Medical student residency preferences and motivational factors: a longitudinal, single-institution perspective

Diversity, Equity, and Inclusion in US Anesthesiology Residency Matching

BACKGROUND

Patient outcomes are improved with physician-patient gender, racial, and ethnic concordance. However, female, Black, Hispanic or Latino, Native Hawaiian-Pacific Islander (NH-PI), and American Indian-Native Alaskan (AI-AN) physicians are underrepresented in anesthesiology. The American Association of Medical Colleges 2018 Diversity in Medicine Report revealed that women comprise only 35% of anesthesiologists yet nearly half of medical school graduates are women. More than 77% of anesthesiologists are White or Asian. Anesthesiology applicant and match trends may provide insights needed to address underrepresentation within anesthesiology. We hypothesized that proportionally fewer women and racially and ethnically minoritized applicants apply and match into anesthesiology.

METHODS

This retrospective observational study identified 47,117 anesthesiology applicants among the 546,298 residency applicants in the Electronic Residency Application Service (ERAS) system between 2011 and 2022 and stratified applicants by self-reported gender, race, and ethnicity. The demographics of anesthesiology trainees reported in the 2014 to 2015, 2018 to 2019, and 2022 to 2023 Accreditation Counsel of Graduate Medical Education (ACGME) Data Resource Books were used as surrogates for matched applicants as demographics are not reported by the National Residency Match Program. To facilitate comparisons, ERAS applicants were grouped into 4-year epochs to align with consolidated ACGME reports corresponding to the application years. Odds ratios (OR); 95% confidence interval of applying to and matching into anesthesiology were analyzed.

RESULTS

Women had lower odds of applying to anesthesiology compared to men overall (OR, 0.55; 95% CI, 0.54-0.56, P < .0001) and maintained significantly lowered odds of applying within each epoch. Women had similar odds of matching into anesthesiology residency compared to men (OR, 1.10; 95% CI, 1.06-1.14, P < .0001). Black, Hispanic or Latino, Asian and NH-PI, and AI-AN applicants had similar odds to White applicants of applying to anesthesiology but odds of matching were significantly lower overall ( P < .0001) for Asian and NH-PI (OR, 0.66; 95% CI, 0.63-0.70), Black (OR, 0.49; 95% CI, 0.45-0.53), Hispanic or Latino (OR, 0.50; 95% CI, 0.46-0.54), and AI-AN (OR, 0.20; 95% CI, 0.15-0.28) applicants. The odds of matching among some minoritized applicants increased in the ACGME 2022 to 2023 report year.

CONCLUSIONS

From 2011 to 2022, women had lower odds of applying to anesthesiology residency than men yet had similar odds of matching. Racial and ethnic minoritized groups had significantly lower odds of matching compared to White applicants despite similar odds of applying. These findings highlight disparities in the anesthesiology match and may help identify opportunities to promote workforce diversity within the field. More detailed reporting of gender, race, and ethnicity in annual match data may better define barriers to entry and identify opportunities for improvement.

How Dobbs May Influence the Geographic Distribution of Medical Trainees in the United States

Third- and fourth-year U.S. medical students applying to residency were surveyed between August 6 and October 22, 2022, to assess the impact of Dobbs v. Jackson Women's Health Organization (Dobbs) on medical student residency application location choices. Across all medical specialties, most respondents were unlikely or very unlikely to apply to one or more residency programs located in a state with abortion restrictions (57.9%) and were considering changes in state abortion access when choosing the location of residencies to apply to (77.0%). Respondents in states with no abortion restrictions were less likely to apply to a program in a state with abortion restrictions (2 [1, 3] p < .001). The Dobbs decision significantly impacts residency application decisions for medical students in all specialties. Students are choosing to avoid or target states with restrictive abortion legislation based on their personal views.

ChatGPT and large language models (LLMs) awareness and use. A prospective cross-sectional survey of U.S. medical students

Generative-AI (GAI) models like ChatGPT are becoming widely discussed and utilized tools in medical education. For example, it can be used to assist with studying for exams, shown capable of passing the USMLE board exams. However, there have been concerns expressed regarding its fair and ethical use. We designed an electronic survey for students across North American medical colleges to gauge their views on and current use of ChatGPT and similar technologies in May, 2023. Overall, 415 students from at least 28 medical schools completed the questionnaire and 96% of respondents had heard of ChatGPT and 52% had used it for medical school coursework. The most common use in pre-clerkship and clerkship phase was asking for explanations of medical concepts and assisting with diagnosis/treatment plans, respectively. The most common use in academic research was for proof reading and grammar edits. Respondents recognized the potential limitations of ChatGPT, including inaccurate responses, patient privacy, and plagiarism. Students recognized the importance of regulations to ensure proper use of this novel technology. Understanding the views of students is essential to crafting workable instructional courses, guidelines, and regulations that ensure the safe, productive use of generative-AI in medical school.

