The Single Graduate Medical Education (GME) Accreditation System Will Change the Future of the Family Medicine Workforce.

PubMed

Peabody, Michael R; O'Neill, Thomas R; Eden, Aimee R; Puffer, James C

2017-01-01

Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected. © Copyright 2017 by the American Board of Family Medicine.

The increase in international medical graduates in family practice residency programs.

PubMed

Koehn, Nerissa N; Fryer, George E; Phillips, Robert L; Miller, John B; Green, Larry A

2002-06-01

The number of filled positions in family practice residency programs decreased by 18.6% from 1997-2001. This study sought to determine the degree of reliance on international medical graduates (IMGs) to fill family practice residency positions and the relative proportion of US citizen IMGs. We analyzed the 1992-2001 National Resident Matching Program results, the 2000 American Medical Association Masterfile, and the 1992-2001 American Academy of Family Physicians Annual Survey of Family Practice Residency Programs. The percentage of IMGs matching in family practice remained stable between the years of 1992-1996 (10.0%-11.8%) but since 1997 has increased to a high of 21.4% in 2001. This rise in IMGs corresponds with a drop in the total percentage of family practice residency positions filled in the Match from 90.5% in 1996 to 76.3% in 2001. Despite the drop in Match numbers, the percentage of first-year family practice positions filled in July has remained in the range of 95.5%-97.8% since 1996. IMGs account for an increasing percentage of post-Match fills from 16.7% in 1996 to 47.9% in 2001. In 1999, a majority of family practice programs (279 [55.6%]), had at least one IMG. Of these, 48 programs (9.6%) had at least 50% of residents who were IMGs, and eight programs (1.6%) were entirely composed of IMGs. In five states (Connecticut, Illinois, Michigan, New Jersey, and New York), more than 25% of family practice residents were IMGs. Family practice is becoming increasingly reliant on IMGs to fill residency positions.

Do the Personalities of International and U.S. Medical Graduates in Psychiatry Differ? A Preliminary Study

ERIC Educational Resources Information Center

Vaidya, Nutan; Sierles, Frederick S.; Sandu, Ioana C.; Silberman, Edward K.

2006-01-01

Objective: To compare personality traits of psychiatry residents with various characteristics. Method: The authors administered Cloninger's personality inventory to residents at two schools. Results: There were no trait differences between international medical graduates (IMGs) and U.S. medical graduates (USMGs) or those for whom psychiatry was a…

A framework for understanding international medical graduate challenges during transition into fellowship programs.

PubMed

Sockalingam, Sanjeev; Khan, Attia; Tan, Adrienne; Hawa, Raed; Abbey, Susan; Jackson, Timothy; Zaretsky, Ari; Okrainec, Allan

2014-01-01

Previous studies have highlighted unique needs of international medical graduates (IMG) during their transition into medical training programs; however, limited data exist on IMG needs specific to fellowship training. We conducted the following mixed-method study to determine IMG fellow training needs during the transition into fellowship training programs in psychiatry and surgery. The authors conducted a mixed-methods study consisting of an online survey of IMG fellows and their supervisors in psychiatry or surgery fellowship training programs and individual interviews of IMG fellows. The survey assessed (a) fellows' and supervisors' perceptions on IMG challenges in clinical communication, health systems, and education domains and (b) past orientation initiatives. In the second phase of the study, IMG fellows were interviewed during the latter half of their fellowship training, and perceptions regarding orientation and adaptation to fellowship in Canada were assessed. Survey data were analyzed using descriptive and Mann-Whitney U statistics. Qualitative interviews were analyzed using grounded theory methodology. The survey response rate was 76% (35/46) and 69% (35/51) for IMG fellows and supervisors, respectively. Fellows reported the greatest difficulty with adapting to the hospital system, medical documentation, and balancing one's professional and personal life. Supervisors believed that fellows had the greatest difficulty with managing language and slang in Canada, the healthcare system, and an interprofessional team. In Phase 2, fellows generated themes of disorientation, disconnection, interprofessional team challenges, a need for IMG fellow resources, and a benefit from training in a multicultural setting. Our study results highlight the need for IMG specific orientation resources for fellows and supervisors. Maslow's Hierarchy of Needs may be a useful framework for understanding IMG training needs.

International Medical Graduates and the Discursive Patterns of Patient-Centred Communication

ERIC Educational Resources Information Center

Woodward-Kron, Robyn

2016-01-01

In many Western countries such as Australia, international medical graduates (IMGs) play a crucial role in meeting health workforce needs. For doctors for whom English is an additional language and who have received their medical education in non-Western settings, a challenge is the patient-centred approach to communication, which is well…

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario.

PubMed

Yen, Wendy; Hodwitz, Kathryn; Thakkar, Niels; Martimianakis, Maria Athina Tina; Faulkner, Dan

2016-12-01

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO's alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed.

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario

PubMed Central

Yen, Wendy; Hodwitz, Kathryn; Thakkar, Niels; Martimianakis, Maria Athina (Tina); Faulkner, Dan

2016-01-01

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO’s alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed. PMID:28344705

International medical graduates and the cardiology workforce.

PubMed

Kostis, John B; Ahmad, Busharat

2004-09-15

Recent publications have expressed the view that there is a shortage of cardiologists and it is growing worse. Both an increasing demand and a diminishing supply of cardiologists have been projected. An increase in the number of international medical graduates (IMGs) who enter cardiology practice has been proposed as a remedy for a projected shortage. The IMGs have to overcome challenges including clinical practice, language proficiency, and cultural differences before they are incorporated into the fabric of U.S. cardiology. With hard work, perseverance, excellence,compassionate care and support and mentoring, many have contributed to scientific and clinical cardiology in the U.S. Whether in the absence of a present crisis the projected shortage of cardiologists necessitates change in U.S. immigration policy is an open question.

Acculturation Needs of Pediatric International Medical Graduates: A Qualitative Study.

PubMed

Osta, Amanda D; Barnes, Michelle M; Pessagno, Regina; Schwartz, Alan; Hirshfield, Laura E

2017-01-01

Phenomenon: International medical graduates (IMGs) play a key role in host countries' health systems but face unique challenges, which makes effective, tailored support for IMGs essential. Prior literature describing the acculturation needs of IMGs focused primarily on communication content and style. We conducted a qualitative study to explore acculturation that might be specific to IMG residents who care for children. In a study conducted from November 2011 to April 2012, we performed four 90-minute semistructured focus groups with 26 pediatric IMG residents from 12 countries. The focus group transcripts were analyzed using open and focused coding methodology. The focus groups and subsequent analysis demonstrated that pediatric IMG residents' socialization to their home culture impacts their transition to practice in the United States; they must adjust not only to a U.S. culture, different from their own, but also to the culture of medicine in the United States. We identified the following new acculturation themes: understanding the education system and family structure, social determinants of health, communication with African American parents, contraception, physician handoffs, physicians' role in prevention, adolescent health, and physicians' role in child advocacy. We further highlight the acculturation challenges faced by pediatric IMG residents and offer brief recommendations for the creation of a deliberate acculturation curriculum for pediatric IMG residents. Insight: Residency training is a unique period in physicians' personal and professional development and can be particularly challenging for IMGs. There is a significant gap in the identified acculturation needs and the current curricula available to IMG residents who care for children.

Graduates of Lebanese medical schools in the United States: an observational study of international migration of physicians.

PubMed

Akl, Elie A; Maroun, Nancy; Major, Stella; Chahoud, Bechara; Schünemann, Holger J

2007-04-05

As healthcare systems around the world are facing increasing physician shortages, more physicians are migrating from low to high income countries. As an illustrative case of international migration of physicians, we evaluated the current number and historical trends of Lebanese medical graduates (LMG) in the US, and compared their characteristics to those of US medical graduates (USMG) and other international medical graduates (IMG). We evaluated the number of LMG using the 2004 the American Medical Association Physicians' Professional Data (AMA-PPD) and then compared it to the number of graduates of other countries. We evaluated the historical trends using the 1978-2004 historical files of the AMA-PPD. We analyzed the characteristics of all LMG and compared them to a random sample of 1000 USMG and a random sample of 1000 IMG using the 2004 AMA-PPD. In 2004, there were 2,796 LMG in the US, constituting 1.3% of all IMG. Compared to other foreign countries contributing to the US physician workforce, Lebanon ranked 2nd after adjusting for country population size (about 4 million) and 21st overall. About 40% of those who graduated from Lebanese medical schools in the last 25 years are currently active physicians in the US. Since 1978, the number of LMG in the US showed a consistent upward trend at a rate of approximately 71 additional graduates per year. Compared with USMG and IMG, LMG were more likely to work in medical research (OR = 2.31; 95% Confidence Interval (CI) = 1.21; 4.43 and OR = 2.63; 95% CI = 1.34; 5.01, respectively) and to be board certified (OR = 1.43; 95% CI = 1.14; 1.78 and OR = 2.04; 95% CI = 1.65;2.53, respectively) and less likely to be in family practice (OR = 0.14; 95% CI = 0.10; 0.19 and OR = 0.18; 95% CI = 0.12; 0.26, respectively). Given the magnitude and historical trends of migration of LMG to the US, further exploration of its causes and impact is warranted. High income countries should consider the consequences of their human resources

Supporting international medical graduates' transition to their host-country: realist synthesis.

PubMed

Kehoe, Amelia; McLachlan, John; Metcalf, Jane; Forrest, Simon; Carter, Madeline; Illing, Jan

2016-10-01

Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs' transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective. The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement. Sixty-two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self-efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment. Organisational, training and individual contexts all play a role in IMGs' adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given. © 2016 The Authors

Professional experiences of international medical graduates practicing primary care in the United States.

PubMed

Chen, Peggy Guey-Chi; Nunez-Smith, Marcella; Bernheim, Susannah May; Berg, David; Gozu, Aysegul; Curry, Leslie Ann

2010-09-01

International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Qualitative study based on in-depth in-person interviews. Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. A standardized interview guide was used to explore professional experiences of IMGs. Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.

Recent trends in psychiatry residency workforce with special reference to international medical graduates.

PubMed

Rao, Nyapati R

2003-01-01

This study examines trends in the supply, distribution, and demographics of psychiatry residents during the 1990s. It evaluates the extent to which the predicted downsizing of psychiatry residency training programs actually occurred and how it affected training programs of different sizes and locations. Data for this study were obtained from the American Medical Association's (AMA) Annual Survey of Graduate Medical Education (GME) Programs, the AMA GME directory, and the APA Graduate Medical Census. The study compares the roles played by international medical graduates (IMGs) in contrast to U.S. medical graduates (USMGs) in these trends. There was a significant decline in the number of residents during the years studied. The median training program size also decreased. International medical graduates found broad acceptance in training programs of all locations and sizes, including medical school based programs. Implications of the findings are discussed regarding the impact of current graduate medical education (GME) and immigration policies on future workforce patterns. The field will have to decide whether it can afford anymore residency downsizing in light of emerging evidence of a shortage of psychiatrists.

Combining interdisciplinary and International Medical Graduate perspectives to teach clinical and ethical communication using multimedia.

PubMed

Woodward-Kron, Robyn; Flynn, Eleanor; Delany, Clare

2011-01-01

In Australia, international medical graduates (IMGs) play a crucial role in addressing workforce shortages in healthcare. Their ability to deliver safe and effective healthcare in an unfamiliar cultural setting is intrinsically tied to effective communication. Hospital-based medical clinical educators, who play an important role in providing communication training to IMGs, would benefit from practical resources and an understanding of the relevant pedagogies to address these issues in their teaching. This paper examines the nature of an interdisciplinary collaboration to develop multimedia resources for teaching clinical and ethical communication to IMGs. We describe the processes and dynamics of the collaboration, and outline the methodologies from applied linguistics, medical education, and health ethics that we drew upon. The multimedia consist of three video clips of challenging communication scenarios as well as experienced IMGs talking about communication and ethics. The multimedia are supported by teaching guidelines that address relevant disciplinary concerns of the three areas of collaboration. In the paper's discussion we point out the pre-conditions that facilitated the interdisciplinary collaboration. We propose that such collaborative approaches between the disciplines and participants can provide new perspectives to address the multifaceted challenges of clinical teaching and practice.

How international medical graduates view their learning needs for UK GP training.

PubMed

Warwick, Christopher

2014-03-01

International medical graduates (IMGs) form a vital group of general practitioners (GPs) in the NHS. They are known to face additional challenges above and beyond those faced by UK medical graduates in the course of their GP training. Whilst they are a heterogeneous group of professionals, their views on what they need to learn, and how they are supported, are often distant from those of the educators responsible for planning their education. This study was undertaken, through narrative-based focus groups, to explore the issues which matter to the IMGs, in an attempt to empower their voices about their experiences in GP training, and to see what lessons could be drawn from these views. The findings confirmed the central importance, and considerable challenge involved, in making an effective transition into the culture of the NHS and UK general practice. The IMGs felt that induction needed to be an on-going, iterative process of learning which continued throughout training, with a more effective individualised learning needs analysis at the start of GP training. Lack of sophisticated language skills was highlighted as a real concern. Recognition that their lack of knowledge about the NHS at the start of training should not be seen as an indicator of deficiency, but a clue to what they needed to learn were also key messages. IMGs also felt the earlier in their training they undertook a GP placement, the quicker they would start to understand the culture of general practice in the UK. Further work following on from this research should include how to manage change in the educational network for these barriers to be overcome.

Credentialing and retention of visa trainees in post-graduate medical education programs in Canada.

PubMed

Mathews, Maria; Kandar, Rima; Slade, Steve; Yi, Yanqing; Beardall, Sue; Bourgeault, Ivy; Buske, Lynda

2017-06-12

Visa trainees are international medical graduates (IMG) who come to Canada to train in a post-graduate medical education (PGME) program under a student or employment visa and are expected to return to their country of origin after training. We examined the credentialing and retention of visa trainees who entered PGME programs between 2005 and 2011. Using the Canadian Post-MD Education Registry's National IMG Database linked to Scott's Medical Database, we examined four outcomes: (1) passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), (2) obtaining a specialty designation (CCFP, FRCPC/SC), and (3) working in Canada after training and (4) in 2015. The National IMG Database is the most comprehensive source of information on IMG in Canada; data were provided by physician training and credentialing organizations. Scott's Medical Database provides data on physician locations in Canada. There were 233 visa trainees in the study; 39.5% passed the MCCQE2, 45.9% obtained a specialty designation, 24.0% worked in Canada after their training, and 53.6% worked in Canada in 2015. Family medicine trainees (OR = 8.33; 95% CI = 1.69-33.33) and residents (OR = 3.45; 95% CI = 1.96-6.25) were more likely than other specialist and fellow trainees, respectively, to pass the MCCQE2. Residents (OR = 7.69; 95% CI = 4.35-14.29) were more likely to obtain a specialty credential than fellows. Visa trainees eligible for a full license were more likely than those not eligible for a full license to work in Canada following training (OR = 3.41; 95% CI = 1.80-6.43) and in 2015 (OR = 3.34; 95% CI = 1.78-6.27). Visa training programs represent another route for IMG to qualify for and enter the physician workforce in Canada. The growth in the number of visa trainees and the high retention of these physicians warrant further consideration of the oversight and coordination of visa trainee programs in provincial and in pan

Professional Experiences of International Medical Graduates Practicing Primary Care in the United States

PubMed Central

Nunez-Smith, Marcella; Bernheim, Susannah May; Berg, David; Gozu, Aysegul; Curry, Leslie Ann

2010-01-01

Background International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. Objective To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Design Qualitative study based on in-depth in-person interviews. Participants Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. Approach A standardized interview guide was used to explore professional experiences of IMGs. Key Results Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of “the deal”; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Conclusions Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs’ experiences may also improve the experiences of an increasingly diverse healthcare workforce. PMID:20502974

(Dis)Orientation of International Medical Graduates: An Approach to Foster Teaching, Learning, and Collaboration (TLC)

ERIC Educational Resources Information Center

Tan, Adrienne; Hawa, Raed; Sockalingam, Sanjeev; Abbey, Susan E.

2013-01-01

Objective: The Teaching for Learning and Collaboration (TLC) Program is a teaching-skills program focusing on methods to improve student learning. This program was adopted to address the professional and personal challenges faced by International Medical Graduates (IMGs) completing a fellowship in psychosomatic medicine. Method: The authors…

Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school.

PubMed

Shankar, P Ravi; Dubey, Arun K; Nandy, Atanu; Herz, Burton L; Little, Brian W

2014-01-01

Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care.  Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation.   The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied. Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth.  Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues. About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above. Graduates from Caribbean medical schools have a

Student perception about working in rural United States/Canada after graduation: a study in an offshore Caribbean medical school

PubMed Central

Shankar, P Ravi; Dubey, Arun K; Nandy, Atanu; Herz, Burton L; Little, Brian W

2015-01-01

Introduction: Rural residents of the United States (US) and Canada face problems in accessing healthcare. International medical graduates (IMGs) play an important role in delivering rural healthcare. IMGs from Caribbean medical schools have the highest proportion of physicians in primary care.  Xavier University School of Medicines admits students from the US, Canada and other countries to the undergraduate medical (MD) course and also offers a premedical program. The present study was conducted to obtain student perception about working in rural US/Canada after graduation.   Methods: The study was conducted among premedical and preclinical undergraduate medical (MD) students during October 2014. The questionnaire used was modified from a previous study. Semester of study, gender, nationality, place of residence and occupation of parents were noted. Information about whether students plan to work in rural US/Canada after graduation, possible reasons why doctors are reluctant to work in rural areas, how the government can encourage rural practice, possible problems respondents anticipate while working in rural areas were among the topics studied. Results: Ninety nine of the 108 students (91.7%) participated. Forty respondents were in favor of working in rural US/Canada after graduation. Respondents mentioned good housing, regular electricity, water supply, telecommunication facilities, and schools for education of children as important conditions to be fulfilled. The government should provide higher salaries to rural doctors, help with loan repayment, and provide opportunities for professional growth.  Potential problems mentioned were difficulty in being accepted by the rural community, problems in convincing patients to follow medical advice, lack of exposure to rural life among the respondents, and cultural issues. Conclusions: About 40% of respondents would consider working in rural US/Canada. Conditions required to be fulfilled have been mentioned above

Systems-Based Aspects in the Training of IMG or Previously Trained Residents: Comparison of Psychiatry Residency Training in the United States, Canada, the United Kingdom, India, and Nigeria

ERIC Educational Resources Information Center

Jain, Gaurav; Mazhar, Mir Nadeem; Uga, Aghaegbulam; Punwani, Manisha; Broquet, Karen E.

2012-01-01

Objectives: International medical graduates (IMGs) account for a significant proportion of residents in psychiatric training in the United States. Many IMGs may have previously completed psychiatry residency training in other countries. Their experiences may improve our system. Authors compared and contrasted psychiatry residency training in the…

The Role of International Medical Graduates in America?s Small Rural Critical Access Hospitals

ERIC Educational Resources Information Center

Hagopian, Amy; Thompson, Matthew J.; Kaltenbach, Emily; Hart, L. Gary

2004-01-01

Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. Purpose: This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH…

Utilizing international medical graduates in health care delivery: brain drain, brain gain, or brain waste? A win-win approach at University of California, Los Angeles.

PubMed

Dowling, Patrick T; Bholat, Michelle Anne

2012-12-01

After identifying many unlicensed Hispanic international medical graduates (IMGs) legally residing in southern California, University of California, Los Angeles developed an innovative program to prepare these sidelined physicians to enter family medicine residency programs and become licensed physicians. On completion of a 3-year family medicine residency-training program, these IMGs have an obligation to practice in a federally designated underserved community in the state for 2 to 3 years. As the US health care system moves from physician-centered practices to patient-focused teams, with primary care serving as the foundation for building patient-centered medical homes, attention to educating IMGs in these concepts is crucial. Copyright © 2012 Elsevier Inc. All rights reserved.

Cultural transition of international medical graduate residents into family practice in Canada.

PubMed

Triscott, Jean A C; Szafran, Olga; Waugh, Earle H; Torti, Jacqueline M I; Barton, Martina

2016-05-04

To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada's health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

Cultural transition of international medical graduate residents into family practice in Canada

PubMed Central

Triscott, Jean A.C.; Waugh, Earle H.; Torti, Jacqueline M.I.; Barton, Martina

2016-01-01

Objectives To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. Methods This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Results Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths.  At the same time, IMG residents appeared to experience challenges in the areas of:  (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada’s health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning,  unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles.   Conclusions Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum.  IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning. PMID:27149322

Well-being of family medicine graduates

PubMed Central

Szafran, Olga; Woloschuk, Wayne; Torti, Jacqueline M.I.; Myhre, Douglas

2017-01-01

Abstract Objective To determine family medicine graduates’ professional and personal well-being, general health status, stress levels, coping strategies, and the degree to which they felt supported or isolated in professional life; and to compare findings by sex, practice location, and location of medical school (Canadian medical graduates [CMGs] vs international medical graduates [IMGs]). Design Retrospective, cross-sectional survey. Setting University of Alberta in Edmonton and the University of Calgary in Alberta. Participants A total of 651 graduates who completed one of the family medicine residency programs during 2006 to 2011. Main outcome measures Using a 5-point Likert scale, graduates rated their general health status, their personal and professional well-being, their level of stress, and the degree to which they felt supported or isolated in professional life. Respondents also identified important life events, their caregiving roles, and stress-coping strategies. Results Of 651 graduates, 307 (47.2%) responded to the survey. Personal and professional well-being and general health status were rated as very good or excellent by 72.0%, 76.6%, and 74.7% of graduates, respectively. Overall, 39.3% reported high or extremely high levels of stress, with CMGs exhibiting significantly higher stress levels than IMGs (P = .02). Stress scores were inversely related to personal and professional well-being and health status. In terms of coping strategies, a significantly greater proportion of female than male graduates reported talking to colleagues (76.5% vs 64.3%; P = .026) and seeking professional counseling (18.7% vs 6.1%; P = .002). Also, a significantly greater proportion of IMGs than CMGs (52.9% vs 32.5%; P = .003), as well as those in rural (35.8%) or urban (49.3%) practices than those in metropolitan locations (30.1%) (P = .03), turned to spiritual or religious practices for stress management. Of all respondents, 54.8% felt highly or extremely

Predicting performance using background characteristics of international medical graduates in an inner-city university-affiliated Internal Medicine residency training program.

PubMed

Kanna, Balavenkatesh; Gu, Ying; Akhuetie, Jane; Dimitrov, Vihren

2009-07-13

IMGs constitute about a third of the United States (US) internal medicine graduates. US residency training programs face challenges in selection of IMGs with varied background features. However data on this topic is limited. We analyzed whether any pre-selection characteristics of IMG residents in our internal medicine program are associated with selected outcomes, namely competency based evaluation, examination performance and success in acquiring fellowship positions after graduation. We conducted a retrospective study of 51 IMGs at our ACGME accredited teaching institution between 2004 and 2007. Background resident features namely age, gender, self-reported ethnicity, time between medical school graduation to residency (pre-hire time), USMLE step I & II clinical skills scores, pre-GME clinical experience, US externship and interest in pursuing fellowship after graduation expressed in their personal statements were noted. Data on competency-based evaluations, in-service exam scores, research presentation and publications, fellowship pursuance were collected. There were no fellowships offered in our hospital in this study period. Background features were compared between resident groups according to following outcomes: (a) annual aggregate graduate PGY-level specific competency-based evaluation (CBE) score above versus below the median score within our program (scoring scale of 1 - 10), (b) US graduate PGY-level specific resident in-training exam (ITE) score higher versus lower than the median score, and (c) those who succeeded to secure a fellowship within the study period. Using appropriate statistical tests & adjusted regression analysis, odds ratio with 95% confidence intervals were calculated. 94% of the study sample were IMGs; median age was 35 years (Inter-Quartile range 25th - 75th percentile (IQR): 33-37 years); 43% women and 59% were Asian physicians. The median pre-hire time was 5 years (IQR: 4-7 years) and USMLE step I & step II clinical skills scores

Personality characteristics and attributes of international medical graduates in general practice training: Implications for supporting this valued Australian workforce.

PubMed

Laurence, Caroline O; Eley, Diann S; Walters, Lucie; Elliott, Taryn; Cloninger, Claude Robert

2016-10-01

To describe the personality profiles of International Medical Graduates (IMGs) undertaking General Practice (GP) training in Australia. A better understanding of the personal characteristics of IMGs may inform their training and enhance support for their vital contribution to the Australian rural workforce. Cross-sectional self-report questionnaires. Independent variables included socio-demographics, prior training, the Temperament and Character Inventory, and the Resilience Scale. GP registrars (IMGs = 102; AMGs = 350) training in the Australian General Practice Training rural and general pathway and the Australian College of Rural and Remote Medicine independent pathway. Univariate analysis explored the differences in levels of traits between IMG and AMG registrars. Compared to the general population both groups have moderately high resilience, and well-organised characters with high Self-directedness, high Cooperativeness and low Self-transcendence, supported by temperaments which were high in Persistence and Reward Dependence. IMGs were different than AMGs in two temperament traits, Novelty Seeking and Persistence and two character traits, Self-directedness and Cooperativeness. Factors such as cultural and training backgrounds, personal and professional expectations, and adjustments necessary to assimilate to a new lifestyle and health system are likely to be responsible for differences found between groups. Understanding the personality profiles of IMGs provides opportunities for targeted training and support which may in turn impact on their retention in rural areas. © 2016 National Rural Health Alliance Inc.

Predicting performance using background characteristics of international medical graduates in an inner-city university-affiliated Internal Medicine residency training program

PubMed Central

Kanna, Balavenkatesh; Gu, Ying; Akhuetie, Jane; Dimitrov, Vihren

2009-01-01

Background IMGs constitute about a third of the United States (US) internal medicine graduates. US residency training programs face challenges in selection of IMGs with varied background features. However data on this topic is limited. We analyzed whether any pre-selection characteristics of IMG residents in our internal medicine program are associated with selected outcomes, namely competency based evaluation, examination performance and success in acquiring fellowship positions after graduation. Methods We conducted a retrospective study of 51 IMGs at our ACGME accredited teaching institution between 2004 and 2007. Background resident features namely age, gender, self-reported ethnicity, time between medical school graduation to residency (pre-hire time), USMLE step I & II clinical skills scores, pre-GME clinical experience, US externship and interest in pursuing fellowship after graduation expressed in their personal statements were noted. Data on competency-based evaluations, in-service exam scores, research presentation and publications, fellowship pursuance were collected. There were no fellowships offered in our hospital in this study period. Background features were compared between resident groups according to following outcomes: (a) annual aggregate graduate PGY-level specific competency-based evaluation (CBE) score above versus below the median score within our program (scoring scale of 1 – 10), (b) US graduate PGY-level specific resident in-training exam (ITE) score higher versus lower than the median score, and (c) those who succeeded to secure a fellowship within the study period. Using appropriate statistical tests & adjusted regression analysis, odds ratio with 95% confidence intervals were calculated. Results 94% of the study sample were IMGs; median age was 35 years (Inter-Quartile range 25th – 75th percentile (IQR): 33–37 years); 43% women and 59% were Asian physicians. The median pre-hire time was 5 years (IQR: 4–7 years) and USMLE step

Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates

PubMed Central

Farhan, Nabeel; Motschall, Edith; Vach, Werner; Boeker, Martin

2017-01-01

Objectives An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs. Methods This review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized. Results Among 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science

Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates.

PubMed

Michalski, Kerstin; Farhan, Nabeel; Motschall, Edith; Vach, Werner; Boeker, Martin

2017-01-01

An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs. This review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized. Among 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science-oriented, without focusing on

Challenges and Solutions for Latin American-Trained International Medical Graduates in Psychiatry Residency

PubMed Central

Hausmann-Stabile, Carolina; Zayas, Luis H.; Hauser, David; Carvajal, Carlos; Mejia, Carlina; Nieves, Delia

2014-01-01

Objective Latin American-trained IMGs in psychiatry face multiple challenges that go beyond their medical training. These challenges call for innovative problem-solving. Although the professional development of IMGs has been discussed in the professional literature, little is written about their experiences. In this case study report, a group of IMGs reflect on their experiences and describe how they solved challenges. Method Using cogenerative ethnography, four IMGs trained in Colombia, Dominican Republic and Mexico provided insights on their challenges and solutions while adapting to psychiatric residency training. Individual interviews, focused discussion, focus groups, and written reports were analyzed using data reduction, data display, and conclusion drawing techniques. Results We illustrate the challenges of IMG training in psychiatry using their reflections and stories. We categorized these challenges into three domains: immigration and acculturation; social adjustment; and medical training. Quotes were selected to illustrate IMGs’ challenges and coping strategies. Conclusion Some of the combined cultural, social and academic challenges of Latin American-trained IMGs in psychiatry are described. Recognizing and planning for the personal challenges of IMGs in psychiatry can enhance the transition into psychiatric training. Ultimately, improvements in IMG training converts into improved healthcare for all patients. PMID:25673899

IMG candidates' demographic characteristics as predictors of CEHPEA CE1 results

PubMed Central

Nayer, Marla; Rothman, Arthur

2013-01-01

Objective To assess the extent to which demographic characteristics are related to international medical graduate (IMG) candidate performance on the Centre for the Evaluation of Health Professionals Educated Abroad General Comprehensive Clinical Examination 1 (CE1). Design Retrospective study. Setting Toronto, Ont. Participants All IMG candidates who registered for and took the CE1 in 2007 (n = 430), 2008 (n = 480), and 2009 (n = 472) were included in this analysis. All candidates completed the Centre for the Evaluation of Health Professionals Educated Abroad CE1, a 12-station objective structured clinical examination. Main outcome measures Mean (SD) examination scores for groups based on demographic variables (age, region of medical training, and Medical Council of Canada Qualifying Examination Part 1 [MCCQE1] score) were calculated. Analysis of variance was done using CE1 examination total scores as the dependent variables. Results Candidates from countries where both medical education and patient care are conducted in English and those from South America and Western Europe achieved the highest scores, while candidates from the Western Pacific region and Africa achieved the lowest scores. Younger candidates achieved higher scores than older candidates. These results were consistent across the 3 years of CE1 examination administration. There was a significant relationship between MCCQE1 and CE1 scores in 2 of the 3 years: 2007 (r = 0.218, P < .001) and 2008 (r = 0.23, P < .01). Conclusion The CE1 includes an assessment of communication skills; hence it is reasonable that candidates with stronger English skills have the highest scores on the CE1. Age, as a proxy for time since graduation, also has a substantial effect on examination scores, possibly owing to those further from their training lacking some currency of knowledge or being in focused rather than general practices. It is reasonable that those who had higher scores on the written test (the MCCQE1) would

Medical professionalism in the new millennium: are there intercultural differences? Brief report and commentary.

PubMed

Shah, Manasi M; Summerhill, Eleanor M; Manthous, Constantine A

2009-05-01

We hypothesized that differences in premedical and medical indoctrination might lead to demonstrable differences in notions of medical professionalism among U.S. medical schoolgraduates (USMG) and international medical graduates (IMG). We used the previously validated Barry Challenges to Professionalism questionnaire to query applicants to our Medicine residency. Two hundred sixty-six of 1,476 applicants responded; 57 were USMG and 188 IMG were non-U.S. citizens. There were no significant differences in responses based on gender or medical school background (comparing USMG vs IMG). Graduates of U.S. and Canadian schools were more likely than those of Indian schools to answer correctly three of 10 questions. We use the results of this ostensibly "negative" study to comment on the foundations for the hypothesis and logistic difficulty of studying the question.

Efficacy of Accent Modification Training for International Medical Professionals

ERIC Educational Resources Information Center

Khurana, Poonam; Huang, Edgar

2013-01-01

International medical graduates (IMGs) comprise 26% of the U.S. physician work force. While IMGs bring all their knowledge and expertise, their pronunciation and intonation patterns often become a barrier in their ability to be understood. This breakdown in communication can affect physician-patient or physician-staff understanding and hence…

Supporting international medical graduates in rural Australia: a mixed methods evaluation.

PubMed

Wright, Alistair; Regan, Melanie; Haigh, Cathy; Sunderji, Irum; Vijayakumar, Priyanga; Smith, Cathy; Nestel, Debra

2012-01-01

In Australia, international medical graduates (IMGs) make a substantial contribution to rural medical workforces. They often face significant communication, language, professional and cultural barriers, in addition to the other challenges of rural clinical practice. The Gippsland Inspiring Professional Standards among International Experts (GIPSIE) program was designed to provide educational support to IMGs across a large geographical region using innovative educational methods to ultimately build capacity in the provision of rural medical education. GIPSIE offered 5 sessions over 3 months. Simulation-based training was a prominent theme and addressed clinical knowledge, attitudes and skills and included a range of activities (eg procedural skills training with benchtop models, management of the acutely ill patient with SimMan, patient assessment skills with simulated patients). Diverse clinical communication skills were explored (eg teamwork, handover, telephone, critical information). Audiovisual review of performance was enabled through the use of iPod nano devices. GIPSIE was underpinned by a website offering diverse learning resources. Content experts were invited to lead sessions that integrated knowledge and skills reflecting local practice. IMGs were recruited from hospitals (n = 15) and general practices (n = 2) across the region. It was aimed to evaluate the impact of GIPSIE on the clinical practice of IMG participants. Evaluation measures included pre- and post-program 15 item multisource feedback (MSF), post-program questionnaires and, in order to address retention, telephone interviews exploring participants' responses 3 months after the program finished. Fifteen participants completed GIPSIE and rated the program highly, especially the simulation-based activities with feedback and later audiovisual review on iPods and the GIPSIE website. Suggestions were made to improve several aspects of the program. Participants reported increased knowledge, skills

Aspects of medical migration with particular reference to the United Kingdom and the Netherlands.

PubMed

Herfs, Paul G P

2014-10-14

In most countries of the European Economic Area (EEA), there is no large-scale migration of medical graduates with diplomas obtained outside the EEA, which are international medical graduates (IMGs). In the United Kingdom however, health care is in part dependent on the influx of IMGs. In 2005, of all the doctors practising in the UK, 31% were educated outside the country. In most EEA-countries, health care is not dependent on the influx of IMGs.The aim of this study is to present data relating to the changes in IMG migration in the UK since the extension of the European Union in May 2004. In addition, data are presented on IMG migration in the Netherlands. These migration flows show that migration patterns differ strongly within these two EU-countries. This study makes use of registration data on migrating doctors from the General Medical Council (GMC) in the UK and from the Dutch Department of Health. Moreover, data on the ratio of medical doctors in relation to a country's population were extracted from the World Health Organization (WHO). The influx of IMGs in the UK has changed in recent years due to the extension of the European Union in 2004, the expansion of UK medical schools and changes in the policy towards non-EEA doctors.The influx of IMGs in the Netherlands is described in detail. In the Netherlands, many IMGs come from Afghanistan, Iraq and Surinam. There are clear differences between IMG immigration in the UK and in the Netherlands. In the UK, the National Health Service continues to be very reliant on immigration to fill shortage posts, whereas the number of immigrant doctors working in the Netherlands is much smaller. Both the UK and the Netherlands' regulatory bodies have shared great concerns about the linguistic and communication skills of both EEA and non-EEA doctors seeking to work in these countries. IMG migration is a global and intricate problem. The source countries, not only those where English is the first or second language, experience

How we developed Doctors Speak Up: an evidence-based language and communication skills open access resource for International Medical Graduates.

PubMed

Woodward-Kron, Robyn; Fraser, Catriona; Pill, John; Flynn, Eleanor

2015-01-01

Some International Medical Graduates (IMGs) need to develop language and communication skills for patient-centred care but have limited opportunities to do so. To develop an evidence-based, language and communication skills web resource for IMG doctors and supervisors, focussing on culturally challenging patient interviews. Forty-eight IMGs participated in four practice OSCEs. We video-recorded the interactions and applied discourse analytic methods to investigate salient language and communication features. The findings from the OSCE workshops showed that many participants demonstrated aspects of patient-centred interviewing but were hindered by limited interactional competence to elicit information and negotiate behaviours as well as a limited repertoire of English grammar, vocabulary, and phonological phrasing for effective interaction. These findings guided the choice of content and pedagogy for the development of the web-based resource Doctors Speak Up. Evaluation and uptake of the Doctors Speak Up website confirm the demand for a resource combining targeted communication skills and language instruction. Over 19 500 users visited the website between March 2012 and November 2013.

Medical education in Israel 2016: five medical schools in a period of transition.

PubMed

Reis, Shmuel; Urkin, Jacob; Nave, Rachel; Ber, Rosalie; Ziv, Amitai; Karnieli-Miller, Orit; Meitar, Dafna; Gilbey, Peter; Mevorach, Dror

2016-01-01

We reviewed the existing programs for basic medical education (BME) in Israel as well as their output, since they are in a phase of reassessment and transition. The transition has been informed, in part, by evaluation in 2014 by an International Review Committee (IRC). The review is followed by an analysis of its implications as well as the emergent roadmap for the future. The review documents a trend of modernizing, humanizing, and professionalizing Israeli medical education in general, and BME in particular, independently in each of the medical schools. Suggested improvements include an increased emphasis on interactive learner-centered rather than frontal teaching formats, clinical simulation, interprofessional training, and establishment of a national medical training forum for faculty development. In addition, collaboration should be enhanced between medical educators and health care providers, and among the medical schools themselves. The five schools admitted about 730 Israeli students in 2015, doubling admissions from 2000. In 2014, the number of new licenses, including those awarded to Israeli international medical graduates (IMGs), surpassed for the first time in more than a decade the estimated need for 1100 new physicians annually. About 60 % of the licenses awarded in 2015 were to IMGs. Israeli BME is undergoing continuous positive changes, was supplied with a roadmap for even further improvement by the IRC, and has doubled its output of graduates. The numbers of both Israeli graduates and IMGs are higher than estimated previously and may address the historically projected physician shortage. However, it is not clear whether the majority of newly licensed physicians, who were trained abroad, have benefited from similar recent improvements in medical education similar to those benefiting graduates of the Israeli medical schools, nor is it certain that they will benefit from the further improvements that have recently been recommended for the Israeli

Realization of entry-to-practice milestones by Canadians who studied medicine abroad and other international medical graduates: a retrospective cohort study.

PubMed

Mathews, Maria; Kandar, Rima; Slade, Steve; Yi, Yanqing; Beardall, Sue; Bourgeault, Ivy

2017-06-19

International medical graduates must realize a series of milestones to obtain full licensure. We examined the realization of milestones by Canadian and non-Canadian graduates of Western or Caribbean medical schools, and Canadian and non-Canadian graduates from other medical schools. Using the National IMG Database (data available for 2005-2011), we created 2 cohorts: 1) international medical graduates who had passed the Medical Council of Canada Qualifying Examination Part I between 2005 and 2010 and 2) those who had first entered a family medicine postgraduate program between 2005 and 2009, or had first entered a specialty postgraduate program in 2005 or 2006. We examined 3 entry-to-practice milestones; obtaining a postgraduate position, passing the Medical Council of Canada Qualifying Examination Part II and obtaining a specialty designation. Of the 6925 eligible graduates in cohort 1, 2144 (31.0%) had obtained a postgraduate position. Of the 1214 eligible graduates in cohort 2, 1126 (92.8%) had passed the Qualifying Examination Part II, and 889 (73.2%) had obtained a specialty designation. In multivariate analyses, Canadian graduates of Western or Caribbean medical schools (odds ratio [OR] 4.69, 95% confidence interval [CI] 3.82-5.71) and Canadian graduates of other medical schools (OR 1.49, 95% CI 1.31-1.70) were more likely to obtain a postgraduate position than non-Canadian graduates of other (not Western or Caribbean) medical schools. There was no difference among the groups in passing the Qualifying Examination Part II or obtaining a specialty designation. Canadians who studied abroad were more likely than other international medical graduates to obtain a postgraduate position; there were no differences among the groups in realizing milestones once in a postgraduate program. These findings support policies that do not distinguish postgraduate applicants by citizenship or permanent residency status before medical school. Copyright 2017, Joule Inc. or its

Perspective: private schools of the Caribbean: outsourcing medical education.

