Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study

PURPOSE

The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students.

METHOD

Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses.

RESULTS

Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty.

CONCLUSIONS

This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

Piloting a National Curricular Resource for the Transition to Surgical Residency: Characteristics of Participating Schools and Their Students

OBJECTIVE

To determine the extent to which U.S. Liaison Committee of Medical Education (LCME)-accredited medical schools chose to participate in piloting a national curricular resource, the American College of Surgeons/Association of Program Directors in Surgery/Association of Surgical Education Resident Prep Curriculum ("ACS-surgery-prep curriculum"), and implications of such participation for student access nationally to this resource.

DESIGN

We examined the significance of school-level differences in ACS-surgery-prep curriculum pilot participation and student-level differences in curriculum access based on medical school attended in bivariate analysis.

SETTING

U.S. medical schools choosing to participate in the ACS-surgery-prep curriculum through 2021. Students graduating from U.S. LCME-accredited medical schools in 2020-2021 were invited to complete the Association of American Medical Colleges 2021 Graduation Questionnaire (GQ).

PARTICIPANTS

Our study included data for 2569 students intending surgery specialties (16% of 16,353 2021 GQ respondents) from ACS-surgery-prep curriculum pilot and non-pilot schools.

RESULTS

Of 148 medical schools attended by 2021 GQ respondents, 93 (63%) were identified as ACS-surgery-prep curriculum pilot schools. Pilot participation varied by school region, community-based designation, and research intensity (each p < 0.05) but not by ownership or transition to residency (TTR) course requirements (each p > 0.05). Of 2569 GQ respondents nationally intending surgery specialties, 1697 (66%) attended an ACS-surgery-prep curriculum pilot school; this proportion did not vary by gender or race/ethnicity (each p > 0.05) but varied by students' school TTR course requirements (p < 0.001). Findings were similar among the 1059 students intending general surgery specialties specifically (41% of all 2569 students intending surgery specialties).

CONCLUSIONS

Many U.S. LCME-accredited medical schools piloted this national TTR surgery curriculum. School-level characteristics associated with pilot participation can inform outreach efforts to encourage the participation of interested schools in piloting this TTR resource. With this curriculum distribution model, we observed no gender or racial/ethnic disparities in curriculum access nationally among students intending surgery specialties.

Association Between a Medical School Applicant's Community College Attendance and the Likelihood of Application Acceptance: An Investigation of Select Medical School Characteristics

PURPOSE

One-third of medical school applicants attend a community college (CC), and they represent a diverse group of applicants. However, they have a lower likelihood of being accepted to medical school. Using application-level data, this study examines how an applicant's CC attendance impacts the likelihood of application acceptance and how 3 medical school characteristics moderate this association.

METHOD

Data examined were from 2,179,483 applications submitted to at least one of 146 U.S. Liaison Committee on Medical Education-accredited medical schools by 124,862 applicants between 2018 and 2020. The outcome was application acceptance. The main measures were applicants' CC attendance (no, lower [> 0%-19% of college course hours], or higher [≥ 20%]) and 3 medical school characteristics: geographic region, private versus public control, and admissions policy regarding CC coursework. Multilevel logistic regression models estimated the association between CC attendance and the likelihood of application acceptance and how this association was moderated by school characteristics.

RESULTS

Among applicants, 23.8% (29,704/124,862) had lower CC attendance and 10.3% (12,819/124,862) had higher CC attendance. Regression results showed that, relative to no CC attendance, applications with lower (adjusted odds ratio [AOR] = .96; 95% confidence internal [CI], .94-.97) and higher (AOR = .78; 95% CI, .76-.81) CC attendance had significantly decreased odds of acceptance when the 3 school characteristics were included. Each of the 3 medical school characteristics significantly moderated the association between an applicant's CC attendance and the likelihood of application acceptance.

CONCLUSIONS

The negative association between CC attendance and medical school application acceptance varies by medical school characteristics. Professional development for admissions officers focused on understanding the CC pathway and potential biases related to CC attendance would likely be beneficial in terms of trying to attract and select a diverse cohort of medical students in a holistic and equitable manner.