Characteristics and Experiences Associated with Interest in Global Surgery: What Brings US Medical Students to the Field?

INTRODUCTION

An estimated 5 billion people lack access to safe surgical care. Development and nurturing of medical student interest in global surgery can play a part in addressing this need. This study examines characteristics and experiences of medical students in the United States (US) associated with interest in global surgery.

METHODS

A cross-sectional survey study of US-based medical students was performed. Student leaders from the Global Surgery Student Alliance were recruited via email and distributed the online survey to peers at their institutions. Responses from students currently training outside of the US were excluded, as were surveys with <80% completion. Descriptive statistics and multivariate analysis were performed with p < 0.05 indicating significance in R (Vienna, Austria).

RESULTS

About 708 responses from students at 38 US medical schools were analyzed. 251 students (34.6%) identified as being interested in global surgery. After adjusting for covariates on multivariable regression, demographic factors significantly associated with interest in global surgery were Hispanic/Latino ethnicity (in comparison to Non-Hispanic White/Caucasian, OR = 1.30) and being born outside of the United States (OR = 1.21). Increased interest was also associated with previous clinical experiences in low or middle-income countries (OR = 1.19), public or global health experiences (OR = 1.18), and international service experiences (OR = 1.13).

CONCLUSIONS

While many factors may influence student interest in global surgery, previous global health experience and nonclinical global service work are important predictors regardless of background. Our results suggest that medical educators should look to both international clinical and nonclinical collaborations as a means to cultivate and nourish global surgery interest in medical students.

Crafting the Future Doctor: Mentorship in the First Year of Medical School

Background: The Clinically Reimagined Apprenticeship For Physician Training (CRAFT) program is a volunteer, student-run, clinical mentorship program that started in 2015 at an academic medical center in the Mid-Atlantic region. Clinical exposure during the first year of medical school may influence a student's decision to pursue internal medicine for their residency program of choice.Methods: A retrospective chart analysis of CRAFT program volunteers was conducted. First-year medical school students at an academic medical center in the Mid-Atlantic region (first-year classes of 2020 to 2022) who participated in the CRAFT program (N=77) were followed from first year until their medical school graduation. Information regarding first year mentor's specialty and student's match list data were collected.Results: Students (51%) who participated in CRAFT matched into the same specialty of medicine as their CRAFT program mentors (P=0.765, Chi Square Test). The top specialties represented included emergency medicine, internal medicine, obstetrics/gynecology, and surgery. Of students (23%) who chose mentors in internal medicine, 50% matched into internal medicine residency programs (P<0.0001, Chi Square Test).Conclusion: Clinical mentorship programs during the first year of medical school may be important for choosing future residency programs, leading to successful career goals. Timely engagement with mentors can be crucial in influencing career choices in the field of internal medicine.

Attracting medical school graduates to residency programs in remotely located hospitals: the challenge lies beyond financial incentives

BACKGROUND

Recruitment to residency programs in hospitals located in other than major hubs ("remotely located") is a challenge in many countries. In 2011, the Israeli Ministry of Health launched a 10-year financial incentive to encourage physicians to enroll in residency programs in such hospitals. Nearly 1 billion New Israeli Shekels (260 million US$) were invested in that program which had only limited success. As a new physician association's collective agreement is impending, we aimed to measure the effectiveness of selected incentives in attracting medical school graduates to residencies in remotely located hospitals.

METHODS

This study included Israeli medical students in their final year of medical school. We used an online questionnaire with multiple-choice demographic questions and a 5-point Likert scale to gauge the effect of various incentives on their preference for residency location.

