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Khoshpouri P, Mohseni A, Dabiri M, Ansari G, Zadeh FS, Ataeinia B, Saadat N, Sherbaf FG, Yousem DM. International Medical Graduates in Radiology Residencies: Demographics, Performance, and Visa Issues. Acad Radiol 2023; 30:3124-3134. [PMID: 37183141 DOI: 10.1016/j.acra.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/03/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023]
Abstract
RATIONALE AND OBJECTIVES The number of international medical graduates (IMG) in radiology residencies has varied from year to year even as the number of candidates continues to grow. It is unclear from which countries the IMGs are arriving and what visas are being used to accommodate them. MATERIALS AND METHODS We sent a survey to 195 program directors (PD) in diagnostic radiology (DR) inquiring about the number and nationality of IMG residents in their program, their attitudes about IMG candidates, the performance of their IMG trainees, and the visas that are offered. RESULTS We received responses from 121 of 195 (62.1%) DR programs (121/149 =81.2% of actionable emails). 80/121 (66.1%) had at least one IMG in their DR residency program and the countries of origin included India (36), Iran (30), Saudi Arabia (24), Egypt (16), Canada (14), Brazil (14), and Pakistan (9), as the most common. While most programs (76/104, 73.1%) offered J1 visas, 23/99 (23.2%) provided H-1B visas to trainees. IMG DR residents overall performed as well as American graduates, with an equal number of PDs saying IMGs performed better and worse than American graduates. PDs' issues with IMGs centered on visas: (1) expense, (2) lack of familiarity, (3) Educational Commission for Foreign Medical Graduates regulations, and (4) time commitment in submitting paperwork. CONCLUSION Most radiology IMG residents originate from India and Middle Eastern countries. Once enrolled, IMG residents perform similarly to US graduates. However, adding IMG candidates to the training program requires overcoming bureaucratic and monetary hurdles around visas. SUMMARY SENTENCE Most DR international medical graduate residents are from India or the Middle East. Although their performance is the same as American graduates in general, PDs note the monetary and bureaucratic hassles accompanying their recruitment.
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Affiliation(s)
- Parisa Khoshpouri
- Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada (P.K.)
| | - Alireza Mohseni
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.)
| | - Mona Dabiri
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran (M.D.)
| | - Golnoosh Ansari
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.)
| | | | - Bahar Ataeinia
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (B.A.)
| | - Niloufar Saadat
- Department of Radiology, University of Texas Southwestern, Dallas, Texas (N.S.)
| | - Farzaneh Ghazi Sherbaf
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, California (F.G.S.)
| | - David M Yousem
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, Baltimore, Maryland (A.M., G.A., D.M.Y.).
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Newbury A, Cerniglia CA, DeBenedectis CM, Harman A, Lo HS. Radiology program director's perspective on a novel hands-on advanced elective. Clin Imaging 2023; 102:93-97. [PMID: 37657275 DOI: 10.1016/j.clinimag.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/25/2023] [Accepted: 07/31/2023] [Indexed: 09/03/2023]
Abstract
With the advent of the USMLE Step 1 exam moving to a pass/fail status, Radiology Program Directors (PDs) and Associate Program Directors (APDs) need alternative methods of identifying interested and engaged medical students who are applying to their program. Additionally, undergraduate radiology medical education in the United States varies widely from institution to institution with no universal mandatory radiology component. To address these problems, we implemented an advanced fourth year hands-on radiology elective where the students were treated as first year radiology residents (R1s), giving them resident-level access to the Picture Archive and Communication System (PACS) and dictation software, and allowing them to perform entry-level procedures with appropriate supervision. After implementation of the elective, a 5-question online survey was sent to two hundred and ninety-eight PDs and APDs via the Association of Program Directors in Radiology (APDR) listserv, of which seventy-two responses were compiled, yielding a response rate of 24%. The survey focused on how a hands-on medical student elective would help in assessing prospective candidates and predicting R1 performance. Most respondents felt interest in radiology, motivation, and interpersonal skills would be better assessed after such an elective and the vast majority felt hands-on Advanced Elective would be at least slightly predictive of first year resident performance. Based on this information, we believe implementing a hands-on advanced radiology elective would significantly help address the passive nature of traditional radiology electives, providing valuable information to PDs and APDs and giving the best possible radiology experience to our medical students.
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Affiliation(s)
- Alex Newbury
- University of Massachusetts Chan Medical School, Department of Radiology, Worcester, MA 01655, United States of America.
