was also an increase in unmatched otolaryngology applicants (.0497). USMLE Step I scores increased between match time periods both among matched ( P = .025) and unmatched applicants ( P = .036). When comparing 5-year core otolaryngology residency positions to 6-year or 7-year research positions, the probability of having an unfilled research position was 24.8 times higher than having an unfilled core position. Conclusions: Eight years ago, otolaryngology changed from an early to conventional time frame matching process. The match is now more competitive, as evidenced by an increase in the overall number of otolaryngology residency applications, an increased number of unmatched applicants, and an increase of 17 points on average among matched applicants on the USMLE Step I Score. Meanwhile, otolaryngology research positions remain more unlikely to fill compared with core positions.

Is Orthopedics More Competitive Today Than When My Attending Matched? An Analysis of National Resident Matching Program Data for Orthopedic PGY1 Applicants From 1984 to 2011

This study evaluated supply and demand trends for orthopedic postgraduate year 1 (PGY1) positions from 1984 to 2011 for the purpose of estimating national intercandidate competition over time. National Resident Matching Program (NRMP) data for orthopedic surgery from 1984 to 2011 were collected. Proxy variables including (total number of orthopedic applicants/number of orthopedic PGY1 positions), (number of US senior applicants to orthopedics/number of orthopedic PGY1 positions), (number of US seniors matching into orthopedics/number of US senior orthopedic applicants), (total number of matched orthopedic applicants/total number of orthopedic applicants), and (total number of US applicants who fail to match into orthopedics/total number of US senior applicants into orthopedics) as well as average United States Medical Licensing Examination Step 1 scores were used to gauge the level of competition between candidates and were compared over time. Academic medical center in the Midwestern United States. Medical professors and medical students. The NRMP data suggested that the number of positions per applicant decreased or remained stable since 1984 and that the percentage of applicants who did not match was no higher now than in the past. This finding was primarily because of the relative decrease in the ratio of applicants to available PGY1 positions, which stems from the number of positions increasing more rapidly than the number of applicants. The NRMP data from 1984 to 2011 supported our hypothesis that intercandidate competition intensity for orthopedic PGY1 positions has not increased over time. The misconception that orthopedics is becoming more competitive likely arises from the increased number of applications submitted per candidate and the resulting relative importance placed on objective criteria such as United States Medical Licensing Examination Step 1 scores when programs select interview cohorts.

How Competitive Is the Match for Radiology Residency? Present View and Historical Perspective

Interest in radiology as a career among US medical students has changed. The aim of this study was to investigate the recent and historical trends in residency applications and how they have affected competitiveness in obtaining a position. Statistics published by the National Resident Matching Program in "Results and Data: Main Residency Match" for 1991 to 2013 were analyzed. The number of radiology residency positions has trended upward over the past 23 years; however, the number of applicants from US medical schools has been widely variable. The number of applicants peaked in 2009 but has since decreased every year. The number of positions per US senior applicant (PPUSA) is a judge of specialty competitiveness on a supply-and-demand basis. A lower PPUSA indicates a more competitive specialty. Radiology saw its most competitive year in 2001, with only 0.91 PPUSA. PPUSA has been on the rise every year since 2009. From 2009 to 2013, the number of residency positions increased by 56, but there were 241 fewer US senior medical students preferring radiology. In 2013, there were 1,143 residency positions available for only 845 US senior medical students who preferred the specialty. The PPUSA was 1.35, making 2013 the least competitive year in obtaining a radiology residency position since 1998. Over the past 23 years, 5.5% of all US senior medical students have applied to radiology for residency. Interest reached an all-time high in 2009, at almost 7%. In 2013, only 4.8% of all US seniors preferred radiology, the lowest since 1999. The historical (1991-2013), current (2011-2013), and most recent (2013) PPUSAs for radiology were 1.19, 1.29, and 1.35, respectively. For comparison, the current PPUSAs for the following specialties were: 0.74 for plastic surgery, 0.83 for orthopedic surgery, 0.95 for dermatology, 1.10 for general surgery, 1.24 for obstetrics and gynecology, 1.31 for anesthesiology, 1.42 for pediatrics, and 1.80 for internal medicine (1.80). Although radiology residency positions have continued to increase, interest among US seniors has dropped every year since 2009. The 2013 match was the least competitive since 1998. Over the past 3 years, the competitiveness of matching radiology on a supply-and-demand basis has been close to that of obstetrics and gynecology and anesthesiology.