The Resident Readiness Survey: A National Process for Program Directors to Provide Standardized Feedback to Medical Schools About Their Graduates

Background The process for program directors (PDs) to provide feedback to medical schools about their graduates' readiness for postgraduate year 1 (PGY-1) training is burdensome and does not generate national benchmarking data. Objective The Association of American Medical Colleges (AAMC) tested the feasibility of administering a standardized Resident Readiness Survey (RRS) to PDs nationally about their PGY-1 residents' preparedness for residency. Methods In 2020 and 2021, the AAMC invited PDs via email to complete RRSs for their PGY-1s who graduated from participating schools; the AAMC provided schools with reports of identified RRS data for their graduates. Outcome measures included school participation rates, PD response rates, PGY-1s' coverage rates (RRSs completed/RRSs PDs invited to complete), RRS completion time (time-stamp difference: RRS opening-submission), and participating schools' feedback about the process collected via AAMC evaluation questionnaires sent to school leaders. Chi-square tested significance of differences between proportions. Results School participation increased from 43.8% (2020: 77 of 176) to 72.4% (2021: 131 of 181). PD response rates, similar in both years overall (2020: 1786 of 2847 [62.7%]; 2021: 2107 of 3406 [61.9%]; P=.48), varied by specialty (P<.001; range 65 of 154 [42.2%], neurology; 109 of 136 [80.1%], internal medicine-pediatrics, both years combined). PGY-1s' coverage rates were similar (P=.21) in 2020 (5567 of 10 712 [52.0%]) and 2021 (9688 of 18 372 [52.7%]). RRS completion time averaged less than 3 minutes. Numerous school leaders reported that RRS data stimulated new, or supported ongoing, curricular quality improvement. Conclusions Administration of a standardized RRS to PDs nationally about PGY-1s preparedness for residency is feasible and will continue.

Graduating Medical Students' Experiences with Away (In-Person and Virtual) Rotations During COVID-19: Analysis of the Association of American Medical Colleges (AAMC) 2021 Graduation Questionnaire (GQ)

OBJECTIVE

The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates.

DESIGN

Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models.

SETTING

Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis.

PARTICIPANTS

Our study included data for 15,451 GQ respondents (74% of all 2021 graduates).

RESULTS

Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3).

CONCLUSIONS

The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard.

A44 A 1000 PATIENT CANADIAN NETWORK FOR AUTOIMMUNE LIVER DISEASE EVALUATION OF CLINICAL AND DEMOGRAPHIC PATTERNS OF AUTOIMMUNE HEPATITIS

Background

We sought to understand how the demographics of autoimmune hepatitis (AIH) have changed over time in Canada.

Purpose

Using a large multi-centre Canadian cohort of patients with AIH, we describe the trends in patient and disease characteristics at presentation across 30 years of clinical practice.

Method

Patients from the Canadian Network for Autoimmune Liver Disease with a confirmed diagnosis of AIH (simplified score ≥6) were included for analysis. Patients were grouped into five cohorts according to the year of diagnosis (i.e., <2000, 2000-2004, 2005-2009, 2010-2014, ≥2015). Patient demographics and baseline clinical and biochemistry features of disease activity were investigated using Chi-square tests and Kruskal-Wallis tests adjusted for multiple comparisons. Logistic and linear regression models with estimated means were utilized to further investigate relationships with time and to adjust for confounding.

Result(s)

1016 patients followed across 10 Canadian health centres with AIH were diagnosed between November 1965 and December 2021. Overall, 76.4% (n=776) of patients were female, and the median age at diagnosis was 46 years (IQR 28.2 - 58.3). Cirrhosis at presentation was seen in 20.6% of patients (n=209). The median age at diagnosis increased significantly from 31.8 years [IQR 17.9 - 46.8] pre-2000 to 54 years [IQR 9.0 - 95.2] after 2014 (p<0.001; Figure 1a). This effect of time persisted after adjusting for sex and cirrhosis status at diagnosis. Female sex and the presence of cirrhosis at diagnosis were factors independently associated with older age at presentation (p<0.0001).

The proportion of patients that presented with cirrhosis at diagnosis increased significantly over calendar time, from 13.7% (n=23) pre-2000 to 30.8% (n=69) after 2014 (p=0.003; Figure 1b). Male sex was independently associated with an increased odds of having cirrhosis at presentation (OR= 1.46, CI 1.02 - 2.07) and higher baseline ALT levels compared to females (p=0.036). The proportion of patients that identified as non-white ethnicity increased significantly from 15.2% (n= 24) pre-2000, to 32% (n= 86) after 2014 (p<0.001, Figure 1b). This effect of time on ethnicity was most pronounced after the year 2010 (OR= 2.32, CI 1.39 - 3.98) and persisted after adjusting for sex. There was no significant pattern of change in sex over calendar time.

Image

Conclusion(s)

In Canada, patients with AIH at presentation are now older, have more advanced disease, and are more ethnically diverse than when compared to 30 years ago.