| | - Christopher A Cerniglia
- University of Massachusetts Chan Medical School, Department of Radiology, Worcester, MA 01655, United States of America
| | - Carolynn M DeBenedectis
- University of Massachusetts Chan Medical School, Department of Radiology, Worcester, MA 01655, United States of America. https://twitter.com/@c_debenedectiMD
| | - Aaron Harman
- University of Massachusetts Chan Medical School, Department of Radiology, Worcester, MA 01655, United States of America
| | - Hao S Lo
- University of Massachusetts Chan Medical School, Department of Radiology, Worcester, MA 01655, United States of America
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Yadav S, Dekhne A, Harikrishnan S, Saini B, Shukla J, Tango T, Patel Y, Patel M, Chavda RS, Popat A. The Pass/Fail Effect: A Longitudinal Study of United States Medical Licensing Examination (USMLE) Step 1 Performance Over a Decade. Cureus 2023; 15:e41702. [PMID: 37575720 PMCID: PMC10415954 DOI: 10.7759/cureus.41702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2023] [Indexed: 08/15/2023] Open
Abstract
Objectives This study aimed to analyze the impact of the United States Medical Licensing Examination (USMLE) Step 1 transition to a pass/fail scoring system in 2022 on the performance of first-time test takers in three distinct groups: Doctor of Osteopathy (DO) and Doctor of Medicine (MD) examinees from US/Canadian schools and examinees from non-US/Canadian schools. The analysis spans a decade-long period from 2012 to 2022, offering insights into the implications of this pivotal change in medical education. Methods We analyzed the performance of first-time USMLE Step 1 examinees from US/Canadian MD and DO programs and non-US/Canadian schools from 2012 to 2022, including the transition year to a pass/fail scoring system. Data were obtained from USMLE performance data reports and organized into annual contingency tables. Descriptive statistics and comparative analysis were used to identify trends and differences in performance across the groups. Data visualization techniques were employed to illustrate these findings, and the results were contextualized within the broader changes in medical education. Results In 2021, first-time takers from US/Canadian MD and DO Degree programs had pass rates of 96% and 94%, respectively, while non-US/Canadian schools had a pass rate of 82%. However, in 2022, these rates dropped to 93%, 89%, and 74%, respectively. The most significant relative decline was observed among non-US/Canadian Schools' first-time takers, with an 8% decrease. Repeaters consistently had lower pass rates across all groups. Conclusion The study reveals a notable decline in pass rates following the transition to pass/fail scoring, although this is based on just one year of data. This underscores the importance of students not rushing into the exam and dedicating sufficient time for preparation. The potential impact of this research could be transformative for medical education, but more years of data post-transition will be needed to confirm these initial findings. These findings serve as a reminder that the change in scoring does not diminish the rigor of the exam, prompting students to approach their studies with diligence and patience and potentially paving the way for systemic improvements in medical education and healthcare delivery worldwide.
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Affiliation(s)
- Sweta Yadav
- Internal Medicine, GMERS (Government Medical Education and Research Society) Medical College, Ahmedabad, IND
| | - Anushka Dekhne
- Internal Medicine, American University of Antigua, St. John's, ATG
| | | | - Babita Saini
- Internal Medicine, Uzhhorod National University, Uzhhorod, UKR
| | - Jooi Shukla
- Internal Medicine, Dr. M. K. Shah Medical College and Research Centre, Ahmedabad, IND
| | - Tamara Tango
- Internal Medicine, Faculty of Medicine University of Indonesia, Jakarta, IDN
| | - Yashasvi Patel
- Internal Medicine, Geetanjali Medical College and Hospital, Udaipur, IND
| | - Mitkumar Patel
- Internal Medicine, MGM (Mahatma Gandhi Memorial) Medical College, Navi Mumbai, IND
| | - Raj Singh Chavda
- Internal Medicine, Smt. B. K. Shah Medical Institute & Research Centre, Vadodara, IND
| | - Apurva Popat
- Internal Medicine, Marshfield Clinic, Marshfield, USA
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Manstein SM, Laikhter E, Kazei DD, Comer CD, Shiah E, Lin SJ. The Upcoming Pass/Fail USMLE Step 1 Score Reporting: An Impact Assessment From Medical School Deans. Plast Surg (Oakv) 2023; 31:169-176. [PMID: 37188137 PMCID: PMC10170630 DOI: 10.1177/22925503211034838] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background: The US Medical Licensing Examination (USMLE) Step 1 change to pass/fail has been met with mixed reviews, and the impact on medical student education and residency match is unknown. We surveyed medical school student affairs deans regarding their thoughts on the upcoming transition of Step 1 to pass/fail. Methods: A questionnaire was emailed to medical school deans. Deans were asked to rank the importance of the following after the Step 1 reporting change: Step 2 Clinical Knowledge (Step 2 CK), clerkship grades, letters of recommendation, personal statement, medical school reputation, class rank, Medical Student Performance Evaluation, and research. They were asked how the score change will affect curriculum, learning, diversity, and student mental health. Deans were asked to select 5 specialties they thought would be most affected. Results: Regarding perceived importance of residency applications following the scoring change, the most frequent number 1 choice was Step 2 CK. The majority of deans (93.5%, n = 43) felt that the change to pass/fail would benefit medical student education/learning environment; however, most (68.2%, n = 30) did not believe their school curriculum would change. Students applying to dermatology, neurosurgery, orthopedic surgery, ENT, and plastic surgery were felt to be most affected by the scoring change; 58.7% (n = 27) felt it would not adequately address future diversity. Conclusion: The majority of deans feel the USMLE Step 1 change to pass/fail would benefit medical student education. Deans feel that students applying to traditionally more competitive specialties (ie, programs with fewer overall residency positions available) will be most affected.
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Affiliation(s)
- Samuel M. Manstein
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Elizabeth Laikhter
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Carly D. Comer
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric Shiah
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel J. Lin
- Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Mabeza RM, Christophers B, Ederaine SA, Glenn EJ, Benton-Slocum ZP, Marcelin JR. Interventions Associated With Racial and Ethnic Diversity in US Graduate Medical Education: A Scoping Review. JAMA Netw Open 2023; 6:e2249335. [PMID: 36595293 PMCID: PMC9856938 DOI: 10.1001/jamanetworkopen.2022.49335] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Racially and ethnically minoritized individuals remain underrepresented in graduate medical education relative to their proportion in the population. While many programs and initiatives have been developed to address this problem, there is little consensus regarding strategies that work to improve representation across specialties. OBJECTIVE To examine and synthesize evidence-based practices that have been used to increase the proportions of underrepresented in medicine (URiM) trainees at US residency and fellowship programs. EVIDENCE REVIEW The authors searched PubMed, Google Scholar, Embase, PsycInfo, ERIC, Cochrane Reviews, Cochrane Trials, CINAHL, Scopus, and PROSPERO electronic databases to identify relevant studies published through January 2022. They screened all titles and abstracts for relevance and read full-text articles to identify articles reporting reliable data describing the outcomes of interventions to improve racial and ethnic diversity among trainees. FINDINGS Twenty-seven articles were included in this review. Two studies reported on fellowship programs. The most common interventions included holistic review (48%), decreased emphasis on United States Medical Licensing Examination Step 1 scores (48%), and explicit institutional messaging regarding the importance of diversity (37%). A combination of interventions was associated with an increased number of URiM applicants, interviewees, and matriculants across various medical and surgical specialties. CONCLUSIONS AND RELEVANCE In this scoping review, approaches and interventions associated with increased diversity in residency and fellowship programs were identified. Continued efforts are necessary to sustain such efforts and assess long-term outcomes.