RESULTS

Between July and November 2022, 522 students responded (405 studied in Israeli medical schools [out of 705 students] and 117 in foreign medical schools [out of 1936 students]). Forty-two percent had at least one clerkship in a remotely located hospital, and 24% had included at least one remotely located hospital among their top five choices for internship. Only 13% reported that they prefer a residency program in those institutions. The incentive selected by students as most persuasive was government assistance in acceptance to and financial support for a fellowship abroad, followed by a financial grant and fewer on-call hours. Only 7% of the students indicated that no incentive would influence them to choose a remotely located hospital for their residency training. Medical education in a remotely located university and the choice of at least one remotely located hospital among the top five choices for internship were significantly associated with positive incentive receptivity, whereas male sex and older age were associated with negative receptivity.

CONCLUSION

This study on the attitudes of Israeli medical school graduates toward incentives aimed at attracting them to residencies in remotely located institutions revealed that career development opportunities and assistance in obtaining fellowships might influence their choice.

Factors Affecting Specialty Training Preference Among UK Medical Students (FAST): Protocol for a National Cross-Sectional Survey

BACKGROUND

The UK medical education system faces a complex landscape of specialty training choices and heightened competition. The Factors Affecting Specialty Training Preference Among UK Medical Students (FAST) study addresses the need to understand the factors influencing UK medical students' specialty choices, against a backdrop of increasing challenges in health care workforce planning.

OBJECTIVE

The primary objectives of the FAST study are to explore UK medical students' preferred specialties and the factors that influence these choices. Secondary objectives are to evaluate students' confidence in securing their chosen specialty, to understand how demographic and academic backgrounds affect their decisions, and to examine how specialty preferences and confidence levels vary across different UK medical schools.

METHODS

A cross-sectional survey design will be used to collect data from UK medical students. The survey, comprising 17 questions, uses Likert scales, multiple-choice formats, and free-text entry to capture nuanced insights into specialty choice factors. The methodology, adapted from the Ascertaining the Career Intentions of UK Medical Students (AIMS) study, incorporates adjustments based on literature review, clinical staff feedback, and pilot group insights. This approach ensures comprehensive and nondirective questioning. Data analysis will include descriptive statistics to establish basic patterns, ANOVA for group comparisons, logistic regression for outcome modeling, and discrete choice models for specialty preference analysis.

RESULTS

The study was launched nationally on December 4, 2023. Data collection is anticipated to end on March 1, 2024, with data analysis beginning thereafter. The results are expected to be available later in 2024.

CONCLUSIONS

The FAST study represents an important step in understanding the factors influencing UK medical students' career pathways. By integrating diverse student perspectives across year groups and medical schools, this study seeks to provide critical insights into the dynamics of specialty, or residency, selection. The findings are anticipated to inform both policy and educational strategies, aiming to align training opportunities with the evolving needs and aspirations of the future medical workforce. Ultimately, the insights gained may guide initiatives to balance specialty distribution, improve career guidance, and improve overall student satisfaction within the National Health Service, contributing to a more stable and effective health care system.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55155.

Evolution of Medical Students' Interest in Orthopaedic Surgery Careers from Matriculation to Graduation

Introduction

Little is known about risk factors for changes in students' interest in orthopaedics during medical school. We aimed to identify variables associated with diminished (vs. sustained) and emerging (vs. no) plans to become board certified in orthopaedic surgery.

Methods

We conducted a retrospective national-cohort study of students who matriculated in US MD-granting medical schools in academic years 1993 to 1994 through 2000 to 2001. The outcome measure was the evolution of students' board-certification plans in orthopaedic surgery from matriculation to graduation using responses on the Association of American Medical Colleges' Matriculating Student Questionnaire and Graduation Questionnaire. Covariates included demographic, attitudinal, experiential, and career intention variables.

Results

Of 53,560 graduates with complete data, 2,765 students reported diminished interest in becoming board certified in orthopaedics, 1,345 reported emerging interest, and 1,327 reported sustained interest. In multivariable logistic regression models, students who were female (adjusted odds ratio [aOR] 1.83, 95% confidence interval [CI] 1.43-2.34), Asian (aOR 1.46, 95% CI 1.18-1.82), reported greater importance of social responsibility (aOR 1.16, 95% CI 1.02-1.33) and prestige (aOR 1.20, 95% CI 1.10-1.30) in choosing a medicine career, and planned full-time university faculty careers (aOR 1.58, 95% CI 1.33-1.89) at graduation were independently more likely to have diminished (vs. sustained) interest. Students who participated in research and/or authorship electives (aOR 3.50, 95% CI 3.00-4.07) and who attended private institutions (aOR 1.23, 95% CI 1.10-1.39) were more likely to have emerging (vs. no) interest.