PubMed

Eckhert, N Lynn

2010-04-01

Twenty-five percent of the U.S. physician workforce is made up of international medical graduates (IMGs), a growing proportion of whom (27% in 2005) are U.S. citizens. Most IMGs graduate from "offshore medical schools" (OMSs), for-profit institutions primarily located in the Caribbean region and established to train U.S. students who will return home to practice medicine. Following the recent call for a larger physician workforce, OMSs rapidly increased in number. Unlike U.S. schools, which must be accredited by the Liaison Committee on Medical Education, OMSs are recognized by their home countries and may not be subject to a rigorous accreditation process. Although gaps in specific data exist, a closer look at OMSs reveals that most enroll three groups of students per year, and many educate students initially at "offshore campuses" and later at clinical sites in the United States. Students from some OMSs are eligible for the U.S. Federal Family Education Loan Program. The lack of uniform data on OMSs is problematic for state medical boards, which struggle to assess the quality of the medical education offered at any one school and which, in some cases, disapprove a school. With the United States' continued reliance on IMGs to meet its health needs, the public and the profession will be best served by knowing more about medical education outside of the United States. Review of medical education in OMSs whose graduates will become part of U.S. health care delivery is timely as the United States reforms its health-care-delivery system.

IMG: the integrated microbial genomes database and comparative analysis system

PubMed Central

Markowitz, Victor M.; Chen, I-Min A.; Palaniappan, Krishna; Chu, Ken; Szeto, Ernest; Grechkin, Yuri; Ratner, Anna; Jacob, Biju; Huang, Jinghua; Williams, Peter; Huntemann, Marcel; Anderson, Iain; Mavromatis, Konstantinos; Ivanova, Natalia N.; Kyrpides, Nikos C.

2012-01-01

The Integrated Microbial Genomes (IMG) system serves as a community resource for comparative analysis of publicly available genomes in a comprehensive integrated context. IMG integrates publicly available draft and complete genomes from all three domains of life with a large number of plasmids and viruses. IMG provides tools and viewers for analyzing and reviewing the annotations of genes and genomes in a comparative context. IMG's data content and analytical capabilities have been continuously extended through regular updates since its first release in March 2005. IMG is available at http://img.jgi.doe.gov. Companion IMG systems provide support for expert review of genome annotations (IMG/ER: http://img.jgi.doe.gov/er), teaching courses and training in microbial genome analysis (IMG/EDU: http://img.jgi.doe.gov/edu) and analysis of genomes related to the Human Microbiome Project (IMG/HMP: http://www.hmpdacc-resources.org/img_hmp). PMID:22194640

IMG: the Integrated Microbial Genomes database and comparative analysis system.

PubMed

Markowitz, Victor M; Chen, I-Min A; Palaniappan, Krishna; Chu, Ken; Szeto, Ernest; Grechkin, Yuri; Ratner, Anna; Jacob, Biju; Huang, Jinghua; Williams, Peter; Huntemann, Marcel; Anderson, Iain; Mavromatis, Konstantinos; Ivanova, Natalia N; Kyrpides, Nikos C

2012-01-01

The Integrated Microbial Genomes (IMG) system serves as a community resource for comparative analysis of publicly available genomes in a comprehensive integrated context. IMG integrates publicly available draft and complete genomes from all three domains of life with a large number of plasmids and viruses. IMG provides tools and viewers for analyzing and reviewing the annotations of genes and genomes in a comparative context. IMG's data content and analytical capabilities have been continuously extended through regular updates since its first release in March 2005. IMG is available at http://img.jgi.doe.gov. Companion IMG systems provide support for expert review of genome annotations (IMG/ER: http://img.jgi.doe.gov/er), teaching courses and training in microbial genome analysis (IMG/EDU: http://img.jgi.doe.gov/edu) and analysis of genomes related to the Human Microbiome Project (IMG/HMP: http://www.hmpdacc-resources.org/img_hmp).

Comparing International and United States Undergraduate Medical Education and Surgical Outcomes Using a Refined Balance Matching Methodology.

PubMed

Zaheer, Salman; Pimentel, Samuel D; Simmons, Kristina D; Kuo, Lindsay E; Datta, Jashodeep; Williams, Noel; Fraker, Douglas L; Kelz, Rachel R

2017-05-01

The aim of this study is to compare surgical outcomes of international medical graduates (IMGs) and United States medical graduates (USMGs). IMGs represent 15% of practicing surgeons in the United States (US), and their training pathways often differ substantially from USMGs. To date, differences in the clinical outcomes between the 2 cohorts have not been examined. Using a unique dataset linking AMA Physician Masterfile data with hospital discharge claims from Florida and New York (2008-2011), patients who underwent 1 of 32 general surgical operations were stratified by IMG and USMG surgeon status. Mortality, complications, and prolonged length of stay were compared between IMG and USMG surgeon status using optimal sparse network matching with balance. We identified 972,718 operations performed by 4581 surgeons (72% USMG, 28% IMG). IMG and USMG surgeons differed significantly in demographic (age, gender) and baseline training (years of training, university affiliation of training hospital) characteristics. USMG surgeons performed complex procedures (13.7% vs 11.1%, P < 0.01) and practiced in urban settings (79.4% vs 75.6%, P < 0.01) more frequently, while IMG surgeons performed a higher volume of studied operations (50.7 ± 5.1 vs 57.8 ± 8.4, P < 0.01). In the matched cohort analysis of 396,810 patients treated by IMG and USMG surgeons, rates of mortality (USMG: 2.2%, IMG: 2.1%; P < 0.001), complications (USMG: 14.5%, IMG: 14.3%; P = 0.032), and prolonged length of stay (pLOS) (USMG: 22.7%, IMG: 22.8%; P = 0.352) were clinically equivalent. Despite considerable differences in educational background, surgical training characteristics, and practice patterns, IMG and USMG-surgeons deliver equivalent surgical care to the patients whom they treat.

IMG 4 version of the integrated microbial genomes comparative analysis system.

PubMed

Markowitz, Victor M; Chen, I-Min A; Palaniappan, Krishna; Chu, Ken; Szeto, Ernest; Pillay, Manoj; Ratner, Anna; Huang, Jinghua; Woyke, Tanja; Huntemann, Marcel; Anderson, Iain; Billis, Konstantinos; Varghese, Neha; Mavromatis, Konstantinos; Pati, Amrita; Ivanova, Natalia N; Kyrpides, Nikos C

2014-01-01

The Integrated Microbial Genomes (IMG) data warehouse integrates genomes from all three domains of life, as well as plasmids, viruses and genome fragments. IMG provides tools for analyzing and reviewing the structural and functional annotations of genomes in a comparative context. IMG's data content and analytical capabilities have increased continuously since its first version released in 2005. Since the last report published in the 2012 NAR Database Issue, IMG's annotation and data integration pipelines have evolved while new tools have been added for recording and analyzing single cell genomes, RNA Seq and biosynthetic cluster data. Different IMG datamarts provide support for the analysis of publicly available genomes (IMG/W: http://img.jgi.doe.gov/w), expert review of genome annotations (IMG/ER: http://img.jgi.doe.gov/er) and teaching and training in the area of microbial genome analysis (IMG/EDU: http://img.jgi.doe.gov/edu).

Foreign Medical Schools: Education Should Improve Monitoring of Schools That Participate in the Federal Student Loan Program. Report to Congressional Committees. GAO-10-412

ERIC Educational Resources Information Center

Scott, George A.

2010-01-01

Each year, the federal government makes a significant financial investment in the education and training of the U.S. physician workforce. A quarter of that physician workforce is composed of international medical graduates (IMG) and they include both U.S. citizens and foreign nationals. Little is known about IMGs with respect to how much they…

English for the Workplace: Doing Patient-Centred Care in Medical Communication

ERIC Educational Resources Information Center

Dahm, Maria R.; Yates, Lynda

2013-01-01

Canada, like other first-world countries, relies in large part on professional immigrants trained in other cultures and languages to complement its workforce in a wide range of professions, including medicine. International medical graduates (IMGs) who are nonnative English-speaking (NNES) and who have trained in different medical contexts are…

IMG 4 version of the integrated microbial genomes comparative analysis system

PubMed Central

Markowitz, Victor M.; Chen, I-Min A.; Palaniappan, Krishna; Chu, Ken; Szeto, Ernest; Pillay, Manoj; Ratner, Anna; Huang, Jinghua; Woyke, Tanja; Huntemann, Marcel; Anderson, Iain; Billis, Konstantinos; Varghese, Neha; Mavromatis, Konstantinos; Pati, Amrita; Ivanova, Natalia N.; Kyrpides, Nikos C.

2014-01-01

The Integrated Microbial Genomes (IMG) data warehouse integrates genomes from all three domains of life, as well as plasmids, viruses and genome fragments. IMG provides tools for analyzing and reviewing the structural and functional annotations of genomes in a comparative context. IMG’s data content and analytical capabilities have increased continuously since its first version released in 2005. Since the last report published in the 2012 NAR Database Issue, IMG’s annotation and data integration pipelines have evolved while new tools have been added for recording and analyzing single cell genomes, RNA Seq and biosynthetic cluster data. Different IMG datamarts provide support for the analysis of publicly available genomes (IMG/W: http://img.jgi.doe.gov/w), expert review of genome annotations (IMG/ER: http://img.jgi.doe.gov/er) and teaching and training in the area of microbial genome analysis (IMG/EDU: http://img.jgi.doe.gov/edu). PMID:24165883

IMG 4 version of the integrated microbial genomes comparative analysis system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Markowitz, Victor M.; Chen, I-Min A.; Palaniappan, Krishna

The Integrated Microbial Genomes (IMG) data warehouse integrates genomes from all three domains of life, as well as plasmids, viruses and genome fragments. IMG provides tools for analyzing and reviewing the structural and functional annotations of genomes in a comparative context. IMG’s data content and analytical capabilities have increased continuously since its first version released in 2005. Since the last report published in the 2012 NAR Database Issue, IMG’s annotation and data integration pipelines have evolved while new tools have been added for recording and analyzing single cell genomes, RNA Seq and biosynthetic cluster data. Finally, different IMG datamarts providemore » support for the analysis of publicly available genomes (IMG/W: http://img.jgi.doe.gov/w), expert review of genome annotations (IMG/ER: http://img.jgi.doe.gov/er) and teaching and training in the area of microbial genome analysis (IMG/EDU: http://img.jgi.doe.gov/edu).« less

Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study

PubMed Central

Viney, Rowena; Needleman, Sarah; Griffin, Ann

2016-01-01

Objectives Explore trainee doctors’ experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification. Design Qualitative semistructured focus group and interview study. Setting Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales. Participants 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad. Results Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work–life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising. Conclusions BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on

Attrition during graduate medical education: medical school perspective.

PubMed

Andriole, Dorothy A; Jeffe, Donna B; Hageman, Heather L; Klingensmith, Mary E; McAlister, Rebecca P; Whelan, Alison J

2008-12-01

To identify predictors of attrition during graduate medical education (GME) in a single medical school cohort of contemporary US medical school graduates. Retrospective cohort study. Single medical institution. Recent US allopathic medical school graduates. Attrition from initial GME program. Forty-seven of 795 graduates (6%) did not complete the GME in their initial specialty of choice. At bivariate analysis, attrition was associated with election to the Alpha Omega Alpha Honor Medical Society, being an MD-PhD degree holder, and specialty choice (all P < .05). Attrition was not associated with graduation year (P = .91), sex (P = .67), or age (P = .12). In a multivariate logistic regression model, MD-PhD degree holder (odds ratio, 3.43; 95% confidence interval, 1.27-9.26; P = .02), election to Alpha Omega Alpha (2.19; 1.04-4.66; P = .04), choice of general surgery for GME (5.32; 1.98-14.27; P < .001), and choice of 5-year surgical specialty including those surgical specialties with a GME training requirement of 5 years or longer (2.74; 1.16-6.44; P = .02) each independently predicted greater likelihood of attrition. Academically highly qualified graduates and graduates who chose training in general surgery or in a 5-year surgical specialty were at increased risk of attrition during GME.

The medical educator, the discourse analyst, and the phonetician: a collaborative feedback methodology for clinical communication.

PubMed

Woodward-Kron, Robyn; Stevens, Mary; Flynn, Eleanor

2011-05-01

Frameworks for clinical communication assist educators in making explicit the principles of good communication and providing feedback to medical trainees. However, existing frameworks rarely take into account the roles of culture and language in communication, which can be important for international medical graduates (IMGs) whose first language is not English. This article describes the collaboration by a medical educator, a discourse analyst, and a phonetician to develop a communication and language feedback methodology to assist IMG trainees at a Victorian hospital in Australia with developing their doctor-patient communication skills. The Communication and Language Feedback (CaLF) methodology incorporates a written tool and video recording of role-plays of doctor-patient interactions in a classroom setting or in an objective structured clinical examination (OSCE) practice session with a simulated patient. IMG trainees receive verbal feedback from their hospital-based medical clinical educator, the simulated patient, and linguists. The CaLF tool was informed by a model of language in context, observation of IMG communication training, and process evaluation by IMG participants during January to August 2009. The authors provided participants with a feedback package containing their practice video (which included verbal feedback) and the completed CaLF tool.The CaLF methodology provides a tool for medical educators and language practitioners to work collaboratively with IMGs to enhance communication and language skills. The ongoing interdisciplinary collaboration also provides much-needed applied research opportunities in intercultural health communication, an area the authors believe cannot be adequately addressed from the perspective of one discipline alone. Copyright © by the Association of American medical Colleges.

Electives in Graduate Medical Education

ERIC Educational Resources Information Center

Kumar, Santosh; Zayapragassarazan, Z.

2013-01-01

Modern curricula have both compulsory portions and electives or portions chosen by students. Electives have been a part of graduate and postgraduate general higher education. Electives are included in various standards for graduate medical education and are also included in proposed Medical Council of India Regulations on Graduate Medical…

IMG/M: integrated genome and metagenome comparative data analysis system

DOE PAGES

Chen, I-Min A.; Markowitz, Victor M.; Chu, Ken; ...

2016-10-13

The Integrated Microbial Genomes with Microbiome Samples (IMG/M: https://img.jgi.doe.gov/m/) system contains annotated DNA and RNA sequence data of (i) archaeal, bacterial, eukaryotic and viral genomes from cultured organisms, (ii) single cell genomes (SCG) and genomes from metagenomes (GFM) from uncultured archaea, bacteria and viruses and (iii) metagenomes from environmental, host associated and engineered microbiome samples. Sequence data are generated by DOE's Joint Genome Institute (JGI), submitted by individual scientists, or collected from public sequence data archives. Structural and functional annotation is carried out by JGI's genome and metagenome annotation pipelines. A variety of analytical and visualization tools provide support formore » examining and comparing IMG/M's datasets. IMG/M allows open access interactive analysis of publicly available datasets, while manual curation, submission and access to private datasets and computationally intensive workspace-based analysis require login/password access to its expert review(ER) companion system (IMG/M ER: https://img.jgi.doe.gov/ mer/). Since the last report published in the 2014 NAR Database Issue, IMG/M's dataset content has tripled in terms of number of datasets and overall protein coding genes, while its analysis tools have been extended to cope with the rapid growth in the number and size of datasets handled by the system.« less

IMG/M: integrated genome and metagenome comparative data analysis system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, I-Min A.; Markowitz, Victor M.; Chu, Ken

The Integrated Microbial Genomes with Microbiome Samples (IMG/M: https://img.jgi.doe.gov/m/) system contains annotated DNA and RNA sequence data of (i) archaeal, bacterial, eukaryotic and viral genomes from cultured organisms, (ii) single cell genomes (SCG) and genomes from metagenomes (GFM) from uncultured archaea, bacteria and viruses and (iii) metagenomes from environmental, host associated and engineered microbiome samples. Sequence data are generated by DOE's Joint Genome Institute (JGI), submitted by individual scientists, or collected from public sequence data archives. Structural and functional annotation is carried out by JGI's genome and metagenome annotation pipelines. A variety of analytical and visualization tools provide support formore » examining and comparing IMG/M's datasets. IMG/M allows open access interactive analysis of publicly available datasets, while manual curation, submission and access to private datasets and computationally intensive workspace-based analysis require login/password access to its expert review(ER) companion system (IMG/M ER: https://img.jgi.doe.gov/ mer/). Since the last report published in the 2014 NAR Database Issue, IMG/M's dataset content has tripled in terms of number of datasets and overall protein coding genes, while its analysis tools have been extended to cope with the rapid growth in the number and size of datasets handled by the system.« less

IMG/M: integrated genome and metagenome comparative data analysis system

PubMed Central

Chen, I-Min A.; Markowitz, Victor M.; Chu, Ken; Palaniappan, Krishna; Szeto, Ernest; Pillay, Manoj; Ratner, Anna; Huang, Jinghua; Andersen, Evan; Huntemann, Marcel; Varghese, Neha; Hadjithomas, Michalis; Tennessen, Kristin; Nielsen, Torben; Ivanova, Natalia N.; Kyrpides, Nikos C.

2017-01-01

The Integrated Microbial Genomes with Microbiome Samples (IMG/M: https://img.jgi.doe.gov/m/) system contains annotated DNA and RNA sequence data of (i) archaeal, bacterial, eukaryotic and viral genomes from cultured organisms, (ii) single cell genomes (SCG) and genomes from metagenomes (GFM) from uncultured archaea, bacteria and viruses and (iii) metagenomes from environmental, host associated and engineered microbiome samples. Sequence data are generated by DOE's Joint Genome Institute (JGI), submitted by individual scientists, or collected from public sequence data archives. Structural and functional annotation is carried out by JGI's genome and metagenome annotation pipelines. A variety of analytical and visualization tools provide support for examining and comparing IMG/M's datasets. IMG/M allows open access interactive analysis of publicly available datasets, while manual curation, submission and access to private datasets and computationally intensive workspace-based analysis require login/password access to its expert review (ER) companion system (IMG/M ER: https://img.jgi.doe.gov/mer/). Since the last report published in the 2014 NAR Database Issue, IMG/M's dataset content has tripled in terms of number of datasets and overall protein coding genes, while its analysis tools have been extended to cope with the rapid growth in the number and size of datasets handled by the system. PMID:27738135

Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

PubMed Central

Viney, Rowena; Jayaweera, Hirosha; Griffin, Ann

2018-01-01

Objectives To explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change. Design Qualitative semistructured individual and group interview study. Setting Postgraduate medical education in the UK. Participants Individuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers. Results Representatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty. Conclusions Representatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic

IMG ER: a system for microbial genome annotation expert review and curation.

PubMed

Markowitz, Victor M; Mavromatis, Konstantinos; Ivanova, Natalia N; Chen, I-Min A; Chu, Ken; Kyrpides, Nikos C

2009-09-01

A rapidly increasing number of microbial genomes are sequenced by organizations worldwide and are eventually included into various public genome data resources. The quality of the annotations depends largely on the original dataset providers, with erroneous or incomplete annotations often carried over into the public resources and difficult to correct. We have developed an Expert Review (ER) version of the Integrated Microbial Genomes (IMG) system, with the goal of supporting systematic and efficient revision of microbial genome annotations. IMG ER provides tools for the review and curation of annotations of both new and publicly available microbial genomes within IMG's rich integrated genome framework. New genome datasets are included into IMG ER prior to their public release either with their native annotations or with annotations generated by IMG ER's annotation pipeline. IMG ER tools allow addressing annotation problems detected with IMG's comparative analysis tools, such as genes missed by gene prediction pipelines or genes without an associated function. Over the past year, IMG ER was used for improving the annotations of about 150 microbial genomes.

Perceived causes of differential attainment in UK postgraduate medical training: a national qualitative study.

PubMed

Woolf, Katherine; Rich, Antonia; Viney, Rowena; Needleman, Sarah; Griffin, Ann

2016-11-25

Explore trainee doctors' experiences of postgraduate training and perceptions of fairness in relation to ethnicity and country of primary medical qualification. Qualitative semistructured focus group and interview study. Postgraduate training in England (London, Yorkshire and Humber, Kent Surrey and Sussex) and Wales. 137 participants (96 trainees, 41 trainers) were purposively sampled from a framework comprising: doctors from all stages of training in general practice, medicine, obstetrics and gynaecology, psychiatry, radiology, surgery or foundation, in 4 geographical areas, from white and black and minority ethnic (BME) backgrounds, who qualified in the UK and abroad. Most trainees described difficult experiences, but BME UK graduates (UKGs) and international medical graduates (IMGs) could face additional difficulties that affected their learning and performance. Relationships with senior doctors were crucial to learning but bias was perceived to make these relationships more problematic for BME UKGs and IMGs. IMGs also had to deal with cultural differences and lack of trust from seniors, often looking to IMG peers for support instead. Workplace-based assessment and recruitment were considered vulnerable to bias whereas examinations were typically considered more rigorous. In a system where success in recruitment and assessments determines where in the country you can get a job, and where work-life balance is often poor, UK BME and international graduates in our sample were more likely to face separation from family and support outside of work, and reported more stress, anxiety or burnout that hindered their learning and performance. A culture in which difficulties are a sign of weakness made seeking support and additional training stigmatising. BME UKGs and IMGs can face additional difficulties in training which may impede learning and performance. Non-stigmatising interventions should focus on trainee-trainer relationships at work and organisational changes to

Comparative genome analysis in the integrated microbial genomes (IMG) system.

PubMed

Markowitz, Victor M; Kyrpides, Nikos C

2007-01-01

Comparative genome analysis is critical for the effective exploration of a rapidly growing number of complete and draft sequences for microbial genomes. The Integrated Microbial Genomes (IMG) system (img.jgi.doe.gov) has been developed as a community resource that provides support for comparative analysis of microbial genomes in an integrated context. IMG allows users to navigate the multidimensional microbial genome data space and focus their analysis on a subset of genes, genomes, and functions of interest. IMG provides graphical viewers, summaries, and occurrence profile tools for comparing genes, pathways, and functions (terms) across specific genomes. Genes can be further examined using gene neighborhoods and compared with sequence alignment tools.

The future of graduate medical education in Germany - position paper of the Committee on Graduate Medical Education of the Society for Medical Education (GMA).

PubMed

David, Dagmar M; Euteneier, Alexander; Fischer, Martin R; Hahn, Eckhart G; Johannink, Jonas; Kulike, Katharina; Lauch, Robert; Lindhorst, Elmar; Noll-Hussong, Michael; Pinilla, Severin; Weih, Markus; Wennekes, Vanessa

2013-01-01

The German graduate medical education system is going through an important phase of changes. Besides the ongoing reform of the national guidelines for graduate medical education (Musterweiterbildungsordnung), other factors like societal and demographic changes, health and research policy reforms also play a central role for the future and competitiveness of graduate medical education. With this position paper, the committee on graduate medical education of the Society for Medical Education (GMA) would like to point out some central questions for this process and support the current discourse. As an interprofessional and interdisciplinary scientific society, the GMA has the resources to contribute in a meaningful way to an evidence-based and future-oriented graduate medical education strategy. In this position paper, we use four key questions with regards to educational goals, quality assurance, teaching competence and policy requirements to address the core issues for the future of graduate medical education in Germany. The GMA sees its task in contributing to the necessary reform processes as the only German speaking scientific society in the field of medical education.

Exploring cultural and linguistic influences on clinical communication skills: a qualitative study of International Medical Graduates.

PubMed

Verma, Anju; Griffin, Ann; Dacre, Jane; Elder, Andrew

2016-06-10

International Medical Graduates (IMGs) are known to perform less well in many postgraduate medical examinations when compared to their UK trained counterparts. This "differential attainment" is observed in both knowledge-based and clinical skills assessments. This study explored the influence of culture and language on IMGs clinical communication skills, in particular, their ability to seek, detect and acknowledge patients' concerns in a high stakes postgraduate clinical skills examination. Hofstede's cultural dimensions framework was used to look at the impact of culture on examination performance. This was a qualitative, interpretative study using thematic content analysis of video-recorded doctor-simulated patient consultations of candidates sitting the MRCP(UK) PACES examination, at a single examination centre in November 2012. The research utilised Hofstede's cultural dimension theory, a framework for comparing cultural factors amongst different nations, to help understand the reasons for failure. Five key themes accounted for the majority of communication failures in station 2, "history taking" and station 4, "communication skills and ethics" of the MRCP(UK) PACES examination. Two themes, the ability to detect clues and the ability to address concerns, related directly to the overall construct managing patients' concerns. Three other themes were found to impact the whole consultation. These were building relationships, providing structure and explanation and planning. Hofstede's cultural dimensions may help to contextualise some of these observations. In some cultures doctor and patient roles are relatively inflexible: the doctor may convey less information to the patient (higher power distance societies) and give less attention to building rapport (high uncertainty avoidance societies.) This may explain why cues and concerns presented by patients were overlooked in this setting. Understanding cultural differences through Hofstede's cultural dimensions theory

Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK.

PubMed

Woolf, Katherine; Viney, Rowena; Rich, Antonia; Jayaweera, Hirosha; Griffin, Ann

2018-03-09

To explore how representatives from organisations with responsibility for doctors in training perceive risks to the educational progression of UK medical graduates from black and minority ethnic groups (BME UKGs), and graduates of non-UK medical schools (international medical graduates (IMGs)). To identify the barriers to and facilitators of change. Qualitative semistructured individual and group interview study. Postgraduate medical education in the UK. Individuals with roles in examinations and/or curriculum design from UK medical Royal Colleges. Employees of NHS Employers. Representatives from 11 medical Royal Colleges (n=29) and NHS Employers (n=2) took part (55% medically qualified, 61% male, 71% white British/Irish, 23% Asian/Asian British, 6% missing ethnicity). Risks were perceived as significant, although more so for IMGs than for BME UKGs. Participants based significance ratings on evidence obtained largely through personal experience. A lack of evidence led to downgrading of significance. Participants were pessimistic about effecting change, two main barriers being sensitivities around race and the isolation of interventions. Participants felt that organisations should acknowledge problems, but felt concerned about being transparent without a solution; and talking about race with trainees was felt to be difficult. Participants mentioned 63 schemes aiming to address differential attainment, but these were typically local or specialty-specific, were not aimed at BME UKGs and were largely unevaluated. Participants felt that national change was needed, but only felt empowered to effect change locally or within their specialty. Representatives from organisations responsible for training doctors perceived the risks faced by BME UKGs and IMGs as significant but difficult to change. Strategies to help organisations address these risks include: increased openness to discussing race (including ethnic differences in attainment among UKGs); better sharing of

IMG/M-HMP: a metagenome comparative analysis system for the Human Microbiome Project.

PubMed

Markowitz, Victor M; Chen, I-Min A; Chu, Ken; Szeto, Ernest; Palaniappan, Krishna; Jacob, Biju; Ratner, Anna; Liolios, Konstantinos; Pagani, Ioanna; Huntemann, Marcel; Mavromatis, Konstantinos; Ivanova, Natalia N; Kyrpides, Nikos C

2012-01-01

The Integrated Microbial Genomes and Metagenomes (IMG/M) resource is a data management system that supports the analysis of sequence data from microbial communities in the integrated context of all publicly available draft and complete genomes from the three domains of life as well as a large number of plasmids and viruses. IMG/M currently contains thousands of genomes and metagenome samples with billions of genes. IMG/M-HMP is an IMG/M data mart serving the US National Institutes of Health (NIH) Human Microbiome Project (HMP), focussed on HMP generated metagenome datasets, and is one of the central resources provided from the HMP Data Analysis and Coordination Center (DACC). IMG/M-HMP is available at http://www.hmpdacc-resources.org/imgm_hmp/.

Translating Face-to-Face Experiential Learning to Video for a Web-Based Communication Program

ERIC Educational Resources Information Center

Nelles, Laura Jayne; Smith, Cathy M.; Lax, Leila R.; Russell, Lynn

2011-01-01

The cultural, legal and ethical aspects of medical practice in Canada can be problematic for International Medical Graduates (IMGs) to access and learn. The professional behaviours that depend on effective communication often challenge IMGs as they attempt to enter the Canadian medical system. The Communication and Cultural Competence Program…

ImgLib2--generic image processing in Java.

PubMed

Pietzsch, Tobias; Preibisch, Stephan; Tomancák, Pavel; Saalfeld, Stephan

2012-11-15

ImgLib2 is an open-source Java library for n-dimensional data representation and manipulation with focus on image processing. It aims at minimizing code duplication by cleanly separating pixel-algebra, data access and data representation in memory. Algorithms can be implemented for classes of pixel types and generic access patterns by which they become independent of the specific dimensionality, pixel type and data representation. ImgLib2 illustrates that an elegant high-level programming interface can be achieved without sacrificing performance. It provides efficient implementations of common data types, storage layouts and algorithms. It is the data model underlying ImageJ2, the KNIME Image Processing toolbox and an increasing number of Fiji-Plugins. ImgLib2 is licensed under BSD. Documentation and source code are available at http://imglib2.net and in a public repository at https://github.com/imagej/imglib. Supplementary data are available at Bioinformatics Online. saalfeld@mpi-cbg.de

Gene context analysis in the Integrated Microbial Genomes (IMG) data management system.

PubMed

Mavromatis, Konstantinos; Chu, Ken; Ivanova, Natalia; Hooper, Sean D; Markowitz, Victor M; Kyrpides, Nikos C

2009-11-24

Computational methods for determining the function of genes in newly sequenced genomes have been traditionally based on sequence similarity to genes whose function has been identified experimentally. Function prediction methods can be extended using gene context analysis approaches such as examining the conservation of chromosomal gene clusters, gene fusion events and co-occurrence profiles across genomes. Context analysis is based on the observation that functionally related genes are often having similar gene context and relies on the identification of such events across phylogenetically diverse collection of genomes. We have used the data management system of the Integrated Microbial Genomes (IMG) as the framework to implement and explore the power of gene context analysis methods because it provides one of the largest available genome integrations. Visualization and search tools to facilitate gene context analysis have been developed and applied across all publicly available archaeal and bacterial genomes in IMG. These computations are now maintained as part of IMG's regular genome content update cycle. IMG is available at: http://img.jgi.doe.gov.

Plagiarism in graduate medical education.

PubMed

Cole, Ariel Forrester

2007-06-01

The act of overt plagiarism by graduates of accredited residency programs represents a failure in personal integrity. It also indicates a lack of professionalism, one of the six Accreditation Council for Graduate Medical Education (ACGME) competencies for graduate medical education. A recent experience at one geriatric fellowship indicates that the problem of plagiarism may be more prevalent than previously recognized. A situation was discovered at the geriatric medicine fellowship at Florida Hospital Family Medicine Residency Program in Orlando, Fla, in which three of the personal statements included in a total of 26 applications to the fellowship in the past 2 years contained portions plagiarized from a single Web site. The aim in documenting this plagiarism is to raise awareness among medical educators about the availability of online sources of content and ease of electronic plagiarism. Some students and residents may not recognize copying other resources verbatim as plagiarism. Residency programs should evaluate their own need for education about plagiarism and include this in the training of the competency of professionalism.

IMG-ABC: A Knowledge Base To Fuel Discovery of Biosynthetic Gene Clusters and Novel Secondary Metabolites.

PubMed

Hadjithomas, Michalis; Chen, I-Min Amy; Chu, Ken; Ratner, Anna; Palaniappan, Krishna; Szeto, Ernest; Huang, Jinghua; Reddy, T B K; Cimermančič, Peter; Fischbach, Michael A; Ivanova, Natalia N; Markowitz, Victor M; Kyrpides, Nikos C; Pati, Amrita

2015-07-14

In the discovery of secondary metabolites, analysis of sequence data is a promising exploration path that remains largely underutilized due to the lack of computational platforms that enable such a systematic approach on a large scale. In this work, we present IMG-ABC (https://img.jgi.doe.gov/abc), an atlas of biosynthetic gene clusters within the Integrated Microbial Genomes (IMG) system, which is aimed at harnessing the power of "big" genomic data for discovering small molecules. IMG-ABC relies on IMG's comprehensive integrated structural and functional genomic data for the analysis of biosynthetic gene clusters (BCs) and associated secondary metabolites (SMs). SMs and BCs serve as the two main classes of objects in IMG-ABC, each with a rich collection of attributes. A unique feature of IMG-ABC is the incorporation of both experimentally validated and computationally predicted BCs in genomes as well as metagenomes, thus identifying BCs in uncultured populations and rare taxa. We demonstrate the strength of IMG-ABC's focused integrated analysis tools in enabling the exploration of microbial secondary metabolism on a global scale, through the discovery of phenazine-producing clusters for the first time in Alphaproteobacteria. IMG-ABC strives to fill the long-existent void of resources for computational exploration of the secondary metabolism universe; its underlying scalable framework enables traversal of uncovered phylogenetic and chemical structure space, serving as a doorway to a new era in the discovery of novel molecules. IMG-ABC is the largest publicly available database of predicted and experimental biosynthetic gene clusters and the secondary metabolites they produce. The system also includes powerful search and analysis tools that are integrated with IMG's extensive genomic/metagenomic data and analysis tool kits. As new research on biosynthetic gene clusters and secondary metabolites is published and more genomes are sequenced, IMG-ABC will continue to

The longer road to medical school graduation.

PubMed

Kassebaum, D G; Szenas, P L

1994-10-01

The authors followed the academic progress and graduation rates of students matriculating in U.S. medical schools each year between 1976 and 1988. The four-year graduation rates of medical students in MD programs declined from 91.4% for students who matriculated in 1976 to 81.2% for 1988 matriculants. During the same period, the percentage graduating in five years increased from 5.5% to 10.6%, while those still enrolled or on leaves of absence after five years rose from 1.9% to 4.1%. The lengthening of undergraduate medical education is associated with students' spending extra time on special studies or research, but to a greater extent graduation has been delayed for remediation of academic difficulty or slowing of the pace of education to overcome handicaps in academic preparation and learning skills. Underrepresented minority students, particularly black Americans, have lower four-year graduation rates than majority students, and the rate has fallen steadily across successive classes matriculating between 1976 and 1988. The longer periods of undergraduate medical education since 1984, however, have been accompanied by a reversal of the growing attrition rate for black-American students, probably the result of more appropriate pacing of education over the first year or two and the wider availability of student academic support. The longer road to graduation also accumulates greater educational costs, contributing to the escalation in student indebtedness that has been out of proportion to increases in tuition and fees.(ABSTRACT TRUNCATED AT 250 WORDS)

Graduate Medical Education: A Continuing History

ERIC Educational Resources Information Center

Stevens, Rosemary A.

1978-01-01

Five interweaving themes are discussed: the meaning of graduate education; who should control specialization; the role of residents in filling hospital needs; whether graduate medical education is a university responsibility; and how far the distribution of residencies should match perceived manpower needs. (LBH)

Graduate Medical Education Consortia: Changing the Governance of Graduate Medical Education to Achieve Physician Workforce Objectives. Council on Graduate Medical Education, Ninth Report.

ERIC Educational Resources Information Center

Council on Graduate Medical Education.

Earlier reports and studies have endorsed the consortia concept as a vehicle for reorganizing medical education and restructuring the physician workforce. This report by the Council on Graduate Medical Education, which serves in an advisory capacity to the Secretary of the Department of Health and Human Services and to Congress, concurs in this…

The Medical Boomerang: will it come back?

PubMed

McDermott, Cian; Sheridan, Michael; Moore, Katie; Gosbell, Andrew

2015-04-01

To explore the increasing numbers of emergency medicine (EM) registrars that obtained their primary medical degree from UK or Irish universities, who work in emergency departments (ED) throughout Australia and New Zealand. The Victorian Emergency Registrar Study was published at the Australasian College for Emergency Medicine (ACEM) annual scientific meeting in Adelaide in November 2013. As a follow on, ACEM provided the authors with data regarding country of primary degree for international medical graduates (IMG) working as registrars in Australasian EDs. UK and Irish EM registrars make up the largest proportion of IMGs working in Australian and New Zealand EDs. These figures have increased from 34% in 2008 to 45% in 2013. In 2013, there was the highest yearly intake of UK and Irish ED IMG registrars, representing 41% of registrars joining the Australasian EM training programme. Current data show that >25% of all ED registrars working in Australasian EDs studied for their primary medical degree in a university either in Ireland or the UK. While there have been anecdotal reports of increased outflow of junior EM doctors from the UK and Ireland, we provide quantitative data on the extent of the recent (5-year trend data) emigration of UK/Irish EM trainees to Australia and New Zealand and discuss the impact of this on both the UK/Irish and Australasian health systems. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Supporting community annotation and user collaboration in the integrated microbial genomes (IMG) system

DOE PAGES

Chen, I-Min A.; Markowitz, Victor M.; Palaniappan, Krishna; ...

2016-04-26

Background: The exponential growth of genomic data from next generation technologies renders traditional manual expert curation effort unsustainable. Many genomic systems have included community annotation tools to address the problem. Most of these systems adopted a "Wiki-based" approach to take advantage of existing wiki technologies, but encountered obstacles in issues such as usability, authorship recognition, information reliability and incentive for community participation. Results: Here, we present a different approach, relying on tightly integrated method rather than "Wiki-based" method, to support community annotation and user collaboration in the Integrated Microbial Genomes (IMG) system. The IMG approach allows users to use existingmore » IMG data warehouse and analysis tools to add gene, pathway and biosynthetic cluster annotations, to analyze/reorganize contigs, genes and functions using workspace datasets, and to share private user annotations and workspace datasets with collaborators. We show that the annotation effort using IMG can be part of the research process to overcome the user incentive and authorship recognition problems thus fostering collaboration among domain experts. The usability and reliability issues are addressed by the integration of curated information and analysis tools in IMG, together with DOE Joint Genome Institute (JGI) expert review. Conclusion: By incorporating annotation operations into IMG, we provide an integrated environment for users to perform deeper and extended data analysis and annotation in a single system that can lead to publications and community knowledge sharing as shown in the case studies.« less

Supporting community annotation and user collaboration in the integrated microbial genomes (IMG) system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, I-Min A.; Markowitz, Victor M.; Palaniappan, Krishna

Background: The exponential growth of genomic data from next generation technologies renders traditional manual expert curation effort unsustainable. Many genomic systems have included community annotation tools to address the problem. Most of these systems adopted a "Wiki-based" approach to take advantage of existing wiki technologies, but encountered obstacles in issues such as usability, authorship recognition, information reliability and incentive for community participation. Results: Here, we present a different approach, relying on tightly integrated method rather than "Wiki-based" method, to support community annotation and user collaboration in the Integrated Microbial Genomes (IMG) system. The IMG approach allows users to use existingmore » IMG data warehouse and analysis tools to add gene, pathway and biosynthetic cluster annotations, to analyze/reorganize contigs, genes and functions using workspace datasets, and to share private user annotations and workspace datasets with collaborators. We show that the annotation effort using IMG can be part of the research process to overcome the user incentive and authorship recognition problems thus fostering collaboration among domain experts. The usability and reliability issues are addressed by the integration of curated information and analysis tools in IMG, together with DOE Joint Genome Institute (JGI) expert review. Conclusion: By incorporating annotation operations into IMG, we provide an integrated environment for users to perform deeper and extended data analysis and annotation in a single system that can lead to publications and community knowledge sharing as shown in the case studies.« less

Supporting community annotation and user collaboration in the integrated microbial genomes (IMG) system.

PubMed

Chen, I-Min A; Markowitz, Victor M; Palaniappan, Krishna; Szeto, Ernest; Chu, Ken; Huang, Jinghua; Ratner, Anna; Pillay, Manoj; Hadjithomas, Michalis; Huntemann, Marcel; Mikhailova, Natalia; Ovchinnikova, Galina; Ivanova, Natalia N; Kyrpides, Nikos C

2016-04-26

The exponential growth of genomic data from next generation technologies renders traditional manual expert curation effort unsustainable. Many genomic systems have included community annotation tools to address the problem. Most of these systems adopted a "Wiki-based" approach to take advantage of existing wiki technologies, but encountered obstacles in issues such as usability, authorship recognition, information reliability and incentive for community participation. Here, we present a different approach, relying on tightly integrated method rather than "Wiki-based" method, to support community annotation and user collaboration in the Integrated Microbial Genomes (IMG) system. The IMG approach allows users to use existing IMG data warehouse and analysis tools to add gene, pathway and biosynthetic cluster annotations, to analyze/reorganize contigs, genes and functions using workspace datasets, and to share private user annotations and workspace datasets with collaborators. We show that the annotation effort using IMG can be part of the research process to overcome the user incentive and authorship recognition problems thus fostering collaboration among domain experts. The usability and reliability issues are addressed by the integration of curated information and analysis tools in IMG, together with DOE Joint Genome Institute (JGI) expert review. By incorporating annotation operations into IMG, we provide an integrated environment for users to perform deeper and extended data analysis and annotation in a single system that can lead to publications and community knowledge sharing as shown in the case studies.