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Affiliation(s)
- Russyan Mark Mabeza
- David Geffen School of Medicine at the University of California, Los Angeles
| | - Briana Christophers
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, New York
| | - Sophia A. Ederaine
- Department of Dermatology, University of California Irvine School of Medicine, Irvine
| | - Emily J. Glenn
- McGoogan Health Sciences Library, University of Nebraska Medical Center, Omaha
| | | | - Jasmine R. Marcelin
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha
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Medical Students and the Drive for a Single Right Answer: Teaching Complexity and Uncertainty. ATS Sch 2022; 3:27-37. [PMID: 35633993 PMCID: PMC9131886 DOI: 10.34197/ats-scholar.2021-0083ps] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/05/2021] [Indexed: 01/24/2023] Open
Abstract
The arrival of Generation Z, the next generation of medical learners, has been accompanied by efforts to adapt teaching practices for this new group of students. Many have identified challenges associated with addressing the needs of modern medical learners. One particular trend we have observed is that medical students are increasingly requesting an “answer key” for all aspects of their medical education. Students often expect to have the correct answers readily available to them to ensure they have reached the correct conclusion and to determine the precise knowledge they need to master. Yet, for much of medicine, and particularly in the care of critically ill patients with multisystem disease in intensive care units, answers are uncertain, and the body of knowledge is ever-growing. Students’ regular requests for solutions to be provided to them threaten to undermine their development into critically thinking, self-sufficient physicians. We outline three potential contributors to this multifactorial problem and offer corresponding pedagogical solutions. Specifically, we address how prioritizing outcomes over process, discomfort with uncertainty, and fear of faltering can cause students to seek excessive levels of support that may ultimately do more harm than good. Addressing students’ concerns in these three key areas will not only serve students well during their undergraduate medical training but will also equip them with the skills needed to succeed in the clinical realm. To produce physicians capable of navigating an increasingly uncertain world, medical educators will need to help students appreciate that finding the answer is more complex than being provided an answer key.
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Raborn LN, Janis JE. Current Views on the New United States Medical Licensing Examination Step 1 Pass/Fail Format: A Review of the Literature. J Surg Res 2022; 274:31-45. [PMID: 35121548 DOI: 10.1016/j.jss.2022.01.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 11/20/2021] [Accepted: 01/02/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Residency programs have historically used numerical Step 1 scores to screen applicants, making it a career-defining, high-stakes examination. Step 1 scores will be reported as pass/fail starting in January 2022, fundamentally reshaping the residency application review process. This review aimed to identify opinions of physicians and medical students about the new format, identify arguments in support of or against the change, and determine the implications of this change on the residency selection process. METHODS A comprehensive PubMed review was performed in May 2021 to identify articles that discussed the new Step 1 format. Non-English and duplicate articles were excluded. Data collected from each article included publication year, specialty, subjects, and key findings. RESULTS A total of 81 articles were included, 26 of which discussed the impact of the new format within surgical fields (32.1%). Remaining articles discussed the implications within the medical community as a whole (n = 33, 40.7%) and nonsurgical fields (n = 22, 27.2%). Studies suggest Program Directors will rely on Step 2 Clinical Knowledge (CK) scores, medical school reputation, applicant familiarity, Dean's letters, recommendation letters, and research in lieu of numerical Step 1 scores. In addition, concerns have been raised that the new format will disadvantage international, osteopathic, and minority applicants while increasing stress surrounding Step 2 CK. CONCLUSIONS Within the medical community, there are concerns that Step 2 CK will be used to substitute Step 1 and that resident diversity will diminish due to the new Step 1 format. Holistic candidate consideration will be increasingly important.
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Affiliation(s)
- Layne N Raborn
- Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Jeffrey E Janis
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, Ohio State University, Columbus, Ohio.
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Pass/Fail USMLE Step 1 Scoring-A Radiology Program Director Survey. Acad Radiol 2021; 28:1622-1625. [PMID: 32928635 PMCID: PMC7485567 DOI: 10.1016/j.acra.2020.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/14/2020] [Accepted: 08/16/2020] [Indexed: 11/23/2022]
Abstract
Rationale and Objectives In February 2020, administrators for the US medical licensing examination (USMLE) announced that Step 1 reporting would change to pass/fail in hopes of reducing the overemphasis of USMLE performance on the residency selection system and improving medical student well-being. Our objective was to determine the perspectives of diagnostic radiology (DR), interventional radiology (IR), and nuclear medicine (NM) program directors (PDs) regarding pass/fail USMLE Step 1 scoring. Materials and Methods A survey composed of thirteen questions on a three-point Likert scale, five demographic questions, and a free-text question was distributed to 179 DR, 84 IR, and 34 NM PDs from ACGME-accredited residency programs. Results In total, 140 unique responses were obtained (response rate = 47.1%). The PD respondents had a male predominance of 79.1%, average age of 46 ± 7.2 years, and average tenure of 5.9 ± 5.2 years. A majority of PDs (69.6%) disagreed that the change is a good idea, and a minority (21.6%) believe the change will improve medical student well-being. Further, 90.7% of PDs believe a pass/fail format will make it more difficult to objectively compare applicants and most will place more emphasis on USMLE Step 2 scores and medical school reputation (89.3% and 72.7%, respectively). Conclusion The lasting impact of pass/fail Step 1 scoring are uncertain and many radiology PDs do not support this change. While the central motivations to reduce the overemphasis on USMLE Step 1 performance and improve medical student well-being are admirable, it remains to be seen if pass/fail scoring will accomplish these goals.