John D. Corbett (1926-2013)

John D. Corbett (1926-2013)

The Correlation between Global Health Experiences in Low-Income Countries on Choice of Primary Care Residencies for Graduates of an Urban US Medical School

This study sought to determine whether medical students who participate in a global health elective in a low-income country select residencies in primary care at higher rates compared with their classmates and US medical graduates in general. Given the projected increase in demand for primary care physicians, particularly in underserved areas, understanding possible factors that encourage training in primary care or enhance interest in the care of underserved populations may identify opportunities in medical school training. The authors used data from the Office of Student Affairs, SUNY Downstate College of Medicine and the National Residency Matching Program to compare rates of primary care residency selection from 2004 to 2012. Residency selections for students who participated in the SUNY Downstate School of Public Health Global Health Elective were compared with those of their classmates and with residency match data for US seniors. In 7 of the 8 years reviewed, students who participated in the SUNY Downstate School of Public Health Global Health Elective selected primary care residencies at rates higher than their classmates. Across years, 57% of the students who completed the elective matched to primary care residences, which was significantly higher than the 44% for the remainder of Downstate's medical student class (p = 0.0023). In 6 of the 8 years, Downstate students who participated in the Global Health Elective selected primary care residencies at rates higher than US medical school seniors in general; rates were the same for both Downstate Global Health Elective students and US medical school seniors in 2009. Students who participated in a global health experience in a low-income country selected primary care residencies at higher rates than their classmates and US medical school graduates in general. Understanding how these experiences correlate with residency selection requires further investigation; areas of future study are discussed.

Recent Trends in Applicants and the Matching Process for the Integrated Plastic Surgery Match

Matching into a plastic surgery (PS) residency program is a highly competitive process. Selection criteria are very stringent and may influence an applicant's candidacy and application strategy. The purpose of this study was to evaluate recent trends of applicants matching into integrated PS programs using published National Resident Match Program data. Residency match data were gathered for application years 2002 to 2011 using the National Resident Match Program/Association of American Medical Colleges databases. Analyses were limited to the US senior group and excluded the non-US senior group because of the small numbers in the latter group. For all data sets, a logistic regression was performed to analyze the statistical significance of the data. The overall match rate continues to approximately 50%. United States senior applicants were more likely to rank PS only versus PS and others (PS + other) over time (P < 0.0001) with an odds ratio of 1.2 per year (P < 0.0001). For any given year, US senior applicants ranking PS only were more likely to match versus US senior applicants ranking PS + other (odds ratio, 1.71; P < 0.0001). If this trend continues, it is expected that by 2022, 90% of US senior applicants will rank PS only. The proportion of applicants ranking PS only is steadily rising. The ranking strategy used by US senior applicants is self-selecting into a more competitive (PS only) and less competitive (PS + other) applicant pool. If this continues, nearly 50% of applicants will not match and could be left scrambling for an alternative residency position. These findings therefore suggest that all candidates, regardless of their perceived application strength, should consider having a "backup plan."