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Physicians' continuing medical education activities and satisfaction with their ability to stay current in medical information and practice: A cross-sectional study

Background and Aims

Little is known about physicians' approaches to continuing medical education (CME) for continuing professional development despite the rapid evolution of CME offerings. We sought to identify the extent to which demographic, career, and experiential CME-activity variables were independently associated with physicians' satisfaction with their ability to stay current on medical information and practice.

Methods

Using the 2019 Association of American Medical Colleges' National Sample Survey of Physicians data, we ran multivariable logistic regression models examining demographic, career, and experiential (participation in 11 CME activities in the past year) variables for their associations with physicians' satisfaction (satisfied vs. not satisfied/neutral) with their ability to stay current.

Results

Of 5926 respondents, 90% (5341/5926) were satisfied with their ability to stay current. Significant (each two-sided p < 0.05) predictors of respondents who were satisfied included (among others) a surgery specialty (vs. primary care; adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.06-1.88), an academic affiliation (vs. none; AOR = 1.35, 95% CI = 1.10-1.66), and participation (vs. no participation) in each of professional meetings (AOR = 1.31, 95% CI = 1.07-1.60) and journal-based CME (AOR = 1.29, 95% CI = 1.07-1.56). Respondents who self-identified as a race/ethnicity underrepresented in medicine (vs. white; AOR = 0.68, 95% CI = 0.48-0.97) and were between ages 40 and 49 years (vs. 50-59; AOR = 0.74; 95% CI = 0.58-0.94) were less likely to be satisfied. Gender, board certification status, and medical degree type did not independently predict satisfaction (each p > 0.05).

Conclusion

We observed independent associations between physicians' satisfaction with their ability to stay current in medical information and practice and each specialty, academic affiliation, race/ethnicity, age, and CME activity type (for 2 of 11 examined). Findings may be relevant to organizations and institutions designing and implementing CME activities in the current context of COVID-19 pandemic-related in-person activity limitations and can inform targeted interventions addressing differences in the satisfaction we observed to better support physicians' CME.

Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020

IMPORTANCE

Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency.

OBJECTIVE

To assess progress in developing an entrustment process in the Core EPAs framework.

DESIGN, SETTING, AND PARTICIPANTS

In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database.

INTERVENTIONS

Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations.

MAIN OUTCOMES AND MEASURES

On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded.

RESULTS

Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of "ready for indirect supervision" increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P < .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P < .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P < .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs.

CONCLUSIONS AND RELEVANCE

These findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.

Evaluating the Association of a Core EPA-Oriented Patient Handover Curriculum on Medical Students' Self-reported Frequency of Observation and Skill Acquisition

INTRODUCTION

"Giving or receiving a patient handover to transition patient care responsibility" is one of the thirteen Core Entrustable Professional Activities (Core EPAs) for Entering Residency. However, implementing a patient handover curriculum in undergraduate medical education (UME) remains challenging. Educational leaders in the multi-institutional Core EPA8 pilot workgroup developed a longitudinal patient handover UME curriculum that was implemented at two pilot institutions.

MATERIALS AND METHODS

We utilized multi-school graduation questionnaire data to assess the association of our patient handover curriculum on self-reported frequency of observation/feedback and skill acquisition by comparing data from the shared curriculum schools to data from other Core EPA pilot schools (three schools with school-specific curriculum; five without a dedicated handover curriculum). Questionnaire data from 1,278 graduating medical students of the class of 2020 from all ten Core EPA pilot schools were analyzed.

RESULTS

Graduates from the two medical schools that implemented the shared patient handover curriculum reported significantly greater frequency of handover observation/feedback compared to graduates at the other schools (school-specific curriculum (p < .05) and those without a handover curriculum (p < .05)). Graduates from the two shared approach schools also more strongly agreed that they possessed the skill to perform handovers compared to graduates from the other eight pilot schools that did not implement this curriculum.

CONCLUSION

The findings of this study suggest that the implementation of a multi-institutional Core EPA-based curricular model for teaching and assessing patient handovers was successful and could be implemented at other UME institutions.

Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study

PURPOSE

In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions.

METHOD

For each EPA considered (4-13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0->15) per determination. These individual student-level data were de-identified and merged into a multischool database; chi-square analysis tested the significance of associations between variables.

RESULTS

The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations' distribution varied across EPAs (chi-square P < .001) and, for 10/13 EPAs, WBA availability was associated with making (vs not making) entrustment decisions (each chi-square P < .05).

CONCLUSIONS

TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness to perform this EPA with indirect supervision. More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.