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Surgical clerkship: Do examination scores correlate with clinical performance? Am J Surg 2021; 222:1163-1166. [PMID: 34602278 DOI: 10.1016/j.amjsurg.2021.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/23/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aims to determine if there are correlations between clinical performance and objective grading parameters for medical students in the third-year surgery clerkship. METHODS Clerkship grades were compiled from 2016 to 2020. Performance on clinical rotations, NBME shelf exam, oral exam, and weekly quizzes were reviewed. Students were divided into quartiles (Q1-Q4) based on clinical performance. Standard statistical analysis was performed. RESULTS There were 625 students included in the study. Students in Q1+Q2 were more likely than those in Q3+Q4 to score in the top quartile on the shelf exam (29% vs. 19%, p = 0.002), oral exam (24% vs. 17%, p = 0.032), and quizzes (22% vs. 15%, p = 0.024). However, there was negligible correlation between clinical performance and performance on objective measures: shelf exam (R2 = 0.027, p < 0.001), oral exam (R2 = 0.021, p < 0.001), and weekly quizzes (R2 = 0.053, p = 0.092). CONCLUSIONS Clinical performance does not correlate with objective grading parameters for medical students in the third-year surgery clerkship.
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Polanco-Santana JC, Storino A, Souza-Mota L, Gangadharan SP, Kent TS. Ethnic/Racial Bias in Medical School Performance Evaluation of General Surgery Residency Applicants. JOURNAL OF SURGICAL EDUCATION 2021; 78:1524-1534. [PMID: 33637477 DOI: 10.1016/j.jsurg.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 05/02/2023]
Abstract
OBJECTIVE Differential use of communal terms (caring/unselfish traits) versus agentic terms (goal-oriented/leadership/achievement traits) may reveal bias and has been extensively reported in letters of recommendation for residency. We evaluated bias in medical student performance evaluations (MSPE) of general surgery residency applicants. DESIGN This is a retrospective study evaluating ethnic/race bias, as measured by differential use of agentic and communal terms, in MSPEs of residency applicants. 50% of MSPEs were randomly selected. An ethnic bias calculator derived from an open-source online gender bias calculator was populated with a list of validated agentic and communal terms. Relative frequency of communal and agentic terms was used to estimate bias. Multivariable regression was used to assess the association between the terms and ethnicity/race. PARTICIPANTS US medical students applying for a categorical surgery residency position at a single academic institution for a single Match cycle. RESULTS A total of 339 MSPEs were reviewed from 119 US medical schools. Genders were equally represented (women, 51.6%); most participants were white and Asian applicants (79.1%). Overall, MSPEs were more agency biased (65.2%) than communal biased (16.2%) or neutral (18.6%). MSPEs for Black and Hispanic/Latinx applicants were more likely to contain communal rather than agentic terms (adjusted OR: 3.02, 95% CI: 1.52-6.02) when compared to white and Asian applicants. This finding was independent of MSPE writer's gender or rank. CONCLUSIONS Surgery residency applicants self-identifying as Black and Hispanic/Latinx were more likely to be described using communal traits compared to white and Asian applicants, suggesting ethnic/racial bias. Such differences in language utilized in MSPEs may impact residency opportunities for applicants who are under-represented in medicine. Educational efforts aimed at MSPE writers may help to reduce bias.
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Affiliation(s)
| | - Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Lucas Souza-Mota
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sidhu P Gangadharan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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Maxfield CM, Montano-Campos JF, Chapman T, Desser TS, Ho CP, Hull NC, Kelly HR, Kennedy TA, Koontz NA, Knippa EE, McLoud TC, Milburn J, Mills MK, Morgan DE, Morgan R, Peterson RB, Salastekar N, Thorpe MP, Zarzour JG, Reed SD, Grimm LJ. Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. J Am Coll Radiol 2021; 18:1572-1580. [PMID: 34332914 DOI: 10.1016/j.jacr.2021.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/06/2021] [Accepted: 07/09/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass or fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced. METHODS A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors when paired with a numerical or pass or fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes, and odds ratios (ORs) were calculated. RESULTS There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors. DISCUSSION When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.