Role of Dietary Beef and Muscle Mass in the Physical and Mental Functioning of US Seniors

Role of Dietary Beef and Muscle Mass in the Physical and Mental Functioning of US Seniors

Generation Y and the Integrated Plastic Surgery Residency Match

Background:Plastic surgery is the most competitive specialty in medicine. We sought to identify factors associated with the successful match of generation Y applicants into integrated plastic surgery residency.Methods:We utilized the most recent data from the Charting Outcomes in the Match published by the National Resident Matching Program in 2011. We had data on US senior or independent applicant status, Alpha Omega Alpha (AOA) status, attendance of top 40 medical schools, advanced degree status, and number of contiguous ranks within plastic surgery. Our main outcome measure was match status.Results:A total of 81 out of 197 applicants (41.1%) successfully matched into integrated plastic surgery in the 2011 main match. US seniors matched at a significantly higher rate compared to independent applicants (44.0% vs 24.1%, P = 0.044). Matched US seniors were more likely to have AOA membership compared to unmatched US seniors (45.9% vs 27.7%, P = 0.014) and attend a top 40 medical school (52.7% vs 35.1%, P = 0.022). There were no differences in terms of advanced degrees between matched and unmatched US seniors. Unmatched US seniors were more likely to have 3 or fewer contiguous ranks of plastic surgery residency programs than matched US seniors (86.2% vs 68.9%, P = 0.007).Conclusions:US senior status, AOA membership, and attendance at a top 40 medical school are predictors of matching into integrated plastic surgery. Program directors need to be aware of the background of the millennial applicants to recruit and maintain top residents.

Eustress: A Key to Improving Job Satisfaction and Health Among Thai Managers Comparing US, Japanese, and Thai Companies Using SEM Analysis

Eustress or positive stress is defined as stress which enables employees to perform better and increase their job satisfaction. This study confirms that eustress is a key factor in motivating employees to achieve high performance and enhanced job satisfaction. Not enough eustress lead to employee boredom and turnover. On the other hand, large amount of negative stress or distress significantly leads to physical and psychological illness. Exclusive stimulation or too much negative stress is likely to cause illness. Both quantitative and qualitative data were collected for this research. Structural equation modeling techniques were used for statistical data analysis together with in-depth interview analysis of Thai managers reporting to US, Japanese, and Thai senior managements.

English

Earlier this year, 3 days before the vernal equinox, my classmates and I gathered at the ballroom of the Michigan State University Club to learn about our placement in the 2013 Match (National Residency Matching Program a program which annually assigns medical school graduates to residency positions). When the clock struck noon, we tore into white envelopes revealing the destination of the next 35 years of our lives. The room was abuzz with excitement, cheers, and tears as we shared this life-changing moment with one another. We had all matched, most of us to our top programs. Now we could finally breathe a sigh of relief as the anxious uncertainty about whether we would continue on our medical journeys melted away. Unfortunately, this was not the case for every graduate in the United States this year. In fact, 2,076 of this year’s graduating US seniors failed to match and entered the Supplemental Offer and Acceptance Program (SOAP a secondary residency assignment program for those that fail to find a spot in the primary Match). After the SOAP, 528 US seniors remained completely unmatched, more than twice the number in that position in 2012. 1 SOAP was introduced in 2012, so no comparable data are available on the number of unmatched seniors prior to 2012. What is known is that this March, hundreds of US medical students found themselves with an average debt of $170,000, with no residency position to help them. This is a problem that is expected to get worse, not better. The number of graduates is increasing every year, while the number of residency slots is not keeping pace. The reasons for this are multifactorial. To better understand why, it would be helpful to look back at the history of medical education policy.

Interview: Interview with Future Medicinal Chemistry ’s US Senior Editor, Iwao Ojima

Professor Iwao Ojima studied at the University of Tokyo (Japan) before being appointed as a Senior Research Fellow and Group Leader at the Sagami Institute of Chemical Research. He is now Director of the Institute of Chemical Biology and Drug Discovery at State University of New York (USA) and has been a visiting professor in European, North American and Asian academic institutions. Professor Ojima agreed to serve as the US Senior Editor of Future Medicinal Chemistry when it launched in 2009 and continues to provide his expertise to the journal. Professor Ojima spoke to Future Medicinal Chemistry about why medicinal chemistry is such an exciting field to work in, the state of the pharmaceutical industry, and what features and issues make this journal unique.