IMG-ABC: An Atlas of Biosynthetic Gene Clusters to Fuel the Discovery of Novel Secondary Metabolites

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, I-Min; Chu, Ken; Ratner, Anna

2014-10-28

In the discovery of secondary metabolites (SMs), large-scale analysis of sequence data is a promising exploration path that remains largely underutilized due to the lack of relevant computational resources. We present IMG-ABC (https://img.jgi.doe.gov/abc/) -- An Atlas of Biosynthetic gene Clusters within the Integrated Microbial Genomes (IMG) system1. IMG-ABC is a rich repository of both validated and predicted biosynthetic clusters (BCs) in cultured isolates, single-cells and metagenomes linked with the SM chemicals they produce and enhanced with focused analysis tools within IMG. The underlying scalable framework enables traversal of phylogenetic dark matter and chemical structure space -- serving as a doorwaymore » to a new era in the discovery of novel molecules.« less

IMG-ABC. A knowledge base to fuel discovery of biosynthetic gene clusters and novel secondary metabolites

DOE PAGES

Hadjithomas, Michalis; Chen, I-Min Amy; Chu, Ken; ...

2015-07-14

In the discovery of secondary metabolites, analysis of sequence data is a promising exploration path that remains largely underutilized due to the lack of computational platforms that enable such a systematic approach on a large scale. In this work, we present IMG-ABC (https://img.jgi.doe.gov/abc), an atlas of biosynthetic gene clusters within the Integrated Microbial Genomes (IMG) system, which is aimed at harnessing the power of “big” genomic data for discovering small molecules. IMG-ABC relies on IMG’s comprehensive integrated structural and functional genomic data for the analysis of biosynthetic gene clusters (BCs) and associated secondary metabolites (SMs). SMs and BCs serve asmore » the two main classes of objects in IMG-ABC, each with a rich collection of attributes. A unique feature of IMG-ABC is the incorporation of both experimentally validated and computationally predicted BCs in genomes as well as metagenomes, thus identifying BCs in uncultured populations and rare taxa. We demonstrate the strength of IMG-ABC’s focused integrated analysis tools in enabling the exploration of microbial secondary metabolism on a global scale, through the discovery of phenazine-producing clusters for the first time in lphaproteobacteria. IMG-ABC strives to fill the long-existent void of resources for computational exploration of the secondary metabolism universe; its underlying scalable framework enables traversal of uncovered phylogenetic and chemical structure space, serving as a doorway to a new era in the discovery of novel molecules. IMG-ABC is the largest publicly available database of predicted and experimental biosynthetic gene clusters and the secondary metabolites they produce. The system also includes powerful search and analysis tools that are integrated with IMG’s extensive genomic/metagenomic data and analysis tool kits. As new research on biosynthetic gene clusters and secondary metabolites is published and more genomes are sequenced, IMG

The founding of the Mayo School of Graduate Medical Education.

PubMed

Boes, Christopher J; Long, Timothy R; Rose, Steven H; Fye, W Bruce

2015-02-01

The Mayo Foundation for Medical Education and Research (hereafter the Mayo Foundation), the precursor to the Mayo School of Graduate Medical Education, was incorporated in 1915. The Mayo Foundation, which was affiliated with the University of Minnesota Graduate School, aimed to establish a higher standard for training medical specialists. Together, the University of Minnesota and the Mayo Foundation pioneered a graduate medical education program that allowed residents to earn master's and PhD degrees in clinical medicine and surgery. Unlike elsewhere in the United States, the residency training program was not pyramidal. (In a pyramidal residency program, each training year, some residents are systematically eliminated to reduce the number of more senior trainees.) All those who started the Mayo Foundation residency program had an opportunity to finish depending on their own merits. Louis B. Wilson, the first director of the Mayo Foundation, became a major figure in graduate medical education in the 1920s and 1930s. Although the granting of graduate degrees in medicine and surgery stopped over time, Mayo Clinic ultimately became the largest site of graduate medical education in the world. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Perceptions of medical graduates and their workplace supervisors towards a medical school clinical audit program.

PubMed

Davis, Stephanie; O'Ferrall, Ilse; Hoare, Samuel; Caroline, Bulsara; Mak, Donna B

2017-07-07

This study explores how medical graduates and their workplace supervisors perceive the value of a structured clinical audit program (CAP) undertaken during medical school. Medical students at the University of Notre Dame Fremantle complete a structured clinical audit program in their final year of medical school.  Semi-structured interviews were conducted with 12 Notre Dame graduates (who had all completed the CAP), and seven workplace supervisors (quality and safety staff and clinical supervisors).  Purposeful sampling was used to recruit participants and data were analysed using thematic analysis. Both graduates and workplace supervisors perceived the CAP to be valuable. A major theme was that the CAP made a contribution to individual graduate's medical practice, including improved knowledge in some areas of patient care as well as awareness of healthcare systems issues and preparedness to undertake scientifically rigorous quality improvement activities. Graduates perceived that as a result of the CAP, they were confident in undertaking a clinical audit after graduation.  Workplace supervisors perceived the value of the CAP beyond an educational experience and felt that the audits undertaken by students improved quality and safety of patient care. It is vital that health professionals, including medical graduates, be able to carry out quality and safety activities in the workplace. This study provides evidence that completing a structured clinical audit during medical school prepares graduates to undertake quality and safety activities upon workplace entry. Other health professional faculties may be interested in incorporating a similar program in their curricula.

Graduate-entry medical students: older and wiser but not less distressed.

PubMed

Casey, Dion; Thomas, Susan; Hocking, Darren R; Kemp-Casey, Anna

2016-02-01

Australia has a growing number of graduate-entry medical courses. It is known that undergraduate medical students have high levels of psychological distress; however, little is known about graduate-entry medical students. We examined whether graduate-entry medical students had higher levels of psychological distress than the same-age general population. Psychological distress was assessed in 122 graduate-entry medical students in an Australian graduate-entry medical school using the 21-item Depression Anxiety and Stress Scale. Mean scores and the proportion of students with scores in the highly distressed range were compared with non-clinical population norms. Scores were also compared across demographic characteristics. Medical students reported higher mean depression, anxiety and stress scores than the general population and were more likely to score in the moderate to extremely high range for anxiety (45% vs. 13%; p<0.001) and stress (17% vs. 13%; p=0.003). Anxiety and stress were higher in students aged ≥30 years than in younger students. Despite their maturity, graduate-entry students experienced high psychological distress. Anxiety and stress were higher, not lower, with increasing age. Our results suggest that graduate-entry medical students warrant the same level of concern as their school-leaving counterparts. Further interventions to support these students during medical school are warranted. © The Royal Australian and New Zealand College of Psychiatrists 2015.

Entry of US Medical School Graduates Into Family Medicine Residencies: 2015-2016.

PubMed

Kozakowski, Stanley M; Travis, Alexandra; Bentley, Ashley; Fetter, Gerald

2016-10-01

This is the 35th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents. Approximately 8.7% of the 18,929 students graduating from US MD-granting medical schools and 15.5% of the 5,314 students graduating from DO-granting medical schools between July 2014 and June 2015 entered an ACGME family medicine residency in 2015. Together, 10.2% of graduates of MD- and DO-granting schools entered family medicine. Of the 1,640 graduates of the MD-granting medical schools who entered a family medicine residency in 2015, 80% graduated from 70 of the 134 schools (52%). In 2015, DO-granting medical schools graduated 823 into ACGME-accredited family medicine residencies, 80% graduating from 19 of the 32 schools (59%). In aggregate, medical schools west of the Mississippi River represent less than a third of all MD-granting schools but have a rate of students selecting family medicine that is 40% higher than schools located east of the Mississippi. Fifty-one percent (24/47) of states and territories containing medical schools produce 80% of the graduates entering ACGME-accredited family medicine residency programs. A rank order list of MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2015 and prior AAFP census data.

Pre-internship Nigerian medical graduates lack basic musculoskeletal competency.

PubMed

Nottidge, Timothy Eyo; Ekrikpo, Udeme; Ifesanya, Adeleke Olusegun; Nnabuko, Richard E; Dim, Edwin Maduakonam; Udoinyang, Clement Inyang

2012-04-01

Our aim was to assess the basic musculoskeletal competency of pre-internship graduates from Nigerian medical schools. We administered the Freedman and Bernstein basic musculoskeletal competency examination to 113 pre-internship graduates from seven Nigerian medical schools over a three year period from 2008 to 2010 at the University of Uyo Teaching Hospital. Five specialist residents took the examination to test criteria relevance. All graduates failed this test, obtaining scores ranging from 7% to 67%. The duration of the orthopaedic posting, and observation of operative fracture fixation, were not significant determinants of the score. The two final-year specialist residents each had a marginal pass in the examination. Basic musculoskeletal competency among pre-internship Nigerian medical-school graduates is inadequate.

Military graduate medical education in internal medicine: an outcomes study.

PubMed

Cation, L J; Lenihan, D J; Gutierrez-Nunez, J J

2001-04-01

Military graduate medical education has come under increasing scrutiny in recent years as the size of the military medical force declines. To document the outcomes of military graduate medical education in internal medicine, a cohort of Air Force internal medicine residency graduates from Wright-Patterson Medical Center were studied and their residency performance, staff performance, and active duty retention recorded. The study cohort had an outstanding residency performance, as measured by research experience and board certification rate. They also performed well as military staff physicians, receiving numerous individual military medals while holding important administrative and supervisory positions in the military. Finally, the study cohort had a higher than expected active duty retention rate. These findings support the notion that military graduate medical education in internal medicine produces outstanding military internists.

Building Faculty Community: Fellowship in Graduate Medical Education Administration

PubMed Central

Edler, Alice A.; Dohn, Ann; Davidson, Heather A.; Grewal, Daisy; Behravesh, Bardia; Piro, Nancy

2009-01-01

Introduction The Department of Graduate Medical Education at Stanford Hospital and Clinics has developed a professional training program for program directors. This paper outlines the goals, structure, and expected outcomes for the one-year Fellowship in Graduate Medical Education Administration program. Background The skills necessary for leading a successful Accreditation Council for Graduate Medical Education (ACGME) training program require an increased level of curricular and administrative expertise. To meet the ACGME Outcome Project goals, program directors must demonstrate not only sophisticated understanding of curricular design but also competency-based performance assessment, resource management, and employment law. Few faculty-development efforts adequately address the complexities of educational administration. As part of an institutional-needs assessment, 41% of Stanford program directors indicated that they wanted more training from the Department of Graduate Medical Education. Intervention To address this need, the Fellowship in Graduate Medical Education Administration program will provide a curriculum that includes (1) readings and discussions in 9 topic areas, (2) regular mentoring by the director of Graduate Medical Education (GME), (3) completion of a service project that helps improve GME across the institution, and (4) completion of an individual scholarly project that focuses on education. Results The first fellow was accepted during the 2008–2009 academic year. Outcomes for the project include presentation of a project at a national meeting, internal workshops geared towards disseminating learning to peer program directors, and the completion of a GME service project. The paper also discusses lessons learned for improving the program. PMID:21975722

What's new in graduate medical education?

PubMed

Hernandez, Raquel G

2016-12-01

The development of new graduate medical education programmes provides both opportunities and challenges. Efforts to address physician workforce shortages as well as a realisation that curricula need to be updated to adjust to our rapidly changing healthcare environment have resulted in more educators considering the "how to" and "what's new" of programme development. Understanding the Next Accreditation System, an accreditation system introduced by the Accreditation Council of Graduate Medical Education in 2012, is critical to the success of new as well as existing residency and fellowship programmes. Although many educators are aware of the general rational for the Next Accreditation System, an in-depth understanding of the meaning of Next Accreditation System is necessary from an experiential and theoretical perspective to be able to successfully launch new programmes and moves towards accreditation. A new paediatric categorical residency programme and a new paediatric surgical programme were developed at our institution immediately following the implementation of Next Accreditation System. We provide a series of insights and perspectives based on our experience relative to what priorities we saw outlined from both the programmatic and the institutional perspective to have our graduate medical education programmes reviewed for accreditation. During this discussion, the following objectives are outlined: to overview the Next Accreditation System as a framework and priorities, to discuss the opportunities and challenges that may exist in developing new programmes, and to discuss future directions in the evaluation of trainees and assessment of training competency. Although challenges are outlined, we hope to relay the continued excitement and opportunities that exist relative to enhancing training curricula for future graduate medical education programme builders.

Perceptions of medical graduates and their workplace supervisors towards a medical school clinical audit program

PubMed Central

O'Ferrall, Ilse; Hoare, Samuel; Caroline, Bulsara; Mak, Donna B.

2017-01-01

Objectives This study explores how medical graduates and their workplace supervisors perceive the value of a structured clinical audit program (CAP) undertaken during medical school. Methods Medical students at the University of Notre Dame Fremantle complete a structured clinical audit program in their final year of medical school.  Semi-structured interviews were conducted with 12 Notre Dame graduates (who had all completed the CAP), and seven workplace supervisors (quality and safety staff and clinical supervisors).  Purposeful sampling was used to recruit participants and data were analysed using thematic analysis. Results Both graduates and workplace supervisors perceived the CAP to be valuable. A major theme was that the CAP made a contribution to individual graduate’s medical practice, including improved knowledge in some areas of patient care as well as awareness of healthcare systems issues and preparedness to undertake scientifically rigorous quality improvement activities. Graduates perceived that as a result of the CAP, they were confident in undertaking a clinical audit after graduation.  Workplace supervisors perceived the value of the CAP beyond an educational experience and felt that the audits undertaken by students improved quality and safety of patient care. Conclusions It is vital that health professionals, including medical graduates, be able to carry out quality and safety activities in the workplace. This study provides evidence that completing a structured clinical audit during medical school prepares graduates to undertake quality and safety activities upon workplace entry. Other health professional faculties may be interested in incorporating a similar program in their curricula.  PMID:28692425

[Work activity of medical graduates at the University of Chile: Analysis per campus and graduation year].

PubMed

Vargas, Patricia; López, Nancy; Urrutia, Leonardo; Acevedo, Jhonny; Sandoval, Daniela; Cortés, Belén

2015-10-01

The University promotes practices and values that influence their students in the pursuit of their occupational interests. To determine working activity features of medical graduates from the University of Chile and their relationship with undergraduate characteristics. Medical graduates of the University of Chile were invited to complete a survey using a virtual server. The survey collected demographic, socioeconomic, work and guild characteristics. Undergraduate data, as campus and graduation years were obtained. The survey was completed by 333 physicians (167 men) aged 29 ± 2 years, graduated from 2007 to 2010. Ninety four percent had a paid work, 59% were employed in public hospitals and 28% in primary care health centers. The predominant type of work activity was performed in the public health service (55%), while 17% worked in private health services. Activity in public health services or primary care were significantly associated with the pursuit of undergraduate clinical activities in specific campuses of the University. The employment rate of medical graduates was high. Differences observed by graduation campus and type of work may be due to the modeling that students receive from teachers.

Biostatistical and medical statistics graduate education

PubMed Central

2014-01-01

The development of graduate education in biostatistics and medical statistics is discussed in the context of training within a medical center setting. The need for medical researchers to employ a wide variety of statistical designs in clinical, genetic, basic science and translational settings justifies the ongoing integration of biostatistical training into medical center educational settings and informs its content. The integration of large data issues are a challenge. PMID:24472088

Participation in medicine by graduates of medical schools in the United Kingdom up to 25 years post graduation: national cohort surveys.

PubMed

Goldacre, Michael J; Lambert, Trevor W

2013-05-01

To determine--as a guide to assess outcomes of medical education, and for medical workforce planning--whether the great majority of graduates from UK medical schools eventually practice medicine. The authors estimated the level of participation in medicine, in selected years after graduation, of nine cohorts (graduating between 1974 and 2002, inclusive) of graduates from medical schools in the United Kingdom. Their estimation is based on survey-garnered data combined with national employment data, and it uses the statistical method of capture-recapture analysis. This method provides both a lower likely limit and an upper likely limit of the percentage of doctors practicing in medicine. The lower and upper limits depend, essentially, on a range of assumptions about nonresponders. The authors estimate that at least 90% of graduates from UK medical schools work in medicine for many years after graduation. Women are only slightly less likely than men to follow a medical career. To illustrate, of the doctors who lived in the United Kingdom before medical school, at 10 years after graduation, between 95.6% and 98.8% of men were in medicine, as were between 91.9% and 93.3% of women. UK medical graduates from homes outside the United Kingdom were less likely to work in the National Health Service and more likely to pursue a career outside the United Kingdom, but were not appreciably less likely than graduates from UK homes to work in medicine. UK-trained doctors rarely give up a medical career within 25 years of graduation.

Profile of graduates of Israeli medical schools in 1981--2000: educational background, demography and evaluation of medical education programs.

PubMed

Bitterman, Noemi; Shalev, Ilana

2005-05-01

In light of changes in the medical profession, the different requirements placed on physicians and the evolving needs of the healthcare system, the need arose to examine the medical education curriculum in Israel. This survey, conducted by the Samuel Neaman Institute for Science and Technology, summarizes 20 years of medical education in Israel's four medical schools, as the first stage in mapping the existing state of medical education in Israel and providing a basis for decision-making on future medical education programs. To characterize the academic background of graduates, evaluate their attitudes towards current and alternative medical education programs, and examine subgroups among graduates according to gender, medical school, high school education, etc. The survey included graduates from all four Israeli medical schools who graduated between the years 1981 and 2000 in a sample of 1:3. A questionnaire and stamped return envelope were sent to every third graduate; the questionnaire included open and quantitative questions graded on a scale of 1 to 5. The data were processed for the entire graduate population and further analyzed according to subgroups such as medical schools, gender, high school education, etc. The response rate was 41.3%. The survey provided a demographic profile of graduates over a 20 year period, their previous educational and academic background, additional academic degrees achieved, satisfaction, and suggestions for future medical education programs. The profile of the medical graduates in Israel is mostly homogenous in terms of demographics, with small differences among the four medical schools. In line with recommendations of the graduates, and as an expression of the changing requirements in the healthcare system and the medical profession, the medical schools should consider alternative medical education programs such as a bachelor's degree in life sciences followed by MD studies, or education programs that combine medicine with

Burnout and psychiatric morbidity in new medical graduates.

PubMed

Willcock, Simon M; Daly, Michele G; Tennant, Christopher C; Allard, Benjamin J

2004-10-04

To determine the prevalence of psychiatric morbidity and burnout in final-year medical students, and changes in these measures during the intern year. Prospective longitudinal cohort study over 18 months, with assessment of psychiatric morbidity and burnout on six occasions. All 117 students in the first graduating cohort of the University of Sydney Graduate Medical Program were invited to participate in the study; 110 consented. Psychiatric morbidity assessed with the 28-item General Health Questionnaire and burnout assessed with the Maslach Burnout Inventory. The point prevalence of participants meeting criteria for psychiatric morbidity and burnout rose steadily throughout the study period. Internship remains a stressful time for medical graduates, despite initiatives to better support them during this period. The implications for the doctors themselves and for the communities they serve warrant further attention, including programs specifically aimed at reducing the rate of psychological morbidity and burnout during internship.

Costs of a medical education: comparison with graduate education in law and business.

PubMed

Kerr, Jason R; Brown, Jeffrey J

2006-02-01

The costs of graduate school education are climbing, particularly within the fields of medicine, law, and business. Data on graduate level tuition, educational debt, and starting salaries for medical school, law school, and business school graduates were collected directly from universities and from a wide range of published reports and surveys. Medical school tuition and educational debt levels have risen faster than the rate of inflation over the past decade. Medical school graduates have longer training periods and lower starting salaries than law school and business school graduates, although physician salaries rise after completion of post-graduate education. Faced with an early debt burden and delayed entry into the work force, careful planning is required for medical school graduates to pay off their loans and save for retirement.

Entry of US Medical School Graduates Into Family Medicine Residencies: 2014-2015.

PubMed

Kozakowski, Stanley M; Fetter, Gerald; Bentley, Ashley

2015-10-01

This is the 34th national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD-granting and DO-granting medical schools who entered Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs as first-year residents in 2014. Approximately 8.5% of the 18,241 students graduating from US MD-granting medical schools between July 2013 and June 2014 entered a family medicine residency. Of the 1,458 graduates of the US MD-granting medical schools who entered a family medicine residency in 2014, 80% graduated from 69 of the 131 schools. Eleven schools lacking departments or divisions of family medicine produced only a total of 26 students entering family medicine. In aggregate, medical schools west of the Mississippi River represent less than a third of all US MD-granting schools but have an aggregate rate of students selecting family medicine that is two-thirds higher than schools to the east of the Mississippi. A rank order list of US MD-granting medical schools was created based on the last 3 years' average percentage of graduates who became family medicine residents, using the 2014 and prior AAFP census data. US MD schools continue to fail to produce a primary care workforce, a key measure of social responsibility as measured by their production of graduates entering into family medicine. DO-granting and international medical school graduates filled the majority of ACGME-accredited family medicine first-year resident positions in 2014.

42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Payments to MA organizations for graduate medical... Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the time that...

42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Payments to MA organizations for graduate medical... Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the time that...

[Returning students' perspectives on adjusting to medical graduate school in Korea: an interview study].

PubMed

Park, So Youn; Kwon, Oh Young; Yoon, Tai Young

2015-03-01

The recent trend of switching from medical graduate school to medical school in Korea raises questions about the adjustments that students must make in medical education. We examined the perceptions of medical graduate students with regard to their adaptation in medical education. Sixteen semistructured, in-depth interviews were administered to medical graduate students who received their first degrees in foreign countries. The interviews addressed their perceptions of their experience in medical graduate school and on how well they adjusted to medical education. Students perceived their adaptation to medical graduate school in two dimensions: academic achievement and cultural adjustment. In academic achievement, a limited student-teacher relationship was recognized by students. Students tended to be passive in the classroom due to an uncomfortable atmosphere. They also reported witnessing culture shock in relation to the paucity of information on entrance into medical graduate school. Freshmen voiced many difficulties in adjusting to the unique culture in medical graduate school, in contrast to upper classmen. However, only 32% of students experienced helpful mentoring for their problems. Students' perspectives should guide all decisions made about medical education in an altered educational system.Self-regulated learning and a good mentoring program can help prepare students for medical education and professional life.

42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Payments to MA organizations for graduate medical... Payments to Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the time...

42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Payments to MA organizations for graduate medical... Payments to Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the time...

42 CFR 422.324 - Payments to MA organizations for graduate medical education costs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Payments to MA organizations for graduate medical... Payments to Medicare Advantage Organizations § 422.324 Payments to MA organizations for graduate medical education costs. (a) MA organizations may receive direct graduate medical education payments for the time...

Foreign Medical Graduates in the 1980s: Trends in Specialization.

ERIC Educational Resources Information Center

Mick, Stephen S.; Worobey, Jacqueline Lowe

1984-01-01

Despite predictions of a physician surplus by 1990, graduates of foreign medical schools (both aliens and U.S. citizens) continue to flow into the United States. Secondary analysis of 1980 data suggests that graduates of foreign schools may secure their presence within the American medical system by selecting specialties where shortages exist. (KH)

Setting Priorities for Graduate Medical Education,

DTIC Science & Technology

1996-02-01

assist the work of these staffs. 14. SUBJECT TERMS Attrition, data bases, education , mathematical models, medical personnel, military medicine, naval...CRM 95-209 / February 1996 Setting Priorities for Graduate Medical Education Neil B. Carey • Marjorie D. Curia • Oliver A. Smith 19960718 027...the tirae for reviewing instructions, searching existing data sources gathering and maintaining the data needed, and reviewing the collection of

75 FR 79006 - Council on Graduate Medical Education; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-17

... Graduate Medical Education; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Medical Education (COGME). Dates and Times: January 19, 2011, 8:30 a.m.-4 p.m., January 20, 2011, 8:30 a.m... first day will consist of presentations covering various aspects of graduate medical education, Bureau...

Building a local medical workforce in Tasmania: where are international fee-paying medical graduates likely to work?

PubMed

Cheek, Colleen; Hays, Richard; Allen, Penny; Walker, Gary; Shires, Lizzi

2017-01-01

Much of regional Australia continues to face challenges in recruitment and retention of medical practitioners, despite the apparently successful rural medical education initiatives funded by the Commonwealth Government. International fee-paying (IFP) medical students are a significant component of Australian medical education, contributing additional income and more diverse learning environments for universities. Their contribution to the Australian medical workforce is harder to determine. After obtaining registration, IFP graduates may apply to remain in Australia as skilled migrants. Since 1999 there has been a 325% increase in the number of international medical students in Australia, with approximately 73% of IFP graduates remaining in Australia for at least some postgraduate training. Recognising the potential contribution of IFP students to the Tasmanian medical workforce, the authors sought better understanding of the career intentions and work locations of IFP graduates from the medical program in Tasmania, Australia, through two studies. Firstly, a quantitative study was conducted of the locations of all IFP graduates from the Tasmanian medical program, and then a qualitative study exploring graduating students' intentions and factors that contribute to their decisions about work location choices. This was a cohort study of IFP students who graduated from the University of Tasmania School of Medicine over the period 2000-2015. Work locations for 2016 were mapped to a Modified Monash rurality classification. Semi-structured interviews were held with 15 final year IFP medical students, exploring career intentions and location preferences. There were 261 IFP graduates, 54.4% male. The most common country of origin was Malaysia (55.2%). In 2016, 189 (72.4 %) were working in Australia, 42 (16.1%) in Tasmania and 126 (66.7%) in areas categorised as Modified Monash 1. Recent graduates in postgraduate year 1/2 (71.3%) were more likely to be working in Tasmania

The changing geography of Americans graduating from foreign medical schools.

PubMed

Johnson, Karin; Hagopian, Amy; Veninga, Catherine; Hart, L Gary

2006-02-01

To study U.S.-born international medical graduates in order to analyze changes in their numbers and countries of training from the 1960s and before until the early 2000s. This study was conducted from 2003-2004 at the Center for Health Workforce Studies, University of Washington. The analysis was based on data from March 2002 from the American Medical Association (AMA) for active physicians. AMA data were supplemented with data from several other sources. Descriptive statistics were produced on country of birth, country of medical school training, and year of training for all foreign-trained, patient-care physicians whose birth country was known. At least 17,000 of the foreign-trained physicians practicing in the United States are known to have been born in the United States. American physicians have graduated from foreign medical schools in increasing numbers since the 1960s. The number of U.S.-born physicians who graduated from a foreign medical school peaked in the early 1980s, but the phenomenon endures today. However, the countries in which these physicians chose to attend medical schools have changed significantly from the 1950s to the early 2000s. Over time, U.S.-born physicians have become much less likely to train in Europe and much more likely to train in certain Caribbean countries. U.S.-born physicians who graduate from medical schools abroad tend to train in just a handful of countries and attend a limited number of medical schools.

Importance and benefits of the doctoral thesis for medical graduates

PubMed Central

Giesler, Marianne; Boeker, Martin; Fabry, Götz; Biller, Silke

2016-01-01

Introduction: The majority of medical graduates in Germany complete a doctorate, even though a doctoral degree is not necessary for the practice of medicine. So far, little is known about doctoral candidates’ view on the individual benefit a doctoral thesis has for them. Consequently, this is the subject of the present investigation. Method: Data from surveys with graduates of the five medical faculties of Baden-Württemberg from the graduation years 2007/2008 (N=514) and 2010/2011 (N=598) were analysed. Results: One and a half years after graduating 53% of those interviewed had completed their doctorate. When asked about their motivation for writing a doctoral thesis, participants answered most frequently “a doctorate is usual” (85%) and “improvement of job opportunities” (75%), 36% said that an academic career has been their primary motive. Less than 10% responded that they used their doctoral thesis as a means to apply for a job. The proportion of graduates working in health care is equally large among those who have completed a thesis and those who have not. Graduates who pursued a thesis due to scientific interest are also currently more interested in an academic career and recognise more opportunities for research. An implicit benefit of a medical thesis emerged with regard to the self-assessment of scientific competences as those who completed a doctorate rated their scientific competencies higher than those who have not. Discussion: Although for the majority of physicians research interest is not the primary motivation for completing a doctorate, they might nevertheless achieve some academic competencies. For graduates pursuing an academic career the benefit of completing a medical thesis is more obvious. PMID:26958656

Importance and benefits of the doctoral thesis for medical graduates.

PubMed

Giesler, Marianne; Boeker, Martin; Fabry, Götz; Biller, Silke

2016-01-01

The majority of medical graduates in Germany complete a doctorate, even though a doctoral degree is not necessary for the practice of medicine. So far, little is known about doctoral candidates' view on the individual benefit a doctoral thesis has for them. Consequently, this is the subject of the present investigation. Data from surveys with graduates of the five medical faculties of Baden-Württemberg from the graduation years 2007/2008 (N=514) and 2010/2011 (N=598) were analysed. One and a half years after graduating 53% of those interviewed had completed their doctorate. When asked about their motivation for writing a doctoral thesis, participants answered most frequently "a doctorate is usual" (85%) and "improvement of job opportunities" (75%), 36% said that an academic career has been their primary motive. Less than 10% responded that they used their doctoral thesis as a means to apply for a job. The proportion of graduates working in health care is equally large among those who have completed a thesis and those who have not. Graduates who pursued a thesis due to scientific interest are also currently more interested in an academic career and recognise more opportunities for research. An implicit benefit of a medical thesis emerged with regard to the self-assessment of scientific competences as those who completed a doctorate rated their scientific competencies higher than those who have not. Although for the majority of physicians research interest is not the primary motivation for completing a doctorate, they might nevertheless achieve some academic competencies. For graduates pursuing an academic career the benefit of completing a medical thesis is more obvious.

Career Choice of "Fifth Pathway" Graduates from New York State Medical Schools.

ERIC Educational Resources Information Center

Stimmel, Barry; Smith, Harry, Jr.

1985-01-01

Graduates of "fifth pathway" programs at medical schools in New York state between 1976-1978 were studied to determine their professional careers and choice of medical specialties. Fifth pathway graduates, 95 percent from Mexican medical schools, were more likely to select nonprimary care than primary care specialties. (Author/MLW)

Foreign medical graduates in the 1980s: trends in specialization.

PubMed Central

Mick, S S; Worobey, J L

1984-01-01

Secondary analysis of data collected by the American Medical Association and the Graduate Medical Education National Advisory Committee (GMENAC) suggests that measures to diminish the flow of alien Foreign Medical Graduates (FMGs) into the United States have been less effective than planned. Declining trends in the proportion of FMG house officers in the mid- to late-1970s have recently stabilized around 19 per cent. There has also been a dramatic increase in the number of US citizen Foreign Medical Graduates ( USFMGs ) in house officer positions. A pattern of alien FMG and USFMG house officer specialization correlates with specialties designated by the GMENAC as shortage areas by 1990 (r = -.49, p less than .05). Despite the GMENAC prediction of a surplus of physicians by 1990, differential selection of alien FMGs and USFMGs into shortage specialties may assure their substantial future presence in the US health care system. PMID:6742255

Workplace discrimination: experiences of practicing physicians.

PubMed

Coombs, Alice A Tolbert; King, Roderick K

2005-04-01

In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status.

Can the academic background of medical graduates be detected during internship?

PubMed Central

Woodward, C. A.; McAuley, R. G.

1983-01-01

Performance ratings were obtained by the clinical supervisors of four graduated classes of McMaster University medical students during internship. The supervisors detected no difference in performance between the graduates who met the "traditional" admissions criteria (both an undergraduate grade point average of 3.1 or greater on a 4-point scale and previous training in biology, general and organic chemistry, and physics) and those who lacked one or both of these prerequisites. These data suggest that medical schools can expand their admissions criteria without fearing that their graduates will perform less well as interns because of a lack of traditional academic preparation for medical school. PMID:6883258

Development of an in vitro mechanical gastric system (IMGS) with realistic peristalsis to assess lipid digestibility.

PubMed

Barros, Lorena; Retamal, Christian; Torres, Héctor; Zúñiga, Rommy N; Troncoso, Elizabeth

2016-12-01

A new in vitro mechanical gastric system (IMGS) was fabricated which incorporates: a J-shaped stomach, a mechanical system with realistic peristaltic frequency and force magnitude, and a reproduction of the gastric pH curve. To evaluate the impact of a more realistic gastric peristalsis on the intestinal lipolysis of protein-stabilized O/W emulsions, the emulsions were subjected to two different in vitro digestion methodologies: (i) gastric digestion in the IMGS and intestinal digestion in a stirred beaker (SB), and (ii) gastric and intestinal digestion assays carried out in SBs. At the end of the intestinal digestion, the total amount of free fatty acids released was significantly higher for the first methodology (IMGS-SB) in comparison with the second one (27.5% vs. 23.0%), probably due to the higher physical instability induced by the IMGS in the gastric contents. These results reaffirm that O/W emulsion stability plays a crucial role in controlling the final extent of lipolysis of this kind of food-grade emulsions. Copyright © 2016 Elsevier Ltd. All rights reserved.

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2011 CFR

2011-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2014 CFR

2014-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2013 CFR

2013-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

42 CFR 413.80 - Direct GME payments: Determination of weighting factors for foreign medical graduates.

Code of Federal Regulations, 2012 CFR

2012-10-01

... factors for foreign medical graduates. 413.80 Section 413.80 Public Health CENTERS FOR MEDICARE & MEDICAID... weighting factors for foreign medical graduates. (a) The weighting factor for a foreign medical graduate is determined under the provisions of § 413.79 if the foreign medical graduate— (1) Has passed FMGEMS; or (2...

IMG/VR: a database of cultured and uncultured DNA Viruses and retroviruses

DOE PAGES

Paez-Espino, David; Chen, I. -Min A.; Palaniappan, Krishna; ...

2016-10-30

Viruses represent the most abundant life forms on the planet. Recent experimental and computational improvements have led to a dramatic increase in the number of viral genome sequences identified primarily from metagenomic samples. As a result of the expanding catalog of metagenomic viral sequences, there exists a need for a comprehensive computational platform integrating all these sequences with associated metadata and analytical tools. Here we present IMG/VR (https://img.jgi.doe.gov/vr/), the largest publicly available database of 3908 isolate reference DNA viruses with 264 413 computationally identified viral contigs from > 6000 ecologically diverse metagenomic samples. Approximately half of the viral contigs aremore » grouped into genetically distinct quasi-species clusters. Microbial hosts are predicted for 20 000 viral sequences, revealing nine microbial phyla previously unreported to be infected by viruses. Viral sequences can be queried using a variety of associated metadata, including habitat type and geographic location of the samples, or taxonomic classification according to hallmark viral genes. IMG/VR has a user-friendly interface that allows users to interrogate all integrated data and interact by comparingwith external sequences, thus serving as an essential resource in the viral genomics community.« less

IMG/VR: a database of cultured and uncultured DNA Viruses and retroviruses

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paez-Espino, David; Chen, I. -Min A.; Palaniappan, Krishna

Viruses represent the most abundant life forms on the planet. Recent experimental and computational improvements have led to a dramatic increase in the number of viral genome sequences identified primarily from metagenomic samples. As a result of the expanding catalog of metagenomic viral sequences, there exists a need for a comprehensive computational platform integrating all these sequences with associated metadata and analytical tools. Here we present IMG/VR (https://img.jgi.doe.gov/vr/), the largest publicly available database of 3908 isolate reference DNA viruses with 264 413 computationally identified viral contigs from > 6000 ecologically diverse metagenomic samples. Approximately half of the viral contigs aremore » grouped into genetically distinct quasi-species clusters. Microbial hosts are predicted for 20 000 viral sequences, revealing nine microbial phyla previously unreported to be infected by viruses. Viral sequences can be queried using a variety of associated metadata, including habitat type and geographic location of the samples, or taxonomic classification according to hallmark viral genes. IMG/VR has a user-friendly interface that allows users to interrogate all integrated data and interact by comparingwith external sequences, thus serving as an essential resource in the viral genomics community.« less

Medicare and Graduate Medical Education.

DTIC Science & Technology

1995-09-01

research. The physician counts reported here are based on American Medical Association counts of doctors of medicine (M.D.s). Schools of osteopathy ...whose graduates receive a doctor of osteopathy degree, produce about 5 percent of a more broadly defined physician workforce. Even critics who have...provided insurance, and federal subsi- dies directed toward the supply of physicians. Con- ventional economic analysis would stress that in the

Primary care careers among recent graduates of research-intensive private and public medical schools.

PubMed

Choi, Phillip A; Xu, Shuai; Ayanian, John Z

2013-06-01

Despite a growing need for primary care physicians in the United States, the proportion of medical school graduates pursuing primary care careers has declined over the past decade. To assess the association of medical school research funding with graduates matching in family medicine residencies and practicing primary care. Observational study of United States medical schools. One hundred twenty-one allopathic medical schools. The primary outcomes included the proportion of each school's graduates from 1999 to 2001 who were primary care physicians in 2008, and the proportion of each school's graduates who entered family medicine residencies during 2007 through 2009. The 25 medical schools with the highest levels of research funding from the National Institutes of Health in 2010 were designated as "research-intensive." Among research-intensive medical schools, the 16 private medical schools produced significantly fewer practicing primary care physicians (median 24.1% vs. 33.4%, p < 0.001) and fewer recent graduates matching in family medicine residencies (median 2.4% vs. 6.2%, p < 0.001) than the other 30 private schools. In contrast, the nine research-intensive public medical schools produced comparable proportions of graduates pursuing primary care careers (median 36.1% vs. 36.3%, p = 0.87) and matching in family medicine residencies (median 7.4% vs. 10.0%, p = 0.37) relative to the other 66 public medical schools. To meet the health care needs of the US population, research-intensive private medical schools should play a more active role in promoting primary care careers for their students and graduates.

Influence of training changes on the stability of specialty choices of UK medical graduates: surveys of the graduates of 2002 and 2008.

PubMed

Svirko, Elena; Lambert, Trevor W; Goldacre, Michael J

2015-01-01

To explore the impact of Modernising Medical Careers (MMC) training on the stability of medical career choices in the UK. Graduates of 2002 and 2008 from all UK medical schools, 1 and 3 years postgraduation. Questionnaire surveys were conducted of 2002 and 2008 graduates from all UK medical schools 1 and 3 years post graduation. Doctors gave their specialty choice(s) and rated the influence of each of 11 factors on their career choice. 2008 graduates were a little more likely than graduates of 2002 to retain their year 1 choice in year 3 (77.3% vs. 73.3%; p = 0.002). Among 2008 graduates, the percentage retaining their year 1 choice varied between 42% (clinical oncology) and 79% (general practice). Enthusiasm for a specialty, student experience and inclinations before medical school were associated with choice retention; consideration of domestic circumstances and hours/working conditions were associated with changes of choice. 2008 graduates were more likely than 2002s to be influenced by enthusiasm for a specialty, self-appraisal of their skills, working hours and their domestic circumstances; and less likely to be influenced by their experience of jobs, a particular teacher/department or eventual financial prospects. Post-MMC, graduates were less likely to change their career choice and more likely to be motivated by personal factors and self-assessment of their suitability to a particular area of work. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

US residency training before and after the 1997 Balanced Budget Act.

PubMed

Salsberg, Edward; Rockey, Paul H; Rivers, Kerri L; Brotherton, Sarah E; Jackson, Gregory R

2008-09-10

Graduate medical education (GME) determines the size and characteristics of the future workforce. The 1997 Balanced Budget Act (BBA) limited Medicare funding for additional trainees in GME. There has been concern that because Medicare is the primary source of GME funding, the BBA would discourage growth in GME. To examine the number of residents in training before and after the BBA, as well as more recent changes in GME by specialty, sex, and type and location of education. Descriptive study using the American Medical Association/Association of American Medical Colleges National GME Census on physicians in Accreditation Council for Graduate Medical Education (ACGME)-accredited programs to examine changes in the number and characteristics of residents before and after the BBA. Differences in the number of physicians in ACGME-accredited training programs overall, by specialty, and by location and type of education. The number of residents and fellows changed little between academic year (AY) 1997 (n = 98,143) and AY 2002 (n = 98,258) but increased to 106,012 in AY 2007, a net increase of 7869 (8.0%) over the decade. The annual number of new entrants into GME increased by 7.6%, primarily because of increasing international medical graduates (IMGs). United States medical school graduates (MDs) comprised 44.0% of the overall growth from 2002 to 2007, followed by IMGs (39.2%) and osteopathic school graduates (18.8%). United States MD growth largely resulted from selection of specialties with longer training periods. From 2002 to 2007, US MDs training in primary care specialties decreased by 2641, while IMGs increased by 3286. However, increasing subspecialization rates led to fewer physicians entering generalist careers. After the 1997 BBA, there appears to have been a temporary halt in the growth of physicians training in ACGME programs; however, the number increased from 2002 to 2007.

Obstructive sleep apnea knowledge and attitudes among recent medical graduates training in Ecuador.

