How Prospective Physical Medicine and Rehabilitation Trainees Rank Residency Training Programs

Training Program Factors Most Important to Women When Selecting an Otolaryngology Residency

OBJECTIVES

The aim of the study was to determine factors that female resident physicians find most influential when choosing an otolaryngology residency program.

METHODS

A three-part survey was sent to current female otolaryngology residents via email evaluating the importance of 19 characteristics impacting program choice. The 19 factors were scored from 1 (least important) to 5 (most important). The participants also ranked their personal top five most influential factors. Data were analyzed using descriptive statistics.

RESULTS

One-hundred and fifty of 339 contacted residents participated. Most were aged 30-39 (63%), white (70%), and married (43%). Eighty-five percent had no children, and 52% did not plan to have children during residency. The highest scoring factors derived from Likert scale ratings included resident camaraderie (4.5 ± 0.8), resident happiness (4.4 ± 0.8), and case variety/number (4.4 ± 0.8). The lowest scoring factors were number of fellows (2.9 ± 1.1), attitudes toward maternity leave (2.7 ± 1.3), and maternity leave policies (2.4 ± 1.2). The top five most influential factors and the percentage selecting this were resident camaraderie (57%), resident happiness (57%), academic reputation (51%), case variety/number (47%), and early surgical/clinical experience (44%). Gender-specific factors were infrequently selected. However, 51 (34%) ranked at least one gender-specific factor within their top five list.

CONCLUSION

Non-gender-related factors, like resident camaraderie and surgical experiences, were most valued by women. Conversely, gender-specific factors were less critical and infrequently ranked. Ninety-nine residents (64%) rated exclusively gender-neutral characteristics in their top five list of most influential factors. Our data offer insight into program characteristics most important to female otolaryngology residents, which may assist residency programs hoping to match female applicants.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:600-606, 2024.

Urology Match: Important Factors Women Consider When Choosing a Residency Training Program

OBJECTIVE

To determine factors that women urology resident physicians rate as most influential when selecting residency programs.

METHODS

Surveys were emailed to female urology residents during the 2021-2022 academic year. Residents scored 19 factors influencing residency program choice from 1 "least" to 5 "most" important and ranked their top 5 most influential factors. Data were analyzed via descriptive statistics and quantile regression.

RESULTS

One hundred thirty-six (37%) of 367 female urology residents who received the survey participated. Eighty-two percent had no children and 57% did not plan to have children during residency. The three highest scoring factors derived from Likert scale ratings were resident camaraderie (4.6 ± 0.5 [mean ± SD]), resident happiness (4.6 ± 0.6), and case variety/number (4.4 ± 0.8). As a whole, the lowest scoring characteristics were attitudes toward maternity leave (2.6 ± 1.2) and maternity leave policies (2.5 ± 1.2). Married residents were more likely than those who were single and engaged/in a committed relationship to rank attitudes and policies toward maternity leave as more important (3 vs 2 vs 2, P <.0001). Residents with children were more likely than those without children to rank maternity leave policies as more important (3 vs 2, P <.0001).

CONCLUSION

As a whole, women urology residents prioritized non-gender-related factors. However, gender-specific factors were rated highly by married residents and those with children or planning to have children. Urology training programs may use these results to highlight desirable characteristics to aid recruitment of female residents.

The Importance of Female Mentors and Safety in the Workplace to Female Otolaryngology Applicants When Creating Rank Lists

OBJECTIVES

The aim of this research is to understand the importance of female career mentors, research mentors, co-residents, and program directors/chairs to current female otolaryngology residents when applying to residency. The importance of safety in the workplace was also investigated.

METHODS

Surveys were sent via electronic mail to 119 programs, and program directors were asked to distribute them to female residents. Using the Likert scale, participants ranked the importance of various factors when creating a rank list, in particular, importance of safety in the workplace and importance of female mentors in various leadership positions. Demographic information, geographic location, LGBTQ identification, and fellowship plans were also collected.

RESULTS

There were 62 participants nationally. Eighty-seven percent (n = 54) of participants stated that having at least 1 female attending and having female co-residents was "very important" or "important" when ranking programs. A number of respondents replied that having a female career development mentor (38.7% [n = 24] and 43.5% [n = 27]), female program director or chair (4.8% [n = 3] and 16.1% [n = 10]), and female research mentor (12.9% [n = 8] and 29% [n = 18]) was "very important" or "important," respectively. Ninety-three percent (n = 58) replied that feeling safe in their training environment was "very important" or "important."

