Is there declining interest in general surgery training?

PURPOSE

To monitor and report the quality of categorical first-year surgery residents matched to U.S. general surgery training programs from 1996 to 2001.

METHODS

A survey was sent to 258 program directors of accredited general surgery training programs. In this survey, data were requested regarding United States Medical Licensing Exam (USMLE) Step 1 and 2 scores, matched residents' rank list position, Alpha Omega Alpha (AOA) status, number of applications received, and interviews granted pertaining to all National Residency Matching Program (NRMP) residents matched. In addition, the USMLE and NRMP were petitioned for national data regarding Step 1 and 2 scores in all entering surgery residents and first-time USMLE takers.

RESULTS

Usable survey data were received on 1241 residents. The number for each year (and percent of total matched PGY-1 residents) was as follows: 1996-196 (20.0), 1997-206 (20.4), 1998-204 (19.9), 1999-212 (21.0), 2000-212 (20.7), and 2001-211 (21.7). The mean Step 1 scores increased over time (p < 0.001), and programs with 5 or more categorical spots had higher scores than those with 4 or less (p < 0.001). The depth required to fill the rank list increased over the study period (p < 0.05). National data received from the NRMP from 1994 to 2001 (mean of 916 residents at each year) showed a similar increase in USMLE Step 1 scores when compared with our survey. The proportion of AOA students matching into general surgery has decreased from 30% in 1996 to 15% in 2001 (p < 0.001).

CONCLUSIONS

Over the 6 years of our study, USMLE Step 1 scores increased and the results of our survey are in agreement with the national data. However, the proportion of AOA students declined, implying the top 10% of the medical school class found general surgery training less attractive. Also, programs went deeper into their rank lists to fill, implying a shrinking pool of candidates.

[Clinical anatomy as an integrating element in teaching surgical subjects]

Different conceptions to revise the licensing regulations for physicians (Approbationsordnung für Arzte) aim to interlock preclinical and clinical subjects. Therefore a more practice-oriented anatomy has to be taught in basic and postgraduate medical education. At the Westfalian Wilhelms University of Münster we established an interdisciplinary anatomical education, executed by clinical lecturers in cooperation with the educational staff of the Department of Anatomy. The intergral element is the comprehensive constitution of clinical anatomy: clinical practitioners of different specialties together with anatomists give lessons in applied anatomy accompanying the dissection course. Clinically experienced lecturers of anatomy guide senior medical students in practical courses, refreshing their anatomical knowledge using particular prosections. These courses correlate with the topics of the distinct clinical tutorials. Conjointly clinical practitioners and anatomists plan, and perform meetings in postgraduate medical education.

Behind the physician licensure numbers: false impressions, retirement crisis, and migration

This communication examines the supply of primary-care physicians at the state level. It shows that the number of actively practicing physicians is considerably less than the number of licensed physicians; the age distribution of primary-care physicians has a bulge in the ages younger than 50, and this bulge may lead in the near future to an unexpected increase in physician attrition due to retirement; and, at the state level, migration may be playing the dominant role in determining the total supply of primary-care physicians.

Changing nature of physician licensure. Implications for medical education in California

Recent upheavals within health care delivery, technological advances, and changing attitudes among consumers have challenged and changed health professions licensure. At the same time, traditional regulatory frameworks remain in place. Beginning with a comparison of California's physician regulation with other states, we explore this tension between established regulatory systems and emerging reforms. Current trends in regulatory reform across the United States and in California include efforts to standardize practice requirements, expand scopes of practice for nonphysicians, and restructure boards. Because of these trends, medical educators will be expected to prepare physicians to practice under increased scrutiny and expectations of accountability; promote interdisciplinary education, training, and practice; and step up the efforts toward uniformity in medical education, training, and practice.

[Bleeders and healers in Brazil (1808-28)]

Based on documentation from the institution known as Fisicatura-mor (1808-28), and mainly on proceedings involving its official 'accreditation' of medical activities, this analysis of popular therapists opens access to categories like bleeders and healers, who were persecuted for their activities down through the nineteenth century. The curing practices employed by these bleeders and curandeiros ranked low on the hierarchy of procedures acceptable by the Fisicatura-mor. Quantitative data analysis demonstrates a link between these practices and disadvantaged social positions. Also analyzed was information that popular therapists and their clientele provided on these practices and on how they are accepted.

[Scope of social medicine 20 years after adoption into medical education--analysis test questions 1976-1996 by the IMPP (Institute for Medical and Pharmaceutical Test Questions)]

The list of educational objectives known as "Gegenstandskatalog" for each discipline within medical education should be represented in constancy at least in the sum of multiple-choice examinations which are part of German licensing regulations. All multiple-choice questions of social medicine which have been used within the last twenty years were looked up and compared with all the objectives of the discipline. The surprising results were: several objectives were highly overrepresented. Others never were asked for, among them such important ones as "social environment and illness", "cooperation in health systems" and "forms of organisation and impact of non-professional support systems". This result of the study undermines the commonly assumed close relation between official educational objectives and multiple-choice questions and therefore the composition of examinations in general. For other disciplines still no similar studies exist. Again it is necessary to ask what are really the educational goals and what are the educational objectives of all the disciplines, if not those of the "Gegenstandskatalog".

Medical licensure for osteopathic physicians in Louisiana: why the State Board of Medical Examiners should accept the NBOME

The Louisiana State Board of Medical Examiners does not recognize the examination offered by the National Board of Osteopathic Medical Examiners as a valid pathway to licensure, either directly or by endorsement. The State Board recognizes the United States Medical Licensing Examination (USMLE) as the appropriate examination for direct licensure. For licensure by endorsement, the State Board will license physicians who have passed any of the allopathic national licensing examinations. Osteopathic physicians do not take the USMLE or other allopathic licensing examinations because they test students on allopathic medical education and do not measure osteopathic medical training. Instead, osteopathic medical students take the examination offered by the National Board of Osteopathic Medical Examiners. The National Board of Osteopathic Medical Examiners' test is accepted by every other state and is an appropriate measure of the abilities of osteopathic physicians.