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Affiliation(s)
- Charles M Maxfield
- Vice-Chair of Education, Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | - J Felipe Montano-Campos
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Teresa Chapman
- Residency Program Director, Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Terry S Desser
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | - Christopher P Ho
- Residency Program Director, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Hillary R Kelly
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Nicholas A Koontz
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emily E Knippa
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Theresa C McLoud
- Vice-Chair of Education, Residency Program Director, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - James Milburn
- Residency Program Director, Department of Radiology, Ochsner Health System, New Orleans, Louisiana
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Desiree E Morgan
- Vice-Chair of Education, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Rustain Morgan
- Residency Program Director, Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ryan B Peterson
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ninad Salastekar
- Department of Radiology, SUNY Upstate Medical University, Syracuse, New York
| | | | - Jessica G Zarzour
- Radiology Residency Program Director, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
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Tseng JR, Kang YS, Youm J, Pandit R. Radiology resident selection factors predict resident performance. Clin Imaging 2021; 80:225-228. [PMID: 34352495 DOI: 10.1016/j.clinimag.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/04/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine selection factors that predict radiology resident performance. METHODS 59 consecutive radiology residents from 2002 to 2015 were ranked on performance during residency. Correlations and multiple regression analyses were performed to predict resident performance from the following selection factors: United States Medical Licensing Exam (USMLE) Step 1 score, medical school rank, Alpha Omega Alpha (AOA) membership, honors in clinical rotations, Medical Student Performance Evaluation (MSPE), and interview score. Results were compared against predictions from Match rank position. RESULTS Five selection factors showed significant or marginally significant correlations with resident performance (r = 0.2 to 0.3). The interview score was not significantly correlated. A multiple regression model comprised of the USMLE Step 1 score, medical school rank, AOA membership, and interview score predicted resident performance, with an adjusted R2 of 0.19. The interview score was included in the model but did not achieve statistical significance. Match rank did not predict resident performance, with an R2 of 0.01. CONCLUSIONS A multiple regression model comprised of the USMLE Step 1 score, medical school rank, and AOA membership predicted radiology resident performance and may assist with resident selection.
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Affiliation(s)
- Jeffrey R Tseng
- Santa Clara Valley Medical Center, Department of Radiology, 751 South Bascom Avenue, San Jose, CA 95128, United States of America.
| | - Young S Kang
- Santa Clara Valley Medical Center, Department of Radiology, 751 South Bascom Avenue, San Jose, CA 95128, United States of America
| | - Jiwon Youm
- Santa Clara Valley Medical Center, Department of Radiology, 751 South Bascom Avenue, San Jose, CA 95128, United States of America
| | - Rajul Pandit
- Santa Clara Valley Medical Center, Department of Radiology, 751 South Bascom Avenue, San Jose, CA 95128, United States of America
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Carmody JB, Green LM, Kiger PG, Baxter JD, Cassese T, Fancher TL, George P, Griffin EJ, Haywood YC, Henderson D, Hueppchen NA, Karras DJ, Leep Hunderfund AN, Lindsley JE, McGuire PG, Meholli M, Miller CS, Monrad SU, Nelson KL, Olson KA, Pahwa AK, Starr SR, Tunkel AR, Van Eck RN, Youm JH, Ziring DJ, Rajasekaran SK. Medical Student Attitudes toward USMLE Step 1 and Health Systems Science - A Multi-Institutional Survey. TEACHING AND LEARNING IN MEDICINE 2021; 33:139-153. [PMID: 33289589 DOI: 10.1080/10401334.2020.1825962] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Phenomenon: Because of its importance in residency selection, the United States Medical Licensing Examination Step 1 occupies a critical position in medical education, stimulating national debate about appropriate score use, equitable selection criteria, and the goals of undergraduate medical education. Yet, student perspectives on these issues and their implications for engagement with health systems science-related curricular content are relatively underexplored. Approach: We conducted an online survey of medical students at 19 American allopathic medical schools from March-July, 2019. Survey items were designed to elicit student opinions on the Step 1 examination and the impact of the examination on their engagement with new, non-test curricular content related to health systems science. Findings: A total of 2856 students participated in the survey, representing 23.5% of those invited. While 87% of students agreed that doing well on the Step 1 exam was their top priority, 56% disagreed that studying for Step 1 had a positive impact on engagement in the medical school curriculum. Eighty-two percent of students disagreed that Step 1 scores should be the top item residency programs use to offer interviews. When asked whether Step 1 results should be reported pass/fail with no numeric score, 55% of students agreed, while 33% disagreed. The majority of medical students agreed that health systems science topics were important but disagreed that studying for Step 1 helped learn this content. Students reported being more motivated to study a topic if it was on the exam, part of a course grade, prioritized by residency program directors, or if it would make them a better physician in the future. Insights: These results confirm the primacy of the United States Medical Licensing Examination Step 1 exam in preclinical medical education and demonstrate the need to balance the objectives of medical licensure and residency selection with the goals of the broader medical profession. The survey responses suggest several potential solutions to increase student engagement in health systems science curricula which may be especially important after Step 1 examination results are reported as pass/fail.