Changes in the National Residency Matching Program Policy: Are Internal Medicine Program Directors “All-In”?

Michael Adams, MD, FACP, is Program Director of Medicine at Georgetown University; Thomas B. Morrison, MD, is Fellow in Cardiovascular Medicine at Vanderbilt University; Stephanie Call, MD, is Program Director of Medicine at Virginia Commonwealth University; Andrew J. Halvorsen, MS, is Biostatistician and Project and Data Manager in the Internal Medicine Residency Office of Educational Innovations at Mayo Clinic; Jared Moore, MD, is Chief Medical Resident in Internal Medicine at Ohio State University; Maria Lucarelli, MD, is Associate Program Director in Internal Medicine at Ohio State University; Steven Angus, MD, is Program Director of Medicine at the University of Connecticut Health Center; and Furman S. McDonald, MD, MPH, is Program Director of Internal Medicine Residency Office of Educational Innovations at the Mayo Clinic. Funding: This study was supported in part by the Mayo Clinic Internal Medicine Residency Office of Educational Innovations as part of the ACGME Educational Innovations Project. The Mayo Clinic Survey Research Center provided assistance with the survey design and data collection. We are grateful for the support of the Association of Program Directors of Internal Medicine and the members of the Survey Committee and to the residency program directors who completed the Association of Program Directors in Internal Medicine (APDIM) survey. While we are reporting the results of the APDIM Survey Committee, we are not presuming to speak for the organization and our paper does not constitute an official policy statement of APDIM, the APDIM Council, or any other organzation with which any of the authors may be affiliated.

Ophthalmology Residency Match Outcomes for 2011

To determine the match rate and predictors of matching into an ophthalmology residency. Population-based, cross-sectional study. All 746 candidates who submitted an application for the 2011 ophthalmology residency match. The Ophthalmology Residency Matching Program applicant database was reviewed to determine applicant characteristics and match outcomes. For US seniors, multivariate regression analysis was performed to determine predictors of matching. Match rate and predictors of US seniors matching. Rank lists were submitted by 622 applicants, among whom 458 (74%) matched. The match rate was higher for US seniors (83%) than for independent applicants (41%; P < 0.001). US seniors who matched were more likely to be Alpha Omega Alpha medical honor society members (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.16-7.29), to attend medical schools ranked in the top 40 according to National Institutes of Health funding (OR, 2.25; CI, 1.14-4.43), and to have ranked more programs (OR, 1.44; CI, 1.29-1.60). Those ranking 6 to 10 programs had an 80% to 90% chance of matching, and those ranking more than 10 programs had a greater than 90% chance of matching. No clear benefit was observed by ranking additional programs once 11 had already been ranked. Average US Medical Licensing Examination Step 1 scores were 239 ± 14 and 223 ± 18 for applicants who were matched and unmatched, respectively; this difference was significant by univariate analysis (P < 0.001) but not by multivariate regression (P = 0.163). Ophthalmology ranks among the most competitive specialties in medicine. Those most likely to match were US seniors who maintained academic excellence beginning in their preclinical years. A finite relationship exists between ranking a greater number of programs and having a greater chance of matching.

Influenza-Related Mortality Trends in Japanese and American Seniors: Evidence for the Indirect Mortality Benefits of Vaccinating Schoolchildren

BackgroundThe historical Japanese influenza vaccination program targeted at schoolchildren provides a unique opportunity to evaluate the indirect benefits of vaccinating high-transmitter groups to mitigate disease burden among seniors. Here we characterize the indirect mortality benefits of vaccinating schoolchildren based on data from Japan and the US.MethodsWe compared age-specific influenza-related excess mortality rates in Japanese seniors aged ≥65 years during the schoolchildren vaccination program (1978–1994) and after the program was discontinued (1995–2006). Indirect vaccine benefits were adjusted for demographic changes, socioeconomics and dominant influenza subtype; US mortality data were used as a control.ResultsWe estimate that the schoolchildren vaccination program conferred a 36% adjusted mortality reduction among Japanese seniors (95%CI: 17–51%), corresponding to ∼1,000 senior deaths averted by vaccination annually (95%CI: 400–1,800). In contrast, influenza-related mortality did not change among US seniors, despite increasing vaccine coverage in this population.ConclusionsThe Japanese schoolchildren vaccination program was associated with substantial indirect mortality benefits in seniors.