PubMed

Chérrez-Ojeda, Iván; Calderón, Juan Carlos; Fernández García, Andrea; Jeffe, Donna B; Santoro, Ilka; Vanegas, Emanuel; Cherrez, Annia; Cano, José; Betancourt, Freddy; Simancas-Racines, Daniel

2018-01-01

We aimed to assess recent Latin American medical school graduates' knowledge and attitudes about OSA and examine whether their knowledge and attitudes about OSA differed from practicing physicians. Recent medical graduates completed the Spanish translation of the OSA Knowledge and Attitudes (OSAKA) questionnaire at the 2013 national primary-care residency-placement meeting in Ecuador. The OSAKA includes 18 knowledge and five attitudinal items about OSA. We compared recent graduates' data with data collected in 2010-2011 from practicing physicians using chi-square tests of associations among categorical variables and analysis of variance of differences in mean knowledge and attitude scores. Unadjusted logistic regression models tested the odds that recent graduates (vs. practicing physicians) answered each item correctly. Of 265 recent graduates, 138 (52.1%) were male, and mean age was 25.9 years. Although mean knowledge was low overall, scores were lower for recent graduates than for the 367 practicing physicians (53.5% vs. 60.4%;  p  < 0.001). Practicing physicians were significantly more likely to answer specific items correctly with one exception-recent graduates were more likely to know that < 5 apneas-hypopneas/h is normal (OR 1.47, 1.03-2.07). Physicians in practice attributed greater importance to OSA as clinical disorder and the need for identifying patients with OSA; but recent graduates reported greater confidence in managing patients with OSA and CPAP. OSA-focused educational interventions during medical school should help to improve recent medical graduates' abilities to diagnose and treat OSA. We recommend a greater number of hours of medical students' exposure to sleep education.

Demographic attributes and knowledge acquisition among graduate-entry medical students.

PubMed

Finucane, Paul; Flannery, Denise; McGrath, Deirdre; Saunders, Jean

2013-01-01

Recent changes to undergraduate (basic) medical education in Ireland have linked an expansion of student numbers with wide-ranging reforms. Medical schools have broadened access by admitting more mature students from diverse backgrounds and have increased their international student numbers. This has resulted in major changes to the demographic profile of students at Irish medical schools. To determine whether the demographic characteristics of students impact on their academic performance and specifically on their rate of knowledge acquisition. As a formative assessment exercise, we administered a progress test to all students twice each year during a 4 year graduate-entry medical programme. We compared scores over time between students from different age cohorts, of different gender, of different nationalities and from different academic backgrounds. In the 1143 tests taken by 285 students to date, there were no significant differences in the rate of knowledge acquisition between the various groups. Early in the course, students from a non-biological science background performed less well than others but outperformed their peers by the time of graduation. Neither age, gender, nationality nor academic background impacts on the rate of knowledge acquisition among graduate-entry medical students.

Ethics curriculum for emergency medicine graduate medical education.

PubMed

Marco, Catherine A; Lu, Dave W; Stettner, Edward; Sokolove, Peter E; Ufberg, Jacob W; Noeller, Thomas P

2011-05-01

Ethics education is an essential component of graduate medical education in emergency medicine. A sound understanding of principles of bioethics and a rational approach to ethical decision-making are imperative. This article addresses ethics curriculum content, educational approaches, educational resources, and resident feedback and evaluation. Ethics curriculum content should include elements suggested by the Liaison Committee on Medical Education, Accreditation Council for Graduate Medical Education, and the Model of the Clinical Practice of Emergency Medicine. Essential ethics content includes ethical principles, the physician-patient relationship, patient autonomy, clinical issues, end-of-life decisions, justice, education in emergency medicine, research ethics, and professionalism. The appropriate curriculum in ethics education in emergency medicine should include some of the content and educational approaches outlined in this article, although the optimal methods for meeting these educational goals may vary by institution. Copyright © 2011 Elsevier Inc. All rights reserved.

A Review of the Medical Education Literature for Graduate Medical Education Teachers

PubMed Central

Locke, Kenneth A.; Bates, Carol K.; Karani, Reena; Chheda, Shobhina G.

2013-01-01

Background A rapidly evolving body of literature in medical education can impact the practice of clinical educators in graduate medical education. Objective To aggregate studies published in the medical education literature in 2011 to provide teachers in general internal medicine with an overview of the current, relevant medical education literature. Review We systematically searched major medical education journals and the general clinical literature for medical education studies with sound design and relevance to the educational practice of graduate medical education teachers. We chose 12 studies, grouped into themes, using a consensus method, and critiqued these studies. Results Four themes emerged. They encompass (1) learner assessment, (2) duty hour limits and teaching in the inpatient setting, (3) innovations in teaching, and (4) learner distress. With each article we also present recommendations for how readers may use them as resources to update their clinical teaching. While we sought to identify the studies with the highest quality and greatest relevance to educators, limitation of the studies selected include their single-site and small sample nature, and the frequent lack of objective measures of outcomes. These limitations are shared with the larger body of medical education literature. Conclusions The themes and the recommendations for how to incorporate this information into clinical teaching have the potential to inform the educational practice of general internist educators as well as that of teachers in other specialties. PMID:24404262

[Current states and future aspects of graduate schools for adult graduate students: experiences of the master's course as a medical technologist].

PubMed

Obara, Takehiro; Suwabe, Akira

2012-12-01

The educational system for medical technologists (MTs) has gradually shifted from a three-year technical school system to a four-year university system. It is worthwhile for MTs to advance to a graduate school, in order to improve their routine-work skills, performances, and also to advance their own research as well as to learn how to direct younger MTs. Recently, MTs who advance to the graduate school as adult graduate students are increasing. In this article, the current states and future aspects of the graduate school of Iwate Medical University are reported. In our Department of Central Clinical Laboratory in Iwate Medical University Hospital, three of my colleagues have completed the master's course of the graduate school as adult graduate students, and three are currently attending the school. Nevertheless, none of them has advanced to the doctor's course yet. The primary reason why they do not advance is the heavy burden on any adult graduate students physically, mentally, and financially to study in the graduate school and carry out routine duties at the same time. Thus, in order to encourage MTs to go or to graduate school education, it is important to arrange systems which will enable MTs to advance to the graduate school as adult graduate students. I believe there are three key elements to make this possible. Firstly, prepare easier access to curriculums for MTs to study special fields and learn special skills. Secondly, arrange an increase in the salary scheme depending on the degree attained from the graduate school. Thirdly, provide financial support for graduate school expenses. In conclusion, it is expected that a large number of MTs will advance to the graduate school if these changes for a better educational environment are made.

IMG/VR: a database of cultured and uncultured DNA Viruses and retroviruses.

PubMed

Paez-Espino, David; Chen, I-Min A; Palaniappan, Krishna; Ratner, Anna; Chu, Ken; Szeto, Ernest; Pillay, Manoj; Huang, Jinghua; Markowitz, Victor M; Nielsen, Torben; Huntemann, Marcel; K Reddy, T B; Pavlopoulos, Georgios A; Sullivan, Matthew B; Campbell, Barbara J; Chen, Feng; McMahon, Katherine; Hallam, Steve J; Denef, Vincent; Cavicchioli, Ricardo; Caffrey, Sean M; Streit, Wolfgang R; Webster, John; Handley, Kim M; Salekdeh, Ghasem H; Tsesmetzis, Nicolas; Setubal, Joao C; Pope, Phillip B; Liu, Wen-Tso; Rivers, Adam R; Ivanova, Natalia N; Kyrpides, Nikos C

2017-01-04

Viruses represent the most abundant life forms on the planet. Recent experimental and computational improvements have led to a dramatic increase in the number of viral genome sequences identified primarily from metagenomic samples. As a result of the expanding catalog of metagenomic viral sequences, there exists a need for a comprehensive computational platform integrating all these sequences with associated metadata and analytical tools. Here we present IMG/VR (https://img.jgi.doe.gov/vr/), the largest publicly available database of 3908 isolate reference DNA viruses with 264 413 computationally identified viral contigs from >6000 ecologically diverse metagenomic samples. Approximately half of the viral contigs are grouped into genetically distinct quasi-species clusters. Microbial hosts are predicted for 20 000 viral sequences, revealing nine microbial phyla previously unreported to be infected by viruses. Viral sequences can be queried using a variety of associated metadata, including habitat type and geographic location of the samples, or taxonomic classification according to hallmark viral genes. IMG/VR has a user-friendly interface that allows users to interrogate all integrated data and interact by comparing with external sequences, thus serving as an essential resource in the viral genomics community. © The Author(s) 2016. Published by Oxford University Press on behalf of Nucleic Acids Research.

Workplace discrimination: experiences of practicing physicians.

PubMed Central

Coombs, Alice A. Tolbert; King, Roderick K.

2005-01-01

BACKGROUND: In response to a growing concern regarding physician discrimination in the workplace, this study was developed to: (1) describe the types of discrimination that exist for the practicing physician and (2) determine which groups of physicians are more likely to experience the various forms of discrimination. METHODS: Surveys were mailed to 1930 practicing physicians in Massachusetts. Participants were asked if they had encountered discrimination, how significant the discrimination was against a specific group, the frequency of personal discrimination, and the type of discrimination. Factor analysis identified four types of discrimination: career advancement, punitive behaviors, practice barriers and hiring barriers. RESULTS: A total of 445 responses were received (a 24% response rate). Sixty-three percent of responding physicians had experienced some form of discrimination. Respondents were women (46%), racial/ethnic minorities (42%) and international medical graduates (IMGs) (40%). In addition, 26% of those classified as white were also IMGs. Over 60% of respondents believed discrimination against IMGs was very or somewhat significant. Almost 27% of males acknowledged that gender bias against females was very or somewhat significant. IMGs were more likely to indicate that discrimination against IMGs was significant in their current organization. Of U.S. medical graduates (USMGs) 44% reported that discrimination against IMGs in their current organization was significant. Nonwhites were more likely to report that discrimination based on race/ethnicity was significant. Nearly 29% of white respondents also believed that such discrimination was very or somewhat significant. CONCLUSIONS: Physicians practicing in academic, research, and private practice sectors experience discrimination based on gender, ethnic/racial, and IMG status. Images Figure 3 Figure 4 Figure 5 PMID:15868767

Case Reports, Case Series - From Clinical Practice to Evidence-Based Medicine in Graduate Medical Education.

PubMed

Sayre, Jerry W; Toklu, Hale Z; Ye, Fan; Mazza, Joseph; Yale, Steven

2017-08-07

Case reports and case series or case study research are descriptive studies that are prepared for illustrating novel, unusual, or atypical features identified in patients in medical practice, and they potentially generate new research questions. They are empirical inquiries or investigations of a patient or a group of patients in a natural, real-world clinical setting. Case study research is a method that focuses on the contextual analysis of a number of events or conditions and their relationships. There is disagreement among physicians on the value of case studies in the medical literature, particularly for educators focused on teaching evidence-based medicine (EBM) for student learners in graduate medical education. Despite their limitations, case study research is a beneficial tool and learning experience in graduate medical education and among novice researchers. The preparation and presentation of case studies can help students and graduate medical education programs evaluate and apply the six American College of Graduate Medical Education (ACGME) competencies in the areas of medical knowledge, patient care, practice-based learning, professionalism, systems-based practice, and communication. A goal in graduate medical education should be to assist residents to expand their critical thinking, problem-solving, and decision-making skills. These attributes are required in the teaching and practice of EBM. In this aspect, case studies provide a platform for developing clinical skills and problem-based learning methods. Hence, graduate medical education programs should encourage, assist, and support residents in the publication of clinical case studies; and clinical teachers should encourage graduate students to publish case reports during their graduate medical education.

Vertically integrated medical education and the readiness for practice of graduates.

PubMed

Wijnen-Meijer, Marjo; Ten Cate, Olle; van der Schaaf, Marieke; Burgers, Chantalle; Borleffs, Jan; Harendza, Sigrid

2015-12-21

Medical curricula become more and more vertically integrated (VI) to prepare graduates better for clinical practice. VI curricula show early clinical education, integration of biomedical sciences and focus on increasing clinical responsibility levels for trainees. Results of earlier questionnaire-based studies indicate that the type of the curriculum can affect the perceived preparedness for work as perceived by students or supervisors. The aim of the present study is to determine difference in actual performance of graduates from VI and non-VI curricula. We developed and implemented an authentic performance assessment based on different facets of competence for medical near-graduates in the role of beginning residents on a very busy day. Fifty nine candidates participated: 30 VI (Utrecht, The Netherlands) and 29 non-VI (Hamburg, Germany). Two physicians, one nurse and five standardized patients independently assessed each candidate on different facets of competence. Afterwards, the physicians indicated how much supervision they estimated each candidate would require on nine so called "Entrustable Professional Activities (EPAs)" unrelated to the observed scenarios. Graduates from a VI curriculum received significantly higher scores by the physicians for the facet of competence "active professional development", with features like 'reflection' and 'asking for feedback'. In addition, VI graduates scored better on the EPA "solving a management problem", while the non-VI graduates got higher scores for the EPA "breaking bad news". This study gives an impression of the actual performance of medical graduates from VI and non-VI curricula. Even though not many differences were found, VI graduates got higher scores for features of professional development, which is important for postgraduate training and continuing education.

In Search of Coherence: A View from the Accreditation Council for Graduate Medical Education

ERIC Educational Resources Information Center

Leach, David C.

2005-01-01

The Conjoint Committee on Continuing Medical Education has developed a position paper, a set of recommendations, and next steps in the reform of continuing medical education (CME). The Accreditation Council for Graduate Medical Education (ACGME) sets standards for and accredits residency programs in graduate medical education and is not directly…

Patients of doctors further from medical school graduation have poorer outcomes.

PubMed

Norcini, John J; Boulet, John R; Opalek, Amy; Dauphinee, W Dale

2017-05-01

There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume. This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes. This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in-hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed. After adjustment, recent practice volume did not have a statistically significant association with in-hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality. Recent practice volume does not mitigate the increase in patient mortality associated with physicians' time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Trends in Pathology Graduate Medical Education Programs and Positions, 2001 to 2017.

PubMed

Petriceks, Aldis H; Salmi, Darren

2018-01-01

The US medical workforce is facing an impending physician shortage. This shortage holds special concern for pathologists, as many senior practitioners are set to retire in the coming years. Indeed, studies indicate a "pathologist gap" may grow through 2030. As such, it is important to understand current and future trends in US pathology. One key factor is graduate medical education. In this study, we analyzed data from the Accreditation Council of Graduate Medical Education, to determine the change in pathology graduate medical education programs and positions, from 2001 to 2017. We found that pathology programs and positions have increased since the 2001 to 2002 academic year, even after adjusting for population growth. However, this increase is much lower than that of total graduate medical education. Furthermore, many pathology subspecialties have declined in population-adjusted levels. Other subspecialties, such as selective pathology, have grown disproportionately. Our findings may be valuable for understanding the state of US pathology, now and in the future. They imply that more resources-or technological innovations-may be needed for specific pathology programs, in hopes of closing the pathologist gap for both this specialty and its subspecialties.

Increasing the graduation rates of minority medical students.

PubMed

Payne, J L; Nowacki, C M; Girotti, J A; Townsel, J; Plagge, J C; Beckham, T W

1986-05-01

The University of Illinois College of Medicine has operated a program since 1969 to recruit minority students into the college and to increase the graduation rates of these students once they enroll. Known as the Medical Opportunities Program (MOP) until 1978, the program was expanded in 1978 and renamed the Urban Health Program (UHP). The authors of the present paper discuss the results of these programs, particularly the effect of granting minority students delays in completing graduation requirements. The MOP (1969 through 1978) increased graduation rates for minority students from 55 percent for those who graduated on time to 81 percent for both on-time and delayed graduates. Under the first seven years of the UHP (1979 through 1985), more minority students have been offered places, and more have enrolled than in the 10 years of the MOP. The retention rate under the UHP, if it holds, will be higher than that under the MOP. For the combined MOP-UHP period, the retention rate for minority students was 88 percent; 69.8 percent of the graduates were on time, and 30.2 were delayed.

Military medical graduates' perceptions of organizational culture in Turkish military medical school.

PubMed

Ozer, Mustafa; Bakir, Bilal; Teke, Abdulkadir; Ucar, Muharrem; Bas, Turker; Atac, Adnan

2008-08-01

Organizational culture is the term used to describe the shared beliefs, perceptions, and expectations of individuals in organizations. In the healthcare environment, organizational culture has been associated with several elements of organizational experience that contribute to quality, such as nursing care, job satisfaction, and patient safety. A range of tools have been designed to measure organizational culture and applied in industrial, educational, and health care settings. This study has been conducted to investigate the perceptions of military medical graduates on organizational culture at Gülhane Military Medical School. A measurement of organizational culture, which was developed by the researchers from Akdeniz University, was applied to all military medical graduates in 2004. This was a Likert type scale that included 31 items. Designers of the measurement grouped all these items into five main dimensions in their previous study. The items were scored on a five-point scale anchored by 1: strongly agree and 5: strongly disagree. Study participants included all military physicians who were in clerkship training period at Gulhane Military Medical Academy in 2004. A total of 106 graduates were accepted to response the questionnaire. The mean age of participants was 25.2 +/- 1.1. At the time of study only 8 (7.5%) graduates were married. The study results have showed that the measurement tool with 31 items had a sufficient reliability with a Cronbach's alpha value of 0.91. Factor analysis has resulted a final measurement tool of 24 items with five factors. Total score and the scores of five subdimensions have been estimated and compared between groups based on living city and marital status. The study has shown the dimension of symbol received positive perceptions while the dimension of organizational structure and efficiency received the most negative perceptions. GMMS has a unique organizational culture with its weak and strong aspects. Conducting this kind

A Survey of Medical Technology Graduates of Illinois State University: 1972-1979.

ERIC Educational Resources Information Center

Spencer, Charles T.

A sample of 170 graduates of the medical technology program at Illinois State University was surveyed to investigate their educational background and their employment history. A total of 228 questionnaires were mailed to all graduates from 1972 through 1979. The demographic data of the ratio of females to males in the field of medical technology…

Performance of women medical graduates from Medical College, Baroda, 1949--74.

PubMed

Bhatt, R V; Soni, J M; Patel, N F

1976-07-01

Women account for 15% of the total admissions in medicine. 271 women have graduated from Medical College, Baroda in 25 years. The examination results are better in women than in men. Obstetrics and gynaecology is the most common speciality selected by women. Job satisfaction is found in 87% of women. Unmarried women account for 15%, 66% have married a doctor and 19% are married to non-medical spouse. Emigration is to the extent of 39%.

Medication calculation skills of graduating nursing students in Finland.

PubMed

Grandell-Niemi, H; Hupli, M; Leino-Kilpi, H

2001-01-01

The aim of this study was to describe the basic mathematical proficiency and the medication calculation skills of graduating nursing students in Finland. A further concern was with how students experienced the teaching of medication calculation. We wanted to find out whether these experiences were associated with various background factors and the students' medication calculation skills. In spring 1997 the population of graduating nursing students in Finland numbered around 1280; the figure for the whole year was 2640. A convenience sample of 204 students completed a questionnaire specially developed for this study. The instrument included structured questions, statements and a medication calculation test. The response rate was 88%. Data analysis was based on descriptive statistics. The students found it hard to learn mathematics and medication calculation skills. Those who evaluated their mathematical and medication calculation skills as sufficient successfully solved the problems included in the questionnaire. It was felt that the introductory course on medication calculation was uninteresting and poorly organised. Overall the students' mathematical skills were inadequate. One-fifth of the students failed to pass the medication calculation test. A positive correlation was shown between the student's grade in mathematics (Sixth Form College) and her skills in medication calculation.

Exit competencies in pathology and laboratory medicine for graduating medical students: the Canadian approach.

PubMed

Ford, Jason; Pambrun, Chantale

2015-05-01

Physicians in every medical and surgical field must be able to use pathology concepts and skills in their practice: for example, they must order and interpret the correct laboratory tests, they must use their understanding of pathogenesis to diagnose and treat, and they must work with the laboratory to care for their patients. These important concepts and skills may be ignored by medical schools and even national/international organizations setting graduation expectations for medical students. There is an evolving international consensus about the importance of exit competencies for medical school graduates, which define the measurable or observable behaviors each graduate must be able to demonstrate. The Canadian Association of Pathologists (CAP) Education Group set out to establish the basic competencies in pathology and laboratory medicine which should be expected of every medical graduate: not competencies for pathologists, but for medical graduates who intend to enter any residency program. We defined 4 targets for pathology and laboratory medicine exit competencies: that they represent only measurable behaviors, that they be clinically focused, that they be generalizable to every medical graduate, and that the final competency document be user-friendly. A set of competencies was developed iteratively and underwent final revision at the 2012 CAP annual meeting. These competencies were subsequently endorsed by the CAP executive and the Canadian Leadership Council on Laboratory Medicine. This clinically focused consensus document provides the first comprehensive list of exit competencies in pathology and laboratory medicine for undergraduate medical education. Copyright © 2015 Elsevier Inc. All rights reserved.

Politics and Graduate Medical Education in Internal Medicine: A Dynamic Landscape.

PubMed

Wardrop, Richard M; Berkowitz, Lee R

2017-02-01

The promotion of change and growth within medical education is oftentimes the result of a complex mix of societal, cultural and economic forces. Graduate medical education in internal medicine is not immune to these forces. Several entities and organizations can be identified as having a major influence on internal medicine training and graduate medical education as a whole. We have reviewed how this is effectively accomplished through these entities and organizations. The result is a constantly changing and dynamic landscape for internal medicine training. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Determinants of the 5-Year Retention and Rural Location of Family Physicians: Results from the Iowa Family Medicine Training Network.

PubMed

Nelson, Gregory C; Gruca, Thomas S

2017-06-01

States are seeking ways to retain primary care physicians trained within their borders. We analyzed the 5-year retention and rural Iowa location decisions for 1,645 graduates of the Iowa Family Medicine Training Network (IFMTN)-eight residency programs (in seven different cities) that are affiliated with the Carver College of Medicine (University of Iowa). Data from 1977-2014 includes 98.5% of active graduates. Location in Iowa 5 years after graduation was the dependent variable in a binary logistic regression. A second model used rural location in Iowa as the dependent variable. Independent variables included graduation year cohort, IMG status, sex, undergraduate medical training in Iowa, medical degree, and residency location. Undergraduate medical training in Iowa was strongly related to retention. Compared to graduates of the AMC residency, graduates of six of the seven community-based programs were significantly more likely to be practicing in Iowa. While the overall proportion of graduates practicing in rural Iowa was high (47.3%), women and IMGs were significantly less likely to practice in rural areas. Graduates of the Mason City program were significantly more likely to practice in a rural area after graduation. The experience of the IFMTN suggests that educating family physicians in community-based programs contributes significantly to in-state retention even 5 years after graduation. While all programs contribute to the rural FM workforce in Iowa, the residency program located in a rural community (Mason City) has a disproportionately positive impact.

A new model to understand the career choice and practice location decisions of medical graduates.

PubMed

Stagg, P; Greenhill, J; Worley, P S

2009-01-01

Australian medical education is increasingly influenced by rural workforce policy. Therefore, understanding the influences on medical graduates' practice location and specialty choice is crucial for medical educators and medical workforce planners. The South Australian Flinders University Parallel Rural Community Curriculum (PRCC) was funded by the Australian Government to help address the rural doctor workforce shortage. The PRCC was the first community based medical education program in Australia to teach a full academic year of medicine in South Australian rural general practices. The aim of this research was to identify what factors influence the career choices of PRCC graduates. A retrospective survey of all contactable graduates of the PRCC was undertaken. Quantitative data were analysed using SPSS 14.0 for Windows. Qualitative data were entered into NVIVO 7 software for coding, and analysed using content analysis. Usable data were collected from 46 of the 86 contactable graduates (53%). More than half of the respondents (54%) reported being on a rural career path. A significant relationship exists between being on a rural career pathway and making the decision prior to or during medical school (p = 0.027), and between graduates in vocational training who are on an urban career path and making a decision on career specialty after graduation from medical school (p = .004). Graduates in a general practice vocational training program are more likely to be on a rural career pathway than graduates in a specialty other than general practice (p = .003). A key influence on graduates' practice location is geographic location prior to entering medical school. Key influences on graduates choosing a rural career pathway are: having a spouse/partner with a rural background; clinical teachers and mentors; the extended rural based undergraduate learning experience; and a specialty preference for general practice. A lack of rural based internships and specialist training

Current dilemmas in overseas doctors' training

PubMed Central

Sandhu, D

2005-01-01

International medical graduates (IMGs) are a remarkably successful professional group in the United Kingdom making up to 30% of the NHS work force. Their very success and media publicity about general practice and consultant shortages, has led to a large influx of inexperienced doctors seeking training opportunities in competitive specialties. In 2003 a record 15 549 doctors joined the medical register of which 9336 doctors were non-European Economic Area citizens. The number of candidates sitting PLAB part 1 and part 2 in 2003 rose by 267% and 283% respectively compared with 2001. Changes to Department of Health, Home Office, and deanery regulations with expansion of medical schools, implementation of European Working Time Directive, Modernising Medical Careers, and the future role of the Postgraduate Medical Education and Training Board, will have an important impact on IMGs' training. Dissemination of realistic information about postgraduate training opportunities is important as the NHS for some time will continue to rely on IMGs. PMID:15701736

Medical student satisfaction, coping and burnout in direct-entry versus graduate-entry programmes.

PubMed

DeWitt, Dawn; Canny, Benedict J; Nitzberg, Michael; Choudri, Jennifer; Porter, Sarah

2016-06-01

There is ongoing debate regarding the optimal length of medical training, with concern about the cost of prolonged training. Two simultaneous tracks currently exist in Australia: direct entry from high school and graduate entry for students with a bachelor degree. Medical schools are switching to graduate entry based on maturity, academic preparedness and career-choice surety. We tested the assumption that graduate entry is better by exploring student preferences, coping, burnout, empathy and alcohol use. From a potential pool of 2188 participants, enrolled at five Australian medical schools, a convenience sample of 688 (31%) first and second year students completed a survey in the middle of the academic year. Participants answered questions about demographics, satisfaction and coping and completed three validated instruments. Over 90% of students preferred their own entry-type, though more graduate-entry students were satisfied with their programme (82.4% versus 65.3%, p < 0.001). There was no difference between graduate-entry and direct-entry students in self-reported coping or in the proportion of students meeting criteria for burnout (50.7% versus 51.2%). Direct-entry students rated significantly higher for empathy (concern, p = 0.022; personal distress, p = 0.031). Graduate-entry students reported significantly more alcohol use and hazardous drinking (30.0% versus 22.8%; p = 0.017). Our multi-institution data confirm that students are generally satisfied with their choice of entry pathway and do not confirm significant psychosocial benefits of graduate entry. Overall, our data suggest that direct-entry students cope with the workload and psychosocial challenges of medical school, in the first 2 years, as well as graduate-entry students. Burnout and alcohol use should be addressed in both pathways. Despite studies showing similar academic outcomes, and higher total costs, more programmes in Australia are becoming graduate entry. Further research on

Restricted career paths for overseas students graduating from Australian medical schools: legal and policy considerations.

PubMed

Elkin, Katie J; Studdert, David M

2010-05-03

A sharp increase in the number of students graduating from Australian medical schools over the next few years looks set to outpace available intern positions. Graduating overseas students will be the first to miss out. While this treatment of overseas students is unlikely to be found unlawful, questions of fairness remain. From a policy standpoint, the bottleneck in intern places could be quite damaging as: it encourages Australian-trained medical graduates with high-quality training and culturally-relevant skills to leave; and it extinguishes a valuable opportunity to steer some of these graduates into geographical areas with the greatest medical workforce needs.

Program Characteristics Influencing Allopathic Students' Residency Selection.

PubMed

Stillman, Michael D; Miller, Karen Hughes; Ziegler, Craig H; Upadhyay, Ashish; Mitchell, Charlene K

2016-04-01

Medical students must consider many overt variables when entering the National Resident Matching Program. However, changes with the single graduate medical education accreditation system have caused a gap in knowledge about more subtle considerations, including what, if any, influence the presence of osteopathic physician (ie, DO) and international medical graduate (IMG) house officers has on allopathic students' residency program preferences. Program directors and selection committee members may assume students' implicit bias without substantiating evidence. To reexamine which program characteristics affect US-trained allopathic medical students' residency selection, and to determine whether the presence of DO and IMG house officers affects the program choices of allopathic medical students. Fourth-year medical students from 4 allopathic medical schools completed an online survey. The Pearson χ(2) statistic was used to compare demographic and program-specific traits that influence ranking decisions and to determine whether school type (private vs public), valuing a residency program's prestige, or interest in a competitive specialty dictated results. Qualitative data were analyzed using the Pandit variation of the Glaser and Strauss constant comparison. Surveys were completed by 323 of 577 students (56%). Students from private vs public institutions were more likely to value a program's prestige (160 [93%] vs 99 [72%]; P<.001) and research opportunities (114 [66%] vs 57 [42%]; P<.001), and they were less likely to consider their prospects of being accepted (98 [57%] vs 111 [81%]; P<.001). A total of 33 (10%) and 52 (16%) students reported that the presence of DO or IMG trainees, respectively, would influence their final residency selection, and these percentages were largely unchanged among students interested in programs' prestige or in entering a competitive specialty. Open-ended comments were generally optimistic about diversification of the physician

Definition of "Rural" Determines the Placement Outcomes of a Rural Medical Education Program: Analysis of Jichi Medical University Graduates

ERIC Educational Resources Information Center

Matsumoto, Masatoshi; Inoue, Kazuo; Kajii, Eiji

2010-01-01

Purpose: To show the impact of changing the definition of what is "rural" on the outcomes of a rural medical education program. Methods: A cross-sectional sample of 643 graduates under obligatory rural service and 1,699 graduates after serving their obligation, all from Jichi Medical University (JMU), a binding rural education program in…

Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan.

PubMed

Imran, Nazish; Azeem, Zahra; Haider, Imran I; Amjad, Naeem; Bhatti, Muhammad R

2011-10-17

The increasing migration of health professionals to affluent countries is not a recent phenomenon and has been addressed in literature. However the various facets of physician migration from Pakistan, the third leading source of International medical graduates has not been rigorously evaluated. The objective of the current study was to survey final year students and recent medical graduates in Lahore, Pakistan about their intentions to train abroad, their post training plans as well as to identify the factors responsible for their motivation for international migration. A self administered structured questionnaire was developed to collect respondents' demographic and educational characteristics, intention to train abroad, their preferred destination & post training intentions of returning to Pakistan. Various influencing factors which impact on medical graduate's motivation to train abroad or stay in Pakistan were explored using a 10 point scale. SPSS software was used for data entry and analysis. Of the 400 eligible respondents, 275 responded (response rate 68.7%). One hundred and sixty six respondents (60.4%) intended to train abroad either for a specialty (54.9%) or a subspecialty (5.5%) The United States and United Kingdom were the most preferred destination. While 14.2% intended to return to Pakistan immediately after training, a significant percentage (10%) never intended to return to Pakistan or wished to stay abroad temporarily (37%). Professional excellence and establishing quickly in the competitive market were the most important goal to be achieved by the respondents for intention for postgraduate training abroad. The most common reasons cited for training abroad were the impact of residency training on future career (mean score 8.20 ± 2.3), financial conditions of doctors (mean score 7.97 ± 2.37) and job opportunities (mean score7.90 ± 2.34). An alarming percentage of medical graduates from Lahore, Pakistan intend to migrate for post graduate

Brain Drain: Post Graduation Migration Intentions and the influencing factors among Medical Graduates from Lahore, Pakistan

PubMed Central

2011-01-01

Background The increasing migration of health professionals to affluent countries is not a recent phenomenon and has been addressed in literature. However the various facets of physician migration from Pakistan, the third leading source of International medical graduates has not been rigorously evaluated. The objective of the current study was to survey final year students and recent medical graduates in Lahore, Pakistan about their intentions to train abroad, their post training plans as well as to identify the factors responsible for their motivation for international migration. Method A self administered structured questionnaire was developed to collect respondents' demographic and educational characteristics, intention to train abroad, their preferred destination & post training intentions of returning to Pakistan. Various influencing factors which impact on medical graduate's motivation to train abroad or stay in Pakistan were explored using a 10 point scale. SPSS software was used for data entry and analysis. Results Of the 400 eligible respondents, 275 responded (response rate 68.7%). One hundred and sixty six respondents (60.4%) intended to train abroad either for a specialty (54.9%) or a subspecialty (5.5%) The United States and United Kingdom were the most preferred destination. While 14.2% intended to return to Pakistan immediately after training, a significant percentage (10%) never intended to return to Pakistan or wished to stay abroad temporarily (37%). Professional excellence and establishing quickly in the competitive market were the most important goal to be achieved by the respondents for intention for postgraduate training abroad. The most common reasons cited for training abroad were the impact of residency training on future career (mean score 8.20 ± 2.3), financial conditions of doctors (mean score 7.97 ± 2.37) and job opportunities (mean score7.90 ± 2.34). Conclusion An alarming percentage of medical graduates from Lahore, Pakistan intend

Can we predict 4-year graduation in podiatric medical school using admission data?

PubMed

Sesodia, Sanjay; Molnar, David; Shaw, Graham P

2012-01-01

This study examined the predictive ability of educational background and demographic variables, available at the admission stage, to identify applicants who will graduate in 4 years from podiatric medical school. A logistic regression model was used to identify two predictors of 4-year graduation: age at matriculation and total Medical College Admission Test score. The model was cross-validated using a second independent sample from the same population. Cross-validation gives greater confidence that the results could be more generally applied. Total Medical College Admission Test score was the strongest predictor of 4-year graduation, with age at matriculation being a statistically significant but weaker predictor. Despite the model's capacity to predict 4-year graduation better than random assignment, a sufficient amount of error in prediction remained, suggesting that important predictors are missing from the model. Furthermore, the high rate of false-positives makes it inappropriate to use age and Medical College Admission Test score as admission screens in an attempt to eliminate attrition by not accepting at-risk students.

Non-Medical Prescription Stimulant Use in Graduate Students: Relationship With Academic Self-Efficacy and Psychological Variables.

PubMed

Verdi, Genevieve; Weyandt, Lisa L; Zavras, Brynheld Martinez

2016-09-01

The objective of this study was to examine graduate students' non-medical use of prescription stimulant medication, and the relationship between non-medical use of prescription stimulants with academic self-efficacy, psychological factors (i.e., anxiety, depression, and stress), and internal restlessness. The sample consisted of 807 graduate students from universities located in five geographic regions of the United States. Past-year rates of self-reported non-medical use were determined to be 5.9%, with overall lifetime prevalence of 17.5%. Observed self-reported non-medical use of prescription stimulant medications was significantly correlated with self-reported levels of anxiety and stress, various aspects of internal restlessness, and perceived safety of the medications. Findings support graduate students' motivations of non-medical prescription stimulant use to be both academic and social in nature. Effective prevention and education efforts are needed to help address the non-medical use of prescription stimulants by graduate students on university campuses. © The Author(s) 2014.

Early-career work location of Memorial University medical graduates: Why the decline in rural practice?

PubMed

Mathews, Maria; Ryan, Dana; Samarasena, Asoka

2017-01-01

In a previous study, we found a decline in the proportion of Memorial University of Newfoundland (MUN) medical alumni practising in rural areas, particularly in Newfoundland and Labrador. The current study focused on the work location of recent graduates and examined the predictors of working in rural Canada and in rural Newfoundland and Labrador within the first 15 years following graduation. We linked data from graduating class lists and the alumni and postgraduate databases with Scott's Medical Database to create a record of all graduates from 1973 to 2008, including their work location. We identified differences and significant predictors for each outcome and then described and compared the characteristics of 4 cohorts of graduating classes. In their early career, 127/1113 (11.4%) MUN medical graduates were working in rural Canada, and 57 (5.1%) were working in rural Newfoundland and Labrador. Having a rural background and being a family physician were predictors of working in rural Canada, and having a rural background, doing at least part of the residency at MUN, being from Newfoundland and Labrador and being a family physician were predictors of working in rural Newfoundland and Labrador. Seventy-four (13.6%) and 33 (6.1%) of 1989-1998 graduates worked in rural Canada and rural Newfoundland and Labrador, respectively, compared to 53 (9.3%) and 24 (4.2%), respectively, of 1999-2008 graduates. The proportion of MUN medical graduates who worked in rural communities early in their career decreased among recent cohorts. The results show the impact of changes in the characteristics of MUN medical graduates, who increasingly opt for specialist practice and residency training outside the province, and the important role of local postgraduate training.

Predicting medical students' intentions to take up rural practice after graduation.

PubMed

Jones, Michael; Humphreys, John; Prideaux, David

2009-10-01

Using a novel longitudinal tracking project, this study develops and evaluates the performance of a predictive model and index of rural medical practice intention based on the characteristics of incoming medical students. Medical school entry survey data were obtained from the Medical Schools Outcome Database (MSOD) project implemented in all Australian and New Zealand medical schools and coordinated through Medical Deans Australia and New Zealand, the representative body for the Deans of 18 Australian and two New Zealand medical schools and faculties. The medical school commencement survey collects data on students' education and family background, including rural upbringing, personal circumstances and scholarships, and on their practice intentions in terms of location and specialty. The MSOD will also allow tracking of medical graduates after graduation. Logistic regression modelling was used to develop a predictive model of rural practice intention. Split-sample validation was used to gain some insight into the stability of performance of the model. Response rates to the MSOD survey exceeded 90% on average. The model findings confirm and extend previous research examining the association of medical student characteristics with intention to take up rural medical practice. The statistically significant independent factors in the model included students' rural backgrounds, financial arrangements and intentions regarding specialist versus generalist practice upon graduation. Model performance was good, with an area under the receiver-operator characteristics curve of 0.86, and reproducible, with an area in a validation sample of 0.83. The model and related index provide important insights into individual factors associated with rural practice intention among students commencing medical studies. The model can also provide a means for optimising the use of scarce medical programme resources, thereby helping to improve the supply of rural medical practitioners. This

Financing graduate medical education to meet the needs of children and the future pediatrician workforce.

PubMed

Shipman, Scott A; Pan, Richard J D

2008-04-01

This policy statement articulates the positions of the American Academy of Pediatrics on graduate medical education and the associated costs and funding mechanisms. It reaffirms the policy of the American Academy of Pediatrics that graduate medical education is a public good and is an essential part of maintaining a high-quality physician workforce. The American Academy of Pediatrics advocates for lifelong learning across the continuum of medical education. This policy statement focuses on the financing of one component of this continuum, namely residency education. The statement calls on federal and state governments to continue their support of residency education and advocates for stable means of funding such as the establishment of an all-payer graduate medical education trust fund. It further proposes a portable authorization system that would allocate graduate medical education funds for direct medical education costs to accredited residency programs on the basis of the selection of the program by qualified student or residents. This system allows the funding to follow the residents to their program. Recognizing the critical workforce needs of many pediatric medical subspecialties, pediatric surgical specialties, and other pediatric specialty disciplines, this statement maintains that subspecialty fellowship training and general pediatrics research fellowship training should receive adequate support from the graduate medical education financing system, including funding from the National Institutes of Health and other federal agencies, as appropriate. Furthermore, residency education that is provided in freestanding children's hospitals should receive a level of support equivalent to that of other teaching hospitals. The financing of graduate medical education is an important and effective tool to ensure that the future pediatrician workforce can provide optimal heath care for infants, children, adolescents, and young adults.

The impact of socially-accountable, community-engaged medical education on graduates in the Central Philippines: Implications for the global rural medical workforce.

PubMed

Siega-Sur, J L; Woolley, T; Ross, S J; Reeve, C; Neusy, A-J

2017-10-01

Developing and retaining a high quality medical workforce, especially within low-resource countries has been a world-wide challenge exacerbated by a lack of medical schools, the maldistribution of doctors towards urban practice, health system inequities, and training doctors in tertiary centers rather than in rural communities. To describe the impact of socially-accountable health professional education on graduates; specifically: their motivation towards community-based service, preparation for addressing local priority health issues, career choices, and practice location. Cross-sectional survey of graduates from two medical schools in the Philippines: the University of Manila-School of Health Sciences (SHS-Palo) and a medical school with a more conventional curriculum. SHS-Palo graduates had significantly (p < 0.05) more positive attitudes to community service. SHS-Palo graduates were also more likely to work in rural and remote areas (p < 0.001) either at district or provincial hospitals (p = 0.032) or in rural government health services (p < 0.001) as Municipal or Public Health Officers (p < 0.001). Graduates also stayed longer in both their first medical position (p = 0.028) and their current position (p < 0.001). SHS-Palo medical graduates fulfilled a key aim of their socially-accountable institution to develop a health professional workforce willing and able, and have a commitment to work in underserved rural communties.