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Affiliation(s)
- J Bryan Carmody
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Lauren M Green
- EVMS-Sentara Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Patti G Kiger
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jared D Baxter
- Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Todd Cassese
- Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Tonya L Fancher
- Department of Internal Medicine, University of California Davis, Sacramento, California, USA
| | - Paul George
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Erin J Griffin
- Office of Medical Education, University of California Davis, Sacramento, California, USA
| | - Yolanda C Haywood
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - David Henderson
- Department of Family Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Nancy A Hueppchen
- Gynecology and Obstetrics, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - David J Karras
- Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | | | - Janet E Lindsley
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Paul G McGuire
- Department of Cell Biology and Physiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Mimoza Meholli
- Department of Medicine, Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Chad S Miller
- School of Medicine, Saint Louis University, Saint Louis, Missouri, USA
| | - Seetha U Monrad
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Kari L Nelson
- Office of Undergraduate and Graduate Medical Education, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kristin A Olson
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Amit K Pahwa
- Department of Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stephanie R Starr
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Allan R Tunkel
- Section of Medical Education, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Richard N Van Eck
- Department of Medical Education, University of North Dakota, School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Julie H Youm
- Office of Medical Education, University of California, Irvine, Irvine, California, USA
| | - Deborah J Ziring
- Academic Affairs, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Senthil K Rajasekaran
- Medical Academic and School Programs, Wayne State University School of Medicine, Detroit, Michigan, USA
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Mullen M, Barnard A, Gavard JA, Miller C, Thomure M. Residency match interview scheduling: quantifying the applicant experience. Postgrad Med J 2021; 98:e12. [PMID: 33707292 DOI: 10.1136/postgradmedj-2020-139514] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/07/2021] [Accepted: 02/20/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The process of offering and scheduling residency interviews varies widely among programmes. Applicants report distress and have advocated for reform. However, there is a paucity of quantitative data to characterise applicant concerns. OBJECTIVE We quantified the interview scheduling experience for US allopathic medical students in the 2020 main residency match. METHODS An anonymous, 13 question survey was sent to student representatives from each Association of American Medical Colleges member institution. Recipients were asked to forward the survey to their entire fourth-year class. RESULTS Of 4314 applicants to whom the survey was sent, 786 (18.2%) responded. Overall, 20.4% reported missing the opportunity to interview at a programme because they did not have adequate time to respond to an invitation; applicants into surgical specialties were significantly more likely than their non-surgical peers to report this experience (26.4% vs 18.4%, p<0.05). Most (57.4%) respondents scheduled an interview knowing they would likely cancel it in the future. The most commonly cited reason for this behaviour was concern that applicants would not receive invitations from other programmes (85.6%). A majority (56.4%) of respondents did not believe the match interview process functions based on equity and merit. CONCLUSIONS About one in five respondents missed the opportunity to interview at a programme because they did not respond to an invitation in time. Most respondents scheduled interviews knowing that they were likely to cancel them in the future. Standardisation of the interview invitation timeline would address these concerns.
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Affiliation(s)
- Mark Mullen
- Department of Psychiatry, Creighton University, Omaha, Nebraska, USA
| | - Amanda Barnard
- Saint Louis University School of Education, Saint Louis, Missouri, USA
| | - Jeffrey A Gavard
- Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Chad Miller
- Office of Curricular Affairs, Saint Louis University, Saint Louis, Missouri, USA
| | - Michael Thomure
- Department of Obstetrics and Gynecology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Pershing S, Co JPT, Katznelson L. The New USMLE Step 1 Paradigm: An Opportunity to Cultivate Diversity of Excellence. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1325-1328. [PMID: 32433311 DOI: 10.1097/acm.0000000000003512] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The February 2020 announcement that United States Medical Licensing Examination (USMLE) Step 1 results will be reported as pass/fail instead of numerical scores has been controversial. Step 1 scores have played a key role in residency selection, including screening for interviews. Although Step 1 scores are viewed as an objective criterion, they have been shown to disadvantage female and underrepresented minority applicants, cause student anxiety and financial burden, and affect student well-being. Furthermore, Step 1 scores incompletely predict applicants' overall residency performance. With this paradigm shift in Step 1 score reporting, residency programs will have fewer objective, standardized metrics for selection decisions, which may lead to greater emphasis on USMLE Step 2 Clinical Knowledge scores or yield unintended consequences, including shifting weight to metrics such as medical school reputation.Yet, greater breadth in residency selection metrics will better serve both applicants and programs. Some students excel in coursework, others in research or leadership. All factors should be recognized, and broader metrics should be implemented to promote and recognize diversity of excellence. Given the need for metrics for residency selection as well as for a more holistic approach to evaluating residency applicants, assessment during medical school should be revisited and made more meaningful. Another opportunity may involve use of situational judgment tests to predict professionalism and performance on other competencies. It will be important to evaluate the impact of the new Step 1 paradigm and related initiatives going forward. Residency application overload must also be addressed.
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Affiliation(s)
- Suzann Pershing
- S. Pershing is assistant professor, Department of Ophthalmology, Stanford University School of Medicine, and chief of ophthalmology and eye care services, Veterans Affairs Palo Alto Heath Care System, Stanford, California
| | - John Patrick T Co
- J.P.T. Co is designated institutional official, Brigham and Women's and Massachusetts General Hospitals, Partners HealthCare, and associate professor of pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Laurence Katznelson
- L. Katznelson is associate dean of graduate medical education and professor of neurosurgery and medicine (endocrinology and metabolism), Stanford University School of Medicine, Stanford, California
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Gabrielson AT, Kohn JR, Sparks HT, Clifton MM, Kohn TP. Proposed Changes to the 2021 Residency Application Process in the Wake of COVID-19. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:1346-1349. [PMID: 32459675 PMCID: PMC7268839 DOI: 10.1097/acm.0000000000003520] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The COVID-19 pandemic has brought unique challenges to the delivery of undergraduate medical education, particularly for current third-year medical students who are preparing to apply to residency. In mid-March, medical schools suspended all clinical rotations for the remainder of the 2019-2020 academic year. As such, third-year medical students may not be able to complete sufficient clinical experiences to make important career choices before they have to submit their residency applications. While the decision to suspend clinical rotations was necessary to protect students, specialty organizations and residency programs must mitigate the deficits in students' clinical education caused by the COVID-19 pandemic.In this Perspective, the authors identify potential challenges for third-year medical students and advocate for solutions to improve the residency application process for students and programs. First, they propose delaying the date that programs can access applicant data through the Electronic Residency Application Service, thereby affording students more time to complete clinical experiences, solidify their specialty decision, and strengthen their residency application. Second, the authors recommend a restriction on the number of visiting rotations that students are expected to complete to allow for a more equitable distribution of these important experiences. Third, they suggest that program directors from each specialty agree on a maximum number of applications per applicant (based on historical data) to curb an upsurge in applications that may stem from the unique circumstances created by COVID-19 without causing applicants undue stress. Lastly, the authors advocate that residency programs develop infrastructure to conduct video-based interviews and engage students through virtual networking events.Amidst the unique environment created by COVID-19, the authors urge governing bodies, specialty organizations, and residency programs to consider these recommendations to improve the efficiency and reduce the stress surrounding the 2021 Match.