Conclusions

Twice as many students lost interest than gained interest in orthopaedics during medical school, and the cohort of students interested in orthopaedics became less diverse over the course of medical school. Several risk factors amenable to change were identified. Interventions that target these risk factors are warranted to increase the diversity of the orthopaedic surgery workforce.

Why do second-cycle medical students choose oncology? A literature overview

INTRODUCTION

Given the current global cancer epidemic across the world, the need for healthcare professionals in this field is crucial. Little is known about the factors that drive medical students toward oncology.

METHOD

We conducted a systematic review of the literature (from 1980 to the present), using several search equations and selecting original articles written in English based on qualitative or quantitative surveys, to understand what motivates medical students to choose oncology.

RESULTS

We identified only seven articles that reported quantitative surveys; no qualitative surveys were found. These seven surveys are composed of closed-ended questions and are pragmatic questionnaires based on field knowledge, but without an underlying theory. These studies most often interrogate students already oriented towards oncology. The following five concepts associated with the choice of oncology had the highest recurrence among these seven surveys, which had been conducted in different countries and at various times: interest in cancer management, initiation of the specialty during the 2nd cycle, job opportunities, low working hours, and quality of life.

DISCUSSION

The literature on this topic is particularly scarce. No qualitative studies have been published in the English language. The limited data in the literature do not allow us to fully comprehend the problem.

What Matters Most: Determinants Associated with the Selection of Medical Residencies in Qatar

Purpose

There have been several studies into medical student career decision making in occidental countries (eg US, UK), but medical career selection in a Middle Eastern context has not been as well studied. This study aims to explore determinants underpinning medical students' residency choice in Qatar.

Patients and methods

During the Fall semester of the 2022-2023 academic year, all (n=358) medical students from the College of Medicine at Qatar University were invited to participate in an online explorative questionnaire about students' career choices and the factors determining their selection.

Results

Of the 358 students, 184 responded (51%). Respondents had a mean age of 20 years; the majority were female (73.9%), Qatari (54.3%), unmarried (97.3%), and enrolled in a pre-clerkship year (55.0%). The most important career determinant was specialty-specific factors. The relative importance of other determinants differed by gender and stage of training. Among our respondents, male students were more likely to rate role models and influencers as being important to their choice, while female students and Qatari students overall were more likely to cite societal obligation. Medical students in Qatar seemed to have career preferences in mind upon entry into medical education. Later-year students were more likely to identify the importance of work-life balance and place of practice, but were less likely to rank prestige and income as an important determinant.

Conclusion

The results of this baseline study suggest that socioeconomic and cultural context influence medical student career decisions.

The Choice! The challenges of trying to improve medical students' satisfaction with their specialty choices

The authors describe the residency match as a two-step process. The first step, the Choice, is where students use a combination of intuitive and analytic information processing to select the specialty that they believe will provide fulfilment and work-life balance over their entire career. The second step, the Match, uses a "deferred-acceptance" algorithm to optimize pairing of students and their specialty choices. Despite being the rate-limiting step, in the minds of students and other stakeholders, the outcomes of the Choice have typically been eclipsed by the outcomes of the Match. A recently published study found that during their second year of residency training, one in 14 physicians reported specialty choice regret, which associates with symptoms of burnout in residents. While the obvious solution is to design interventions that improve the specialty choices of students, this approach faces significant challenges, including the fact that: 1) satisfaction with specialty choice is a difficult-to-define construct; 2) specialty choice regret may be misattributed to a poor choice; and 3) choosing is a more complicated process than matching. The authors end by suggesting that if we hope to improve satisfaction with specialty choice then we should begin by defining this, deciding when to assess it, and then creating assessment tools for which there is validity evidence and that can identify the underlying causes of specialty choice regret.

The Timing, Factors, and Impact of USMLE Step 1 Becoming Pass/Fail on the Process of Choosing a Specialty