Medicare Financing of Graduate Medical Education

PubMed Central

Rich, Eugene C; Liebow, Mark; Srinivasan, Malathi; Parish, David; Wolliscroft, James O; Fein, Oliver; Blaser, Robert

2002-01-01

The past decade has seen ongoing debate regarding federal support of graduate medical education, with numerous proposals for reform. Several critical problems with the current mechanism are evident on reviewing graduate medical education (GME) funding issues from the perspectives of key stakeholders. These problems include the following: substantial interinstitutional and interspecialty variations in per-resident payment amounts; teaching costs that have not been recalibrated since 1983; no consistent control by physician educators over direct medical education (DME) funds; and institutional DME payments unrelated to actual expenditures for resident education or to program outcomes. None of the current GME reform proposals adequately address all of these issues. Accordingly, we recommend several fundamental changes in Medicare GME support. We propose a re-analysis of the true direct costs of resident training (with appropriate adjustment for local market factors) to rectify the myriad problems with per-resident payments. We propose that Medicare DME funds go to the physician organization providing resident instruction, keeping DME payments separate from the operating revenues of teaching hospitals. To ensure financial accountability, we propose that institutions must maintain budgets and report expenditures for each GME program. To establish educational accountability, Residency Review Committees should establish objective, annually measurable standards for GME program performance; programs that consistently fail to meet these minimum standards should lose discretion over GME funds. These reforms will solve several long-standing, vexing problems in Medicare GME funding, but will also uncover the extent of undersupport of GME by most other health care payers. Ultimately, successful reform of GME financing will require “all-payer” support. PMID:11972725

"Exit exams" for medical graduates: a guarantee of quality?

PubMed

Dehury, Ranjit Kumar; Samal, Janmejaya

2017-01-01

Despite a great deal of opposition from many segments of the medical community, the Medical Council of India (MCI) has proposed to the Ministry of Health and Family Welfare, Government of India that a pan-India exit examination be introduced for graduating MBBS doctors. Whether the proposal should be put forward was considered twice, once in 2010 and again in 2013, and finally the plan was ready to be taken forward seriously in 2015. The proposal has elicited appreciation and criticism from different segments of the medical community. It aims to improve the quality of medical professionals and create an all-India chapter of doctors. People are ready to welcome the move if it is integrated with the final year MBBS examination and licentiate examination and serves as an entrance examination for medical graduates. Further, the Supreme Court's order that the National Eligibility and Entrance Test (NEET) be made compulsory aims to create a fair, transparent and non-exploitative system. This move has the potential to reduce corruption and foster a merit-based system of medical education. However, making NEET compulsory would have an impact on the proposed exit examination. Given this background, we analyse the pros and cons of the new initiative on the basis of articles published in newspapers and journals, with a special focus on its impact on improving the standards of quality in the medical profession.

Fifth pathway in New Jersey. House officer preparatory course for US foreign medical graduates.

PubMed

McGrough, W E

1975-06-09

The Fifth Channel in New Jersey is a Fifth Pathway program for US foreign medical graduates. In its third year, 83 percent of its 81 graduates are house officers at 18 US medical school-affiliated hospitals. Performance as house officers is characterized as competitive with peers, including US graduates. Positive attitudes toward work load, fellow workers, and patients compared with those of fellow house staff are noted. Quality of performance as house officers correlates most strongly with the change in mean scores of two batteries of clinical National Board examinations taken during the Fifth Pathway and less strongly with mean scores of single batteries of National Boards, Intelligence quotient, Educational Council for Foreign Medical Graduates (ECFMG) examination, ang age. Recommendations concerning the implementing of similar programs in other states are presented.

Predicting In-State Workforce Retention After Graduate Medical Education Training.

PubMed

Koehler, Tracy J; Goodfellow, Jaclyn; Davis, Alan T; Spybrook, Jessaca; vanSchagen, John E; Schuh, Lori

2017-02-01

There is a paucity of literature when it comes to identifying predictors of in-state retention of graduate medical education (GME) graduates, such as the demographic and educational characteristics of these physicians. The purpose was to use demographic and educational predictors to identify graduates from a single Michigan GME sponsoring institution, who are also likely to practice medicine in Michigan post-GME training. We included all residents and fellows who graduated between 2000 and 2014 from 1 of 18 GME programs at a Michigan-based sponsoring institution. Predictor variables identified by logistic regression with cross-validation were used to create a scoring tool to determine the likelihood of a GME graduate to practice medicine in the same state post-GME training. A 6-variable model, which included 714 observations, was identified. The predictor variables were birth state, program type (primary care versus non-primary care), undergraduate degree location, medical school location, state in which GME training was completed, and marital status. The positive likelihood ratio (+LR) for the scoring tool was 5.31, while the negative likelihood ratio (-LR) was 0.46, with an accuracy of 74%. The +LR indicates that the scoring tool was useful in predicting whether graduates who trained in a Michigan-based GME sponsoring institution were likely to practice medicine in Michigan following training. Other institutions could use these techniques to identify key information that could help pinpoint matriculating residents/fellows likely to practice medicine within the state in which they completed their training.

America's medical school: 5,000 graduates since the "first class".

PubMed

Artino, Anthony R; Gilliland, William R; Cruess, David F; Durning, Steven J

2015-04-01

In 1980, the Uniformed Services University of the Health Sciences (USU) graduated its first class of medical students. As a national university intended to produce "career-committed" military officers and future leaders of the Military Health System, USU functions as the service academy for military medicine and public health. More than 40 years after the school's charter and 5,000 graduates since the first class, we describe the original purpose of USU and provide an update on its achievements. In particular, we address the question of the "staying power" of the University's alumni-the degree to which graduation from the nation's military medical school is associated with long years of devoted service to military medicine. At a time when the MHS is confronting the challenge of extended deployments, rising health care costs, and a growing array of threats to our nation's health, we suggest that America needs USU now more than ever. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Definition of "rural" determines the placement outcomes of a rural medical education program: analysis of Jichi Medical University graduates.

PubMed

Matsumoto, Masatoshi; Inoue, Kazuo; Kajii, Eiji

2010-01-01

To show the impact of changing the definition of what is "rural" on the outcomes of a rural medical education program. A cross-sectional sample of 643 graduates under obligatory rural service and 1,699 graduates after serving their obligation, all from Jichi Medical University (JMU), a binding rural education program in Japan, were used as the data source. Communities were divided into decile groups according to population density, and the cut-off for "rural/nonrural" was altered in order to study its impact on the data. The rural practice rate of obliged graduates had its peak in the decile groups with the lowest population densities, while the peak rates of postobligation graduates and non-JMU physicians were at the decile groups with the highest population densities. Rural practice rates of all of the 3 groups of physicians increased with the increase in inclusiveness of rural definition. The ratio of rural practice rate of obliged graduates to that of non-JMU physicians ("relative effectiveness") increased remarkably with the increase in exclusiveness of rural definition. The relative effectiveness of postobligation graduates did not substantially increase after the cut-off exceeded a certain point of exclusiveness. Definition of "rural" largely determined the rural practice rate and relative effectiveness of JMU graduates. The results suggest that results of past outcome studies of rural medical education programs are potentially biased depending on how rural is defined.

Entrustable Professional Activities for Pathology: Recommendations From the College of American Pathologists Graduate Medical Education Committee.

PubMed

McCloskey, Cindy B; Domen, Ronald E; Conran, Richard M; Hoffman, Robert D; Post, Miriam D; Brissette, Mark D; Gratzinger, Dita A; Raciti, Patricia M; Cohen, David A; Roberts, Cory A; Rojiani, Amyn M; Kong, Christina S; Peterson, Jo Elle G; Johnson, Kristen; Plath, Sue; Powell, Suzanne Zein-Eldin

2017-01-01

Competency-based medical education has evolved over the past decades to include the Accreditation Council for Graduate Medical Education Accreditation System of resident evaluation based on the Milestones project. Entrustable professional activities represent another means to determine learner proficiency and evaluate educational outcomes in the workplace and training environment. The objective of this project was to develop entrustable professional activities for pathology graduate medical education encompassing primary anatomic and clinical pathology residency training. The Graduate Medical Education Committee of the College of American Pathologists met over the course of 2 years to identify and define entrustable professional activities for pathology graduate medical education. Nineteen entrustable professional activities were developed, including 7 for anatomic pathology, 4 for clinical pathology, and 8 that apply to both disciplines with 5 of these concerning laboratory management. The content defined for each entrustable professional activity includes the entrustable professional activity title, a description of the knowledge and skills required for competent performance, mapping to relevant Accreditation Council for Graduate Medical Education Milestone subcompetencies, and general assessment methods. Many critical activities that define the practice of pathology fit well within the entrustable professional activity model. The entrustable professional activities outlined by the Graduate Medical Education Committee are meant to provide an initial framework for the development of entrustable professional activity-related assessment and curricular tools for pathology residency training.

Exploring the influence of workplace supports and relationships on safe medication practice: A pilot study of Australian graduate nurses.

PubMed

Sahay, Ashlyn; Hutchinson, Marie; East, Leah

2015-05-01

Despite the growing awareness of the benefits of positive workplace climates, unsupportive and disruptive workplace behaviours are widespread in health care organisations. Recent graduate nurses, who are often new to a workplace, are particularly vulnerable in unsupportive climates, and are also recognised to be at higher risk for medication errors. Investigate the association between workplace supports and relationships and safe medication practice among graduate nurses. Exploratory study using quantitative survey with a convenience sample of 58 nursing graduates in two Australian States. Online survey focused on graduates' self-reported medication errors, safe medication practice and the nature of workplace supports and relationships. Spearman's correlations identified that unsupportive workplace relationships were inversely related to graduate nurse medication errors and erosion of safe medication practices, while supportive Nurse Unit Manager and supportive work team relationships positively influenced safe medication practice among graduates. Workplace supports and relationships are potentially both the cause and solution to graduate nurse medication errors and safe medication practices. The findings develop further understanding about the impact of unsupportive and disruptive behaviours on patient safety and draw attention to the importance of undergraduate and continuing education strategies that promote positive workplace behaviours and graduate resilience. Copyright © 2015 Elsevier Ltd. All rights reserved.

Improving the Return on Investment of Graduate Medical Education in North Carolina.

PubMed

Newton, Warren; Wouk, Noah; Spero, Julie C

2016-01-01

The National Academy of Medicine has called for fundamental reform in the governance and accountability of graduate medical education, but how to implement this change is unclear. We describe the North Carolina graduate medical education system, and we propose tracking outcomes and aligning residency stipends with outcomes such as specialty choice, practice in North Carolina, and acceptance of new Medicaid and Medicare patients. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Research Ethics Education in Post-Graduate Medical Curricula in I.R. Iran.

PubMed

Nikravanfard, Nazila; Khorasanizadeh, Faezeh; Zendehdel, Kazem

2017-08-01

Research ethics training during post-graduate education is necessary to improve ethical standards in the design and conduct of biomedical research. We studied quality and quantity of research ethics training in the curricula of post-graduate programs in the medical science in I.R. Iran. We evaluated curricula of 125 post-graduate programs in medical sciences in I.R. Iran. We qualitatively studied the curricula by education level, including the Master and PhD degrees and analyzed the contents and the amount of teaching allocated for ethics training in each curriculum. We found no research ethics training in 72 (58%) of the programs. Among the 53 (42%) programs that considered research ethics training, only 17 programs had specific courses for research ethics and eight of them had detailed topics on their courses. The research ethics training was optional in 25% and mandatory in 76% of the programs. Post-graduate studies that were approved in the more recent years had more attention to the research ethics training. Research ethics training was neglected in most of the medical post-graduate programs. We suggest including sufficient amount of mandatory research ethics training in Master and PhD programs in I.R. Iran. Further research about quality of research ethics training and implementation of curricula in the biomedical institutions is warranted. © 2016 John Wiley & Sons Ltd.

Career choices for paediatrics: national surveys of graduates of 1974-2002 from UK medical schools.

PubMed

Turner, G; Lambert, T W; Goldacre, M J; Turner, Steve

2007-05-01

Knowledge of UK doctors' career intentions and pathways is essential for understanding future workforce requirements. The aim of this study was to report career choices for and career progression in paediatrics in the UK. Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974. In total, 74% (24 621/33 412) and 73% (20 720/28 459) of doctors responded at 1 and 3 years after graduation. Choices for paediatrics 1 year after qualifying fell from 7.8% of 1974 graduates to 5.0% of 1983 graduates, increased to 7.2% of 1993 graduates, and since the level has remained fairly constant. Approximately twice the percentage of women graduates than men graduates indicated a long-term career choice for paediatrics. A total of 44% of those who chose paediatrics 1 year after graduation were working in it 10 years after qualifying. Experience of the subject as a student, and enthusiasm/commitment: what I really want to do, affected long-term career choices more for paediatrics than for other medical careers. The proportion of junior doctors wishing to become paediatricians has not changed much during the last 30 years. The planned increase in the number of medical school graduates is necessary to increase the number of UK-trained consultant paediatricians. Medical students who experience enthusiastic and stimulating training in paediatrics may be more likely to become paediatricians.

Social capital among migrating doctors: the "bridge" over troubled water.

PubMed

Terry, Daniel R; Quynh, Lê

2014-01-01

The purpose of this paper is to examine the concept of social capital among International Medical Graduates (IMGs). It will specifically examine bridging social capital and greater intercultural communication which provides IMGs access to the wider community and plays a key role in cross-cultural adaptation and acculturation. A review of the literature. An Australian wide shortage of doctors has led to an increased reliance on the recruitment of IMGs. As IMGs migrate, they may encounter different meanings of illness, models of care and a number of social challenges. Nevertheless, greater cross-cultural adaptation and acculturation occurs through bridging social capital, where intercultural communication, new social networks and identity aids integration. This process produces more opportunities for economic capital growth and upward mobility than bonding social capital. Concerns regarding immigration, appropriate support and on-going examination processes have been expressed by IMGs in a number of studies and policy papers. However, there is very little insight into what contributes cross-cultural adaptation of IMGs. As IMGs migrate to not only a new country, but also a new health system and workplace they arrive with different cultural meanings of illness and models of care. These differences may be in contrast to the dominant western medical model, but often bring positive contributions to patient care in the new environment. In addition, improving bridging social capital provides IMGs access to the wider community and has been demonstrated to play a key role in cross-cultural adaptation and ultimately acculturation.

78 FR 52537 - Council on Graduate Medical Education; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-23

... Graduate Medical Education; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Medical Education (COGME). Date and Time: September 9, 2013 (8:30 a.m.-5:00 p.m.), September 10, 2013 (8... financing of medical education training, and the development of performance measures and longitudinal...

Prepared to practice? Perception of career preparation and guidance of recent medical graduates at two campuses of a transnational medical school: a cross-sectional study.

PubMed

Kassim, Sameer S; McGowan, Yvonne; McGee, Hannah; Whitford, David L

2016-02-09

Graduating medical students enter the workforce with substantial medical knowledge and experience, yet little is known about how well they are prepared for the transition to medical practice in diverse settings. We set out to compare perceptions of medical school graduates' career guidance with their perceptions of preparedness to practice as interns. We also set out to compare perceptions of preparedness for hospital practice between graduates from two transnational medical schools. This was a cross-sectional study. A Preparedness for Hospital Practice (PHPQ) survey and career guidance questionnaire was sent to recent medical graduates, incorporating additional free text responses on career preparation. Data was analyzed using descriptive statistics and tests of association including Chi-square, Mann-Whitney U and Kruskal-Wallis H tests. Forty three percent (240/555) of graduates responded to the survey: 39 % of respondents were domestic (Dublin, Ireland or Manama, Kingdom of Bahrain) and interning locally; 15 % were overseas students interning locally; 42 % were overseas students interning internationally and 4 % had not started internship. Two variables explained 13 % of the variation in preparedness for hospital practice score: having planned postgraduate education prior to entering medical school and having helpful career guidance in medical school. Overseas graduates interning internationally were more likely to have planned their postgraduate career path prior to entering medical school. Dublin graduates found their career guidance more helpful than Bahrain counterparts. The most cited shortcomings were lack of structured career advice and lack of advice on the Irish and Bahraini postgraduate systems. This study has demonstrated that early consideration of postgraduate career preparation and helpful medical school career guidance has a strong association with perceptions of preparedness of medical graduates for hospital practice. In an era of increasing

Gamification as a tool for enhancing graduate medical education

PubMed Central

Nevin, Christa R; Westfall, Andrew O; Rodriguez, J Martin; Dempsey, Donald M; Cherrington, Andrea; Roy, Brita; Patel, Mukesh; Willig, James H

2014-01-01

Introduction The last decade has seen many changes in graduate medical education training in the USA, most notably the implementation of duty hour standards for residents by the Accreditation Council of Graduate Medical Education. As educators are left to balance more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed. Objectives To assess acceptance and use of a novel gamification-based medical knowledge software among internal medicine residents and to determine retention of information presented to participants by this medical knowledge software. Methods We designed and developed software using principles of gamification to deliver a web-based medical knowledge competition among internal medicine residents at the University of Alabama (UA) at Birmingham and UA at Huntsville in 2012–2013. Residents participated individually and in teams. Participants accessed daily questions and tracked their online leaderboard competition scores through any internet-enabled device. We completed focus groups to assess participant acceptance and analysed software use, retention of knowledge and factors associated with loss of participants (attrition). Results Acceptance: In focus groups, residents (n=17) reported leaderboards were the most important motivator of participation. Use: 16 427 questions were completed: 28.8% on Saturdays/Sundays, 53.1% between 17:00 and 08:00. Retention of knowledge: 1046 paired responses (for repeated questions) were collected. Correct responses increased by 11.9% (p<0.0001) on retest. Differences per time since question introduction, trainee level and style of play were observed. Attrition: In ordinal regression analyses, completing more questions (0.80 per 10% increase; 0.70 to 0.93) decreased, while postgraduate year 3 class (4.25; 1.44 to 12.55) and non-daily play (4.51; 1.50 to 13.58) increased odds of attrition. Conclusions Our software

Vocal Health Education and Medical Resources for Graduate-Level Vocal Performance Students.

PubMed

Latham, Katherine; Messing, Barbara; Bidlack, Melissa; Merritt, Samantha; Zhou, Xian; Akst, Lee M

2017-03-01

Most agree that education about vocal health and physiology can help singers avoid the development of vocal disorders. However, little is known about how this kind of education is provided to singers as part of their formal training. This study describes the amount of instruction in these topics provided through graduate-level curricula, who provides this instruction, and the kinds of affiliations such graduate singing programs have with medical professionals. This is an online survey of music schools with graduate singing programs. Survey questions addressed demographics of the programs, general attitudes about vocal health instruction for singers, the amount of vocal health instruction provided and by whom it was taught, perceived barriers to including more vocal health instruction, and any affiliations the voice program might have with medical personnel. Eighty-one survey responses were received. Instruction on vocal health was provided in 95% of the schools. In 55% of the schools, none of this instruction was given by a medical professional. Limited time in the curriculum, lack of financial support, and lack of availability of medical professional were the most frequently reported barriers to providing more instruction. When programs offered more hours of instruction, they were more likely to have some of that instruction given by a medical professional (P = 0.008) and to assess the amount of instruction provided positively (P = 0.001). There are several perceived barriers to incorporating vocal health education into graduate singing programs. Opportunity exists for more collaboration between vocal pedagogues and medical professionals in the education of singers about vocal health. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Medical students’ characteristics as predictors of career practice location: retrospective cohort study tracking graduates of Nepal’s first medical college

PubMed Central

Shakya, Rabina; Pokhrel, Bharat M; Eyal, Nir; Rijal, Basista P; Shrestha, Ratindra N; Sayami, Arun

2012-01-01

Objective To determine, in one low income country (Nepal), which characteristics of medical students are associated with graduate doctors staying to practise in the country or in its rural areas. Design Observational cohort study. Setting Medical college registry, with internet, phone, and personal follow-up of graduates. Participants 710 graduate doctors from the first 22 classes (1983-2004) of Nepal’s first medical college, the Institute of Medicine. Main outcome measures Career practice location (foreign or in Nepal; in or outside of the capital city Kathmandu) compared with certain pre-graduation characteristics of medical student. Results 710 (97.7%) of the 727 graduates were located: 193 (27.2%) were working in Nepal in districts outside the capital city Kathmandu, 261 (36.8%) were working in Kathmandu, and 256 (36.1%) were working in foreign countries. Of 256 working abroad, 188 (73%) were in the United States. Students from later graduating classes were more likely to be working in foreign countries. Those with pre-medical education as paramedics were twice as likely to be working in Nepal and 3.5 times as likely to be in rural Nepal, compared with students with a college science background. Students who were academically in the lower third of their medical school class were twice as likely to be working in rural Nepal as those from the upper third. In a regression analysis adjusting for all variables, paramedical background (odds ratio 4.4, 95% confidence interval 1.7 to 11.6) was independently associated with a doctor remaining in Nepal. Rural birthplace (odds ratio 3.8, 1.3 to 11.5) and older age at matriculation (1.1, 1.0 to 1.2) were each independently associated with a doctor working in rural Nepal. Conclusions A cluster of medical students’ characteristics, including paramedical background, rural birthplace, and lower academic rank, was associated with a doctor remaining in Nepal and with working outside the capital city of Kathmandu. Policy

A Graduate Academic Program in Medical Information Science.

ERIC Educational Resources Information Center

Blois, Marsden S., Jr.; Wasserman, Anthony I.

A graduate academic program in medical information science has been established at the University of California, San Francisco, for the education of scientists capable of performing research and development in information technology in the health care setting. This interdisciplinary program, leading to a Doctor of Philosophy degree, consists of an…

A survey of manual vacuum aspiration’s experiences among the new medical graduates in Thailand

PubMed Central

2013-01-01

Background Despite Thai laws permitting abortion conducted by registered medical practitioners, unsafe abortion still kills and maims Thai women as a result of inadequate access to safe abortion services. Surgical evacuation of the uterus by manual vacuum aspirator (MVA) is a safe and effective technique recommended by the World Health Organization (WHO) guidelines. This study assessed new medical graduates’ MVA experiences during their clinical years in medical schools. Methods Cross-sectional questionnaire surveys on all new medical graduates participating in the annual assembly arranged by the Ministry of Public Health in 2010 and 2012 were applied. Descriptive and inferential statistics were employed for data analysis. Results The significant minority of new graduates (44% and 43% in 2010 and 2012 batches) had seen but never used MVA. The proportion of graduates who had ‘never seen’ reduced from 32% in 2010 to 23% in 2012 while the proportion of ‘ever used’ had noticeably increased from 24% to 34% in corresponding years. Graduates from medical schools outside Bangkok and vicinity and those reporting confidence in their surgical skills tended to have more MVA experience. The 2012 graduation year was also positively related to higher experience on MVA. Conclusion Though the proportion of graduates who had ever used MVA was still low in 2012, a positive change from that in 2010 was observed. Medical schools outside Bangkok and vicinity provided more opportunities for learning MVA. It is recommended that medical schools, especially in Bangkok and vicinity should provide more MVA learning opportunities for students. Adequate training and regular hands-on MVA practice should be incorporated into a wide range of clinical practice. PMID:24025699

Factors Influencing Choice of Medical Specialty of Preresidency Medical Graduates in Southeastern Nigeria

PubMed Central

Eze, Boniface Ikenna; Okoye, Onochie Ike; Maduka-Okafor, Ferdinand Chinedu; Aguwa, Emmanuel Nwabueze

2011-01-01

Background This study examined the determinants of specialty choice of preresidency medical graduates in southeastern Nigeria. Methods We used a comparative cross-sectional survey of preresidency medical graduates who took the Basic Sciences Examination of the Postgraduate Medical College in Enugu, southeastern Nigeria, in March 2007. Data on participants' demographics and specialty selected, the timing of the decision, and factors in specialty selection were collected using a questionnaire. Data were examined using descriptive and analytical statistics. P < .05 was considered significant. Results The survey response rate was 90.8% (287 of 316). The sample included 219 men and 68 women, ranging in age from 24 to 53 years and with a mean age of 33.5 ± 1.1 (SD) years. Career choice was more frequently influenced by personal interest (66.6%), career prospects (9.1%), and appraisal of own skills/aptitudes (5.6%), and it was least affected by altruistic motives (1.7%) and influence of parents/relations (1.7%). The respondents selected specialties at different rates: obstetrics and gynecology (22.6%), surgery (19.6%), pediatrics (16.0%), anesthesiology (3.1%), psychiatry (0.3%), and dentistry (0.0%). Most (97.2%) participants had decided on specialty choice by the end of their fifth (of a total 16 years) postgraduate year. The participants significantly more frequently preferred surgery and pediatrics to other disciplines (P < .002, after Bonferroni correction for multiple comparisons). Conclusions Preresidency medical graduates in southeastern Nigeria were influenced by personal interest, career prospects, and personal skills/aptitude in deciding which specialty training to pursue. The most frequently chosen specialties were surgery and pediatrics. These findings have implications for Nigeria's education and health care policy makers. PMID:22942964

The need for a comprehensive medication safety module in medical education.

PubMed

Chandy, Sujith John

2016-10-01

A rising number of medicines and minimal emphasis on rational prescribing in the medical curriculum may compromise medication safety. There is no focused module in the curriculum dealing with factors affecting safety such as quality, medicines management, rational use, and approach to adverse effects. Creating awareness of these issues would hopefully plant a seed of safe prescribing and encourage pharmacovigilance. A study was therefore done to determine the need for such a module. A quasi-experimental pre-post module study. Medical students ( n = 88) completing pharmacology term were recruited after informed consent. A questionnaire containing 20 questions on various themes was administered and scored. Subsequently a module was developed and relevant safety themes taught to the students. After one month, the questionnaire was re-administered. The pre module score was 9.52/20. Knowledge about the various themes, adverse effects, medication management, quality issues and rational use were similar though poor knowledge was evident in specific areas such as clinical trials, look alike-sound alike medicines (LASA) and medicine storage. The post module score was 12.24/20. The improvement of score was statistically significant suggesting the effectiveness of the module. The relatively poor knowledge and improvement with a specific educational module emphasizes the need of such a module within the medical curriculum to encourage safe use of medicines by Indian Medical Graduates (IMG). It is hoped that the policy makers in medical education will introduce such a module within the medical curriculum.

Training-related harassment and drinking outcomes in medical residents versus graduate students.

PubMed

Shinsako, S A; Richman, J A; Rospenda, K M

2001-12-01

This study examined the prevalence of sexual harassment and generalized workplace abuse, and their differential effects on drinking behaviors in medical residents and graduate students at an urban American university. While medical residents had greater odds of experiencing harassment and abuse in their training programs, it was found that in most cases their deleterious drinking behaviors decreased, whereas graduate student drinking behaviors increased as a consequence of these experiences. The drinking outcomes of men were more affected by harassment and abuse than those of women.

Admission factors associated with international medical graduate certification success: a collaborative retrospective review of postgraduate medical education programs in Ontario.

PubMed

Grierson, Lawrence E M; Mercuri, Mathew; Brailovsky, Carlos; Cole, Gary; Abrahams, Caroline; Archibald, Douglas; Bandiera, Glen; Phillips, Susan P; Stirrett, Glenna; Walton, J Mark; Wong, Eric; Schabort, Inge

2017-11-24

The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates. We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations. International medical graduates who entered an Ontario residency program between 2005 and 2012 and had written a certification examination by the time of the analysis (2015) were included in the study. Data available at the time of admission for each resident, including demographic characteristics, previous experiences and previous professional experiences, were collected from each of the 6 Ontario medical schools and matched with certification examination results provided by The CFPC and the RCPSC. We developed logistic regression models to determine the association of each factor with success on the examinations. Data for 900 residents were analyzed. The models revealed resident age to be strongly associated with performance across all examinations. Fluency in English, female sex and the Human Development Index value associated with the country of medical school training had differential associations across the examinations. The findings should contribute to an improved understanding of certification success by international medical graduates, help residency programs identify at-risk residents and underpin the development of specific educational and remedial interventions. In considering the results, it should be kept in mind that some variables are not amenable to changes in selection criteria. Copyright 2017, Joule Inc. or its licensors.

Valued experiences of graduate students in their role as educators in undergraduate training in Ugandan medical schools.

PubMed

Rukundo, Godfrey Zari; Kasozi, Jannat; Burani, Aluonzi; Byona, Wycliff; Kirimuhuzya, Claude; Kiguli, Sarah

2017-11-25

In most medical schools, graduate students, sometimes referred to as graduate teaching assistants, often participate in the training of undergraduate students. In developing countries like Uganda, are typically involved in undergraduate training. However, prior to this study there were no standard guidelines for this involvement. At the same time, the views and experiences of the graduate students in their role as educators had not been documented. Therefore, the aim of this study was to explore the views and experiences of graduate students about their involvement in undergraduate training in three Ugandan medical schools. The findings of this study will contribute to the development of policies for training in Ugandan medical schools. This was a qualitative study in which thirty in-depth-interviews were conducted among second and third year graduate students in three Ugandan medical schools in the MESAU consortium (Medical Education Services to all Ugandans) including Mbarara University of Science and Technology, Makerere College of Health Sciences and Kampala International University, Western Campus. All graduate students from all the three medical schools viewed their involvement in undergraduate training as important. The study also revealed that graduate students increase available human resources and often compensate for the teaching missed when senior educators were absent. The graduate students expressed important views that need to be considered in the design of educational programs where they are to be involved. The respondents also reported a number of challenges in this undertaking that included lack of motivation, lack of orientation and having heavy workloads. The presence and commitment of senior educators to guide and support the graduate students in teaching activities was viewed as one significant intervention that would increase the effectiveness of their educational contributions. Graduate students enjoy their involvement in the training of

Assessing curriculum effectiveness: a survey of Uniformed Services University medical school graduates.

PubMed

Picho, Katherine; Gilliland, William R; Artino, Anthony R; DeZee, Kent J; Dong, Ting; McManigle, John E; Cruess, David F; Durning, Steven J

2015-04-01

This study assessed alumni perceptions of their preparedness for clinical practice using the Accreditation Council for Graduate Medical Education (ACGME) competencies. We hypothesized that our alumni's perception of preparedness would be highest for military-unique practice and professionalism and lowest for system-based practice and practice-based learning and improvement. 1,189 alumni who graduated from the Uniformed Services University (USU) between 1980 and 2001 completed a survey modeled to assess the ACGME competencies on a 5-point, Likert-type scale. Specifically, self-reports of competencies related to patient care, communication and interpersonal skills, medical knowledge, professionalism, systems-based practice, practice-based learning and improvement, and military-unique practice were evaluated. Consistent with our expectations as the nation's military medical school, our graduates were most confident in their preparedness for military-unique practice, which included items assessing military leadership (M = 4.30, SD = 0.65). USU graduates also indicated being well prepared for the challenges of residency education in the domain of professionalism (M = 4.02, SD = 0.72). Self-reports were also high for competencies related to patient care (M = 3.86, SD = 0.68), communication and interpersonal skills (M = 3.88, SD = 0.66), and medical knowledge (M = 3.78, SD = 0.73). Consistent with expectations, systems-based practice (M = 3.50, SD = 0.70) and practice-based learning and improvement (M = 3.57, SD = 0.62) were the lowest rated competencies, although self-reported preparedness was still quite high. Our findings suggest that, from the perspective of our graduates, USU is providing both an effective military-unique curriculum and is preparing trainees for residency training. Further, these results support the notion that graduates are prepared to lead and to practice medicine in austere environments. Compared to other competencies that were assessed, self

IMG-ABC: new features for bacterial secondary metabolism analysis and targeted biosynthetic gene cluster discovery in thousands of microbial genomes

DOE PAGES

Hadjithomas, Michalis; Chen, I-Min A.; Chu, Ken; ...

2016-11-29

Secondary metabolites produced by microbes have diverse biological functions, which makes them a great potential source of biotechnologically relevant compounds with antimicrobial, anti-cancer and other activities. The proteins needed to synthesize these natural products are often encoded by clusters of co-located genes called biosynthetic gene clusters (BCs). In order to advance the exploration of microbial secondary metabolism, we developed the largest publically available database of experimentally verified and predicted BCs, the Integrated Microbial Genomes Atlas of Biosynthetic gene Clusters (IMG-ABC) (https://img.jgi.doe.gov/abc/). Here, we describe an update of IMG-ABC, which includes ClusterScout, a tool for targeted identification of custom biosynthetic genemore » clusters across 40 000 isolate microbial genomes, and a new search capability to query more than 700 000 BCs from isolate genomes for clusters with similar Pfam composition. Additional features enable fast exploration and analysis of BCs through two new interactive visualization features, a BC function heatmap and a BC similarity network graph. These new tools and features add to the value of IMG-ABC's vast body of BC data, facilitating their in-depth analysis and accelerating secondary metabolite discovery.« less

IMG-ABC: new features for bacterial secondary metabolism analysis and targeted biosynthetic gene cluster discovery in thousands of microbial genomes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hadjithomas, Michalis; Chen, I-Min A.; Chu, Ken

Secondary metabolites produced by microbes have diverse biological functions, which makes them a great potential source of biotechnologically relevant compounds with antimicrobial, anti-cancer and other activities. The proteins needed to synthesize these natural products are often encoded by clusters of co-located genes called biosynthetic gene clusters (BCs). In order to advance the exploration of microbial secondary metabolism, we developed the largest publically available database of experimentally verified and predicted BCs, the Integrated Microbial Genomes Atlas of Biosynthetic gene Clusters (IMG-ABC) (https://img.jgi.doe.gov/abc/). Here, we describe an update of IMG-ABC, which includes ClusterScout, a tool for targeted identification of custom biosynthetic genemore » clusters across 40 000 isolate microbial genomes, and a new search capability to query more than 700 000 BCs from isolate genomes for clusters with similar Pfam composition. Additional features enable fast exploration and analysis of BCs through two new interactive visualization features, a BC function heatmap and a BC similarity network graph. These new tools and features add to the value of IMG-ABC's vast body of BC data, facilitating their in-depth analysis and accelerating secondary metabolite discovery.« less

Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula.

PubMed

Schlett, Christopher L; Doll, Hinnerk; Dahmen, Janosch; Polacsek, Ole; Federkeil, Gero; Fischer, Martin R; Bamberg, Fabian; Butzlaff, Martin

2010-01-14

Problem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula. Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p < 0.001), except for "Medical knowledge" and "Research competence". Comparing competencies required at work and taught in medical school, PBL was associated with benefits in "Interdisciplinary thinking" (Delta + 0.88), "Independent learning/working" (Delta + 0.57), "Psycho-social competence" (Delta + 0.56), "Teamwork" (Delta + 0.39) and "Problem-solving skills" (Delta + 0.36), whereas "Research competence" (Delta--1.23) and "Business competence" (Delta--1.44) in the PBL-based curriculum needed improvement. Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development.

A pre-admission program for underrepresented minority and disadvantaged students: application, acceptance, graduation rates and timeliness of graduating from medical school.

PubMed

Strayhorn, G

2000-04-01

To determine whether students' performances in a pre-admission program predicted whether participants would (1) apply to medical school, (2) get accepted, and (3) graduate. Using prospectively collected data from participants in the University of North Carolina at Chapel Hill's Medical Education Development Program (MEDP) and data from the Association of American Colleges Student and Applicant Information Management System, the author identified 371 underrepresented minority (URM) students who were full-time participants and completed the program between 1984 and 1989, prior to their acceptance into medical school. Logistic regression analysis was used to determine whether MEDP performance significantly predicted (after statistically controlling for traditional predictors of these outcomes) the proportions of URM participants who applied to medical school and were accepted, the timeliness of graduating, and the proportion graduating. Odds ratios with 95% confidence intervals were calculated to determine the associations between the independent and outcome variables. In separate logistic regression models, MEDP performance predicted the study's outcomes after statistically controlling for traditional predictors with 95% confidence intervals. Pre-admission programs with similar outcomes can improve the diversity of the physician workforce and the access to health care for underrepresented minority and economically disadvantaged populations.

Specialty Choices of Kuwaiti Medical Graduates during the Last Three Decades

ERIC Educational Resources Information Center

Al-Jarallah, Khaled F.; Moussa, Mohamed A. A.

2003-01-01

Introduction: This study examined postgraduate specialty training of Kuwaiti medical graduates during 1968 to 1999 and identified their attained professional qualifications to reveal scarcity in some specialties. Method: A survey was carried out involving review of the records maintained at the Kuwait Institute for Medical Specialization (KIMS)…

Female military medical school graduates entering surgical internships: are we keeping up with national trends?

PubMed

Vertrees, Amy; Laferriere, Nicole; Elster, Eric; Shriver, Craig D; Rich, Norman M

2014-10-01

Ratios of women graduating from the only US military medical school and entering surgical internships were reviewed and compared with national trends. Data were obtained from the Uniformed Services University of the Health Sciences graduation announcements from 2002 to 2012. There were 1,771 graduates from 2002 to 2012, with 508 female (29%) and 1,263 male (71%) graduates. Female graduates increased over time (21% to 39%; P = .014). Female general surgery interns increased from 3.9% to 39% (P = .025). Female overall surgical subspecialty interns increased from 20% in 2002 to 36% in 2012 (P = .046). Women were represented well in obstetrics (57%), urology (44%), and otolaryngology (31%), but not in neurosurgery, orthopedics, and ophthalmology (0% to 20%). The sex disparity between military and civilian medical students occurs before entry. Once in medical school, women are just as likely to enter general surgery or surgical subspecialty as their male counterparts. Increased ratio of women in the class is unlikely to lead to a shortfall except in specific subspecialties. Published by Elsevier Inc.

Gamification as a tool for enhancing graduate medical education.

PubMed

Nevin, Christa R; Westfall, Andrew O; Rodriguez, J Martin; Dempsey, Donald M; Cherrington, Andrea; Roy, Brita; Patel, Mukesh; Willig, James H

2014-12-01

The last decade has seen many changes in graduate medical education training in the USA, most notably the implementation of duty hour standards for residents by the Accreditation Council of Graduate Medical Education. As educators are left to balance more limited time available between patient care and resident education, new methods to augment traditional graduate medical education are needed. To assess acceptance and use of a novel gamification-based medical knowledge software among internal medicine residents and to determine retention of information presented to participants by this medical knowledge software. We designed and developed software using principles of gamification to deliver a web-based medical knowledge competition among internal medicine residents at the University of Alabama (UA) at Birmingham and UA at Huntsville in 2012-2013. Residents participated individually and in teams. Participants accessed daily questions and tracked their online leaderboard competition scores through any internet-enabled device. We completed focus groups to assess participant acceptance and analysed software use, retention of knowledge and factors associated with loss of participants (attrition). Acceptance: In focus groups, residents (n=17) reported leaderboards were the most important motivator of participation. Use: 16 427 questions were completed: 28.8% on Saturdays/Sundays, 53.1% between 17:00 and 08:00. Retention of knowledge: 1046 paired responses (for repeated questions) were collected. Correct responses increased by 11.9% (p<0.0001) on retest. Differences per time since question introduction, trainee level and style of play were observed. Attrition: In ordinal regression analyses, completing more questions (0.80 per 10% increase; 0.70 to 0.93) decreased, while postgraduate year 3 class (4.25; 1.44 to 12.55) and non-daily play (4.51; 1.50 to 13.58) increased odds of attrition. Our software-enabled, gamification-based educational intervention was well accepted

Job requirements compared to medical school education: differences between graduates from problem-based learning and conventional curricula

PubMed Central

2010-01-01

Background Problem-based Learning (PBL) has been suggested as a key educational method of knowledge acquisition to improve medical education. We sought to evaluate the differences in medical school education between graduates from PBL-based and conventional curricula and to what extent these curricula fit job requirements. Methods Graduates from all German medical schools who graduated between 1996 and 2002 were eligible for this study. Graduates self-assessed nine competencies as required at their day-to-day work and as taught in medical school on a 6-point Likert scale. Results were compared between graduates from a PBL-based curriculum (University Witten/Herdecke) and conventional curricula. Results Three schools were excluded because of low response rates. Baseline demographics between graduates of the PBL-based curriculum (n = 101, 49% female) and the conventional curricula (n = 4720, 49% female) were similar. No major differences were observed regarding job requirements with priorities for "Independent learning/working" and "Practical medical skills". All competencies were rated to be better taught in PBL-based curriculum compared to the conventional curricula (all p < 0.001), except for "Medical knowledge" and "Research competence". Comparing competencies required at work and taught in medical school, PBL was associated with benefits in "Interdisciplinary thinking" (Δ + 0.88), "Independent learning/working" (Δ + 0.57), "Psycho-social competence" (Δ + 0.56), "Teamwork" (Δ + 0.39) and "Problem-solving skills" (Δ + 0.36), whereas "Research competence" (Δ - 1.23) and "Business competence" (Δ - 1.44) in the PBL-based curriculum needed improvement. Conclusion Among medical graduates in Germany, PBL demonstrated benefits with regard to competencies which were highly required in the job of physicians. Research and business competence deserve closer attention in future curricular development. PMID:20074350

Ego identity development in physicians: a cross-cultural comparison using a mixed method approach.