CONCLUSION

Having female mentors as well as safety in the workplace in residency is important to a vast majority of residents and applicants when creating a rank list. Programs with women in these roles may gain a disproportionate number of female residents because they may be more desirable places than those without women in these roles.

Variability in procedure volume of physical medicine and rehabilitation residents graduating from 2014 to 2021

BACKGROUND

Adequate exposure to commonly performed procedures during physical medicine and rehabilitation (PM&R) residency is an important issue.

OBJECTIVE

To assess temporal trends and variabilities in reported procedural volumes, including the number of residents achieving procedure minimum requirements as established by the Accredited Council for Graduate Medical Education (ACGME) PM&R Residency Review Committee.

DESIGN

This was a retrospective cohort study of PM&R residents graduating from 2013-2014 to 2020-2021. Descriptive statistics were calculated for tracked procedures and compared over time with analysis of variance (ANOVA) tests. Variability was calculated as the procedure volume difference between the 90th and 10th percentile groups.

SETTING

ACGME-accredited PM&R residency training programs.

PARTICIPANTS

A total of 3231 PM&R residents graduating from 2014 to 2021.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Reported procedure volume and number of residents achieving minimum requirements.

RESULTS

Total procedure volume increased over the study period (436 ± 225 to 523 ± 238, p = .013). The percentage of all procedures that were performed versus observed was stable over the study period (81%-77%, p = .234). Variability in total reported procedure volume remained stable over the study period. The percentage of PM&R residents not achieving minimum requirements ranged from 2% for peripheral joint injections to 22% for ultrasound in the contemporary training period.

CONCLUSIONS

The volume of reported procedures has increased along with the number of PM&R residency programs and residents. Variabilities in total reported procedure volume were stable over time, but PM&R residents struggle to obtain minimum requirements for ultrasound procedures.

Improving resident confidence with a low-cost interventional spine course

Background

Procedure training is highly desired by residents pursuing a career in interventional pain medicine; however, the opportunities for hands-on training may vary amongst residency programs for various reasons.

Objective

To evaluate the change in residents' self-perceive competence after participation in a novel low-cost resident interventional spine course, as well as how resident experience (years of training) influences change over time. This article offers step-by-step details on how to implement a resident interventional spine course.

Methods

Residents completed a pre- and post-course survey in the domains of self-perceived confidence, knowledge, and skills related to interventional spine procedures.

Results

Over five years, 19 individual residents participated in an annual elective interventional spine course (four residents chose to repeat the course during their training, one of which repeated it twice). The dimensions with highest percent improved change included the ability to perform a procedure kit set-up, followed by post-procedure complication management. Residents earlier in their training showed significantly greater improvement in rating their ability to conduct a pre-procedure chart review and addressing post-procedure complications compared to more experienced residents. In addition, resident feedback regarding the course was resoundingly positive. Of the 12 graduated residents, half applied and successfully matched into a pain medicine or sports medicine fellowship.

Conclusion

A low-cost interventional spine course appears to be a practical option to help improve residents' confidence related to various aspects of interventional spine procedures.

Incorporating Holistic Review in Recruitment in a Physical Medicine and Rehabilitation Residency Program

ABSTRACT

Traditional residency recruitment practices are vulnerable to unconscious biases, inequity, lack of diversity, and have limited ability to predict future clinical competency. Holistic review and evidence-based strategies, such as structured interviews and situational judgment tests, can mitigate these limitations. A physical medicine and rehabilitation residency program restructured its residency recruitment process using holistic review principles and evidence-based strategies during the 2020-2021 academic year. A subcommittee developed a weighted screening rubric based on Association of American Medical Colleges core competencies and semistructured interview questions targeting specific domains. Formal implicit bias training was provided. Screening scores determined interview invitations. Applicants participated in three different domain-focused semistructured interviews. Screening and interview scores were combined to form the program rank list. A postinterview anonymous questionnaire was sent to interviewees to obtain feedback. Four hundred eighty-nine applicants were screened (82 interview invitations, 80 interviewed, 8 matched). The respondents to the postinterview questionnaire found that interviews evaluated them objectively (90%) and improved their impression of the program (90%). The program's match was consistent with previous matches. Interviewed applicants represented a racially diverse group. Most questionnaire respondents had a positive impression of the interview process. This article demonstrates incorporating holistic review into residency recruitment and provides specific resources to aid other institutions pursuing similar goals.