Core Entrustable Professional Activities (EPAs) and the Transition from Medical School to Residency: the Postgraduate Year One Resident Perspective

INTRODUCTION

The Association of American Medical Colleges (AAMC) proposed thirteen core Entrustable Professional Activities (EPAs) that all graduates should be able to perform under indirect supervision upon entering residency. As an underlying premise is that graduates ready to do so will be better prepared to transition to the responsibilities of residency, we explored the relationship between postgraduate year (PGY)-1 residents' self-assessed preparedness to perform core EPAs under indirect supervision at the start of residency with their ease of transition to residency.

METHODS

Using response data to a questionnaire administered in September 2019 to PGY-1 residents who graduated from AAMC core EPA pilot schools, we examined between-group differences and independent associations for each of PGY-1 position type, specialty, and "EPA-preparedness" score (proportion of EPAs the resident reported as prepared to perform under indirect supervision at the start of residency) and ease of transition to residency (from 1 = much harder to 5 = much easier than expected).

RESULTS

Of 274 questionnaire respondents (19% of 1438 graduates), 241 (88% of 274) had entered PGY-1 training and completed all questionnaire items of interest. EPA-preparedness score (mean 0.71 [standard deviation 0.26]) correlated with ease of transition (3.1 [0.9]; correlation = .291, p < .001). In linear regression controlling for specialty (among other variables), EPA-preparedness score (β-coefficient 1.08; 95% confidence interval .64-1.52; p < .001) predicted ease of transition to residency.

CONCLUSION

Graduates who felt prepared to perform many of the core EPAs under indirect supervision at the start of PGY-1 training reported an easier-than-expected transition to residency.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01370-3.

Tolerance for Ambiguity Among Medical Students: Patterns of Change During Medical School and Their Implications for Professional Development

PURPOSE

Tolerance for ambiguity (TFA) is important for physicians, with implications for ethical behavior and patient care. This study explores how medical students' TFA changes from matriculation to graduation and how change in empathy and openness to diversity are associated with this change.

METHOD

Data for students who took the Matriculating Student Questionnaire (MSQ) in 2013 or 2014 and the Medical School Graduation Questionnaire (GQ) in 2017 or 2018 were drawn from the Association of American Medical Colleges (n = 17,221). Both the MSQ and GQ included a validated TFA scale and a shortened version of the Interpersonal Reactivity Index; the MSQ also included an openness to diversity scale. Tercile groups were used to assess how TFA changed from the MSQ to GQ, and regression analyses were used to assess associations between change in TFA and openness to diversity and between change in TFA and change in empathy.

RESULTS

Mean TFA scores decreased (d = -.67) among students with the highest TFA at matriculation but increased (d = .60) among students with the lowest TFA at matriculation. Regression results showed that change in TFA was significantly and positively associated with change in empathy (beta = .05, P < .001) and that openness to diversity (as reported at matriculation) was significantly and positively associated with TFA at graduation (beta = .05, P < .001).

CONCLUSIONS

This is the first nationally representative study to suggest that medical students' TFA changes over time, but in different directions depending on TFA at matriculation. TFA over time was also associated with change in empathy and openness to diversity. Medical schools should consider strategies to assess TFA in their admissions processes and for cultivating TFA throughout the learning process.

MD-PhD Program Graduates' Engagement in Research: Results of a National Study

PURPOSE

To determine if specialty, among other professional development and demographic variables, predicted MD-PhD program graduates' research engagement.

METHOD

The authors merged the 2015 Association of American Medical Colleges (AAMC) National MD-PhD Program Outcomes Survey database with selected data from the AAMC Student Records System, Graduation Questionnaire, and Graduate Medical Education (GME) Track Resident Survey. At the person level, they tested variables of interest for independent associations with MD-PhD graduates' research engagement using chi-square, Pearson correlations, and analysis of variance tests and logistic and linear regressions.

RESULTS

Of 3,297 MD-PhD graduates from 1991-2010 who were no longer in GME training in 2015, 78.0% (2,572/3,297) reported research engagement. In models controlling for several variables, a neurology (vs internal medicine; adjusted odds ratio [AOR]: 2.48; 95% confidence interval [CI]: 1.60-3.86) or pathology (vs internal medicine; AOR: 1.89; 95% CI: 1.33-2.68) specialty, full-time faculty/research scientist career intention at graduation (vs all other career intentions; AOR: 3.04; 95% CI: 2.16-4.28), and ≥ 1 year of GME research (vs no GME research year[s]; AOR: 2.45; 95% CI: 1.96-3.06) predicted a greater likelihood of research engagement. Among graduates engaged in research, the mean percentage of research time was 49.9% (standard deviation 30.1%). Participation in ≥ 1 year of GME research (beta [β] coefficient: 7.99, P < .001) predicted a higher percentage of research time, whereas a radiation oncology (β: -28.70), diagnostic radiology (β: -32.92), or surgery (β: -29.61) specialty, among others, predicted a lower percentage of research time (each P < .001 vs internal medicine).

