What Behaviors Could Increase The Chances Of US Senior Medical Students To Match Into Residency Programs? 

Match: This analysis of the National Resident Matching Program Applicant Survey responses of senior medical students in US allopathic medical schools (“US seniors”) compares survey responses from students who matched into a residency program vs. those who did not, and contains much useful information for students and those who advise them.  The data is weakened by a 49% overall response rate and a fair amount of missing data; however the number of included students is high at 7,762 and the percentage of students in the cohort who were unmatched, 96%, is very similar to the overall percentage of US seniors who are unmatched at 94%.  Importantly, this matched percentage has not changed in the last few decades, despite increasing numbers of non-US seniors applying during this time frame. Students were broken into 4 categories of “strength” based only on their self-reported USMLE Step 1 certifying examination score as compared to the mean and standard deviation (SD) of that score for US seniors who  matched into their preferred specialty.  Overall, “strong” or “solid” students who scored above the mean for their preferred specialty had only about a 2% risk of not matching, while “weak” students who scored below 1 SD of the mean had a 10% risk of not matching.  Unmatched students answered several survey questions quite differently (>10% differences) than students who matched, suggesting they had “a fundamental misunderstanding of how the matching algorithm works.”  For example, many fewer of the unmatched students ranked the programs in order of their preference, ranked all programs that they were willing to attend, or ranked a “safety net” program.  Surprising to this (older) reviewer were the sheer numbers of applications involved, which must be putting huge stresses on students and on residency programs.  Even “strong” students, with USMLE1  scores more than 1 SD over the mean, applied to an average of 31 programs.  Such large numbers of applications may not be necessary for most students, if they can utilize the Match more strategically. — Laura Willett, MD

Liang, Mei MS; Curtin, Laurie S. PhD; Signer, Mona M. MPH; Savoia, Maria C. MD, “Unmatched U.S. Allopathic Seniors in the 2015 Main Residency Match: A Study of Applicant Behavior, Interview Selection, and Match Outcome.” Academic Medicine Nov, 2016

Link To Article

Posted in Undergraduate Medical Education | Tagged , ,

In Search Of Continuity For Resident Continuity Practice

Continuity: Those involved in resident continuity practice will want to make note of this article that describes factors associated with continuity at 4 ambulatory residency training programs (internal medicine, pediatrics, family medicine, and med-peds), all at Level 3 PCMH (Patient-Centered Medical Home) designated practices in Upstate New York. Visit data (provider and patient characteristics) from these sites were compared to those from 30 affiliated non-teaching primary care practices in the community. Of almost 400,000 visits analyzed, continuity was higher in non-teaching community practices (87.3%) compared to resident practices (56%) or faculty practices (62%, p <.001). Factors associated with continuity included consistent use of scheduling protocols, absence of advanced practitioners, higher clinical faculty time, policies for handoffs from graduating seniors to interns, and dismissal policies for excessive missed appointments. While this study confirms what is already known about lack of continuity in resident practices, it also adds useful insight into how we might improve continuity, especially as many of the factors identified should be modifiable and likely not cost-prohibitive.  — Sarang Kim, MD

Fortuna et al, Factors Associated With Resident Continuity In Ambulatory Training Practices. Journal of Graduate Medical Education October 2016

Link To Article

Posted in Graduate Medical Education | Tagged , ,

Program Directors Weigh In On 13 Core Entrustable Professional Activities (EPAs) 

Entrustable Professional Activities: Thirteen core EPAs have been proposed as a standard for North American medical school graduation.  In this study, researchers surveyed internal medicine program directors (PDs) for their views on the EPAs: their importance, observed performance gaps in their own trainees, and methods of communication across training settings.  The survey response rate was 57%, with a modest over-representation of larger and university-based programs.  At least 75% of these PDs thought that their entering interns “must” or “should” be able to perform without direct supervision 11 of the 13 proposed EPAs.  The two activities not meeting this bar were “Identify systems failures and contribute to a culture of safety and improvement” and “Perform general procedures of a physician”. {Editor’s note: surgical PDs might well rank this last EPA higher.}  Major gaps were noted between entering interns’ actual capabilities under indirect supervision and our expectations, even in EPAs rated among the most important, including developing a prioritized differential diagnosis, providing oral presentations, and recognition of patients requiring urgent or emergent care.  Majorities of PDs agreed that EPA information should be shared by medical schools with residency programs, and then by residency programs  with fellowship programs and employers; and 71% felt that an EPA checklist from medical schools would be helpful.  There was less consensus on the timing and optimal use of such information. — Laura Willett, MD

Angus, Steven V. MD; Vu, T. Robert MD; Willett, Lisa L MD, MACM; Call, Stephanie MD, MSPH; Halvorsen, Andrew J. MS; Chaudhry, Saima MD, MSHS “Internal Medicine Residency Program Directors’ Views of the Core Entrustable Professional Activities for Entering Residency: An Opportunity to Enhance Communication of Competency Along the Continuum.” Academic Medicine, Oct 2016

Link To Article

Posted in Graduate Medical Education | Tagged ,

Should Implicit Bias Testing Be Required On The Admissions Committee? 