Background  Choosing a medical specialty is an important decision. A combination of factors influenced this decision. Student characteristics and examination performances can influence this decision. With the transition of the United States Medical Licensing Examination (USMLE) Step 1 becoming pass/fail, it is important to analyze the specialty decision process. Objective The purpose of this multimethod study is to assess when in the curriculum students choose a specialty, what factors influence their decision, and the impact of USMLE Step 1 scores on a student's assessment of competitiveness. Methods In February 2022, a survey was prepared and approved by the University of Nevada, Las Vegas (UNLV) Institutional Review Board (IRB). The survey contained multiple-choice questions and a free-response section. The survey was sent to the Class of 2022 and 2023 students at Kirk Kerkorian School of Medicine who follow a Longitudinal Integrated Clerkship. Descriptive statistics and one-sample t-tests were calculated. Results A total of 89 students completed the survey: 42 out of 60 students (70%) from the Class of 2022 and 47 out of 61 students (77%) from the Class of 2023. This study found that 78.8% of longitudinal interleaved clerkship (LInC) students committed to their specialty during the second half of the clinical year. The effects of positive and negative experiences during clerkships were most significantly different (p < 0.001). Conclusion The majority of LInC students arrive at their decision by the latter half of the clinical year. A variety of factors help students arrive at their decision. Our findings suggest that the pass/fail grading system will make it more difficult for students to assess their personal competitiveness.

Factors Influencing Medical Students' Interest in Dermatology: A Cross-Sectional Study in the Eastern Province of Saudi Arabia

Introduction The demand for dermatologists is increasing due to the rising prevalence of skin diseases and the growing importance of dermatological care. However, there is limited research investigating the factors that influence medical students' interest in pursuing dermatology as a career option in Saudi Arabia, specifically in the Eastern Province. Methods This cross-sectional study aimed to assess the impact of dermatology rotation experience on the interest and perception of medical students and interns in the Eastern Province of Saudi Arabia. The participants consisted of medical students and interns located specifically in the Eastern Province. Data were collected through an online self-administered questionnaire that captured socio-demographic characteristics and evaluated the impact of dermatology rotation experience using a 3-point Likert scale. Convenient non-probability sampling was employed by sharing the questionnaire link on popular social media platforms. Results A total of 697 medical students from the Eastern Province of Saudi Arabia participated in this study, with an almost equal distribution between genders. A substantial proportion of participants expressed a strong preference for dermatology as their future career. While approximately 60% had completed a dermatology rotation, more than half found the process tiring. However, most participants agreed that dermatology offers flexible working hours, a better lifestyle, superior career options, and higher earnings compared to other healthcare professions. The study also revealed that factors such as age, marital status, academic level, GPA (grade point average), and income influenced the impact of the dermatology rotation. Conclusion This study sheds light on the factors influencing medical students' interest in dermatology and their perceptions of dermatology rotations. The findings emphasize the importance of diversity, early exposure, educational interventions, and supportive environments in promoting dermatology as a career choice. Overcoming barriers, enhancing transparency in assessment systems, and improving educational experiences can further foster interest in dermatology among medical students and address the growing demand for dermatological care.

Utilization of Video Otoscopes for Otoscopy Skills Training of Third Year Medical Students

Purpose

Effective teaching and assessment of otologic examinations are challenging. Current methods of teaching otoscopy using traditional otoscopes have significant limitations. We hypothesized that use of all-in-one video otoscopes provides students with an opportunity for real-time faculty feedback and re-practicing of skills, increasing self-reported confidence.

Methods

An otoscopy microskills competency checklist was provided to third-year medical students during their pediatric clerkship to self-assess otoscopy technique during patient examinations, and to clinical preceptors to assess and provide feedback during exams. Over the course of two years, we collected data from students randomly assigned to train on a video otoscope or a traditional otoscope during the clerkship. Pre- and post-clerkship surveys measured confidence in performing otoscopy microskills, making a diagnosis and documentation of findings. For those students who trained on the video otoscope, we solicited post-clerkship feedback on the experience of using a video otoscope.

Results

Pre-clerkship confidence did not differ between the groups, but the video otoscope trained group had significantly higher scores than the traditional otoscope trained group on all self-reported technical and diagnostic microskills confidence questions items post-clerkship. Students trained on video otoscopes had a significant increase in confidence with all microskills items (p-values<0.001), however confidence in the traditional otoscope trained group did not change over time (p-values>0.10). Qualitative feedback from the video otoscope trained group reflected positive experiences regarding "technique/positioning" and "feedback from preceptors.".

Conclusion

Teaching otoscopy skills to pediatric clerkship medical students using a video otoscope significantly enhanced confidence compared to those training on a traditional otoscope by 1. enabling preceptors and students to simultaneously visualize otoscopy findings 2. allowing preceptors to provide real-time feedback and 3. providing opportunity for deliberate practice of microskills. We encourage the use of video otoscopes to augment student confidence and self-efficacy when training in otoscopy.