Match Shows Med Students Believe in Specialty's Future

Great news abounded for family medicine in this year’s National Resident Matching Program, with a record-breaking 94.4% of our residency positions filled. More than 100 additional medical students chose family medicine this year compared with last, and the percentage of US seniors who chose the

An international perspective on interest in a general surgery career among final-year medical students

Background The level of interest in general surgery among US seniors has been declining; however, it may be perceived as a more attractive career outside the United States. Methods A survey was developed and distributed to students at medical schools in 8 countries. Results were analyzed to determine whether interest in general surgery was related to sex of the respondent or economic standing of the country. Results We noted differences in the level of interest in general surgery, ranging from 8% in Italy to 58% in India. As in the United States, there was a difference in the level of interest between sexes, with a male preponderance. Students from economically less developed countries expressed a greater interest in general surgery compared with students from countries with high development. Conclusions Our study suggested the level of interest for general surgery may depend on the sex and the location of the student. Further comparison studies may suggest means to stimulate student interest in the field.

Brainstem lesions in clinically isolated syndromes

Number of baseline lesions has been shown to predict future attacks and disability in clinically isolated syndromes (CIS). To investigate the role of baseline infratentorial lesions in long-term prognosis. Subjects were included in a prospective cohort of patients with CIS. Patients underwent brain MRI within 3 months after CIS onset. Number and location of lesions at baseline were prospectively studied. Retrospective scan analysis was conducted to specifically look at number and location of infratentorial lesions. We analyzed the time to a second attack and to reach EDSS 3.0. We included 246 patients with CIS followed for a median of 7.7 years. Patients with infratentorial lesions had both a higher risk of conversion (71.4% vs 29.6%; hazard ratio [HR] 3.3; 95% confidence interval [CI] 2.2-4.8; p < 0.001) and of developing disability (32.5% vs 12.4%; HR 2.4; 95% CI 1.3-4.3; p = 0.003). Presence of at least one cerebellar lesion was associated with an increased risk of conversion (HR 2.4; 95% CI 1.3-4.5; p = 0.007). Presence of at least one brainstem lesion increased both the risk of conversion (HR 2.9; 95% CI 1.7-5.0; p < 0.001) and disability (HR 2.5; 95% CI 1.1-5.4; p = 0.026). Broken down into number of lesions, the presence of infratentorial lesions increased both the risk of conversion (83% vs 61%) (HR 22.3; 95% CI 9.7-51.1; p < 0.001) and of reaching EDSS 3.0 (40% vs 19%) (HR 3.2; 95% CI 1.3-7.4; p = 0.008) only in patients with 9 or more lesions. Presence of infratentorial lesions increases the risk for disability. Brainstem rather than cerebellar lesions may be responsible for poor prognosis.

Match Rates Into Higher-Income, Controllable Lifestyle Specialties for Students From Highly Ranked, Research-Based Medical Schools Compared With Other Applicants