CONCLUSIONS

Most MD-PhD graduates were engaged in research, but the extent of their engagement varied substantially among specialties. Across specialties, participation in research during GME may be one factor that sustains MD-PhD graduates' subsequent early- to midcareer research engagement.

Association of Summer College Academic Enrichment Program Participation With Medical Student Diversity and Intent to Practice in Underserved Areas

This cohort study examines the association of participation in a summer college academic enrichment program with diversity of students in medical school and intent to practice in underserved areas.

Mapping the Mission Statements of U.S. LCME-Accredited Medical Schools: An Exploration of Organizational Communalities

PURPOSE

Mission statements (MSs) express an organization's purpose and reflect the broader social environment in which they function. The authors analyze MS text to explore how medical schools can be relationally viewed and how particular thematic narratives within MSs can be deployed to associate schools in hithertofore unexplored ways.

METHOD

The authors analyzed the MSs (as of 1/1/2017) of 144 U.S. Liaison Committee on Medical Education-accredited schools. Using schools as their unit of analysis, they coded MSs using 44 themes. They employed content analysis to identify themes within MSs, factor analysis to identify core thematic dimensions embedded in MSs, and network analysis to examine relationships among schools based on these thematic dimensions. The authors used four standard school characteristics to examine the validity of their results.

RESULTS

Content analysis revealed 20 core themes. Factor analysis identified four thematic dimensions: Primary Care/Diversity; Future Learning-External; Traditional; and Learning Environment-Internal. Based on the 20 core themes and using the MSs of 125 schools with nonextreme MS code counts, the authors found that schools form a complete network, and that schools form distinctive network-based clusters based on the identified factors. The four thematic dimensions were significantly differentiated across the four standard school characteristics.

CONCLUSIONS

The authors found distinctive patterns of MS linkages among schools along with thematic linkages within MS themes, supporting the contentions that medical schools can be both differentiated and connected based on their MSs and that understanding MS content must move beyond simple frequency counts of MS attributes.

The Association Between a Holistic Review in Admissions Workshop and the Diversity of Accepted Applicants and Students Matriculating to Medical School

PURPOSE

The authors tested for an association between the Association of American Medical Colleges' holistic review in admissions (HRA) workshop and the compositional diversity of medical school accepted applicants and matriculants in schools that held workshops compared with those that did not.

METHOD

The authors examined school-level data from 134 medical schools accredited by the Liaison Committee on Medical Education for the years 2006-2016 using information from the American Medical College Application Service. They used a fixed-effects regression to examine the within-school association between an HRA workshop and four measures of diversity: percent first-generation college student, percent black/African American, percent Hispanic, and overall level of racial/ethnic diversity as measured by a diversity index.

RESULTS

For schools that held an HRA workshop, descriptive statistics showed higher mean values across all four measures of diversity for the post-HRA workshop period (the HRA implementation period) compared with the preworkshop period (accepted applicants: d = 0.34-0.79; matriculants: d = 0.29-0.73). Analyzing data for all schools, including those that did not hold a workshop, regression models showed that the HRA implementation period was associated with a significant and sustained increase in all four measures of diversity. These findings were consistent for both accepted applicants (P < .01) and matriculants (P < .01).

CONCLUSIONS

The significant increases in all four measures of diversity following an HRA workshop support the conclusion that this workshop was associated with increased compositional diversity at the participating medical schools.

First Year Medical Student Peer Nominations of Professionalism: A Methodological Detective Story about Making Sense of Non-Sense