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Affiliation(s)
- Andrew T. Gabrielson
- A.T. Gabrielson is a urology resident, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaden R. Kohn
- J.R. Kohn is a gynecology and obstetrics resident, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hayley T. Sparks
- H.T. Sparks is a pediatrics resident, Department of Pediatrics, Children’s National Hospital, Washington, DC
| | - Marisa M. Clifton
- M.M. Clifton is assistant professor, female pelvic medicine and reconstructive surgery, and director, urology residency program, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Taylor P. Kohn
- T.P. Kohn is a urology resident, The James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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18
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Affiliation(s)
- Benjamin L Mazer
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, USA
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19
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Hafferty FW, O'Brien BC, Tilburt JC. Beyond High-Stakes Testing: Learner Trust, Educational Commodification, and the Loss of Medical School Professionalism. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:833-837. [PMID: 32079955 DOI: 10.1097/acm.0000000000003193] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
With ever-growing emphasis on high-stakes testing in medical education, such as the Medical College Admission Test and the United States Medical Licensing Examination Step 1, there has been a recent surge of concerns on the rise of a "Step 1 climate" within U.S. medical schools. The authors propose an alternative source of the "climate problem" in current institutions of medical education. Drawing on the intertwined concepts of trust and professionalism as organizational constructs, the authors propose that the core problem is not hijacking-by-exam but rather a hijackable learning environment weakened by a pernicious and under-recognized tide of commodification within the U.S. medical education system. The authors discuss several factors contributing to this weakening of medicine's control over its learning environments, including erosion of trust in medical school curricula as adequate preparation for entry into the profession, increasing reliance on external profit-driven sources of medical education, and the emergence of an internal medical education marketplace. They call attention to breaches in the core tenets of a profession-namely a logic that differentiates its work from market and managerial forces, along with related slippages in discretionary decision making. The authors suggest reducing reliance on external performance metrics (high-stakes exams and corporate rankings), identifying and investing in alternative metrics that matter, abandoning the marketization of medical education "products," and attending to the language of educational praxis and its potential corruption by market and managerial lexicons. These steps might salvage some self-governing independence implied in the term "profession" and make possible (if not probable) a recovery of a public trust becoming of the term and its training institutions.
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Affiliation(s)
- Frederic W Hafferty
- F.W. Hafferty is professor of medical education, Division of General Internal Medicine and Program in Professionalism and Values, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0002-5604-7268. B.C. O'Brien is professor of medicine, Department of Medicine, and education scientist, Center for Faculty Educators, University of California, San Francisco, School of Medicine, San Francisco, California. J.C. Tilburt is professor of medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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20
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Williams M, Kim EJ, Pappas K, Uwemedimo O, Marrast L, Pekmezaris R, Martinez J. The impact of United States Medical Licensing Exam (USMLE) step 1 cutoff scores on recruitment of underrepresented minorities in medicine: A retrospective cross-sectional study. Health Sci Rep 2020; 3:e2161. [PMID: 32318628 PMCID: PMC7170452 DOI: 10.1002/hsr2.161] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/27/2020] [Accepted: 03/30/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS United States Medical Licensing Exam (USMLE) scores are the single, most objective criteria for admission into residency programs in the country. Underrepresented minorities in medicine (URiM) are found to have lower USMLE scores compared to their White counterparts. The objective of this study is to examine how USMLE step 1 cutoff scores may exclude self-reported URiM from the residency interview process across various specialties. METHODS This was a retrospective cross-sectional study of 10 541 applicants to different residency programs at Zucker School of Medicine at Hofstra/Northwell Health between May 2014 and May 2015. We identified Blacks and Hispanics as URiM. The primary outcome is the percentage of applicants with USMLE step 1 score above different ranges of cutoff score, from 205 to 235 in five-point increments, by race/ethnicity and by URiM status. Secondary outcome is percentages of URiM vs non-URiM above and below mean USMLE step 1 scores by different specialties (internal medicine, obstetrics/gynecology, pediatrics, and psychiatry). RESULTS The study sample included 2707 White, 722 Black, 805 Hispanic, 5006 Asian, and 562 Other Race/Ethnicity applicants. Overall, 50.2% were male, 21.3% URiM, 7.4% had limited English proficiency, 67.6% attended international medical schools, and 2.4% are Alpha Omega Alpha Honor Medical Society (AOA) members. The mean (±SD) USMLE step 1 score was significantly greater among non-URiM applicants as compared to URiM applicants (223.7 ± 19.4 vs 216.1 ± 18.4, P < .01, two-sample t-test). Non-URiM applicants were younger, and the percentage of male and AOA applicants was greater among non-URiM applicants as compared to URiM applicants (50.5% vs 47.7%, P = .02, Chi-Square test; 2.9% vs 1.2%, P < .01, Chi-Square test, respectively). CONCLUSION Using a USMLE step 1 cutoff score as an initial filter for applicant recruitment and selection could jeopardize the benefits of a diverse residency program. Practical implications are discussed.