Admissions: Maybe, according to these results.  All 140 admissions committee members took a test for white-black implicit bias, and then took a survey based on their experiences.  This was followed by a discussion of aggregate results by the committee along with an implicit bias expert.  Results were reported by gender and faculty vs. student status, but not by under-represented minority (URM) status.  No group of committee members reported explicit bias, but all groups (male and female, students and faculty) displayed moderate to substantial implicit bias based on the test.  Sixty-seven percent felt that the exercise was worthwhile.  In the next admissions cycle, there were no statistically significant changes in the percentage of URM applicants interviewed (20% to 19%), the percentage URM interviewees offered acceptance (32% to 29%), or the percentage of accepted URM students matriculating (43% to 54%). — Laura Willett, MD

 

Quinn Capers IV, MD, Daniel Clinchot, MD, Leon McDougle, MD, and Anthony G. Greenwald, PhD, Implicit Racial Bias in Medical School Admissions, Academic Medicine, September 2016

Link To Article

 

 

 

Posted in Undergraduate Medical Education | Tagged , ,

Our Learners Need That “BERD” In The Hand 

Clinical and Translational Science: For the clinical educator, more questions than answers are raised by this survey data from mostly high-profile US institutions with Clinical and Translational Science Awards (CTSA).  CTSA Consortium institutions were surveyed regarding the biostatistics, epidemiology, and research design (BERD) programs which supported these teams.  There was wide variability amongst the programs, but some trends were apparent.  The median number of BERD FTEs was about 3.0, with a dominant representation of biostatisticians.  The BERD units did a large amount of consulting with both junior and senior investigators, and contributed to multiple grant applications and manuscripts.  “It is unknown how many of these consultations were for students, residents, or fellow; our experience is that access to CTSA-supported consulting by these groups varies across the CTSA consortium.”  For learners expected to produce high-quality scholarly activity, access to BERD specialists is needed, and often not attainable without significant cost.–Laura Willett, MD

Rahbar MH, Dickerson AS, Ahn C, Carter RE, Hessabi M, Lindsell CJ, Nietert PJ, Oster RA, Pollock BH, Welty LJ. Characteristics of Biostatistics, Epidemiology, and Research Design Programs in Institutions With Clinical and Translational Science Awards. Acad Med. 2016 Aug

Link To Article

Posted in Graduate Medical Education, Undergraduate Medical Education | Tagged , , , ,

Are They “Competent For Unsupervised Practice”?

Milestones: Residency program directors will be interested in this description of end-of-year milestones data from 2,030 categorical pediatric residents in  forty-seven representative 3-year categorical programs.  Milestones are generally rated on a 1-5 scale for 21 different subcompetencies.  In pediatrics, milestone ratings are anchored by behavior descriptions.  (In some other specialties, ratings are explicitly benchmarked with level 4 described as “ready for unsupervised practice.”)  As anticipated, median subcompetency milestone rankings increased with year of training, from 2.5-3.0 for first-year residents to 4.0 (for all subcompetencies except quality improvement) for third-year residents.  The gap in milestone ranking between the lowest 10% and highest 10% of residents closed substantially over year of training, as well.  Overall, 21% of graduating residents achieved a score of at least 4 in all subcompetencies, and 79% achieved a score of at least 3 in all subcompetencies. — Laura Willett, MD

Li ST, Tancredi DJ, Schwartz A, Guillot AP, Burke AE, Trimm RF, Guralnick S, Mahan JD, Gifford KA; Association of Pediatric Program Directors (APPD) Longitudinal Educational Assessment Research Network (LEARN) Validity of Resident Self-Assessment Group. Competent for Unsupervised Practice: Use of Pediatric Residency Training Milestones to Assess Readiness. Acad Med. 2016 July

Link To Article

Posted in Graduate Medical Education | Tagged , ,

Experts Propose A Primary-Care Curriculum

Primary Care: Education experts at Harvard Medical School, along with several medical students, propose a primary-care curriculum to coordinate activities across departments and develop a greater understanding of primary care in all students.  Eleven major themes emerged in their discussions:  longitudinal patient experiences across all 4 years; comfort with uncertainty and undifferentiated illness presentations; care management across organizations; communication skills; common acute care syndromes; common chronic illness issues; prevention; mental illness, substance use, and violence; quality improvement; interprofessional training; and population health issues.  These are worthy and difficult-to-achieve goals.   Curricular change alone is unlikely to increase the supply of U.S. primary-care physicians, unless the compensation difference with subspecialists is diminished.  — Laura Willett, MD

Fazio SB, Demasi M, Farren E, Frankl S, Gottlieb B, Hoy J, Johnson A, Kasper J, Lee P, McCarthy C, Miller K, Morris J, O’Hare K, Rosales R, Simmons L, Smith B, Treadway K, Goodell K, Ogur B. Blueprint for an Undergraduate Primary Care Curriculum. Acad Med. 2016 Jul 12.

Link To Article

Posted in Undergraduate Medical Education | Tagged , ,