This article explores the assessment of professionalism within a cohort of medical students during a sequential 13-week medical school histology and anatomy course. Across seven data points, students were asked to identify a professionalism role model from amongst their peers and to score Likert-structured rationales for their decision. Based on density scores, an initial social network analysis identified six peer-nomination "stars." However, analysis of these stars revealed considerable variability and random-like "noise" in both the nomination and explanation data sets. Subsequent analyses of both data sets explored the possibility of underlying patterns in this noise using tests of reliability, principal components factor analysis, and fixed-effects regression analysis. These explorations revealed the presence of two dimensions (professional vs. supportive) in how students sought to explain their nomination decisions. Although data variability remained quite high, significantly less variability was present in the professional than in the supportive dimension, suggesting that academic helpfulness rationales are both empirically distinct and more mutable than rationales grounded in professionalism-related factors. In addition, data showed that the greater the stability in one's choice of a professionalism role model nomination over the T1-T7 data periods, the more stable one's reasons for that nomination-both for professionalism and supportive dimensions. Results indicate that while peer assessment of professionalism by first-year medical students may not be very reliable, students can differentiate between more personal and professional factors, even at this early stage in their professional development. Formal instruction within the pre-clinical curriculum should recognize and address this distinction. Anat Sci Educ. © 2018 American Association of Anatomists.

Community College Pathways to Medical School and Family Medicine Residency Training

PURPOSE

Medical students who attend community college are more likely to express intention to train in family medicine. This study examined whether community college attendance is associated with family medicine residency training in a national sample of US medical school graduates.

METHODS

We performed a cross-sectional analysis using the Association of American Medical Colleges matriculant files of residency trainees who graduated from medical school between 2010 to 2012. Residency specialty (family medicine vs other) was modeled using logistic regression analysis; the key independent variable was community college attendance, with categories of non-community college (reference); community college while in high school; community college after graduating from high school, then transfer to 4-year university; and community college after graduating from a 4-year university or as a postbaccalaureate. The logistic model adjusted for age, sex, race/ethnicity, years in medical school, parental education (a marker of socioeconomic status), and high school US region.

RESULTS

Of the 43,382 medical school graduates studied, 25.9% attended community college and 8.7% trained in family medicine. In unadjusted analysis, graduates attending community college while in high school, after graduating from high school with transfer to 4-year university, or after graduating from a 4-year university or as a postbaccalaureate (12.0%, 12.7%, and 10.8%, respectively) were more likely to train in family medicine compared with their peers who did not attend community college (7.7%). Respective adjusted odds ratios were 1.47 (95% CI, 1.33-1.63; P <.001), 1.27 (95% CI, 1.06-1.52; P = .009), and 1.17 (95% CI, 1.06-2.29; P = .002). Among family medicine residents, 32.7% of those who were white, 35.2% of those Asian, 50.8% of those Latino, and 32.7% of those black or African American attended community college.

CONCLUSIONS

US medical school graduates who attended community college were more likely to train in family medicine, suggesting community college is an important pathway for increasing the primary care workforce.

Predicting Peer Nominations Among Medical Students: A Social Network Approach

PURPOSE

Minimal attention has been paid to what factors may predict peer nomination or how peer nominations might exhibit a clustering effect. Focusing on the homophily principle that "birds of a feather flock together," and using a social network analysis approach, the authors investigated how certain student- and/or school-based factors might predict the likelihood of peer nomination, and the clusters, if any, that occur among those nominations.

METHOD

In 2013, the Jefferson Longitudinal Study of Medical Education included a special instrument to evaluate peer nominations. A total of 211 (81%) of 260 graduating medical students from the Sidney Kimmel Medical College responded to the peer nomination question. Data were analyzed using a relational contingency table and an ANOVA density model.

RESULTS

Although peer nominations did not cluster around gender, age, or class rank, those students within an accelerated program, as well as those entering certain specialties, were more likely to nominate each other. The authors suggest that clerkships in certain specialties, as well as the accelerated program, may provide structured opportunities for students to connect and integrate, and that these opportunities may have an impact on peer nomination. The findings suggest that social network analysis is a useful approach to examine various aspects of peer nomination processes.

CONCLUSIONS

The authors discuss implications regarding harnessing social cohesion within clinical clerkships, the possible development of siloed departmental identity and in-group favoritism, and future research possibilities.

Dimensions of Diversity and Perception of Having Learned From Individuals From Different Backgrounds: The Particular Importance of Racial Diversity

PURPOSE

Selective higher education institutions that take race into account in admissions decisions must be able to demonstrate that their policy is justified by a compelling governmental interest, is narrowly tailored, and is the least restrictive means for achieving that interest. The authors thus investigate whether, among medical students, the association between racial diversity (as distinct from other forms of diversity) and learning from individuals from different backgrounds is unique.

METHOD

The authors examined six dimensions of diversity, including racial/ethnic diversity, among the 2010, 2011, and 2012 cohorts of fourth-year medical students in the United States. They also examined students' responses to two Medical Student Graduation Questionnaire items pertaining to learning from individuals from different backgrounds. They modeled the association between each of the school-level dimensions of diversity and the student-level responses to having learned from others with different backgrounds, and they assessed whether associations vary across different groups of students.