Awareness of Physical Medicine and Rehabilitation as a Specialty Among US Medical Students

ABSTRACT

The objectives were to assess US medical students' awareness about physical medicine and rehabilitation, their career goals that may align with physical medicine and rehabilitation, and their exposure to physical medicine and rehabilitation and to compare the demographics of those applying to, interested, or not interested in physical medicine and rehabilitation residency. This was a descriptive cross-sectional study. An online survey was distributed to 76 medical schools, and 2067 students responded. First-generation and Hispanic/Latino students are less likely to know about physical medicine and rehabilitation. Medical students who heard about physical medicine and rehabilitation before or during college or who are first-generation students to attend medical school are more likely to be interested in physical medicine and rehabilitation. Medical students identified as female, Black or African American, and more advanced in medical training have lesser interest. Rotating in physical medicine and rehabilitation at their home institution and shadowing a physical medicine and rehabilitation physician also increase the likelihood of respondents to apply to physical medicine and rehabilitation residency. This study highlights that female students and underrepresented minorities in medicine are less likely to know about physical medicine and rehabilitation or be interested in physical medicine and rehabilitation. First-generation medical students know less about the field but the ones who do have increased interest in physical medicine and rehabilitation. These findings support the need for pipeline programs to improve exposure, recruitment, development, promotion, and retention of first-generation minorities and women into physical medicine and rehabilitation.

Implementation of a required 3rd-year medical student surgical pathology clinical experience

Few medical schools have required experience ​in surgical pathology during the clinical years. After introducing a pilot and preliminary surgical pathology clinical experience into the curriculum, we initiated a required 3rd-year medical student surgical pathology clinical experience that consisted of a one hour introductory lecture; one hour gross room, histology, and immunohistochemistry laboratory introduction; and one hour of one-on-one case sign-out preceptorship with a subspecialty surgical pathologist within the surgery and obstetrics/gynecology block. Concepts that were covered included specimen processing, intraoperative frozen section consultation, completing specimen requisitions, interpreting synoptic reports, and pTNM staging. Students evaluated the surgical pathologist from 1 to 5 (1 “poor/unhelpful,” 2 “marginal,” 3 “neutral,” 4 “good,” 5 “excellent/useful”). Ten multiple-choice questions (included as part of a perioperative services exam) and attendance were incorporated into students’ perioperative services rotation grade. From 2014 to 2018, 757 students participated in the required 3rd-year surgical pathology clinical experience. Thirty academic subspecialty pathologists acted as preceptors with an average of nine sessions per preceptor per year. Evaluation data from 316 students from 2015 to 2018 showed a mean preceptor rating of 4.8/5 (range 4.0–5.0). Students scored an average of 81% on the surgical pathology portion of the exam (range 21–99% for each question). We successfully implemented a required medical student surgical pathology clinical experience. At the clerkship’s conclusion, students demonstrated understanding of key concepts and rated their preceptorship experience highly.

Musculoskeletal Ultrasound as a Motivator for Selecting a Physical Medicine and Rehabilitation Residency Program in the United States: A Multicenter Survey Study

ABSTRACT

This study aimed to determine the influence of musculoskeletal ultrasound (MSKUS) curriculum on applicants during the residency-selection process. A survey of 666 applicants for the Johns Hopkins University, Mayo Clinic, and Harvard/Spaulding Rehabilitation Physical Medicine and Rehabilitation programs was conducted in June 2020. A total of 180 respondents scored the influence of a MSKUS curriculum on their decision making for residency selection. In addition, applicants were asked to rank specific areas of physical medicine and rehabilitation that influenced their decision making. Participants most commonly included MSKUS in their top three areas of interest when constructing their rank order list. When asked whether MSKUS presence within a program had an effect during the interview-selection process, 71% responded with "very important" or "absolutely essential" (P < 0.001). For 74% of applicants, exposure to MSKUS in residency was an important factor when creating their rank order list (P < 0.001). More than 92% of applicants stated that they are "likely" or "very likely" to use MSKUS in their future practice and 83% would recommend a program with MSKUS to future candidates (P < 0.001). Based on these results, a large percentage of physical medicine and rehabilitation applicants intend on using MSKUS in their future practice. Therefore, MSKUS may be an important factor for residency selection.