PubMed

Beran, Tanya N; Violato, Efrem; Faremo, Sonia; Violato, Claudio; Watt, David; Lake, Deidre

2012-05-23

The purpose of this study was to examine the career decision-making process of International Medical Graduates (IMGs). There are two main types of IMGs who apply for licensure in Canada. Canadian International Medical Graduates (CIMGs) were Canadian citizens before leaving to study medicine in a foreign country, in comparison to those non-CIMGs who had studied medicine in a foreign country before immigrating to Canada. Given that their motivations for becoming a doctor in Canada may differ, it is important to examine how they decided to become a doctor for each group separately. A total of 46 IMGs participated in a semi-structured interview - 20 were CIMGs and 26 were non-CIMGs. An iterative process of content analysis was conducted to categorize responses from five open-ended questions according to the Ego Identity Statuses theory of career decision-making. Event contingency analysis identified a significant difference between CIMGs and non-CIMGs, Fisher's exact test (1) = 18.79, p < .0001. A total of 55% of CIMGs were categorized as identity achieved and 45% as foreclosed; 100% of non-CIMGs were classified as identity foreclosed. About half of the Canadian citizens who had studied medicine in a foreign country had explored different careers before making a commitment to medicine, and half had not. No IMGs, however, who studied medicine in another country before immigrating to Canada, had explored various career opportunities before selecting medicine.

Ego identity development in physicians: a cross-cultural comparison using a mixed method approach

PubMed Central

2012-01-01

Background The purpose of this study was to examine the career decision-making process of International Medical Graduates (IMGs). There are two main types of IMGs who apply for licensure in Canada. Canadian International Medical Graduates (CIMGs) were Canadian citizens before leaving to study medicine in a foreign country, in comparison to those non-CIMGs who had studied medicine in a foreign country before immigrating to Canada. Given that their motivations for becoming a doctor in Canada may differ, it is important to examine how they decided to become a doctor for each group separately. Methods A total of 46 IMGs participated in a semi-structured interview - 20 were CIMGs and 26 were non-CIMGs. Results An iterative process of content analysis was conducted to categorize responses from five open-ended questions according to the Ego Identity Statuses theory of career decision-making. Event contingency analysis identified a significant difference between CIMGs and non-CIMGs, Fisher’s exact test (1) = 18.79, p < .0001. A total of 55% of CIMGs were categorized as identity achieved and 45% as foreclosed; 100% of non-CIMGs were classified as identity foreclosed. Conclusion About half of the Canadian citizens who had studied medicine in a foreign country had explored different careers before making a commitment to medicine, and half had not. No IMGs, however, who studied medicine in another country before immigrating to Canada, had explored various career opportunities before selecting medicine. PMID:22620975

The circle game: understanding physician migration patterns within Canada.

PubMed

Dauphinee, W Dale

2006-12-01

This report explores the movement of physicians to, from, and within Canada and identifies recurring patterns of migration. The primary position of the report is that physician movement is part of reality both internationally and within Canada, and that movement of Canadian-trained physicians creates a need for international medical graduates (IMGs) in "physician-losing" locations. The report's argument is based on data retrieved from public sources on aggregate physician practice patterns in Canada and analyzed for migration patterns. In addition, literature was reviewed on factors affecting the migration patterns being described.Canadian-educated physicians have tended to move from less prosperous to more prosperous provinces and from rural to urban areas; because of the resulting need, the physician-losing locales generally have the highest proportions of IMGs. Physicians traditionally have tended to emigrate from Canada to the United States, thus increasing Canadian demand for IMGs, but recently this movement has slowed and even reversed. In Canada, liberalized immigration policies for physicians combined with a shortage of postgraduate training positions to create a serious bottleneck early in the current decade. However, this problem is now being resolved. In summary, physician migration within Canada shows specific long-term patterns, and IMGs will be needed in underserved areas for years to come. Well-informed policies for workforce management are essential in Canada to ensure an adequate physician supply consisting mainly of Canadian-educated physicians but also including IMGs. A role for nonadvocacy groups such as the Educational Commission for Foreign Medical Graduates may be to help ensure that recruitment of physicians from developing countries follows accepted ethical principles.

75 FR 34464 - Council on Graduate Medical Education; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration Council on Graduate Medical Education; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Medical Education (COGME). Dates and Times: July 13, 2010, 12 p.m.-2 p.m. EST. Place: This meeting will be...

Specialising in radiology in Switzerland: still attractive for medical school graduates?

PubMed

Buddeberg-Fischer, B; Hoffmann, A; Christen, S; Weishaupt, D; Kubik-Huch, R A

2012-07-01

To gain insight into the professional characteristics of radiologists in Switzerland and to determine how to enhance the attractiveness of radiology to medical graduates as a specialty. Data from 262 members of the Swiss Society of Radiology (m:f = 76:24%) obtained in a questionnaire survey were analysed regarding socio-demographic variables, working status, specialty, main fields of interest, career success, mentoring and reasons for the shortage of radiologists. 35 (56.4%) female and 85 (45.5%) male radiologists were aged ≤ 45 years. 228 (87%) were board-certified; 44 (17.9%) had completed a sub-specialisation. Men worked part-time mostly just before retirement, while women worked part-time at a younger age. As reasons for specialty choice, the wide range of clinical work and the combination of technology and medicine were ranked highest. Women reported significantly less career success and support. To improve the attractiveness of radiology to graduates, radiology should be visible on medical school curricula. In Switzerland, more female radiologists work part-time than male ones, and there is less career success and support for women. In order to make radiology more attractive to medical graduates as a specialty, structured residency programmes and reliable gender-respecting career support are needed. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

IMG-ABC: new features for bacterial secondary metabolism analysis and targeted biosynthetic gene cluster discovery in thousands of microbial genomes.

PubMed

Hadjithomas, Michalis; Chen, I-Min A; Chu, Ken; Huang, Jinghua; Ratner, Anna; Palaniappan, Krishna; Andersen, Evan; Markowitz, Victor; Kyrpides, Nikos C; Ivanova, Natalia N

2017-01-04

Secondary metabolites produced by microbes have diverse biological functions, which makes them a great potential source of biotechnologically relevant compounds with antimicrobial, anti-cancer and other activities. The proteins needed to synthesize these natural products are often encoded by clusters of co-located genes called biosynthetic gene clusters (BCs). In order to advance the exploration of microbial secondary metabolism, we developed the largest publically available database of experimentally verified and predicted BCs, the Integrated Microbial Genomes Atlas of Biosynthetic gene Clusters (IMG-ABC) (https://img.jgi.doe.gov/abc/). Here, we describe an update of IMG-ABC, which includes ClusterScout, a tool for targeted identification of custom biosynthetic gene clusters across 40 000 isolate microbial genomes, and a new search capability to query more than 700 000 BCs from isolate genomes for clusters with similar Pfam composition. Additional features enable fast exploration and analysis of BCs through two new interactive visualization features, a BC function heatmap and a BC similarity network graph. These new tools and features add to the value of IMG-ABC's vast body of BC data, facilitating their in-depth analysis and accelerating secondary metabolite discovery. © The Author(s) 2016. Published by Oxford University Press on behalf of Nucleic Acids Research.

77 FR 38071 - Council on Graduate Medical Education; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... graduate medical education, evaluation of teaching programs especially in terms of meeting community needs...' development of performance measures and methods of longitudinal evaluation specific to the training programs...

78 FR 27407 - Council on Graduate Medical Education; Notice of Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-10

... Graduate Medical Education; Notice of Meeting In accordance with section 10(a)(2) of the Federal Advisory... Medical Education (COGME). Date and Time: May 30, 2013, 10:00 a.m.-5:00 p.m. Eastern Time. Place: Webinar... Education provides advice and recommendations to the Secretary of the Department of Health and Human...

Funding of Graduate Medical Education in a Market-Based Healthcare System.

PubMed

Schuster, Barbara L

2017-02-01

The graduate medical education (GME) process in the United States is considered the most respected model for high-quality education of graduate physicians in the world. With substantial funding through government and private insurers and through structured educational accreditation standards, the American Board of Medical Specialists-certified physicians are recognized for their expertise in delivering high-quality medical care. However, under fiscal constraints and changing social expectations, questions are continually posed about the process of funding and whether the "physician outcomes" are sufficient to continue with the investment. This article reviews the history of postgraduate physician education, the multiple funding pathways, disruptions to a placid educational system and changing social expectations. The ultimate issues involve the core goals of GME and how much GME should shoulder responsibility for changing the healthcare system. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Physicians' exodus: why medical graduates leave Austria or do not work in clinical practice.

PubMed

Scharer, Sebastian; Freitag, Andreas

2015-05-01

Austria has the highest number of medical graduates of all Organisation for Economic Co-operation and Development (OECD) countries in relation to its population size, but over 30% choose not to pursue a career as physicians in the country. This article describes under- and postgraduate medical education in Austria and analyses reasons for the exodus of physicians. In Austria, medicine is a 5- or 6-year degree offered at four public and two private medical schools. Medical graduates have to complete training in general medicine or a speciality to attain a licence to practice. While not compulsory for speciality training, board certification in general medicine has often been regarded as a prerequisite for access to speciality training posts. Unstructured postgraduate training curricula, large amounts of administrative tasks, low basic salaries and long working hours present for incentives for medical graduates to move abroad or to work in a non-clinical setting. The scope of current reforms, such as the establishment of a new medical faculty and the implementation of a common trunk, is possibly insufficient in addressing the issue. Extensive reforms regarding occupational conditions and the structure of postgraduate medical education are necessary to avoid a further exodus of junior doctors.

The state of pediatrics residency training: a period of transformation of graduate medical education.

PubMed

Sectish, Theodore C; Zalneraitis, Edwin L; Carraccio, Carol; Behrman, Richard E

2004-09-01

Graduate medical education is in a period of transformation. This article reviews the state of pediatrics residency training by summarizing the changing demographics within training programs, examining the new educational paradigm with an emphasis on competency-based education and continuous professional development, and describing forces influencing the workplace and the focus on work-life balance. Strategies are suggested for leaders in graduate medical education to meet the challenges experienced during this period of transformation.

Critical factors in career decision making for women medical graduates.

PubMed

Lawrence, Joanna; Poole, Phillippa; Diener, Scott

2003-04-01

Within the next 30 years there will be equal numbers of women and men in the medical workforce. Indications are that women are increasing their participation in specialties other than general practice, although at a slower rate than their participation in the workforce as a whole. To inform those involved in training and employment of medical women, this study investigated the influencing factors in career decision making for female medical graduates. A total of 305 women medical graduates from the University of Auckland responded to a mail survey (73% response rate) which examined influences on decision making, in both qualitative and quantitative ways, as part of a larger survey. Most women were satisfied with their careers. The principal component analysis of the influencing factors identified four distinct factors important in career choice - interest, flexibility, women friendliness and job security, although the first two of these were rated more highly than the others. Barriers to full participation by medical women in training and employment need to be systematically examined and removed. This is not only to allow women themselves to reach their full potential, but for workforce and socio-economic reasons. Initiatives that allow and value more flexible training and work practices, particularly through the years of child raising, are necessary for women and the health care workforce at large.

State of the Plastic Surgery Workforce and the Impact of Graduate Medical Education Reform on Training of Plastic Surgeons.

PubMed

Janes, Lindsay; Lanier, Steven T; Evans, Gregory R D; Kasten, Steven J; Hume, Keith M; Gosain, Arun K

2017-08-01

Although recent estimates predict a large impending shortage of plastic surgeons, graduate medical education funding through the Centers for Medicare and Medicaid Services remains capped by the 1997 Balanced Budget Act. The authors' aim was to develop a plan to stimulate legislative action. The authors reviewed responses of the American Society of Plastic Surgeons, American College of Surgeons, and American Medical Association from January of 2015 to a House Energy & Commerce Committee request for input on graduate medical education funding. In addition, all program directors in plastic surgery were surveyed through the American Council of Academic Plastic Surgeons to determine their graduate medical education funding sources. All three organizations agree that current graduate medical education funding is inadequate to meet workforce needs, and this has a significant impact on specialty selection and distribution for residency training. All agreed that funding should be tied to the resident rather than to the institution, but disagreed on whether funds should be divided between direct (allocated to residency training) and indirect (allocated to patient care) pools, as is currently practiced. Program directors' survey responses indicated that only 38 percent of graduate medical education funds comes from the Centers for Medicare and Medicaid Services. Organized medicine is at risk of losing critically needed graduate medical education funding. Specific legislation to support additional graduate medical education positions and funding (House Resolutions 1180 and 4282) has been proposed but has not been universally endorsed, in part because of a lack of collaboration in organized medicine. Collaboration among major organizations can reinvigorate these measures and implement real change in funding.

International Medical Graduates: Learning for Practice in Alberta, Canada

ERIC Educational Resources Information Center

Lockyer, Jocelyn; Hofmeister, Marianna; Crutcher, Rodney; Klein, Douglas; Fidler, Herta

2007-01-01

Introduction: There is little known about the learning that is undertaken by physicians who graduate from a World Health Organization-listed medical school outside Canada and who migrate to Canada to practice. What do physicians learn and what resources do they access in adapting to practice in Alberta, a province of Canada? Methods: Telephone…

Proposing a Model of Co-Regulated Learning for Graduate Medical Education.

PubMed

Rich, Jessica V

2017-08-01

Primarily grounded in Zimmerman's social cognitive model of self-regulation, graduate medical education is guided by principles that self-regulated learning takes place within social context and influence, and that the social context and physical environment reciprocally influence persons and their cognition, behavior, and development. However, contemporary perspectives on self-regulation are moving beyond Zimmerman's triadic reciprocal orientation to models that consider social transactions as the central core of regulated learning. Such co-regulated learning models emphasize shared control of learning and the role more advanced others play in scaffolding novices' metacognitive engagement.Models of co-regulated learning describe social transactions as periods of distributed regulation among individuals, which instrumentally promote or inhibit the capacity for individuals to independently self-regulate. Social transactions with other regulators, including attending physicians, more experienced residents, and allied health care professionals, are known to mediate residents' learning and to support or hamper the development of their self-regulated learning competence. Given that social transactions are at the heart of learning-oriented assessment and entrustment decisions, an appreciation for co-regulated learning is likely important for advancing medical education research and practice-especially given the momentum of new innovations such as entrustable professional activities.In this article, the author explains why graduate medical educators should consider adopting a model of co-regulated learning to complement and extend Zimmerman's models of self-regulated learning. In doing so, the author suggests a model of co-regulated learning and provides practical examples of how the model is relevant to graduate medical education research and practice.

Integration of international medical graduates in u.s. Psychiatry: the role of acculturation and social support.

PubMed

Atri, Ashutosh; Matorin, Anu; Ruiz, Pedro

2011-01-01

the authors investigated whether social support and acculturation could predict the mental health of international medical graduates pursuing psychiatric residencies in the United States. a 55-item online survey was assembled by combining three validated instruments for mental health, social support, and acculturation. A link to the survey was e-mailed to training directors of all psychiatric residency and fellowship programs. Directors were requested to forward the survey to their international medical graduate residents for completion between December 2008 and February 2009. one hundred eight international medical graduates from 70 different psychiatric residencies and fellowships completed the entire survey. Respondents' mental health scores were normally distributed. The vast majority scored very high on survey items related to mental health. Acculturation, social support, and postgraduate training year were significant predictors of mental health. residency training programs should attempt to incorporate measures that would help boost the social support and acculturation of international medical graduates (especially junior-level trainees). Acculturation could be improved by language training and courses in American history, culture, and customs, and social support could be expanded by mentoring relationships.

Singapore's proposed graduate medical school--an expensive medical tutorial college or an opportunity for transforming Singapore medicine?

PubMed

Soo, K C

2005-07-01

The proposed Graduate Medical School at the Outram Campus will open in 2007. The main value of this medical school is the transformation of the medical institutions in the campus and SingHealth into Academic Medical Centres. Such centres will train and host quality physicians and physician-scientists. It will help push the development of translational research, complementing the country's investment in Biopolis. It will also underpin Singapore's push into regional medical tourism and its development as an educational hub in the biomedical sciences.

The Time Is Now: Using Graduates' Practice Data to Drive Medical Education Reform.

PubMed

Triola, Marc M; Hawkins, Richard E; Skochelak, Susan E

2018-06-01

Medical educators are not yet taking full advantage of the publicly available clinical practice data published by federal, state, and local governments, which can be attributed to individual physicians and evaluated in the context of where they attended medical school and residency training. Understanding how graduates fare in actual practice, both in terms of the quality of the care they provide and the clinical challenges they face, can aid educators in taking an evidence-based approach to medical education. Although in their infancy, efforts to link clinical outcomes data to educational process data hold the potential to accelerate medical education research and innovation. This approach will enable unprecedented insight into the long-term impact of each stage of medical education on graduates' future practice. More work is needed to determine best practices, but the barrier to using these public data is low, and the potential for early results is immediate. Using practice data to evaluate medical education programs can transform how the future physician workforce is trained and better align continuously learning medical education and health care systems.

Socioeconomic Characteristics and Motivations for Entering a Medical College--Differences between Graduate and Undergraduate Saudi Medical Students

ERIC Educational Resources Information Center

AL-Jahdali, Hamdan; Alqarni, Turki; AL-Jahdali, Sarah; Baharoon, Salim A.; AL-Harbi, Abdullah S.; Binsalih, Salih A.; Alshimemeri, Abdulah; Al Sayyari, Abdullah A.

2014-01-01

Objective: The aim of this study is to investigate the reasons for and the factors associated with deciding to enter a medical school in our graduate and undergraduate medical students and whether differ between the two groups. Method: This is a cross-sectional study. The survey we developed to investigate demographic and socioeconomic data and…

The road to an academic medicine career: a national cohort study of male and female U.S. medical graduates.

PubMed

Andriole, Dorothy A; Jeffe, Donna B

2012-12-01

To explore the relationship between gender and full-time faculty appointment in a national cohort of contemporary U.S. medical school graduates. The authors analyzed deidentified, individual records for the 1998-2004 national cohort of U.S. medical graduates using multivariate logistic regression to identify predictors of full-time faculty appointment through July 2009. They reported adjusted odds ratios (aOR) significant at P < .05. Of 66,889 graduates, 12,038 (18.0%) had held full-time faculty appointments. Among all graduates, women (aOR = 1.21) were more likely than men to have held faculty appointments. Among only male graduates, those who participated in research during college (aOR = 1.08), who entered medical school with greater planned career involvement in research (aOR = 1.08), and who authored/coauthored a research paper during medical school (aOR = 1.12) were more likely, and those with higher debt were less likely (aOR = 0.96), to have held faculty appointments. Among only faculty appointees, higher proportions of men than women had participated in medical school research electives (63.5% [3,899/6,138] versus 54.2% [3,197/5,900]; P < .001) and authored/coauthored research papers during medical school (44.1% [2,707/6,138] versus 33.6% [1,981/5,900]; P < .001); female faculty had reported higher debt at medical school graduation than had male faculty (P = .014). In this national cohort of U.S. medical graduates, women were more likely than men to have held full-time faculty appointments. However, male and female faculty appointees entered academic medicine with different research experiences and debt, possibly impacting their academic medicine career trajectories.

Preferred practice location at medical school commencement strongly determines graduates' rural preferences and work locations.

PubMed

Herd, Marie S; Bulsara, Max K; Jones, Michael P; Mak, Donna B

2017-02-01

To identify factors influencing whether Australian medical graduates prefer to, or actually, work rurally. Secondary analysis of longitudinal data from Medical Schools Outcomes Database (MSOD) using univariate and multivariate logistic regression. Twenty Australian medical schools. Australian or New Zealand citizens and Australian permanent residents who completed MSOD questionnaires between 2006 and 2013. Preferred and actual work locations 1 (PGY1) and 3 (PGY3) years postgraduation. Of 20 784 participants, 4028 completed a PGY1 or PGY3 questionnaire. Self-reported preference for rural practice location at medical school commencement was the most consistent independent predictor of whether a graduate would have a rural location preference at PGY1 (odds ratio (OR) 6.07, 95% confidence interval (CI) 4.91-7.51) and PGY3 (OR 7.95, 95% CI 4.93-12.84), and work rurally during PGY1 (OR 1.38, 95% CI 1.01-1.88) and PGY3 (OR 1.86, 95% CI 1.30-2.64). The effect of preferred practice location at medical school commencement is independent of, and enhances the effect of, rural background. Graduates of graduate-entry programs or with dependent children were less likely to have worked rurally during PGY1 and PGY3 respectively. The most consistent factor associated with rural preferences and work location was students' preferred location of practice at medical school commencement; this association is independent of, and enhances the effect of, rural background. Better understanding of what determines rural preference at medical school commencement and its influence on rural workplace outcomes beyond PGY3 is required to inform Australian medical school selection policies and rural health curricula. © 2016 National Rural Health Alliance Inc.

Performances of U.S. Osteopathic and Canadian Medical School Graduates on the American Board of Internal Medicine Certifying Examinations, 1984-1988.

ERIC Educational Resources Information Center

Shea, Judy A.; And Others

1990-01-01

A study compared the 1984-88 test performances of United States osteopathic medical school graduates and Canadian medical school graduates with those of U.S. and foreign medical school graduates during the same period. Findings, limitations, and implications for recruitment and training of internal medicine specialists are discussed. (Author/MSE)

Advancing Resident Assessment in Graduate Medical Education

PubMed Central

Swing, Susan R.; Clyman, Stephen G.; Holmboe, Eric S.; Williams, Reed G.

2009-01-01

Background The Outcome Project requires high-quality assessment approaches to provide reliable and valid judgments of the attainment of competencies deemed important for physician practice. Intervention The Accreditation Council for Graduate Medical Education (ACGME) convened the Advisory Committee on Educational Outcome Assessment in 2007–2008 to identify high-quality assessment methods. The assessments selected by this body would form a core set that could be used by all programs in a specialty to assess resident performance and enable initial steps toward establishing national specialty databases of program performance. The committee identified a small set of methods for provisional use and further evaluation. It also developed frameworks and processes to support the ongoing evaluation of methods and the longer-term enhancement of assessment in graduate medical education. Outcome The committee constructed a set of standards, a methodology for applying the standards, and grading rules for their review of assessment method quality. It developed a simple report card for displaying grades on each standard and an overall grade for each method reviewed. It also described an assessment system of factors that influence assessment quality. The committee proposed a coordinated, national-level infrastructure to support enhancements to assessment, including method development and assessor training. It recommended the establishment of a new assessment review group to continue its work of evaluating assessment methods. The committee delivered a report summarizing its activities and 5 related recommendations for implementation to the ACGME Board in September 2008. PMID:21975993

Association between proportion of US medical graduates and program characteristics in gastroenterology fellowships.

PubMed

Atsawarungruangkit, Amporn

2017-01-01

Gastroenterology is one of the most competitive internal medicine fellowship. However, factors that associated with program competitiveness have not been documented. The objective of this study was to evaluate associations between characteristics of gastroenterology fellowship programs and their competitiveness through the proportion of US medical graduates for the academic year 2016/17. This study used a retrospective, cross-sectional design with data obtained from the American Medical Association. The proportion of US medical graduates in gastroenterology fellowships was used as an indicator of program competitiveness. Using both univariate and multivariate linear regression analyses, we analyzed the association between the proportion of medical graduates in each program and 27 program characteristics based on a significance level of 0.05. In total, 153 out of 171 gastroenterology fellowship programs satisfied the inclusion criteria. A multivariate analysis revealed that a higher proportion of US medical graduates was significantly associated with five program characteristics: that it was a university-based program (p < 0.001), the ratio of full-time paid faculty to fellow positions (p < 0.001), the proportion of females in the program (p = 0.002), location in the Pacific region (p = 0.039), and a non-smoker hiring policy (p = 0.042). Among the five significant factors, being university based, located in the Pacific, and having a non-smoker hiring policy were likely to remain unchanged over a long period. However, program directors and candidates should pay attention to equivalence between full-time paid faculty and fellowship positions, and the proportion of women in the program. The former indicates the level of supervision while the latter has become increasingly important owing to the higher proportion of women in medicine.

Accrediting Graduate Medical Education in Psychiatry: Past, Present, and Future.

PubMed

Johnson, Toni; John, Nadyah Janine; Lang, Michael; Shelton, P G

2017-06-01

The current terminology, goals, and general competency framework systematically utilized in the education of residents regardless of specialty is almost unrecognizable and quite foreign to those who trained before 2010. For example, the clinical and professional expectations for physicians-in-training have been placed onto a developmental framework of milestones. The expectations required during training have been expanded to include leadership and team participation skills, proficiency in the use of information technology, systems-based knowledge including respect of resources and cost of care, patient safety, quality improvement, population health and sensitivity to diversity for both individual and populations of patients. With these additions to physician training, the Accreditation Council for Graduate Medical Education (ACGME) hopes to remain accountable to the social contract between medicine and the public. With a focus on psychiatric practice, this article provides a general background and overview of the major overhaul of the accreditation process and educational goals for graduate medical education and briefly highlights possibilities for the future.

A Case Study of the Impact of a Sytematic Evaluation Process in a Graduate Medical Education Residency Program

ERIC Educational Resources Information Center

Kromrei, Heidi T.

2014-01-01

The Accreditation Council for Graduate Medical Education has charged institutions that sponsor accredited Graduate Medical Education programs (residency and fellowship specialty programs) with overseeing implementation of mandatory annual program evaluation efforts to ensure compliance with regulatory requirements. Physicians receive scant, if…

Mystery behind the match: an undergraduate medical education–graduate medical education collaborative approach to understanding match goals and outcomes

PubMed Central

Nagler, Alisa; Engle, Deborah L.; Rudd, Mariah; Chudgar, Saumil M.; Weinerth, John L.; Kuhn, Catherine M.; Buckley, Edward; Grochowski, Colleen O’Connor

2016-01-01

Background There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions’ GME programs. Methods We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes. Results A one-sample t-test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found. Discussion We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals. PMID:27702432

Mystery behind the match: an undergraduate medical education-graduate medical education collaborative approach to understanding match goals and outcomes.

PubMed

Nagler, Alisa; Engle, Deborah L; Rudd, Mariah; Chudgar, Saumil M; Weinerth, John L; Kuhn, Catherine M; Buckley, Edward; Grochowski, Colleen O'Connor

2016-01-01

There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions' GME programs. We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes. A one-sample t -test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found. We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals.

A review of cost-effectiveness, cost-containment and economics curricula in graduate medical education.

PubMed

Varkey, Prathibha; Murad, Mohammad H; Braun, Chad; Grall, Kristi J H; Saoji, Vivek

2010-12-01

Numerous studies performed over the last 30 years suggest that doctors have poor knowledge of the costs of medical care. In most graduate medical education programmes, trainees do not receive formal training in cost-effective medical practice. Comprehensive literature search of electronic bibliographic databases for articles that describe health economics, cost-containment and cost-effectiveness curricula in graduate medical education. Critical appraisal of the literature and qualitative description is presented. Heterogeneity of curricula precluded quantitative summary of data. We identified 40 articles that met the inclusion criteria for this review. Internal medicine residents were the targeted learners in 27 studies (68%); Family Medicine and Surgery residents were each targeted in five studies (13%); Rehabilitation, Paediatrics and Emergency Medicine residents were each targeted in one study. In general, the methodological quality of the included studies was poor to moderate and mostly targeted knowledge of health economics or cost-containment as opposed to targeting cost-effectiveness. In terms of describing the standard curricular components, studies sufficiently described the different educational strategies (e.g. didactics, interactive, experiential, self-directed) and the component of learner assessment, but lacked the description of other elements such as needs assessment and curriculum evaluation. Cost-effectiveness curricula in graduate medical education are lacking and clearly needed. © 2010 Blackwell Publishing Ltd.

Changing the Graduate Medical Education Funding Path to Reduce the Price of Health Care Services.

PubMed

Martin, Ralph A

2015-01-01

An analysis of the current Graduate Medical Education (GME) funding stream reveals undesired aspects that limit the number of graduates and may tend to raise the price of health care services. The author shows that a different model of GME funding changes the economic dynamics and takes advantage of economic forces to increase the supply of graduates, while potentially reducing the price of health care services.

Early career retention of Malawian medical graduates: a retrospective cohort study.

PubMed

Mandeville, Kate L; Ulaya, Godwin; Lagarde, Mylene; Gwesele, Lyson; Dzowela, Titha; Hanson, Kara; Muula, Adamson S

2015-01-01

There have been longstanding concerns over Malawian doctors migrating to high-income countries. Early career is a particularly vulnerable period. After significant policy changes, we examined the retention of recent medical graduates within Malawi and the public sector. We obtained data on graduates between 2006 and 2012 from the University of Malawi College of Medicine and Malawi Ministry of Health. We utilised the alumni network to triangulate official data and contacted graduates directly for missing or uncertain data. Odds ratios and chi-squared tests were employed to investigate relationships by graduation year and gender. We traced 256 graduates, with complete information for more than 90%. Nearly 80% of registered doctors were in Malawi (141/178, 79.2%), although the odds of emigration doubled with each year after graduation (odds ratio = 1.98, 95% CI = 1.54-2.56, P < 0.0001). Of the 37 graduates outside Malawi (14.5%), 23 (62.2%) were training in South Africa under a College of Medicine sandwich programme. More than 80% of graduates were working in the public sector (185/218, 82.6%), with the odds declining by 27% for each year after graduation (odds ratio = 0.73, 95% CI = 0.61-0.86, P < 0.0001). While most doctors remain in Malawi and the public sector during their early careers, the odds of leaving both increase with time. The majority of graduates outside Malawi are training in South Africa under visa restrictions, reflecting the positive impact of postgraduate training in Malawi. Concerns over attrition from the public sector are valid and require further exploratory work. © 2014 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Graduate Medical Education Viewed from the National Intern and Resident Matching Program

ERIC Educational Resources Information Center

Graettinger, John S.

1976-01-01

The total number of applicants for first-year programs in graduate medical education through the National Intern and Resident Matching Program in 1976 exceeded the number of positions offered for the second consecutive year. There were deficits in the number of openings offered in the primary care specialties and surfeits in medical and surgical…

The impact of site of graduate medical education training and other factors on physician employee retention.

PubMed

Petrou, Steven P; Lee, Marian D; Griffis, Julie; Rawal, Bhupendra; Robinson, Nell; Murray, Peter M

2014-01-01

This study sought to determine if the site of graduate medical training or other factors impact the length of institutional employment. Physician hires for the home institution were catalogued from January 1, 1996, through December 31, 2006. In analyzing the 253 physician hires, we found no statistically significant advantage in employee retention associated with hiring "one's own" or with U.S. medical school graduates.

Tracking Residents Through Multiple Residency Programs: A Different Approach for Measuring Residents' Rates of Continuing Graduate Medical Education in ACGME-Accredited Programs.

PubMed

Byrne, Lauren M; Holt, Kathleen D; Richter, Thomas; Miller, Rebecca S; Nasca, Thomas J

2010-12-01

Increased focus on the number and type of physicians delivering health care in the United States necessitates a better understanding of changes in graduate medical education (GME). Data collected by the Accreditation Council for Graduate Medical Education (ACGME) allow longitudinal tracking of residents, revealing the number and type of residents who continue GME following completion of an initial residency. We examined trends in the percent of graduates pursuing additional clinical education following graduation from ACGME-accredited pipeline specialty programs (specialties leading to initial board certification). Using data collected annually by the ACGME, we tracked residents graduating from ACGME-accredited pipeline specialty programs between academic year (AY) 2002-2003 and AY 2006-2007 and those pursuing additional ACGME-accredited training within 2 years. We examined changes in the number of graduates and the percent of graduates continuing GME by specialty, by type of medical school, and overall. The number of pipeline specialty graduates increased by 1171 (5.3%) between AY 2002-2003 and AY 2006-2007. During the same period, the number of graduates pursuing additional GME increased by 1059 (16.7%). The overall rate of continuing GME increased each year, from 28.5% (6331/22229) in AY 2002-2003 to 31.6% (7390/23400) in AY 2006-2007. Rates differed by specialty and for US medical school graduates (26.4% [3896/14752] in AY 2002-2003 to 31.6% [4718/14941] in AY 2006-2007) versus international medical graduates (35.2% [2118/6023] to 33.8% [2246/6647]). The number of graduates and the rate of continuing GME increased from AY 2002-2003 to AY 2006-2007. Our findings show a recent increase in the rate of continued training for US medical school graduates compared to international medical graduates. Our results differ from previously reported rates of subspecialization in the literature. Tracking individual residents through residency and fellowship programs provides

Tracking Residents Through Multiple Residency Programs: A Different Approach for Measuring Residents' Rates of Continuing Graduate Medical Education in ACGME-Accredited Programs

PubMed Central

Byrne, Lauren M.; Holt, Kathleen D.; Richter, Thomas; Miller, Rebecca S.; Nasca, Thomas J.

2010-01-01

Background Increased focus on the number and type of physicians delivering health care in the United States necessitates a better understanding of changes in graduate medical education (GME). Data collected by the Accreditation Council for Graduate Medical Education (ACGME) allow longitudinal tracking of residents, revealing the number and type of residents who continue GME following completion of an initial residency. We examined trends in the percent of graduates pursuing additional clinical education following graduation from ACGME-accredited pipeline specialty programs (specialties leading to initial board certification). Methods Using data collected annually by the ACGME, we tracked residents graduating from ACGME-accredited pipeline specialty programs between academic year (AY) 2002–2003 and AY 2006–2007 and those pursuing additional ACGME-accredited training within 2 years. We examined changes in the number of graduates and the percent of graduates continuing GME by specialty, by type of medical school, and overall. Results The number of pipeline specialty graduates increased by 1171 (5.3%) between AY 2002–2003 and AY 2006–2007. During the same period, the number of graduates pursuing additional GME increased by 1059 (16.7%). The overall rate of continuing GME increased each year, from 28.5% (6331/22229) in AY 2002–2003 to 31.6% (7390/23400) in AY 2006–2007. Rates differed by specialty and for US medical school graduates (26.4% [3896/14752] in AY 2002–2003 to 31.6% [4718/14941] in AY 2006–2007) versus international medical graduates (35.2% [2118/6023] to 33.8% [2246/6647]). Conclusion The number of graduates and the rate of continuing GME increased from AY 2002–2003 to AY 2006–2007. Our findings show a recent increase in the rate of continued training for US medical school graduates compared to international medical graduates. Our results differ from previously reported rates of subspecialization in the literature. Tracking individual

Variables Associated with Full-time Faculty Appointment among Contemporary U.S. Medical School Graduates: Implications for Academic Medicine Workforce Diversity

PubMed Central

Andriole, Dorothy A.; Jeffe, Donna B.; Hageman, Heather L.; Ephgrave, Kimberly; Lypson, Monica L.; Mavis, Brian; McDougle, Leon; Roberts, Nicole K.

2011-01-01

Purpose The authors sought to identify variables independently associated with full-time faculty appointment among recent medical graduates. Method With institutional review board approval, the authors developed a database of individualized records for six midwestern medical schools’ 1997–2002 graduates. Using multivariate logistic regression, they identified variables independently associated with full-time faculty appointment from among demographic, medical-school-related, and career-intention variables. They report adjusted odds ratios (OR) and 95% confidence intervals (CI). Results Of 1,965 graduates in the sample, 263 (13.4%) held full-time faculty appointments in 2007–2008, including 14.4% (123/853) of women graduates and 8.6% (17/198) of underrepresented minority (URM) graduates. Women (OR: 1.386, 95% CI: 1.023–1.878), MD/PhD program graduates (OR: 2.331, 95% CI: 1.160–4.683), and graduates who reported a career-setting preference for “full-time university faculty” on the Association of American Medical Colleges’ Graduation Questionnaire (OR: 3.164, 95% CI: 2.231–4.486) were more likely to have a full-time faculty appointment. Graduates who chose family medicine (OR: 0.433, 95% CI: 0.231–0.811) and surgical specialties (OR: 0.497, 95% CI: 0.249–0.994) were less likely to have a full-time faculty appointment. URM race/ethnicity was not independently associated with full-time faculty appointment (OR: 0.788; 95% CI: 0.452–1.375). Conclusions Efforts to increase representation of women graduates in academic medicine seem to have met with greater success than efforts to increase representation of URM graduates. Greater participation of URM students in MD/PhD programs and in interventions during medical school that promote interest in academic-medicine careers may increase URM graduates’ representation in academic medicine. PMID:20592523

The emotions of graduating medical students about prior patient care experiences.

PubMed

Clay, Alison S; Ross, Elizabeth; Chudgar, Saumil M; Grochowski, Colleen O'Connor; Tulsky, James A; Shapiro, Dan

2015-03-01

To determine the emotional responses to patient care activities described by fourth year medical students. Qualitative content analysis for emerging themes in letters written by graduating medical students to patients during a Capstone Course. The patient need not be alive and the letter would never be sent. Six themes emerged from student letters: (1) Sorrow for the depths of patient suffering; (2) Gratitude towards patients and their families; (3) Personal responsibility for care provided to patients; (4) Regret for poor care provided by the student or student's team; (5) Shattered expectations about medicine and training; and (6) Anger towards patients. Students expressed sensitivity to vulnerable patients, including those who were alone, unable to communicate, or for whom care was biased. Students' expressed powerlessness (inability to cure, managing a work-life balance, and challenges with hierarchy) in some essays. At graduation, medical students describe strong emotions about previous patient care experiences, including difficulty witnessing suffering, disappointment with medicine, and gratitude to patients and their families Providing regular opportunities for writing throughout medical education would allow students to recognize their emotions, reflect upon them and promote wellness that would benefit students and their patients. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Graduate Medical Education: Trends in Training and Student Debt. GAO-09-438R

ERIC Educational Resources Information Center

King, Kathleen M.; Scott, George A.

2009-01-01

The federal government invests significantly in medical education through various programs to help ensure that the anticipated supply of new physicians meets the nation's health care needs. Medicare, the federal health care program for elderly and certain disabled people, subsidizes training for medical school graduates in hospitals and other…

Combined experimental and Monte Carlo verification of <IMG ALIGN="BOTTOM" SRC="http://ej.iop.org/images/0031-9155/43/12/008/img1.gif"/> brachytherapy plans for vaginal applicators

NASA Astrophysics Data System (ADS)

Sloboda, Ron S.; Wang, Ruqing

1998-12-01

Dose rates in a phantom around a shielded and an unshielded vaginal applicator containing Selectron low-dose-rate <IMG SRC="http://ej.iop.org/images/0031-9155/43/12/008/img2.gif" ALIGN="TOP"/> sources were determined by experiment and Monte Carlo simulation. Measurements were performed with thermoluminescent dosimeters in a white polystyrene phantom using an experimental protocol geared for precision. Calculations for the same set-up were done using a version of the EGS4 Monte Carlo code system modified for brachytherapy applications into which a new combinatorial geometry package developed by Bielajew was recently incorporated. Measured dose rates agree with Monte Carlo estimates to within 5% (1 SD) for the unshielded applicator, while highlighting some experimental uncertainties for the shielded applicator. Monte Carlo calculations were also done to determine a value for the effective transmission of the shield required for clinical treatment planning, and to estimate the dose rate in water at points in axial and sagittal planes transecting the shielded applicator. Comparison with dose rates generated by the planning system indicates that agreement is better than 5% (1 SD) at most positions. The precision thermoluminescent dosimetry protocol and modified Monte Carlo code are effective complementary tools for brachytherapy applicator dosimetry.

A Policy Prospectus for Graduate Medical Education in New Jersey.

ERIC Educational Resources Information Center

New Jersey State Dept. of Higher Education, Trenton.

A study was undertaken to develop guidelines for the future course of graduate medical education (GME) in New Jersey. General findings were that the current array and total number of hospital-based GME offerings by specialty and location appear sufficient, although attention must be paid to appropriate distribution; that the major basis of funding…

Mediators of Racial/Ethnic Disparities in Mentored K Award Receipt Among U.S. Medical School Graduates.