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Affiliation(s)
- Myia Williams
- Department of MedicineNorthwell HealthManhassetNew York
| | - Eun Ji Kim
- Department of MedicineNorthwell HealthManhassetNew York
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew York
- The Feinstein Institutes for Medical ResearchManhassetNew York
| | - Karalyn Pappas
- The Feinstein Institutes for Medical ResearchManhassetNew York
| | | | - Lyndonna Marrast
- Department of MedicineNorthwell HealthManhassetNew York
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew York
- The Feinstein Institutes for Medical ResearchManhassetNew York
| | - Renee Pekmezaris
- Department of MedicineNorthwell HealthManhassetNew York
- Zucker School of Medicine at Hofstra/NorthwellHempsteadNew York
- The Feinstein Institutes for Medical ResearchManhassetNew York
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21
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Chan D, Sakya SM, Pfeifer CM. United States Medical Licensing Examination Step 1 Pass-or-Fail Reporting: Student Perspectives on Implications for Medical Student Education in Diagnostic Radiology. J Am Coll Radiol 2020; 17:1670-1672. [PMID: 32461049 DOI: 10.1016/j.jacr.2020.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Donald Chan
- Department of Internal Medicine, Riverside Community Hospital, Riverside, California
| | - Surav M Sakya
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Cory M Pfeifer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.
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22
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Crane MA, Chang HA, Azamfirei R. Medical Education Takes a Step in the Right Direction: Where Does That Leave Students? JAMA 2020; 323:2013-2014. [PMID: 32142102 DOI: 10.1001/jama.2020.2950] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Matthew A Crane
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Howard A Chang
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Razvan Azamfirei
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Patel MD, Tomblinson CM, Benefield T, Ali K, DeBenedectis CM, England E, Gaviola GC, Ho CP, Jay AK, Milburn JM, Ong S, Robbins JB, Sarkany DS, Heitkamp DE, Jordan SG. The Relationship Between US Medical Licensing Examination Step Scores and ABR Core Examination Outcome and Performance: A Multi-institutional Study. J Am Coll Radiol 2020; 17:1037-1045. [PMID: 32220580 DOI: 10.1016/j.jacr.2020.02.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/25/2020] [Accepted: 02/27/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE We analyzed multi-institutional data to understand the relationship of US Medical Licensing Examination (USMLE) Step scores to ABR Core examination performance to identify Step score tiers that stratify radiology residents into different Core performance groups. METHODS We collected USMLE Step scores and ABR Core examination outcomes and scores for anonymized residents from 13 different diagnostic radiology residency programs taking the ABR Core examination between 2013 and 2019. USMLE scores were grouped into noniles using z scores and then aggregated into three tiers based on similar Core examination pass-or-fail outcomes. Core performance was grouped using standard deviation from the mean and then measured by the percent of residents with scores below the mean. Differences between Step tiers for Core outcome and Core performance were statistically evaluated (P < .05 considered significant). RESULTS Differences in Step 1 terciles Core failure rates (45.9%, 11.9%, and 3.0%, from lowest to highest Step tiers; n = 416) and below-mean Core performance (83.8%, 54.1%, and 21.1%, respectively; n = 402) were significant. Differences in Step 2 groups Core failure rates (30.0%, 10.6%, and 2.0%, from lowest to highest Step tiers; n = 387) and below-mean Core performance (80.0%, 43.7%, and 14.0%, respectively; n = 380) were significant. Step 2 results modified Core outcome and performance predictions for residents in Step 1 terciles of varying statistical significance. CONCLUSIONS Tiered scoring of USMLE Step results has value in predicting radiology resident performance on the ABR Core examination; effective stratification of radiology resident applicants can be done without reporting numerical Step scores.
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Affiliation(s)
- Maitray D Patel
- Executive Board, Society of Radiologists in Ultrasound, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Courtney M Tomblinson
- Associate Program Director Diagnostic Radiology Residency; Associate Director, Women in Radiology, Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thad Benefield
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kamran Ali
- Program Director Diagnostic Radiology Residency; President, Radiology Group, Department of Radiology, University of Kansas School of Medicine, Wichita, Kansas
| | - Carolynn M DeBenedectis
- Vice Chair for Education; Program Director, Radiology Residency program, Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Eric England
- Vice Chair of Education, Department of Radiology; Program Director, Diagnostic Radiology Residency; Jerome F. Wiot Endowed Chair of Radiology Residency Education, Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Glenn C Gaviola
- Program Director Diagnostic Radiology Residency, Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Christopher P Ho
- Program Director Diagnostic Radiology Residency, Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Ann K Jay
- Vice Chair of Education and Program Director Diagnostic Radiology Residency, Department of Radiology, MedStar Georgetown University Hospital, Washington, DC
| | - James M Milburn
- Vice Chair of Radiology, Section Head Neuroradiology, Program Director of Diagnostic Radiology Residency. ACR: Louisiana State Councilor; Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Seng Ong
- Program Director Diagnostic Radiology Residency, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois
| | - Jessica B Robbins
- Vice Chair of Faculty Development and Enrichment; Associate Program Director Diagnostic Radiology and Integrated Diagnostic/Interventional Radiology Residencies, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David S Sarkany
- Diagnostic Radiology Program Director, Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | | | - Sheryl G Jordan
- Education Director Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Chen DR, Priest KC. In Reply to Griffith, to Weissman, to Schmuter, to Cottrell and Ferrari, and to Syed and Sykora. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1628-1629. [PMID: 31663950 DOI: 10.1097/acm.0000000000002956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- David R Chen
- Fourth-year medical student, University of Washington School of Medicine, Seattle, Washington; ; Twitter: @davidroychen; ORCID: http://orcid.org/0000-0002-5711-8689. Sixth-year MD/PhD student, Oregon Health & Science University, Portland, Oregon; Twitter: @Kelseycpriest; ORCID: http://orcid.org/0000-0003-3929-8177
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Jabbar A, Nabi S, Shafique K, Arshad A. The USMLE Step 1 Pass/Fail Reporting Proposal: Another Opinion. Acad Radiol 2019; 26:1408. [PMID: 31447260 DOI: 10.1016/j.acra.2019.07.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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