RESULTS

Racial/ethnic diversity is unique in its very strong association with student perceptions of having learned from others who are different. The association between racial/ethnic diversity and student perceptions of having learned from others who are different is especially strong for members of historically underrepresented minority groups.

CONCLUSIONS

Compared with other forms of diversity, racial/ethnic diversity has a unique association with students' perceptions of learning from others who are different. This association is of particular relevance to admissions and diversity policies in an era of strict scrutiny of these policies.

The Role of Socioeconomic Status in Medical School Admissions: Validation of a Socioeconomic Indicator for Use in Medical School Admissions

PURPOSE

Socioeconomic status (SES) impacts educational opportunities and outcomes which explains, in part, why the majority of medical students come from the upper two quintiles of family income. A two-factor SES indicator based on parental education (E) and occupation (O) has recently been established by the Association of American Medical Colleges (AAMC). This study validates this two-factor indicator as applicable to the national pool of medical school applicants.

METHOD

The AAMC SES EO indicator classifies applicants into five ordered groups (EO-1 through EO-5) based on four aggregated categories of parental education and two aggregated categories of occupation. The EO indicator was applied to the 2012 American Medical College Application Service applicant pool. The authors examined the associations that the EO category had with six additional and independent indicators of socioeconomic (dis)advantage, as well as with demographic and educational characteristics and life experiences.

RESULTS

The EO indicator could be applied to 89% of the 2012 applicants. The lower the EO category, the stronger the association with each of the six indicators of socioeconomic disadvantage. Other notable, but weaker, associations with the EO indicator were differences by age, race/ethnicity, performance on the Medical College Admission Test, community college attendance, and certain self-reported life experiences.

CONCLUSIONS

The EO indicator provides a simple, intuitive, widely applicable, and valid means for identifying applicants from socioeconomically disadvantaged backgrounds. This affords admissions committees an additional factor to consider during the holistic review of applicants in order to further diversify the medical school class.

Measuring race and ethnicity in the censuses of Australia, Canada, and the United States: Parallels and paradoxes

Most national censuses include questions about race, colour, national origins, ethnicity, ancestry, and tribe in an effort to describe subgroups within their population. In this paper, we focus on changes over the last half-century in the racial and ethnic classification schemes of the censuses in three countries that share important historical and demographic features Australia, Canada, and the United States. We show that there are similarities, as well as some idiosyncratic features, in how these three nations define and describe racial and ethnic subgroups. We then argue that the gathering of data on the racial/ethnic subgroups in these three nations has followed a similar progression over the last half-century because of shifts in the understanding of race and ethnicity, data-gathering procedures, and the ongoing dialogue between each national population and its data-gathering institution.

Ambiguity tolerance of students matriculating to U.S. medical schools

PURPOSE

To examine the psychometric adequacy of a tolerance for ambiguity (TFA) scale for use with medical students. Also, to examine the relationship of TFA to a variety of demographic and personal variables in a national sample of entering U.S. medical students.

METHOD

The authors used data from the 2013 Association of American Medical Colleges Matriculating Student Questionnaire in which questions on TFA were included for the first time that year. Data from 13,867 entering medical students were analyzed to examine the psychometric properties of the TFA scale. In addition, the relationships of TFA to sex, age, perceived stress, and desire to work in an underserved area were analyzed. Finally, the relationship of TFA to specialty preference was examined.

RESULTS

The TFA scale was found to be psychometrically adequate for use in a medical student population. TFA was found to be higher in men and in older students. Lower TFA was associated with higher perceived stress levels. Students with higher TFA were more likely to express desire to work in an underserved area. Different levels of TFA may be associated with certain specialty preferences.

CONCLUSIONS

These findings support the assessment of TFA to understand how this personal characteristic may interact with the medical school experience and with specialty choice. Longitudinal work in this area will be critical to increase this understanding.

Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas

PURPOSE

The projected U.S. physician shortage will disproportionately affect underserved areas. This study examined the impact of medical school educational experiences on positive changes in and reaffirmation of students' intention to practice in underserved areas (practice intention).

METHOD

Medical students (n = 7,361) from 113 U.S. MD-granting medical schools who graduated in 2009-2010 and responded to both the Association of American Medical Colleges' 2006 Matriculating Student Questionnaire and 2010 Graduation Questionnaire were included. Multilevel logistic regression analyses were conducted to determine factors associated with change in and reaffirmation of practice intention.