Factors impacting medical student specialty career choice are poorly understood, but may include income potential and lifestyle features such as limited and predictable work hours. Data from the National Resident Matching Program and the San Francisco Match were used to examine match rates into higher-income controllable lifestyle (CL), lower-income CL, and noncontrollable lifestyle (NCL) specialties from 2002 to 2007. We studied 3 cohorts: students from highly ranked, research-based medical schools, other US senior medical students, and independent applicants (consisting mostly of graduates from foreign medical schools). By 2007, 22.5% of students from highly ranked schools matched into a higher-income CL specialty compared with 16.5% of other US seniors and 8.4% of independent applicants. During the study period, students from highly ranked schools increased their match rate in higher-income CL specialties by 7.9%, while all cohorts experienced declines in match rates for NCL specialties. Compared with other US seniors, students from highly ranked schools were more likely to match into higher-income CL specialties (odds ratio [OR], 1.46; 95% confidence interval [CI]: 1.27-1.68), while independent applicants were much less likely to do so (OR, 0.46; 95% CI: 0.42-0.51). Independent applicants had the highest odds (OR, 2.38; 95% CI: 2.25-2.52) of matching into NCL specialties. All cohorts had declining match rates into NCL specialties from 2002 to 2007. When compared with other US seniors, students from highly ranked schools had the highest odds of matching in higher-income CL specialties, while independent applicants had the highest odds of matching into NCL specialties. These trends are important to consider in light of recent efforts to better balance the physician workforce.

Successfully Matching Into Surgical Specialties: An Analysis of National Resident Matching Program Data

We explored the impact that attributes of US medical school seniors have on their success in matching to a surgical residency, in order to analyze trends for National Resident Matching Program (NRMP) match outcomes in surgical specialties between 2007 and 2009. Using Electronic Residency Application Service data and NRMP outcomes, we analyzed medical students' attributes and their effect in successfully matching students into residency positions in surgery, otolaryngology, orthopedic surgery, plastic surgery, and obstetrics and gynecology. Attributes analyzed included self-reported United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores, Alpha Omega Alpha (AOA) Honor Medical Society membership, research experience, additional graduate degree status, and graduation from a top 40 National Institutes of Health (NIH)-funded medical school. Odds ratios were calculated for each criterion, and 95% confidence intervals were used to determine significance. Between 2007 and 2009, the number of surgical specialty residency positions increased by 86, and the number of applicants increased by 34. Membership in AOA, USMLE Step 1 and Step 2 scores, research experience, and graduation from a top 40 NIH-funded medical school frequently had a significant impact on residents successfully matching into many specialties, while additional graduate degrees had no effect on matching into surgical specialties (range 0.64 to 1.2). Although the statistical significance varied across specialties, higher USMLE Step 1 and Step 2 scores, AOA membership, research experience, and graduation from a top 40 NIH-funded medical school generally had a positive impact on match success to surgical residency for US allopathic seniors. Test preparation and seeking research experience during undergraduate medical education may be effective approaches for increasing the likelihood of success for US seniors matching into a surgical specialty.

Pharmacological Therapies for Osteoarthritis of the Hand

Osteoarthritis (OA) of the hand is highly prevalent in US senior citizens, developing in >50% of individuals aged >60 years. Hormonal, genetic and inflammatory mechanisms are known to increase the risk of hand OA and influence the course of the disease. However, the underlying processes in the development of hand OA are not well understood, and there is no known disease-modifying drug. Likewise, surgical interventions for affected hand joints have not proven as successful as joint replacement for the knee or hip. Current treatment of hand OA focuses on reducing pain and improving patient function to improve quality of life. Pharmacological approaches have included several oral therapies, such as paracetamol (acetaminophen), oral nonsteroidal anti-inflammatory drugs (NSAIDs) and opioids, all of which carry a risk of adverse events that typically increases with age. Topical NSAIDs, recently approved in the US, appear to provide efficacy similar to that of oral NSAIDs for hand OA, with less systemic NSAID exposure. Intra-articular corticosteroids and hyaluronic acid have also shown modest symptomatic efficacy with generally good tolerability. Two proposed disease-modifying therapies, chondroitin sulfate and hydroxychloroquine, have had unclear effects on disease modification in clinical trials. This review of pharmacotherapies for the treatment of hand OA focuses on their efficacy and safety in elderly patients. Articles cited herein were identified via a search of PubMed from January 2005 to November 2009. The bibliographies of articles identified through this search were searched manually for additional references of interest.