Gender and Racial Trends Among Vascular Neurology Fellowship Programs: By Design or By Default

Introduction Benefits of increasing diversity in teams include the addition of different perspectives leading to increased innovation and creativity, faster problem solving, improved workforce morale, and reduced burnout leading to improved patient outcomes. This article reviewed the trend of gender and racial disparity in vascular neurology fellowship programs. Methods We retrospectively analyzed the data extracted from the Accreditation Council for Graduate Medical Education (ACGME)'s annual Data Resource Books from 2007 to 2019. ACGME cataloged gender as men and women and race/ethnicity was categorized as White/Non-Hispanic, Asian or Pacific Island, Hispanic, Black/Non-Hispanic, Native American/Alaskan, others, and unknown. Counts, proportions, relative, and absolute percentage changes were calculated to highlight trends in resident appointments over time and across the specialty of vascular neurology. Results The representation of females increased steadily; with a relative increase of 11.78% from the year 2007 to 2019. Race/ethnicity was reported starting from the year 2011. When averaged across the nine-year study period, 35% of the study sample was White (Non-Hispanic), followed by Asian/Pacific Islanders at 25%. The representation of Hispanics was 4.8%, Black/African Americans were 3%, Native Americans/ Alaskans were 0.23% and Others were 13% of the total study population. For 17.7% of the fellows, racial data were not known and was categorized as Unknown racial distribution. Conclusion Our study concludes that gender and racial disparity persists within the fellowship programs of vascular neurology. Effective strategies at individual, administrative, and national levels are needed to engage women and under-represented minorities in vascular neurology as a career choice.

Virtually Possible: Medical Student Rehabilitation Rotations During a Pandemic

ABSTRACT

The novel coronavirus 2019 pandemic has led to new dilemmas in medical education because of an initial shortage of personal protective equipment, uncertainty regarding disease transmission and treatments, travel restrictions, and social distancing guidelines. These new problems further compound the already existing problem of limited medical student exposure to the field of physical medicine and rehabilitation, particularly for students in medical schools lacking a department of physical medicine and rehabilitation, approximately 50% of medical schools. A virtual medical student physical medicine and rehabilitation rotation was created to mitigate coronavirus 2019-related limitations and impact on medical education. Using audiovisual technology, students had the opportunity to participate in clinical inpatient and outpatient care, live-streamed procedures, and virtual didactics, develop and showcase their clinical knowledge and reasoning skills, and become familiar with the culture of the physical medicine and rehabilitation residency program. Adaptive educational approaches, including integration of the flipped classroom model, success, pitfalls, and areas for improvement will be described and discussed. Providing nontraditional methods for physical medicine and rehabilitation education and exposure to medical students is crucial to maintain and promote growth of the field in this unprecedented and increasingly virtual era.

Factors Influencing Fellowship Decision Making During Physical Medicine & Rehabilitation Residency

ABSTRACT

Previous surveys have demonstrated an increasing trend among graduating physiatry residents who desired to pursue a subspecialty fellowship. There has been sparse information on whether residents start their training with a subspecialty interest in mind and what factors influenced them to choose a fellowship. This article describes a prospective survey in the 2019-2020 academic year in which 175 responses were collected representing 65 (78.3%) of the 83 physical medicine and rehabilitation programs with graduating residents. Nearly 3 in 4 (73.7%, 129/175) reported matching into a fellowship, and among those, 79.8% (103/129) had matched into a pain, spine, or sports medicine fellowship. At the start of residency, 62.3% (109/175) were planning to pursue a fellowship, with 54.9% (96/175) planning to focus on either pain, sports, or spine medicine. Most respondents (72.2%) did not change their initial subspecialty focus during their residency training. Forty-six percent agreed that their anticipated subspecialty influenced their choice of residency program. The results of this survey demonstrate that most graduating residents are matriculating into fellowship training with pain, spine, and/or sports medicine being among the top choices. These results underscore the importance of subspecialty interests of trainees at the start of their residency and how training may influence their subspecialty interest.

Factors in Orthopaedic Residency Decision-making for Female Applicants: A Cross-sectional Study

BACKGROUND

Orthopaedics continues to remain the medical specialty with the lowest sex diversity in the United States. Orthopaedic residency programs are highly motivated to attract the best female candidates in an effort to improve their program diversity, but no studies currently exist that examine the factors of highest importance to female applicants for orthopaedic residency selection.