PubMed

Andriole, Dorothy A; Yan, Yan; Jeffe, Donna B

2017-10-01

Mentored K (K01/K08/K23) career development awards are positively associated with physicians' success as independent investigators; however, individuals in some racial/ethnic groups are less likely to receive this federal funding. The authors sought to identify variables that explain (mediate) the association between race/ethnicity and mentored K award receipt among U.S. Liaison Committee for Medical Education-accredited medical school graduates who planned research-related careers. The authors analyzed deidentified data from the Association of American Medical Colleges and the National Institutes of Health Information for Management, Planning, Analysis, and Coordination II grants database for a national cohort of 28,690 graduates from 1997-2004 who planned research-related careers, followed through August 2014. The authors examined 10 potential mediators (4 research activities, 2 academic performance measures, medical school research intensity, degree program, debt, and specialty) of the association between race/ethnicity and mentored K award receipt in models comparing underrepresented minorities in medicine (URM) and non-URM graduates. Among 27,521 graduates with complete data (95.9% of study-eligible graduates), 1,147 (4.2%) received mentored K awards (79/3,341 [2.4%] URM; 1,068/24,180 [4.4%] non-URM). All variables except debt were significant mediators; together they explained 96.2% (95%, CI 79.1%-100%) of the association between race/ethnicity and mentored K award. Research-related activities during/after medical school and standardized academic measures largely explained the association between race/ethnicity and mentored K award in this national cohort. Interventions targeting these mediators could mitigate racial/ethnic disparities in the federally funded physician-scientist research workforce.

Preparing Medical Graduates for an Interconnected World: Current Practices and Future Possibilities for Internationalizing the Medical Curriculum in Different Contexts

ERIC Educational Resources Information Center

Stütz, Alexander; Green, Wendy; McAllister, Lindy; Eley, Diann

2015-01-01

Preparing medical graduates who are competent to work in a global environment requires broad integration of international and intercultural perspectives throughout the medical curriculum. Employing Leask and Bridge's "conceptual framework of internationalisation of the curriculum," this article first highlights the emphasis placed on…

Theory and practice in the design and conduct of graduate medical education.

PubMed

Hodges, Brian David; Kuper, Ayelet

2012-01-01

Medical education practice is more often the result of tradition, ritual, culture, and history than of any easily expressed theoretical or conceptual framework. The authors explain the importance and nature of the role of theory in the design and conduct of graduate medical education. They outline three groups of theories relevant to graduate medical education: bioscience theories, learning theories, and sociocultural theories. Bioscience theories are familiar to many medical educators but are often misperceived as truths rather than theories. Theories from such disciplines as neuroscience, kinesiology, and cognitive psychology offer insights into areas such as memory formation, motor skills acquisition, diagnostic decision making, and instructional design. Learning theories, primarily emerging from psychology and education, are also popular within medical education. Although widely employed, not all learning theories have robust evidence bases. Nonetheless, many important notions within medical education are derived from learning theories, including self-monitoring, legitimate peripheral participation, and simulation design enabling sustained deliberate practice. Sociocultural theories, which are common in the wider education literature but have been largely overlooked within medical education, are inherently concerned with contexts and systems and provide lenses that selectively highlight different aspects of medical education. They challenge educators to reconceptualize the goals of medical education, to illuminate maladaptive processes, and to untangle problems such as career choice, interprofessional communication, and the hidden curriculum.Theories make visible existing problems and enable educators to ask new and important questions. The authors encourage medical educators to gain greater understanding of theories that guide their educational practices.

The role that graduate medical education must play in ensuring health equity and eliminating health care disparities.

PubMed

Maldonado, Maria E; Fried, Ethan D; DuBose, Thomas D; Nelson, Consuelo; Breida, Margaret

2014-05-01

Despite the 2002 Institute of Medicine report that described the moral and financial impact of health care disparities and the need to address them, it is evident that health care disparities persist. Recommendations for addressing disparities include collecting and reporting data on patient race and ethnicity, supporting language interpretation services, increasing awareness of health care disparities through education, requiring cultural competency training for all health care professionals, and increasing diversity among those delivering health care. The Accreditation Council on Graduate Medical Education places strong emphasis on graduate medical education's role in eliminating health care disparities by asking medical educators to objectively evaluate and report on their trainees' ability to practice patient-centered, culturally competent care. Moreover, one of the objectives of the Accreditation Council on Graduate Medical Education Clinical Learning Environment Review visits as part of the Next Accreditation System is to identify how sponsoring institutions engage residents and fellows in the use of data to improve systems of care, reduce health care disparities, and improve patient outcomes. Residency and fellowship programs should ensure the delivery of meaningful curricula on cultural competency and health care disparities, for which there are numerous resources, and ensure resident assessment of culturally competent care. Moreover, training programs and institutional leadership need to collaborate on ensuring data collection on patient satisfaction, outcomes, and quality measures that are broken down by patient race, cultural identification, and language. A diverse physician workforce is another strategy for mitigating health care disparities, and using strategies to enhance faculty diversity should also be a priority of graduate medical education. Transparent data about institutional diversity efforts should be provided to interested medical students

Outcomes assessment of a residency program in laboratory medicine.

PubMed

Morse, E E; Pisciotto, P T; Hopfer, S M; Makowski, G; Ryan, R W; Aslanzadeh, J

1997-01-01

During a down-sizing of residency programs at a State University Medical School, hospital based residents' positions were eliminated. It was determined to find out the characteristics of the residents who graduated from the Laboratory Medicine Program, to compare women graduates with men graduates, and to compare IMGs with United States Graduates. An assessment of a 25 year program in laboratory medicine which had graduated 100 residents showed that there was no statistically significant difference by chi 2 analysis in positions (laboratory directors or staff), in certification (American Board of Pathology [and subspecialties], American Board of Medical Microbiology, American Board of Clinical Chemistry) nor in academic appointments (assistant professor to full professor) when the male graduates were compared with the female graduates or when graduates of American medical schools were compared with graduates of foreign medical schools. There were statistically significant associations by chi 2 analysis between directorship positions and board certification and between academic appointments and board certification. Of 100 graduates, there were 57 directors, 52 certified, and 41 with academic appointments. Twenty-two graduates (11 women and 11 men) attained all three.

Practice transition in graduate medical education.

PubMed

Shaffer, Robyn; Piro, Nancy; Katznelson, Laurence; Gephart, Melanie Hayden

2017-10-01

Debt repayment, professional negotiation and practice management skills are vital to a successful medical practice, yet are undervalued and seldom taught in graduate medical education. Medical residents need additional training to confidently transition to independent practice, requiring the development of novel curricula. Medical residents need additional training to confidently transition to independent practice METHODS: We developed a trial practice management curriculum to educate senior residents and fellows through voluntary workshops. Topics discussed in the workshops included debt repayment, billing compliance, medical malpractice, contract negotiations, and lifestyle and financial management. Resident self-confidence was assessed, and feedback was obtained through voluntary survey responses before and after attendance at a workshop, scored using a Likert scale. Twenty-five residents from 20 specialties attended a 1-day session incorporating all lectures; 53 residents from 17 specialties attended a re-designed quarterly session with one or two topics per session. Survey evaluations completed before and after the workshop demonstrated an improvement in residents' self-assessment of confidence in contract negotiations (p < 0.001) and their first year in practice (p < 0.001): after the curriculum, 94 per cent (n = 42) of respondents felt confident participating in contract negotiations, and 93 per cent (n = 38) of respondents felt confident about their first year in practice. One hundred per cent of respondents agreed that the presentation objectives were relevant to their needs as residents. Participant responses indicated a need for structured education in practice management for senior trainees. Senior residents and fellows will benefit most from curricula, but have high familial and professional demands on their schedules. © 2017 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Impact of the Rural Clinical School of Western Australia on work location of medical graduates.

PubMed

Playford, Denese E; Evans, Sharon F; Atkinson, David N; Auret, Kirsten A; Riley, Geoffrey J

2014-02-03

To determine whether completing a year of the Rural Clinical School of Western Australia (RCSWA) program is associated with entering the rural medical workforce. Cohort study of graduates from the University of Western Australia who completed Year 5 of medical school between 2002 and 2009, comparing work location (identified from the Australian Health Practitioner Regulation Agency database in March-June 2013) between those who participated in the RCSWA (RCSWA graduates) and those who did not (controls). Rural or urban work location of graduates. Of 1116 eligible graduates, 1017 (91.1%) could be traced and were included in the study. Of 258 RCSWA graduates, 42 (16.3%) were working rurally compared with 36 of 759 controls (4.7%). Of 195 RCSWA graduates from urban backgrounds, 29 (14.9%) were working rurally compared with 26 of 691 urban-background controls (3.8%). Of 63 rural-background RCSWA graduates, 13 (20.6%) were working rurally, compared with 10 of 68 rural-background controls (14.7%). Using logistic regression, RCSWA participation had a strong relationship with working rurally (rural-background RCSWA graduates: odds ratio [OR], 7.5; 95% CI, 3.5-15.8; urban-background RCSWA graduates: OR, 5.1; 95% CI, 2.9-9.1). Rural background without RCSWA participation (OR, 4.2; 95% CI, 1.8-9.2) and older age (age in 2012, 30-39 years: OR, 2.2; 95% CI, 1.3-3.7 v ≥ 40 years: OR, 6.6; 95% CI, 2.8-15.0) were also significant factors for working rurally. Participation in the RCSWA is strongly associated with greater likelihood of working rurally. Graduates from urban backgrounds who participated in the RCSWA were much more likely to work in rural areas than those who did not. These data substantiate the RCSWA as an effective rural workforce strategy.

Medical Colleges in Saudi Arabia: Can We Predict Graduate Numbers?

ERIC Educational Resources Information Center

Althubaiti, Alaa; Alkhazim, Mohammad

2014-01-01

The shortage of Physicians is a major problem in many countries. Medical colleges are often encouraged to increase the graduate numbers. In the Kingdom of Saudi Arabia, Saudi physicians form only 37.89% of the physician manpower. The remainder of the physicians are expatriates. It was recently estimated that the Kingdom would need 29,128…

Research-oriented medical education for graduate medical students.

PubMed

Deo, Madhav G

2013-01-01

rating of 8.1 on a scale of 1 to 10. This cost-effective, 'in-study' module of short-duration 'mobile' workshops can be used to educate graduate medical students in basic research procedures employed in clinical and laboratory medicine research. The module is suitable for resource-strapped developing nations. Copyright 2013, NMJI.

Differential determination of perceived stress in medical students and high-school graduates due to private and training-related stressors.

PubMed

Erschens, Rebecca; Herrmann-Werner, Anne; Keifenheim, Katharina Eva; Loda, Teresa; Bugaj, Till Johannes; Nikendei, Christoph; Lammerding-Köppel, Maria; Zipfel, Stephan; Junne, Florian

2018-01-01

Numerous studies from diverse contexts have confirmed high stress levels and stress-associated health impairment in medical students. This study aimed to explore the differential association of perceived stress with private and training-related stressors in medical students according to their stage of medical education. Participants were high-school graduates who plan to study medicine and students in their first, third, sixth, or ninth semester of medical school or in practical medical training. The self-administered questionnaire included items addressing demographic information, the Perceived Stress Questionnaire, and items addressing potential private and training-related stressors. Results confirmed a substantial burden of perceived stress in students at different stages of their medical education. In particular, 10-28% of students in their third or ninth semesters of medical school showed the highest values for perceived stress. Training-related stressors were most strongly associated with perceived stress, although specific stressors that determined perceived stress varied across different stages of students' medical education. High-school graduates highly interested in pursuing medical education showed specific stressors similar to those of medical students in their third, sixth, or ninth semesters of medical school, as well as stress structures with heights of general stress rates similar to those of medical students at the beginning of practical medical training. High-school graduates offer new, interesting information about students' fears and needs before they begin medical school. Medical students and high-school graduates need open, comprehensive information about possible stressors at the outset of and during medical education. Programmes geared toward improving resilience behaviour and teaching new, functional coping strategies are recommended.

Are efforts to attract graduate applicants to UK medical schools effective in increasing the participation of under-represented socioeconomic groups? A national cohort study

PubMed Central

Cleland, Jennifer; Greatrix, Rachel; Prescott, Gordon

2018-01-01

Introduction Attracting graduates was recommended as a means of diversifying the UK medical student population. Graduates now make up nearly a quarter of the total medical student population. Research to date has focused on comparing the sociodemographic characteristics of applicants to and/or students on traditional and graduate entry programmes (GEMs), yet GEMs account for only 40% of the graduate medical student population. Thus, we aimed to compare the sociodemographic characteristic and outcomes of graduates and non-graduate applicants across a range of programmes. Methods This was an observational study of 117 214 applicants to medicine who took the UK Clinical Aptitude Test (UKCAT) from 2006 to 2014 and who applied to medical school through Universities and Colleges Admissions Service (UCAS). We included applicant demographics, UKCAT total score and offers in our analysis. Applicants were assigned as graduates or non-graduates on the basis of their highest qualification. Multiple logistic regression was used to predict the odds of receiving an offer, after adjusting for confounders. Results Irrespective of graduate or non-graduate status, most applicants were from the highest socioeconomic groups and were from a white ethnic background. Receiving an offer was related to gender and ethnicity in both graduates and non-graduates. After adjusting for UKCAT score, the OR of an offer for graduates versus non-graduates was approximately 0.5 (OR=0.48, 95% CI 0.46 to 0.49). Discussion Our findings indicate that the aim of diversifying the medical student population on socioeconomic grounds by attracting graduates has been only marginally successful. Graduate applicants from widening access backgrounds are less likely than others to be offered a place at medical school. Different approaches must be considered if medicine is to attract and select more socially diverse applicants. PMID:29444782

The future nephrology workforce: will there be one?

PubMed

Parker, Mark G; Ibrahim, Tod; Shaffer, Rachel; Rosner, Mitchell H; Molitoris, Bruce A

2011-06-01

Interest in nephrology as a career is declining and has been on the decline for nearly one decade. From 2002 to 2009, all internal medicine subspecialties except geriatric medicine increased the number of available fellowship positions. However, only two subspecialties attracted fewer United States medical graduates (USMGs) in 2009 than in 2002: geriatric medicine and nephrology. This drop occurred at a time when demand for nephrologists is increasing and when the specialty is having a harder time benefiting from the substantial contribution of international medical graduates (IMGs). Today's USMGs possess fundamentally different career and personal goals from their teachers and mentors. Medical students report receiving minimal exposure to nephrology in clinical rotations, and they perceive that the specialty is too complex, uninteresting, and lacks professional opportunity. Meanwhile, the demographics of kidney disease in the United States, as well as recent national health policy developments, indicate a growing need for nephrologists. Efforts to improve the educational continuum in nephrology and enhance mentorship are essential to restoring interest in nephrology for USMGs, maintaining its appeal among IMGs, and developing a workforce sufficient to meet future demand for renal care.

Academic and Professional Career Outcomes of Medical School Graduates Who Failed USMLE Step 1 on the First Attempt

ERIC Educational Resources Information Center

McDougle, Leon; Mavis, Brian E.; Jeffe, Donna B.; Roberts, Nicole K.; Ephgrave, Kimberly; Hageman, Heather L.; Lypson, Monica L.; Thomas, Lauree; Andriole, Dorothy A.

2013-01-01

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and…

Collision course: the privatization of graduate medical education at one university.

PubMed

Klasko, Stephen K; Ekarius, John C

2007-03-01

On December 18, 2003, Tenet Healthcare Corporation, an investor-owned hospital corporation, announced the closure of Medical College of Pennsylvania Hospital, a historic institution that was home to many of Drexel University College of Medicine's (DUCOM's) faculty, residents, and medical students. The authors summarize the steps that were taken and lessons learned to avoid a disruption in the education of over 200 residents. The authors highlight the response by the medical school; the concerns of the Accreditation Council for Graduate Medical Education (ACGME); the interaction between the Center for Medicare and Medicaid Services (CMS) and the ACGME; the importance of the designated institutional official (DIO) in a crisis situation; and the role of residents as students versus employees when their employer wishes to move or "trade" them to another institution. Through the lens of the DUCOM experience, the authors explore the legal, political, and educational conflicts that occur when an investor-owned company or private hospital employs residents but another entity holds moral and academic accountability for their future. Finally, the authors outline five lessons learned: (1) the important role the ACGME plays as the educational conscience of graduate medical education (GME), (2) the dramatically different roles that the ACGME and the CMS play in regulating and funding the national GME system, (3) the need for constant communication with the affected residents, (4) the important role that the DIO plays in GME, and (5) the need for medical school leaders to remain focused on their educational mission and responsibilities to young physicians.

Career choices for cardiology: cohort studies of UK medical graduates

PubMed Central

2013-01-01

Background Cardiology is one of the most popular of the hospital medical specialties in the UK. It is also a highly competitive specialty in respect of the availability of higher specialty training posts. Our aims are to describe doctors’ early intentions about seeking careers in cardiology, to report on when decisions about seeking a career in cardiology are made, to compare differences between men and women doctors in the choice of cardiology, and to compare early career choices with later specialty destinations. Methods Questionnaire surveys were sent to all UK medical graduates in selected qualification years from 1974–2009, at 1, 3, 5, 7 and 10 years after graduation. Results One year after graduation, the percentage of doctors specifying cardiology as their first choice of long-term career rose from the mid-1990s from 2.4% (1993 cohort) to 4.2% (2005 cohort) but then fell back to 2.7% (2009 cohort). Men were more likely to give cardiology as their first choice than women (eg 4.1% of men and 1.9% of women in the 2009 cohort). The percentage of doctors who gave cardiology as their first choice of career declined between years one and five after qualification: the fall was more marked for women. 34% of respondents who specified cardiology as their sole first choice of career one year post-graduation were later working in cardiology. 24% of doctors practising as cardiologists several years after qualification had given cardiology as their sole first choice in year one. The doctors’ ‘domestic circumstances’ were a relatively unimportant influence on specialty choice for aspiring cardiologists, while ‘enthusiasm/commitment’, ‘financial prospects’, ‘experiences of the job so far’ and ‘a particular teacher/department’ were important. Conclusions Cardiology grew as a first preference one year after graduation to 2005 but is now falling. It consistently attracts a higher percentage of men than women doctors. The correspondence between early

Funding Instability Reduces the Impact of the Federal Teaching Health Center Graduate Medical Education Program.

PubMed

Kurz, Troy; Liaw, Winston; Wingrove, Peter; Petterson, Stephen; Bazemore, Andrew

2017-01-01

The Teaching Health Center Graduate Medical Education (THCGME) program is a decentralized residency training component of the Affordable Care Act, created to combat critical shortages and maldistribution of primary care physicians. The Accreditation Council of Graduate Medical Education and federal data reveal that the THCGME program accounted for 33% of the net increase in family medicine residency positions between 2011 and 2015. However, amid concerns about the program's stability, the contribution of the THCGME program to the net increase fell to 7% after 2015. © Copyright 2017 by the American Board of Family Medicine.

Emotional intelligence assessment in a graduate entry medical school curriculum

PubMed Central

2013-01-01

Background The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor’s EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum. Methods Fifty one graduate entry medical students completed an eight session course on PPD between December 2005 and January 2006. Students completed two measures of EI: self-report (EQ-i) and ability (MSCEIT V2.0) over a two year study period. The data gathered were used to explore the relationship between self-report and ability EI and between EI and student demographics, academic performance and change over time. Results Analysis of the EI data demonstrated that self-report EI did not change over time and was not related to ability EI. Females scored higher than males on a number of self-report and ability EI scores. Self-reported self-awareness was found to deteriorate in males and females over time. High self-reported EI was found to be associated with poor performance on clinical competency assessments but with good performance on a number of bio-medical knowledge based assessments. Conclusions This report concludes that assessments of EI can be incorporated into a medical school curriculum as part of a PPD programme and that the concept of EI may be associated with performance in medical school. PMID:23497237

Emotional intelligence assessment in a graduate entry medical school curriculum.

PubMed

Doherty, Eva M; Cronin, Patricia A; Offiah, Gozie

2013-03-07

The management of emotions in the workplace is a skill related to the ability to demonstrate empathic behaviour towards patients; to manage emotional reactions in oneself and to lead others as part of a team. This ability has been defined as emotional intelligence (EI) and doctor's EI may be related to communication skills and to patient satisfaction levels. This study reports on the use of two assessments of EI as part of a course on Personal and Professional Development (PPD) in a graduate medical school curriculum. Fifty one graduate entry medical students completed an eight session course on PPD between December 2005 and January 2006. Students completed two measures of EI: self-report (EQ-i) and ability (MSCEIT V2.0) over a two year study period. The data gathered were used to explore the relationship between self-report and ability EI and between EI and student demographics, academic performance and change over time. Analysis of the EI data demonstrated that self-report EI did not change over time and was not related to ability EI. Females scored higher than males on a number of self-report and ability EI scores. Self-reported self-awareness was found to deteriorate in males and females over time. High self-reported EI was found to be associated with poor performance on clinical competency assessments but with good performance on a number of bio-medical knowledge based assessments. This report concludes that assessments of EI can be incorporated into a medical school curriculum as part of a PPD programme and that the concept of EI may be associated with performance in medical school.

Toward graduate medical education (GME) accountability: measuring the outcomes of GME institutions.

PubMed

Chen, Candice; Petterson, Stephen; Phillips, Robert L; Mullan, Fitzhugh; Bazemore, Andrew; O'Donnell, Sarah D

2013-09-01

Graduate medical education (GME) plays a key role in the U.S. health care workforce, defining its overall size and specialty distribution and influencing physician practice locations. Medicare provides nearly $10 billion annually to support GME and faces growing policy maker interest in creating accountability measures. The purpose of this study was to develop and test candidate GME outcome measures related to physician workforce. The authors performed a secondary analysis of data from the American Medical Association Physician Masterfile, National Provider Identifier file, Medicare claims, and National Health Service Corps, measuring the number and percentage of graduates from 2006 to 2008 practicing in high-need specialties and underserved areas aggregated by their U.S. GME program. Average overall primary care production rate was 25.2% for the study period, although this is an overestimate because hospitalists could not be excluded. Of 759 sponsoring institutions, 158 produced no primary care graduates, and 184 produced more than 80%. An average of 37.9% of internal medicine residents were retained in primary care, including hospitalists. Mean general surgery retention was 38.4%. Overall, 4.8% of graduates practiced in rural areas; 198 institutions produced no rural physicians, and 283 institutions produced no Federally Qualified Health Center or Rural Health Clinic physicians. GME outcomes are measurable for most institutions and training sites. Specialty and geographic locations vary significantly. These findings can inform educators and policy makers during a period of increased calls to align the GME system with national health needs.

Associations between quality indicators of internal medicine residency training programs

PubMed Central

2011-01-01

Background Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality. Methods Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression. Results Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation. Conclusions Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification. PMID:21651768

Career preferences of graduating medical students in China: a nationwide cross-sectional study.

PubMed

Hou, Jianlin; Xu, Maoyi; Kolars, Joseph C; Dong, Zhe; Wang, Weimin; Huang, Amy; Ke, Yang

2016-05-06

China faces major challenges in the distribution of health professionals with serious shortages in rural areas and in the development of Primary Care Providers (PCPs). This study investigates the career preferences of medical students in China and the impact of rural backgrounds on these preferences. Medical students in the final year of their program in 16 medical schools across China completed a 58-item survey that included questions regarding their demographic characteristics, attitudes toward practice in low resource areas, postgraduate planning, self-assessed competency, university facilities assessment, and financial situation. Descriptive calculation and Logit model were used for the analysis. Completed surveys from 3020 students were included in the analysis. Upon graduation, 48.5% of the medical students preferred to work in urban public hospitals and this percentage rose to 73.6% when students were asked to state their anticipated preference five years after graduation. Students' top three ranked reasons for preferred careers were "good career prospects", "living close to parents/families", and "remuneration". Those who preferred to work in rural areas upon graduation were more likely to be those who lived in rural areas when 1-15 years old (β = 2.05, p < 0.001), had high school in rural areas (β = 1.73, p < 0.001), or had parents' place of current residence in rural areas (β = 2.12, p < 0.001). Similar results were found for those students who preferred to work in PCPs. To address the serious shortages of health professionals in rural areas and PCPs, medical schools should consider strategies to recruit more medical applicants with rural backgrounds and to orient students to rural and primary care interests.

Correlation of admissions statistics to graduate student success in medical physics

PubMed Central

McSpadden, Erin; Rakowski, Joseph; Nalichowski, Adrian; Yudelev, Mark; Snyder, Michael

2014-01-01

The purpose of this work is to develop metrics for evaluation of medical physics graduate student performance, assess relationships between success and other quantifiable factors, and determine whether graduate student performance can be accurately predicted by admissions statistics. A cohort of 108 medical physics graduate students from a single institution were rated for performance after matriculation based on final scores in specific courses, first year graduate Grade Point Average (GPA), performance on the program exit exam, performance in oral review sessions, and faculty rating. Admissions statistics including matriculating program (MS vs. PhD); undergraduate degree type, GPA, and country; graduate degree; general and subject GRE scores; traditional vs. nontraditional status; and ranking by admissions committee were evaluated for potential correlation with the performance metrics. GRE verbal and quantitative scores were correlated with higher scores in the most difficult courses in the program and with the program exit exam; however, the GRE section most correlated with overall faculty rating was the analytical writing section. Students with undergraduate degrees in engineering had a higher faculty rating than those from other disciplines and faculty rating was strongly correlated with undergraduate country. Undergraduate GPA was not statistically correlated with any success metrics investigated in this study. However, the high degree of selection on GPA and quantitative GRE scores during the admissions process results in relatively narrow ranges for these quantities. As such, these results do not necessarily imply that one should not strongly consider traditional metrics, such as undergraduate GPA and quantitative GRE score, during the admissions process. They suggest that once applicants have been initially filtered by these metrics, additional selection should be performed via the other metrics shown here to be correlated with success. The parameters used

Results of physician licence examination and scholarship contract compliance by the graduates of regional quotas in Japanese medical schools: a nationwide cross-sectional survey

PubMed Central

Matsumoto, Masatoshi; Takeuchi, Keisuke; Owaki, Tetsuhiro; Iguchi, Seitaro; Inoue, Kazuo; Kashima, Saori; Tazuma, Susumu; Maeda, Takahiro

2017-01-01

Objectives Responding to the serious shortage of physicians in rural areas, the Japanese government has aggressively increased the number of entrants to medical schools since 2008, mostly as a chiikiwaku, entrants filling a regional quota. The quota has spread to most medical schools, and these entrants occupied 16% of all medical school seats in 2016. Most of these entrants were admitted to medical school with a scholarship with the understanding that after graduation they will practise in designated areas of their home prefectures for several years. The quota and scholarship programmes will be revised by the government starting in 2018. This study evaluates the intermediate outcomes of these programmes. Design Cross-sectional survey to all prefectural governments and medical schools every year from 2014 to 2017 to obtain data on medical graduates. Settings Nationwide. Participants All quota and non-quota graduates with prefecture scholarship in each prefecture, and all the quota graduates without scholarship in each medical school. Primary outcome measures Passing rate of the National License Examination for Physicians and the percentage of graduates who have not bought out the scholarship contract after graduation. Results Most prefectures and medical schools in Japan participated in this study (97.8%–100%). Quota graduates with scholarship were significantly more likely to pass the National License Examination for Physicians than the other medical graduates in Japan at all the years (97.9%, 96.7%, 97.4% and 94.7% vs 93.9%, 94.5%, 94.3% and 91.8%, respectively). The percentage of quota graduates with scholarship who remained in the scholarship contract 3 years after graduation was 92.2% and 89.9% for non-quota graduates with scholarship. Conclusions Quota entrants showed better academic performance than their peers. Most of the quota graduates remained in the contractual workforce. The imminent revision of the national policy regarding quota and scholarship

Determinants of the generalist career intentions of 1995 graduating medical students.

PubMed

Kassebaum, D G; Szenas, P L; Schuchert, M K

1996-02-01

Using national databases of the Association of American Medical College, the authors employed logistic regression analysis to show the relative predictive influences of selected demographic, structural, attitudinal, and educational variables on the specialty careers choices of 1995 U.S. medical school graduates. Plans to pursue certification in family practice or an unspecified generalist career could be predicted with moderate success, while choices of general internal medicine and general pediatrics could not. The intentions of the 1995 graduates to pursue generalist specialty, were significantly associated with demographic factors such as female gender, older student age, and rural hometown; early interest in the generalist specialties; attitudes favoring helping people over seeking opportunities for leadership, intellectual challenge, or research; the presence of a department of family medicine in the medical school; and ambulatory care experiences in the third and fourth years. In the multiple-regression models used in this study, a number of factors widely touted as important to the cultivation of generalism were not significant predictors of generalist decisions; an institutional mission statement expressly addressing the cultivation of generalist careers; giving admission preferences to applicants who vowed an interest in generalism; public (versus private) school sponsorship; discrete organization units for general internal medical or general pediatrics; the proportion of institutional faculty in the general specialty of medicine and pediatrics; the level of educational debt; the students; clinical experiences in the first and second years of medical school. The authors acknowledge the danger of inferring causal relationships from analyses of this kind, and described how the power of previous associations--e.g., that between a required third-year clerkship in family medicine and graduates' family practice career choices--may be weakened when the

Trends in gender, employment, salary, and debt of graduates of US veterinary medical schools and colleges.

PubMed

Chieffo, Carla; Kelly, Alan M; Ferguson, James

2008-09-15

To characterize trends in gender, employment, starting salaries, and educational debt of graduates of US veterinary medical schools and colleges from 1988 to 2007. Meta-analysis. Sample Population-Veterinary medical graduates from 26 or 27 of 27 US veterinary schools and colleges from 1988 through 2007. Data were obtained from surveys published in the JAVMA. A chi2 test for trend was used to analyze trends in choices of employment and educational indebtedness for the veterinary graduate populations over time. The greatest changes in employment occurred in predominantly large animal practice, which attracted 10.7% of new graduates in 1989 but only 2.2% in 2007, and in advanced study, which attracted 15.2% of new graduates in 1989 and 36.8% in 2007. In 2007, 75% of graduates were women, but this gender shift was not associated with the decline in the percentage of graduates entering rural practice. From 1989 through 2007, starting salaries in private practice increased at a rate of 4.60%/y. During the same period, educational debt increased at an annual rate of 7.36%, or 60% higher than the rate of increases for starting salaries. As a result, debt at graduation increased from 1.1 times the starting salary in 1989 to 2.0 times the starting salary in 2007. Veterinary students are now more in debt than they have ever been. This trend together with a substantial increase in the rate of interest charged for government-backed education loans create conditions for new graduates that appear unsustainable.

Scaffolding knowledge building in a Web-based communication and cultural competence program for international medical graduates.

PubMed

Lax, Leila R; Russell, M Lynn; Nelles, Laura J; Smith, Cathy M

2009-10-01

Professional behaviors, tacitly understood by Canadian-trained physicians, are difficult to teach and often create practice barriers for IMGs. The purpose of this design research study was to develop a Web-based program simulating Canadian medical literacy and culture, and to evaluate strategies of scaffolding individual knowledge building. Study 1 (N = 20) examined usability and pedagogic design. Studies 2 (N = 39) and 3 (N = 33) examined case participation patterns. Model design was validated in Study 1. Studies 2 and 3 demonstrated high levels of participation, on unprompted third tries, on knowledge tests. Recursive patterns were strongest on Reflective Exercises. Five strategies scaffolded knowledge building: (1) video simulations, (2) contextualized resources, (3) concurrent feedback, (4) Reflective Exercises, and (5) commentaries prompting "reflection on reflection." Scaffolded design supports complex knowledge building. These findings are concurrent with educational research on the importance of recursion and revision of knowledge for improvable and relational understanding.

Differential determination of perceived stress in medical students and high-school graduates due to private and training-related stressors

PubMed Central

Herrmann–Werner, Anne; Keifenheim, Katharina Eva; Loda, Teresa; Bugaj, Till Johannes; Nikendei, Christoph; Lammerding–Köppel, Maria; Zipfel, Stephan; Junne, Florian

2018-01-01

Objective Numerous studies from diverse contexts have confirmed high stress levels and stress-associated health impairment in medical students. This study aimed to explore the differential association of perceived stress with private and training-related stressors in medical students according to their stage of medical education. Methods Participants were high-school graduates who plan to study medicine and students in their first, third, sixth, or ninth semester of medical school or in practical medical training. The self-administered questionnaire included items addressing demographic information, the Perceived Stress Questionnaire, and items addressing potential private and training-related stressors. Results Results confirmed a substantial burden of perceived stress in students at different stages of their medical education. In particular, 10–28% of students in their third or ninth semesters of medical school showed the highest values for perceived stress. Training-related stressors were most strongly associated with perceived stress, although specific stressors that determined perceived stress varied across different stages of students’ medical education. High-school graduates highly interested in pursuing medical education showed specific stressors similar to those of medical students in their third, sixth, or ninth semesters of medical school, as well as stress structures with heights of general stress rates similar to those of medical students at the beginning of practical medical training. Conclusions High-school graduates offer new, interesting information about students’ fears and needs before they begin medical school. Medical students and high-school graduates need open, comprehensive information about possible stressors at the outset of and during medical education. Programmes geared toward improving resilience behaviour and teaching new, functional coping strategies are recommended. PMID:29385180

Longitudinal rural clerkships: increased likelihood of more remote rural medical practice following graduation.

PubMed

Playford, Denese E; Nicholson, Asha; Riley, Geoffrey J; Puddey, Ian B

2015-03-21

Extended rural clerkships clearly increase the likelihood of rural practice post-graduation. What has not been determined is whether such rural interventions increase the likelihood of graduates practicing in more remote, versus inner regional, locations. The Australian Health Practitioner Regulation Agency database was used to identify the current workplace of every graduate of the Medical School of Western Australia, 1980 to 2011. There were 324 graduates working in a primary practice location defined by the Australian Standard Geographical Classification as inner regional to very remote. They were divided into 3 groups - 200 graduates who entered medical school before commencement of the Rural Clinical School of Western Australia (RCSWA), 63 who entered after the RCSWA had started, but not participated in RCSWA, and 61 who participated in the RCSWA. The RCSWA offers a longitudinal rural clinical clerkship throughout level 5 of the MBBS course. The two groups not participating in the RCSWA had 45.5% and 52.4% of subjects in outer regional/very remote locations, respectively. In comparison, 78.7% of those who had participated in the RCSWA were currently practicing in outer regional/very remote locations. When the 3 groups were compared, the significant predictors of working in a more remote practice compared to working in an inner regional area were being female (OR 1.75 95% CI 1.13, 2.72, P = 0.013) and participating in the RCSWA (OR 4.42, 95% CI 2.26, 8.67, P < 0.001). In multivariate logistic regression that corrected for gender and remoteness of rural address before entry to medical school, participation in the RCSWA still predicted a more than 4-fold increase in the odds of practicing in a more remote area (OR 4.11, 95% CI 2.04, 8.30, P < 0.001). Extended rural clinical clerkship during an undergraduate MBBS course is related to a much greater likelihood of practicing in more remote, under-serviced rural locations.

Medical student selection criteria as predictors of intended rural practice following graduation.

PubMed

Puddey, Ian B; Mercer, Annette; Playford, Denese E; Pougnault, Sue; Riley, Geoffrey J

2014-10-14

Recruiting medical students from a rural background, together with offering them opportunities for prolonged immersion in rural clinical training environments, both lead to increased participation in the rural workforce after graduation. We have now assessed the extent to which medical students' intentions to practice rurally may also be predicted by either medical school selection criteria and/or student socio-demographic profiles. The study cohort included 538 secondary school-leaver entrants to The University of Western Australia Medical School from 2006 to 2011. On entry they completed a questionnaire indicating intention for either urban or rural practice following graduation. Selection factors (standardised interview score, percentile score from the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance (Australian Tertiary Admissions Rank), together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD) and an index of rurality) were examined in relation to intended rural or urban destination of practice. In multivariate logistic regression, students from a rural background had a nearly 8-fold increase in the odds of intention to practice rurally after graduation compared to those from urban backgrounds (OR 7.84, 95% CI 4.10, 14.99, P < 0.001). Those intending to be generalists rather than specialists had a more than 4-fold increase in the odds of intention to practice rurally (OR 4.36, 95% CI 1.69, 11.22, P < 0.001). After controlling for these 2 factors, those with rural intent had significantly lower academic entry scores (P = 0.002) and marginally lower interview scores (P = 0.045). UMAT percentile scores were no different. Those intending to work in a rural location were also more likely to be female (OR 1.93, 95% CI 1.08, 3.48, P = 0.027), to come from the lower eight IRSAD deciles (OR 2.52, 95% CI 1.47, 4.32, P = 0

Are efforts to attract graduate applicants to UK medical schools effective in increasing the participation of under-represented socioeconomic groups? A national cohort study.

PubMed

Kumwenda, Ben; Cleland, Jennifer; Greatrix, Rachel; MacKenzie, Rhoda Katharine; Prescott, Gordon

2018-02-14

Attracting graduates was recommended as a means of diversifying the UK medical student population. Graduates now make up nearly a quarter of the total medical student population. Research to date has focused on comparing the sociodemographic characteristics of applicants to and/or students on traditional and graduate entry programmes (GEMs), yet GEMs account for only 40% of the graduate medical student population. Thus, we aimed to compare the sociodemographic characteristic and outcomes of graduates and non-graduate applicants across a range of programmes. This was an observational study of 117 214 applicants to medicine who took the UK Clinical Aptitude Test (UKCAT) from 2006 to 2014 and who applied to medical school through Universities and Colleges Admissions Service (UCAS). We included applicant demographics, UKCAT total score and offers in our analysis. Applicants were assigned as graduates or non-graduates on the basis of their highest qualification. Multiple logistic regression was used to predict the odds of receiving an offer, after adjusting for confounders. Irrespective of graduate or non-graduate status, most applicants were from the highest socioeconomic groups and were from a white ethnic background. Receiving an offer was related to gender and ethnicity in both graduates and non-graduates. After adjusting for UKCAT score, the OR of an offer for graduates versus non-graduates was approximately 0.5 (OR=0.48, 95% CI 0.46 to 0.49). Our findings indicate that the aim of diversifying the medical student population on socioeconomic grounds by attracting graduates has been only marginally successful. Graduate applicants from widening access backgrounds are less likely than others to be offered a place at medical school. Different approaches must be considered if medicine is to attract and select more socially diverse applicants. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No

Graduates from a traditional medical curriculum evaluate the effectiveness of their medical curriculum through interviews.

PubMed

Watmough, Simon; O'Sullivan, Helen; Taylor, David

2009-10-26

In 1996 The University of Liverpool reformed its medical course from a traditional lecture-based course to an integrated PBL curriculum. A project has been underway since 2000 to evaluate this change. Part of this project has involved gathering retrospective views on the relevance of both types of undergraduate education according to graduates. This paper focuses on the views of traditional Liverpool graduates approximately 6 years after graduation. From February 2006 to June 2006 interviews took place with 46 graduates from the last 2 cohorts to graduate from the traditional Liverpool curriculum. The graduates were generally happy with their undergraduate education although they did feel there were some flaws in their curriculum. They felt they had picked up good history and examination skills and were content with their exposure to different specialties on clinical attachments. They were also pleased with their basic science teaching as preparation for postgraduate exams, however many complained about the overload and irrelevance of many lectures in the early years of their course, particular in biochemistry. There were many different views about how they integrated this science teaching into understanding disease processes and many didn't feel it was made relevant to them at the time they learned it. Retrospectively, they felt that they hadn't been clinically well prepared for the role of working as junior doctor, particularly the practical aspects of the job nor had enough exposure to research skills. Although there was little communication skills training in their course they didn't feel they would have benefited from this training as they managed to pick up had the required skills on clinical attachments. These interviews offer a historical snapshot of the views of graduates from a traditional course before many courses were reformed. There was some conflict in the interviews about the doctors enjoying their undergraduate education but then saying that they

Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study.

PubMed

Muthaura, Patricia N; Khamis, Tashmin; Ahmed, Mushtaq; Hussain, Syeda Ra'ana

2015-10-21

Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training

Commentary: Flexner Redux 2010: graduate medical education in the United States.

PubMed

Whitcomb, Michael E

2009-11-01

The author posits that if Abraham Flexner could be brought back to write a report to address the same question that his 1910 report answered-How are doctors being prepared for practice?-he would not focus on the state of medical students' education, because today's medical students no longer enter practice on graduation from medical school. Instead, he would ask how the country's graduate medical education (GME) system is preparing residents for clinical practice. Such a report is needed because (as concluded by a variety of sources, including recent reports by the Institute of Medicine) GME training must be changed as part of the effort to improve medical care quality. Despite this finding, professional organizations that regulate how GME is designed and conducted have been unwilling to make substantive changes in the ways residents are being prepared for practice. The author reviews the reasons for this, emphasizes the need for a new Flexner-type report to make the public aware of the training deficiencies so the public could exert pressure on government officials to take action, describes groups that have already recognized the problem and proposed solutions (such as having individual programs held accountable for their residents' performance in practice), and makes recommendations, such as (1) having the Medicare program, the single largest payer of GME costs, require certain needed reforms in residents' training, and (2) modernizing state laws so that residents completing training would have to demonstrate that they are adequately prepared to enter practice before being granted licenses.