RESULTS

After controlling for individual characteristics, community health field experience (adjusted odds ratio [OR]: 1.36; 95% CI: 1.18, 1.57), learning another language (OR: 1.41; 95% CI: 1.22, 1.63), cultural competence/awareness experience (OR: 1.38; 95% CI: 1.21, 1.58), becoming more aware of perspectives of individuals from different backgrounds (OR: 1.24; 95% CI: 1.04, 1.48), and attending schools with higher social mission scores (OR: 1.66; 95% CI: 1.28, 2.16) were all significantly associated with positive changes in practice intention from matriculation to graduation. Field experience in community health (OR: 1.24; 95% CI: 0.99, 1.53), learning another language (OR: 1.29; 95% CI: 1.01, 1.65), and attending schools with higher social mission scores (OR: 1.62; 95% CI: 1.09, 2.43) were all significantly associated with reaffirmation of practice intention at graduation.

CONCLUSIONS

Multifaceted factors are associated with practice intention. This study suggests medical schools can play active roles in alleviating the physician shortage in underserved areas through targeted curricular interventions and recruitment.

Medical school mission statements as reflections of institutional identity and educational purpose: a network text analysis

PURPOSE

A medical school's mission statement (MS) is an expression of its vision and a reflection of the broader social environment in which it is embedded. The authors examine how the institutional identity of U.S. medical education is projected through the MSs of all U.S. MD-granting medical schools. In addition, the authors examine the extent to which differences between subsets of schools (public versus private; research-intensive versus "social mission"-oriented) are reflected in their respective MSs.

METHOD

Whereas existing studies have typically sought to uncover core themes using content-analytic approaches, for this 2011 study the authors combined text analysis with network analysis to elaborate core concepts within larger networks of meaning across MSs. They computed measures of centrality (i.e., density or "connectivity") for each concept and presented the aggregations of MSs as semantic networks (i.e., representations or maps of the relationships among concepts).

RESULTS

Analysis across all MSs revealed a dense set of ties among a core set of concepts, indicating a general uniformity among all medical schools; however, the authors identified appreciable differences within subsets of MSs (public versus private and research-intensive versus social-mission-focused).

CONCLUSIONS

MSs of U.S. medical schools are meaningful statements about values and direction. The use of social network text analysis provides an innovative method for understanding the structure of meaning within MSs and, potentially, how these documents might speak to institutional performance outcomes.

Which factors predict the likelihood of reapplying to medical school? An analysis by gender

PURPOSE

To explore factors associated with becoming a repeat applicant to medical school--specifically, factors involving alternative educational and career plans and educational indebtedness--and how they differ by gender.

METHOD

Using deidentified 2009 and 2010 American Medical College Application Service (AMCAS) data, the authors determined the potential and actual 2010 repeat applicants among first-time applicants who were not accepted to medical school in 2009. Using logistic regression models, they then analyzed the deidentified 2008 Pre-MCAT Questionnaire (PMQ) responses of those potential 2010 repeat applicants who had participated in the PMQ to examine associations between aspirants' self-reported alternative educational and career (Plan B) options as well as levels of indebtedness and the likelihood of reapplying. Using population-level demographic data from AMCAS, the authors weighted analyses to more accurately reflect the actual population of potential repeat applicants. They also explored gender-related differences.

RESULTS

Considering as a Plan B applying to a different graduate degree program--business, law, science, another health profession--decreased the likelihood that an unsuccessful 2009 first-time applicant would reapply to medical school in 2010. Aspirants who had more than $20,000 of educational debt were also less likely to become repeat applicants. In separate analyses for men and women, factors associated with the likelihood of reapplying differed noticeably.

CONCLUSIONS

The authors' findings provide insight into how medical school aspirants make decisions about their career and educational pathways, and how factors associated with those decisions shape the social composition of the medical school applicant pool.

The survey of healthcare software in Yugoslavia

The aim of this study is to identify vendors of software packages applicable to health care system as well as to evaluate software packages offered to the health sector by a variety of sources, namely state owned software development companies, privately operated software development companies as well as sole traders. The approach undertaken was to preselect the potential suppliers via an initial targeted interview. Subsequently a questionnaire, consisting of 23 questions, was addressed to the selected vendors and suppliers. The response rate to the questionnaire was 58%. Investigation of 113 has revealed the non government software suppliers clearly lead in copyright ownership, IBM compatible personal computers were the platform of choice whereas majority of code was written utilising languages capable of supporting relational data base queries. The final outcome of the above study is a database of software packages and applications available to the health sector offering the health professionals and institutions guide lines and support in developing information systems, relevant subsystems and modules.