METHODS

A two-part survey was sent to female orthopaedic residents by e-mails available in the American Academy of Orthopaedic Surgery directory, residency program coordinators, Doximity, and institutional websites. The survey included 17 characteristics of residency programs that participants were asked to score for importance and then asked to rank their top five most influential factors when selecting an orthopaedic surgery residency.

RESULTS

The most important factors included camaraderie among residents, happiness of current residents, variety/number of cases, fellowship placement, and early surgical/clinical experience, respectively. The least important factors included sex diversity of faculty and residents, number of female residents, concurrent fellows, number of female faculty geographic location near spouse, and finally, attitudes toward maternity leave.

DISCUSSION

These data support the notion that efforts by orthopaedic residency programs to improve desirability for female applicants should focus on highlighting some of the more universal, nonsex-related factors such as the happiness and camaraderie among residents and the anticipated clinical experiences. This is opposed to showcasing features, such as maternity leave and number of current female faculty or residents, which would seemingly appeal to female applicants.

Trends in the Physical Medicine and Rehabilitation Match: Analysis of NRMP Data from 2007 to 2018

INTRODUCTION

We provide an updated analysis of data about U.S. Physical Medicine and Rehabilitation (PM&R) residency program applicants collected by the National Resident Matching Program (NRMP).

OBJECTIVE

Analyze trends within NRMP data for PM&R residency match rates, compare matched to unmatched applicants, and compare PM&R applicants to other medical specialties.

DESIGN

Secondary analysis of NRMP data.

SETTING

NRMP data set.

PARTICIPANTS

Residency program applicants who participated in the NRMP Match, 2007 to 2018.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Number of applicants, match rates, difference in characteristics including rank order list (ROL), U.S. Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) scores, publications, Alpha Omega Alpha (AOA) status, PhD degree, and experiences in research, volunteer, and work.

RESULTS

Number of applicants and residency positions increased from 2007 to 2018. Length of ROL increased and was longer for matched compared to unmatched applicants, with maximum mean difference of 7.4 in 2016 (95% confidence interval [CI] 5.6-9.2). Matched U.S. Allopathic Seniors had higher USMLE scores compared to unmatched, with a mean difference of 12.7 for Step 1 (95% CI 8.3-17.0) and 12.6 (95% CI 8.6-16.6) for Step 2 CK (P < .001). Number of publications and volunteer experiences were higher for matched U.S. Allopathic Seniors (0.64, 95% CI 0.09-1.2 and 1.5, 95% CI 0.65-2.3, respectively). PM&R USMLE Step 1 and 2 CK scores increased at a significantly faster rate than for all other specialties, with estimated rate differences of 0.46 (95% CI 0.21-0.71) and 0.69 (95% CI 0.45-0.93) points per year, respectively.

CONCLUSIONS

PM&R residency has become more competitive. USMLE Step 1 and 2 CK scores have outpaced the inflation of scores in other specialties. ROL length has increased, suggesting more ranked programs to successfully match. These analyses update our knowledge about PM&R residency applicants and suggest surrogate markers for a successful match.

Factors in Residency Decision Making for Female Neurosurgery Applicants

BACKGROUND

Neurosurgery remains a specialty with one of the largest gender gaps in the United States. Neurosurgery residency programs are highly motivated to attract the best female candidates in an effort to improve their program diversity, but no studies currently exist that examine the factors of highest importance to female applicants for neurosurgery residency selection. The purpose of this study was to determine factors that female neurosurgery residents used when selecting their residency.

METHODS

A 2-part survey was sent to female neurosurgical residents by e-mails collected from the American Association of Neurological Surgeons directory and residency program websites. The survey asked participants to score 17 characteristics of residency programs in terms of importance and then asked them to rank their top 5 most influential factors when selecting a neurosurgery residency.

RESULTS

The most important factors included variety/number of cases, camaraderie and happiness of current residents, early surgical/clinical experience, and academic reputation. The least important factors included gender diversity of faculty and residents, number of female residents, number of female faculty, and attitudes toward maternity leave.

CONCLUSIONS

Efforts to increase female applicants in neurosurgery residency programs should focus on highlighting some more universal, non-gender-related factors, such as happiness and camaraderie among residents and anticipated clinical experiences, as opposed to showcasing features that would seemingly appeal to female applicants, such as maternity leave and number of current female faculty or residents.