Factors affecting residency rank-listing: a Maxdiff survey of graduating Canadian medical students.

PubMed

Wang, Tao; Wong, Benson; Huang, Alexander; Khatri, Prateek; Ng, Carly; Forgie, Melissa; Lanphear, Joel H; O'Neill, Peter J

2011-08-25

In Canada, graduating medical students consider many factors, including geographic, social, and academic, when ranking residency programs through the Canadian Residency Matching Service (CaRMS). The relative significance of these factors is poorly studied in Canada. It is also unknown how students differentiate between their top program choices. This survey study addresses the influence of various factors on applicant decision making. Graduating medical students from all six Ontario medical schools were invited to participate in an online survey available for three weeks prior to the CaRMS match day in 2010. Max-Diff discrete choice scaling, multiple choice, and drop-list style questions were employed. The Max-Diff data was analyzed using a scaled simple count method. Data for how students distinguish between top programs was analyzed as percentages. Comparisons were made between male and female applicants as well as between family medicine and specialist applicants; statistical significance was determined by the Mann-Whitney test. In total, 339 of 819 (41.4%) eligible students responded. The variety of clinical experiences and resident morale were weighed heavily in choosing a residency program; whereas financial incentives and parental leave attitudes had low influence. Major reasons that applicants selected their first choice program over their second choice included the distance to relatives and desirability of the city. Both genders had similar priorities when selecting programs. Family medicine applicants rated the variety of clinical experiences more importantly; whereas specialty applicants emphasized academic factors more. Graduating medical students consider program characteristics such as the variety of clinical experiences and resident morale heavily in terms of overall priority. However, differentiation between their top two choice programs is often dependent on social/geographic factors. The results of this survey will contribute to a better

Implementation of the medical research curriculum in graduate medical school.

PubMed

Park, Kwi Hwa; Kim, Tae-Hee; Chung, Wook-Jin

2011-06-01

The purpose of this study was to analyze the effect of the medical research curriculum on the students' satisfaction and the research self-efficacy. The curriculum was implemented to 79 graduate medical school students who entered in 2007 and 2008. This curriculum is implemented through 3 years consisting of 5 different sub-courses: Research design, Research ethics, Medical statistics, Writing medical paper, and Presentation. The effect of this program was measured with 2 self-administered surveys to students: the course satisfaction survey and the self-efficacy inventories. The Research Self-Efficacy Scale consisted of 18 items from 4 categories: Research design, Research ethics, Data analysis, and Result presentation. The descriptive statistics, paired t-test, and analysis of covariance (ANCOVA) were implemented. The average point of satisfaction of the course was 2.74 out of 4, which told us that students generally satisfied with the course. The frequencies of tutoring for research course were 2 or 3 times on average and each session of tutorial lasted 1.5 to 2 hours. The research self-efficacy in three categories (Research design, Research ethics, and Result presentation) increased significantly (p<0.1). The self-efficacy of the male students was higher than females' one. The self-efficacy was not significantly different by the experience of research paper writing at undergraduate level. The curriculum showed positive results in cultivating research self-efficacy of students. There is a need for improvement of the class of Statistical analysis as students reported that it was difficult.

A new model for graduate education and innovation in medical technology.

PubMed

Yazdi, Youseph; Acharya, Soumyadipta

2013-09-01

We describe a new model of graduate education in bioengineering innovation and design- a year long Master's degree program that educates engineers in the process of healthcare technology innovation for both advanced and low-resource global markets. Students are trained in an iterative "Spiral Innovation" approach that ensures early, staged, and repeated examination of all key elements of a successful medical device. This includes clinical immersion based problem identification and assessment (at Johns Hopkins Medicine and abroad), team based concept and business model development, and project planning based on iterative technical and business plan de-risking. The experiential, project based learning process is closely supported by several core courses in business, design, and engineering. Students in the program work on two team based projects, one focused on addressing healthcare needs in advanced markets and a second focused on low-resource settings. The program recently completed its fourth year of existence, and has graduated 61 students, who have continued on to industry or startups (one half), additional graduate education, or medical school (one third), or our own Global Health Innovation Fellowships. Over the 4 years, the program has sponsored 10 global health teams and 14 domestic/advanced market medtech teams, and launched 5 startups, of which 4 are still active. Projects have attracted over US$2.5M in follow-on awards and grants, that are supporting the continued development of over a dozen projects.

The problems program directors inherit: medical student distress at the time of graduation.

PubMed

Dyrbye, Liselotte N; Moutier, Christine; Durning, Steven J; Massie, F Stanford; Power, David V; Eacker, Anne; Harper, William; Thomas, Matthew R; Satele, Daniel; Sloan, Jeff A; Shanafelt, Tait D

2011-01-01

Distress is prevalent among residents and often attributed to rigors of training. To explore the prevalence of burnout and depression and measured mental quality of life (QOL) among graduating medical students shortly before they began residency. Pooled analysis of data from 1428 fourth year medical students who responded to 1 of 3 multi-institutional studies. Students completed the Maslach Burnout Inventory, PRIME MD, and SF-8 to measure burnout, depression, and low mental QOL (defined as mean mental SF-8 scores ½ a standard deviation below the population norm) and answered demographic items. Shortly before beginning residency, 49% of responding medical students had burnout, 38% endorsed depressive symptoms, and 34% had low mental QOL. While no differences in the prevalence of distress was observed by residency specialty area, there were subtle differences in the manifestation of burnout by specialty. Medical students entering surgical fields had lower mean emotional scores, students entering primary care fields had lower mean depersonalization scores, and students entering non-primary care/non-surgical fields reported the lowest mean personal accomplishment scores (all p ≤ 0.03). Our results indicate a high prevalence of distress among graduating medical students across all specialty disciplines before they even begin residency training.

Gender Comparisons of Young Physicians' Perceptions of Their Medical Education, Professional Life, and Practice: A Follow-Up Study of Jefferson Medical College Graduates.

ERIC Educational Resources Information Center

Hojat, Mohammadreza; And Others

1995-01-01

A survey of 530 male and 137 female graduates of Jefferson Medical College (Pennsylvania) found numerous gender differences in their assessments of selected areas of the medical school curriculum, issues of medical practice and professional life, and specialty choices, professional activities, and research productivity. (Author/MSE)

Essential professional duties for the sub-Saharan medical/dental graduate: An Association of Medical Schools of Africa initiative.

PubMed

Olapade-Olaopa, E O; Sewankambo, N; Iputo, J E; Rugarabamu, P; Amlak, A H; Mipando, M; Monekosso G L

2016-09-01

BACKGROUND - Globally, human resources for health are being optimized to address the increasing health burden and concomitant increased demands on health professionals. These demands are even more exacting in Sub-SaharanAfrica considering the shortage of health care workers, especially physicians. The noteworthy efforts at deploying task-shifting to address this situation not-withstanding, the situation also signals the need to re-define the objectives of medical instruction to ensure effective and contemporary medical practice in a mostly physician-led health workforce across the sub-continent. In this regard, medical and dental graduates must be educated to perform certain minimum essential professional duties competently. Essential Professional Duties are locally relevant professional activities of international standard that represent identifiable outcomes against which the effectiveness of physicians in a specific community can be measured to ensure social accountability. PROCEDURE AND PRODUCT - The Association of Medical Schools of Africa has developed the 'Essential Professional Duties for sub-Saharan medical and dental graduates' to ensure these physicians provide safe and effective contemporary medical/dental practice on the sub-continent. The duties have been grouped into those required for basic patient care, basic administrative skills, basic emergency care, communication, inter-professional relationships, self-directed learning and social responsibilities. Their relevance and suitability have been evaluated prior to their adoption by the Association. CONCLUSION; These Essential Physician Duties have been developed to serve as targets for health professionals training instruments and thus give direction to health system strategies. It is hoped that they will be adopted by medical and dental schools across sub-,. Saharan Africa.

Attitudes of medical laboratory technology graduates towards the internship training period at king faisal university.

PubMed

Bashawri, Layla A M; Ahmed, Mirghani A; Bahnassy, Ahmed A L; Al-Salim, Jawaher A

2006-05-01

The objective of this present survey was to look into the attitudes of medical laboratory technology (MLT) graduates towards the internship training period of the MLT Department, College of Applied Medical Sciences, King Faisal University. A self-administered questionnaire was designed and distributed for this purpose. The study period was from December 1(st) 2002 - 31(st) December 2004. Two-hundred questionnaires were distributed to recent graduates, and 115 were returned completed. All respondents agreed with the importance and necessity of the internship period, and felt it should not be reduced or eliminated. The most favorite laboratory where they liked to work was microbiology (70%). They all agreed that evaluation report with hospital staff and laboratory set up were vital in achieving the goals of the internship period. The majority stressed the significance of safety precautions and the application of theoretical knowledge before performing technical assignments. The respondents had very positive attitudes towards the internship-training period stressing its importance. The most favorite laboratory rotations were in rank order: Microbiology, Serology followed by Histotechnology, Hematology, Blood Banking and finally Clinical Chemistry. The majority of graduates had a very positive attitude also towards medical laboratory technology as a profession.

Post-graduate education for medical specialists focused on patients with medically unexplained physical symptoms; development of a communication skills training programme.

PubMed

Weiland, Anne; Blankenstein, Annette H; Willems, Mariëtte H A; Van Saase, Jan L C M; Van der Molen, Henk T; Van Dulmen, Alexandra M; Arends, Lidia R

2013-09-01

Stepwise description of the development of a post-graduate communication skills training programme for medical specialists focused on patients with medically unexplained physical symptoms (MUPS) to improve specialist interaction with MUPS patients. Using the 'intervention mapping approach' we accomplished a needs assessment (literature study and pilot) to formulate intervention objectives and identify methods and techniques for a MUPS-focused communication skills training programme for medical specialists. A 14-h training programme which consists of experiential learning, role-play and feedback. Using skills from Cognitive Behavioural Therapy, medical specialists are stimulated to explore interrelating factors that reinforce symptoms, to reassure patients effectively and to provide plausible and understandable explanations for MUPS. Dealing with complex referrals and informing GPs properly are also practiced. By applying the 'intervention mapping approach' we were able to create a feasible and promising intervention to improve specialist interaction with MUPS patients. Intervention effects are currently being assessed in a randomized controlled trial. If the RCT demonstrates sufficient effectiveness and efficiency of the MUPS focused communication skills training programme for medical specialists the intervention could be embedded in post-graduate education of medical specialists and residents. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

E-health in graduate and postgraduate medical education: illusions, expectations and reality.

PubMed

Bari, Ferenc; Forczek, Erzsébet; Hantos, Zoltán

2011-01-01

With the overall growth of informatics, the medical education system should also provide programs at both graduate and post-graduate levels. While there is a wide consensus as to the importance of this urgent need, several factors slow down the construction and operation of effective education programs in medical and nursing schools. The increasing need for better and more comprehensive training in informatics is strongly limited by several factors including undefined output skills, tight time frame etc. An efficient development of partnerships within the health care system assumes that all professionals involved must possess strong informatics and interpersonal knowledge, and skills reaching beyond their own individual fields. There is an emerging need to define the basic skills and knowledge for each level of the health care education. Trans-border cooperation offers a unique opportunity for the establishment of common criteria for basic skills and knowledge, via joint discussions, collaborative thinking and concerted action.

User's Guide for MapIMG 2: Map Image Re-projection Software Package

USGS Publications Warehouse

Finn, Michael P.; Trent, Jason R.; Buehler, Robert A.

2006-01-01

BACKGROUND Scientists routinely accomplish small-scale geospatial modeling in the raster domain, using high-resolution datasets for large parts of continents and low-resolution to high-resolution datasets for the entire globe. Direct implementation of point-to-point transformation with appropriate functions yields the variety of projections available in commercial software packages, but implementation with data other than points requires specific adaptation of the transformation equations or prior preparation of the data to allow the transformation to succeed. It seems that some of these packages use the U.S. Geological Survey's (USGS) General Cartographic Transformation Package (GCTP) or similar point transformations without adaptation to the specific characteristics of raster data (Usery and others, 2003a). Usery and others (2003b) compiled and tabulated the accuracy of categorical areas in projected raster datasets of global extent. Based on the shortcomings identified in these studies, geographers and applications programmers at the USGS expanded and evolved a USGS software package, MapIMG, for raster map projection transformation (Finn and Trent, 2004). Daniel R. Steinwand of Science Applications International Corporation, National Center for Earth Resources Observation and Science, originally developed MapIMG for the USGS, basing it on GCTP. Through previous and continuing efforts at the USGS' National Geospatial Technical Operations Center, this program has been transformed from an application based on command line input into a software package based on a graphical user interface for Windows, Linux, and other UNIX machines.

Transition to life--a sendoff to the real world for graduating medical students.

PubMed

Coates, Wendy C; Spector, Tahlia S; Uijtdehaage, Sebastian

2012-01-01

Graduating medical students will enter the workforce, often for the first time. Many have spent the past 20 years as students, receiving financial support from parents, and have not managed real-life issues such as financial planning, real estate, balancing well-being with employment, and integrating into a new community with stressful working conditions. To address a perceived need, we designed an intervention to introduce graduating medical students to financial planning, real estate choices, physician wellness during relocation/internship, and traits of efficient interns. The objectives of this study are to (a) assess baseline experience, knowledge, and comfort of seniors about "real-life" experiences, and (b) assess the efficacy of a 4-hr educational intervention on perceptions of understanding financial planning, real estate choices, intern preparedness, and physician wellness. Acute Care College seniors (classes of 2009 and 2010) attended the intervention after match day and completed a survey to gather demographic data and assess preexisting knowledge and a postintervention survey (1-7 Likert scale). Forty-nine students (45% male; M age = 25.5 years) participated. Prior experiences: 43% no break in education, 51% no full-time job, 38% never signed a rental lease and 94% had not purchased real estate, 90% did not have (or were not aware of having) disability insurance, and 82% had educational debt exceeding $50,000. Following the workshop, students felt more confident in their understanding of life skills topics (real estate, 83%; financial planning, 94%; well-being, 86%). Our workshop assisted in preparing for life after medical school for 98% of the participants. Graduating medical students can gain knowledge about real-life responsibilities and confidence during an educational session prior to starting residency.

Factors associated with successful matching to dermatology residency programs by reapplicants and other applicants who previously graduated from medical school.

PubMed

Stratman, Erik J; Ness, Rachel M

2011-02-01

To identify factors associated with and not associated with successful matching and matriculation (hereinafter "matching") to dermatology residency programs for applicants who previously graduated from medical school and to distinguish which factors are within applicants' control. Observational cohort study. Six accredited academic dermatology residency training programs in the United States. A total of 221 residency applicants who previously graduated from medical school and who applied through standardized electronic application to 1 or more of the participating residency training programs. Matriculation to a dermatology residency program by August 2008 following the 2006 residency application period. Forty-six of 221 former medical school graduates included in this study matched to a dermatology residency program. Factors strongly associated with matching included United States Medical Licensing Examination Step 3 score; submission of letters written by dermatologists from institutions that train dermatology residents; completion of preliminary medicine internships rather than transitional or other internship types; listing of research experience; publishing of medical manuscripts; and completion of non-Accreditation Council for Graduate Medical Examination dermatology fellowships. Factors not associated with increased matching included volunteer work; PhD status; sex; number of posters or presentations at dermatology conferences; quality of journal publications; and first authorship. Most successful applicants limited personal statements to 1 page and did not mention previously failing to match. The study sample represented at least 86% of such nontraditional applicants who matched in 2006. For candidates seeking to match into dermatology residency programs after graduating from medical school, there are factors within their control that are associated with higher rates of match success. This study provides evidence to assist mentors who counsel such candidates

Are Michigan State University medical school (MSU-CHM) alumni more likely to practice in the region of their graduate medical education primary care program compared to non-MSU-CHM alumni?

PubMed

Switzer, Richard; VandeZande, Luke; Davis, Alan T; Koehler, Tracy J

2018-05-24

Over the past 10 years, three new MD schools have been created in the state of Michigan, while the Michigan State University College of Human Medicine (MSU-CHM) has increased their class size to 850 students. The aim of this study was to determine if MSU-CHM alumni who graduate from an MSU-affiliated primary care residency from a single graduate medical education (GME) training program in Michigan are more likely to go on to practice in close proximity to the location of their training program immediately after graduation compared to non MSU-CHM alumni. Changes over time in the proportion of primary care graduates who received fellowship training immediately following residency were also compared between these groups. A review of historical data was performed for all 2000-2016 primary care (Family Medicine, FM; Internal Medicine, IM; Internal Medicine-Pediatrics, IMP; Pediatrics, Peds) program graduates sponsored by Grand Rapids Medical Education Partners (GRMEP). Study variables included primary care program, gender, age at graduation, fellowship training, practice location immediately after graduation and undergraduate medical education location. Summary statistics were calculated for the data. Comparisons were made using the chi-square test or Fisher's Exact test when appropriate. Significance was assessed at p < 0.05. There were 478 primary care program graduates who went into practice immediately following graduation, 102 of whom also graduated from MSU-CHM. Just over half of the graduates were female and the average age at graduation was 32 years. There were 152 FM, 150 IM, 50 IMP and 126 Peds graduates. Those that graduated from both MSU-CHM and GRMEP were more likely to practice in Michigan immediately after residency training (79.4% vs 52.0%; p < 0.001), as well as within 100 miles of GRMEP (71.6% vs 46.4%; p < 0.001). There were 8% of MSU-CHM primary care graduates who went on to fellowship training from 2000 to 2009, increasing to 34% from

Council on Graduate Medical Education First Report of the Council. Volume I.

ERIC Educational Resources Information Center

Health Resources and Services Administration (DHHS/PHS), Rockville, MD. Bureau of Health Professions.

The report contains 44 recommendations on issues related to both undergraduate and graduate medical education. Among 10 principles identified are: the goal increased representation of minorities in the health professions and the importance of considering effects of total health care costs in the Nation. Initial chapters are concerned with…

General surgery residency after graduation from U.S. medical schools: visa-related challenges for the international citizen.

PubMed

Datta, Jashodeep; Zaydfudim, Victor; Terhune, Kyla P

2013-03-01

International-United States medical graduates (I-USMGs) are non-US citizen graduates of U.S. medical schools. Although academically equivalent to US-citizen peers, they are subject to the same visa requirements as non-US citizen international medical graduates. We hypothesized that visa sponsorship policies of general surgery programs (GSPs) may be discordant with the enrollment patterns of I-USMGs. A total of 196 GSPs participated in a telephone survey regarding visa sponsorship policies. Whereas GSPs preferred J-1 to H-1B sponsorship (64.2% vs. 32.6%), I-USMG enrollment favored programs supporting H-1B sponsorship (72.1% vs. 7.5%) (P = .01). University-affiliated programs were more likely to sponsor H1-Bs than independent programs (39.6% vs. 24.4%) (P = .03) and trained a greater proportion of I-USMGs than independent programs (40.6% vs. 14.0%) (P < .01). Restrictive policies against H-1B sponsorship may limit GSPs' I-USMG applicant pool and restrict I-USMGs' surgical training options.

Evolution of osteopathic graduate medical education: integration of osteopathic principles and practice in postdoctoral training.

PubMed

Lemley, William W; Steele, Karen M; Shires, William E; McMahan, Richard M

2007-11-01

Osteopathic principles and practice (OPP) are considered the core, distinguishing elements of the osteopathic medical profession. As such, the American Osteopathic Association introduced Osteopathic Postdoctoral Training Institutions (OPTIs) in 1995 to further incorporate OPP into osteopathic graduate medical education. The current study describes the evolution of the OPP teaching programs at the West Virginia School of Osteopathic Medicine (WVSOM) in Lewisburg in conjunction with its OPTI consortium, the Mountain State OPTI. Developments in distance-learning technology, lecture and workshop curricula for graduate and undergraduate students, and faculty training are described. In addition, elements of "telehealth" technology, including administrative support, and trainee and student evaluations of the programs are examined. It is hoped that the description of WVSOM's curricular evolution and the emphasis on meeting the needs of OPP program attendees will assist other osteopathic medical schools in developing their own unique OPP programs.

Challenges in Teaching the Mechanics of Breathing to Medical and Graduate Students

ERIC Educational Resources Information Center

West, John B.

2008-01-01

The mechanics of breathing has always been a difficult topic for some medical and graduate students. The subject is very quantitative and contains a number of concepts that some students have trouble with, including physical principles such as pressure, flow, volume, resistance, elasticity, and compliance. Apparently, present-day students find the…

Positive impacts on rural and regional workforce from the first seven cohorts of James Cook University medical graduates.

PubMed

Sen Gupta, T; Woolley, T; Murray, R; Hays, R; McCloskey, T

2014-01-01

The regionally-based James Cook University (JCU) School of Medicine aims to meet its mission to address the health needs of the region by combining selection and curriculum strategies shown to increase rural career recruitment outcomes. The School has graduated 536 students in its first seven cohorts from 2005 to 2011. This paper presents the early career practice locations and the specialty training undertaken by these cohorts, and describes the association between later practice location with both hometown at application and internship location. Hometown at application' data for JCU Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates was retrieved from administrative databases held by the university, while postgraduate location and career data were obtained either from personal contact via email, telephone, Facebook or electronically from the Australian Health Practitioner Regulation Authority website. Practice location was described across Australian Standard Geographical Classification Remoteness Area (RA) categories. Data for the primary practice location of 536 JCU MBBS graduates across postgraduate years (PGY) 1 to 7 is 99% complete. A total of 65% of JCU graduates undertook their internship in non-metropolitan locations including 20% in RA 2 and 44% in RA 3-5, a pattern of practice different to that of other Australian clinicians. For the internship year, 'non-metropolitan-origin' JCU MBBS graduates predominantly worked in RA 2-5 locations, while 'metropolitan origin' graduates were more likely to work in major cities. However, by PGY 7, the distribution of 'rural' and 'metropolitan' origin JCU graduates across RA categories was similar. The RA category of internship location - either 'metropolitan (RA 1) or 'non-metropolitan' (RA 2-5) - was associated with the location of subsequent practice across PGY 2-7. This comprehensive data set provides the first real evidence from one of Australia's new medical schools on actual postgraduate practice

Encouragers and discouragers affecting medical graduates' choice of regional and rural practice locations.

PubMed

McKillop, Ann; Webster, Craig; Bennett, Win; O'Connor, Barbara; Bagg, Warwick

2017-12-01

Access to health care as near to where people live as possible is desirable. However, not enough medical graduates choose to work in rural and regional areas, especially in general practice. The career decisions of recent medical graduates are known to be affected by a variety of professional, societal and personal factors. Internationally, medical programmes have exposed students to regional and rural experiences partly to encourage them to seek employment in these areas after graduation. As such, the Pūkawakawa Programme is a year-long regional and rural experience for selected Year 5 students from the University of Auckland‘s Medical Programme in New Zealand in partnership with the Northland District Health Board and two Primary Health Organisations. A lack of clarity about the drivers of rural and regional career decisions underpinned this study, which aimed to explore the barriers and encouragers for students of the programme to return as resident medical officers to the regional hospital where they had gained clinical experience. A mixed-method, descriptive design was used, including a short survey, followed by participation in a focus-group discussion or a one-on-one interview. Survey data were summarised in tabular form and inductive, thematic analysis was applied to transcripts of focus groups and interviews. Nineteen doctors in their first or second year following graduation participated: 15 who had returned to the hospital where they had clinical experience in the programme and four who were employed elsewhere. 'A match of personal goals and intended career intentions' was the reason most frequently selected for junior doctors’ choice of early career employment. Other frequently selected reasons were lifestyle, friends and family close by, and the reputation and experience of the Pūkawakawa Programme. Qualitative data revealed that the learning experience, the unique design of the curriculum and associated support from clinicians were

Postgraduate career intentions of medical students and recent graduates in Malawi: a qualitative interview study.

PubMed

Bailey, Nicola; Mandeville, Kate L; Rhodes, Tim; Mipando, Mwapatsa; Muula, Adamson S

2012-09-14

In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation. Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach. Opportunities for postgraduate training emerged as the most important factor in participants' career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector. Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may be an indicator of the success of salary supplements. In order to

Career Plans and Debt Levels of Graduating U.S. Medical Students, 1981-1986.

ERIC Educational Resources Information Center

Tudor, Cynthia

1988-01-01

Trends in students' responses to the annual graduation questionnaire of the Association of American Medical Colleges from 1981 to 1986 were examined. Changes in career activity reflected increasing interest in full-time academic appointments and decreasing interest in solo, private practices. (Author/MLW)

Association between rural clinical clerkship and medical students' intentions to choose rural medical work after graduation: A cross-sectional study in western China.

PubMed

Liu, Jinlin; Zhu, Bin; Mao, Ying

2018-01-01

A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students' participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson's chi-squared tests and binary logistic regression analyses were performed for data analyses. Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students' intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05-1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48-2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background. Rural clinical clerkship is likely to

Association between rural clinical clerkship and medical students’ intentions to choose rural medical work after graduation: A cross-sectional study in western China

PubMed Central

Zhu, Bin; Mao, Ying

2018-01-01

Background A large number of programs have been implemented in many countries to increase the healthcare workforce recruitment in rural and remote areas. Rural early exposure programs for medical students have been shown to be effective strategies. However, no related studies have been reported before in China. This study was carried out to determine the association between medical students’ participation in rural clinical clerkships and their intentions to choose rural medical work after graduation from western medical schools in China. Methods Based on a two-stage random sampling method, the cross-sectional survey was carried out in ten western provinces in China. A brief questionnaire filled in by medical students was used for data collection. A total of 4278 medical students participated in the study. The response rate was approximately 90.34%. Pearson’s chi-squared tests and binary logistic regression analyses were performed for data analyses. Results Approximately 52.0% of medical students disclosed intentions to work in rural medical institutions after graduation. Only one in five participants had experience with a rural clinical clerkship. Rural clinical clerkships were significantly associated with medical students’ intentions to work in rural medical institutions (OR: 1.24, 95%CI: 1.05–1.46); further analyses indicated that such clerkships only had a significant impact among the medical students with an urban background (OR: 2.10, 95%CI: 1.48–2.97). In terms of the sociodemographic characteristics, younger age, low level of parental education, majoring in general practice, and studying in low-level medical schools increased the odds of having intentions to engage in rural medical work among medical students; however, rural origins was the only positive univariate predictor. In addition, the predictors of intentions to choose rural medical work were different between medical students with a rural background and those with an urban background

How prepared are UK medical graduates for practice? A rapid review of the literature 2009-2014.

PubMed

Monrouxe, Lynn V; Grundy, Lisa; Mann, Mala; John, Zoe; Panagoulas, Eleni; Bullock, Alison; Mattick, Karen

2017-01-13

To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions. A rapid review of the literature (registration #CRD42013005305). Nine major databases (and key websites) were searched in two timeframes (July-September 2013; updated May-June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge. Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures. At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013-2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes. Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy. Educational interventions are needed to address areas of unpreparedness (eg, multidisciplinary team

Impact of the Medical Faculty on Study Success in Freiburg: Results from Graduate Surveys.

PubMed

Biller, Silke; Boeker, Martin; Fabry, Götz; Giesler, Marianne

2015-01-01

Using the data from graduate surveys, this study aims to analyze which factors related to teaching and learning at the Freiburg Faculty of Medicine can influence study success. Study success and the factors influencing it have long been the subject of investigation, with study success being measured in terms of easily quantifiable indicators (final grades, student satisfaction, etc.). In recent years, it has also frequently been assessed in terms of graduate competency levels. Graduate surveys are considered suitable instruments for measuring these dimensions of study success. Data from three Freiburg graduate surveys conducted one and a half years after graduation were drawn upon for the analysis. Study success was operationalized using four indicators: results on the written section of the M2 exam, self-assessment of medical expertise and scientific expertise, and student satisfaction. Using multiple regression analyses, the predictive power was calculated for selected variables, also measured by the graduate surveys, for the different study success indicators. It was possible to identify models that contribute slightly or moderately to the prediction of study success. The score earned on the university entrance qualification demonstrated itself to be the strongest predictor for forecasting the M2 written exam: R(2) is between 0.08 and 0.22 for the three surveys. Different variables specific to degree program structure and teaching are helpful for predicting medical expertise (R(2)=0.04-0.32) and student satisfaction (R(2)=0.12-0.35). The two variables, structure and curricular sequencing of the degree program and combination of theory and practice, show themselves to be significant, sample-invariant predictors (β-weight(Structure)=0.21-0.58, β-weight(Combination)=0.27-0.56). For scientific expertise, no sample-independent predictors could be determined. Factors describing teaching hardly provide any assistance when predicting the written M2 exam score, which

Examining Changes in Certification/Licensure Requirements and the International Medical Graduate Examinee Pool

ERIC Educational Resources Information Center

McKinley, Danette W.; Hess, Brian J.; Boulet, John R.; Lipner, Rebecca S.

2014-01-01

Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal…

Debt on graduation, expected place of practice, and career aspirations of Auckland Medical School students.

PubMed

O'Grady, G; Fitzjohn, J

2001-10-26

To determine the debt level that current Auckland medical students expect to graduate with, and evaluate this debt in the context of their career aspirations and intended place of practice. Simple check-box and fill-in-the-blank surveys were distributed to Auckland University medical students in Years 1 through to 5 during their second week of scheduled lectures in March 2000. Students were asked to provide demographic details, then complete sections on debt and career aspirations. 70% of Auckland medical students participated. Average expected debt was between $60000 to $70000. Predicted size of graduation debt was significantly related with plans to practice medicine overseas, and this trend was especially strong among females. In addition, Maori and Polynesian students bear a disproportionate level of the student debt burden compared to Pakeha and Asian groups. 77% of students indicated a preference for working in private or hospital specialty work. Student debt will have major effects on the composition of the New Zealand medical workforce over coming years. More attention must be paid to the national picture of medical student indebtedness if adequate workforce planning is to be possible.

James Cook University's rurally orientated medical school selection process: quality graduates and positive workforce outcomes.

PubMed

Ray, Robin A; Woolley, Torres; Sen Gupta, Tarun

2015-01-01

The regionally based James Cook University (JCU) College of Medicine and Dentistry aims to meet its mission to address the health needs of the region by using a selection policy favouring rural origin applicants and providing students with early and repeated exposure to rural experiences during training. This study seeks to determine if the JCU medical school's policy of preferentially selecting rural and remote background students is associated with differing patterns of undergraduate performance or graduate practice location. Data at application to medical school and during the undergraduate years was retrieved from administrative databases held by the university and the medical school. Postgraduate location data were obtained either from personal contact via email, telephone or Facebook or electronically from the Australian Health Practitioner Regulation Authority website. Practice location was described across Australian Standard Geographical Classification Remoteness Area (ASGC-RA) categories, with 1 being a major city and 5 being a very remote location. The 856 Australian-based students accepted into the JCU medical program between 2000 and 2008 came from all geographical regions across Australia: 20% metropolitan (ASGC-RA 1), 20% inner regional (ASGC-RA 2), 56% outer regional (ASGC-RA 3), and 5% from remote or very remote locations (ASGC-RA 4 and 5). Having a rural or remote hometown at application (ASGC-RA 3-5) was significantly associated with a lower tertiary entrance score (p<0.001), a lower interview score in the medical school selection process (p<0.001), being less likely to be admitted into the Honours program (p=0.001), being an advanced standing student (p=0.025), being awarded a Medical Rural Bonded Scholarship (p=0.005), taking longer to complete the 6-year course (p=<0.009) and having a lower academic achievement across years 1 to 3 (p=0.002, p=0.005 and p=0.025, respectively). Graduates having either a rural or a remote home town at application

Attitudes towards statistics of graduate entry medical students: the role of prior learning experiences

PubMed Central

2014-01-01

Background While statistics is increasingly taught as part of the medical curriculum, it can be an unpopular subject and feedback from students indicates that some find it more difficult than other subjects. Understanding attitudes towards statistics on entry to graduate entry medical programmes is particularly important, given that many students may have been exposed to quantitative courses in their previous degree and hence bring preconceptions of their ability and interest to their medical education programme. The aim of this study therefore is to explore, for the first time, attitudes towards statistics of graduate entry medical students from a variety of backgrounds and focus on understanding the role of prior learning experiences. Methods 121 first year graduate entry medical students completed the Survey of Attitudes toward Statistics instrument together with information on demographics and prior learning experiences. Results Students tended to appreciate the relevance of statistics in their professional life and be prepared to put effort into learning statistics. They had neutral to positive attitudes about their interest in statistics and their intellectual knowledge and skills when applied to it. Their feelings towards statistics were slightly less positive e.g. feelings of insecurity, stress, fear and frustration and they tended to view statistics as difficult. Even though 85% of students had taken a quantitative course in the past, only 24% of students described it as likely that they would take any course in statistics if the choice was theirs. How well students felt they had performed in mathematics in the past was a strong predictor of many of the components of attitudes. Conclusion The teaching of statistics to medical students should start with addressing the association between students’ past experiences in mathematics and their attitudes towards statistics and encouraging students to recognise the difference between the two disciplines

Attitudes towards statistics of graduate entry medical students: the role of prior learning experiences.

PubMed

Hannigan, Ailish; Hegarty, Avril C; McGrath, Deirdre

2014-04-04

While statistics is increasingly taught as part of the medical curriculum, it can be an unpopular subject and feedback from students indicates that some find it more difficult than other subjects. Understanding attitudes towards statistics on entry to graduate entry medical programmes is particularly important, given that many students may have been exposed to quantitative courses in their previous degree and hence bring preconceptions of their ability and interest to their medical education programme. The aim of this study therefore is to explore, for the first time, attitudes towards statistics of graduate entry medical students from a variety of backgrounds and focus on understanding the role of prior learning experiences. 121 first year graduate entry medical students completed the Survey of Attitudes toward Statistics instrument together with information on demographics and prior learning experiences. Students tended to appreciate the relevance of statistics in their professional life and be prepared to put effort into learning statistics. They had neutral to positive attitudes about their interest in statistics and their intellectual knowledge and skills when applied to it. Their feelings towards statistics were slightly less positive e.g. feelings of insecurity, stress, fear and frustration and they tended to view statistics as difficult. Even though 85% of students had taken a quantitative course in the past, only 24% of students described it as likely that they would take any course in statistics if the choice was theirs. How well students felt they had performed in mathematics in the past was a strong predictor of many of the components of attitudes. The teaching of statistics to medical students should start with addressing the association between students' past experiences in mathematics and their attitudes towards statistics and encouraging students to recognise the difference between the two disciplines. Addressing these issues may reduce students

Examining Sense of Community among Medical Professionals in an Online Graduate Program

ERIC Educational Resources Information Center

Lewis, Kadriye O.; McVay-Dyche, Jennifer; Chen, Haiqin; Seto, Teresa L.

2015-01-01

As the number of online degree programs continues to grow, one of the greatest challenges is developing a sense of community among learners who do not convene at the same time and place. This study examined the sense of community among medical professionals in an online graduate program for healthcare professionals. We took the sample from a fully…

The Primary Care Physician Workforce: Ethical and Policy Implications

PubMed Central

Starfield, Barbara; Fryer, George E.

2007-01-01

PURPOSE We undertook a study to examine the characteristics of countries exporting physicians to the United States according to their relative contribution to the primary care supply in the United States. METHODS We used data from the World Health Organization and from the American Medical Association Physician Masterfile to gather sociodemographic, health system, and health characteristics of countries and the number of international medical graduates (IMGs) for the countries, according to the specialty of their practice in the United States. RESULTS Countries whose medical school graduates added a relatively greater percentage of the primary care physicians than the overall percentage of primary care physicians in the United States (31%) were poor countries with relatively extreme physician shortages, high infant mortality rates, lower life expectancies, and lower immunization rates than countries contributing relatively more specialists to the US physician workforce. CONCLUSION The United States disproportionately uses graduates of foreign medical schools from the poorest and most deprived countries to maintain its primary care physician supply. The ethical aspects of depending on foreign medical graduates is an important issue, especially when it deprives disadvantaged countries of their graduates to buttress a declining US primary care physician supply. PMID:18025485

Residency training in physiatry during a time of change: funding of graduate medical education and other issues.

PubMed

DeLisa, J A; Jain, S S; Kirshblum, S

1998-01-01

Decision makers at the federal and state level are considering, and some states have enacted, a reduction in total United States residency positions, a shift in emphasis from specialist to generalist training, a need for programs to join together in training consortia to determine local residency position allocation strategy, a reduction in funding of international medical graduates, and a reduction in funding beyond the first certificate or a total of five years. A 5-page, 24-item questionnaire was sent to all physiatry residency training directors. The objective was to discern a descriptive database of physiatry training programs and how their institutions might respond to cuts in graduate medical education funding. Fifty-eight (73%) of the questionnaires were returned. Most training directors believe that their primary mission is to train general physiatrists and, to a much lesser extent, to train subspecialty or research fellows. Directors were asked how they might handle reductions in house staff such as using physician extenders, shifting clinical workload to faculty, hiring additional faculty, and funding physiatry residents from practice plans and endowments. Physiatry has had little experience (29%; 17/58) with voluntary graduate medical education consortiums, but most (67%; 34/58) seem to feel that if a consortium system is mandated, they would favor a local or regional over a national body because they do not believe the specialty has a strong enough national stature. The major barriers to a consortium for graduate medical education allocation were governance, academic, fiscal, bureaucratic, and competition.

From nuclear submarines to graduate medical education: applying David Marquet's intent-based leadership model.

PubMed

Fernandez-Salvador, Camilo; Oney, Rebecca; Song, Sungjin A; Camacho, Macario

2017-10-11

L. David Marquet, a decorated Navy Captain, transformed an underperforming submarine crew by empowering his subordinates to be leaders and reach their full potential. He called this intent-based leadership (IBL). What would happen if Marquet's model were implemented in Graduate Medical Education (GME)?In this letter to the editor, we summarize the potential of the IBL model in graduate medical education as opposed to the traditional leader-follower method. IBL harnesses human productivity toward the shared goals of GME, which are patient care and trainee learning. This shift in mindset could lead both teachers and trainees to focus more on the real reason that we undertake GME and change behaviors for the better. We suggest that IBL can and should be adopted in GME and propose that both patients and providers will benefit from this action.

A pilot Tuning Project-based national study on recently graduated medical students' self-assessment of competences--the TEST study.

PubMed

Grilo Diogo, Pedro; Barbosa, Joselina; Ferreira, Maria Amélia

2015-12-19

The Tuning Project is an initiative funded by the European Commission that developed core competences for primary medical degrees in Europe. Students' grouped self-assessments are used for program evaluation and improvement of curricula. The TEST study aimed to assess how do Portuguese medical graduates self-assess their acquisition of core competences and experiences of contact with patients in core settings according to the Tuning framework. Translation of the Tuning's competences (Clinical Practice - CP), Knowledge (K) items and Clinical Settings (CS) was performed. Questionnaires were created in paper and electronic formats and distributed to 1591 graduates from seven Portuguese medical schools (July 2014). Items were rated in a 6-point Likert scale (0-5) of levels of competence. Exploratory factor analysis (EFA) was conducted and Cronbach's alpha was used to evaluate the internal consistency of the questionnaire. Kruskal-Wallis and Dunn's tests were used for multiple comparisons. Three hundred eighty seven questionnaires were analyzed, corresponding to 24% of the target population. EFA yielded an 11-factor solution for CP and a 6-factor solution for K items. The median value of CP factors was 2.8 (p25 = 2.0; p75 = 3.5) and the median value of K factors was 2.6 (2.0; 3.2). Factor scores ranged from 1.3 (Legal principles) to 4.0 (Ethical principles). Clinical presentations, psychological aspects of illness, evidence-based medicine and promotion of health showed the highest results. Lower scores were detected in medical emergencies, practical procedures, prescribing drugs and legal principles. More than 90% of graduates experienced having contact with patients in 8 CS but only 24% of graduates had contact in all 14 CS. Graduates had the least contact with patients in the emergency rooms, intensive care units, palliative, rehabilitation and anesthetic care. Significant differences (p < 0.05) among schools were detected in 8 factors and 7 settings. We

Graduates from a reformed undergraduate medical curriculum based on Tomorrow's Doctors evaluate the effectiveness of their curriculum 6 years after graduation through interviews.

PubMed

Watmough, Simon D; O'Sullivan, Helen; Taylor, David C M

2010-09-29

In 1996 Liverpool reformed its medical curriculum from a traditional lecture based course to a curriculum based on the recommendations in Tomorrow's Doctors. A project has been underway since 2000 to evaluate this change. This paper focuses on the views of graduates from that reformed curriculum 6 years after they had graduated. Between 2007 and 2009 45 interviews took place with doctors from the first two cohorts to graduate from the reformed curriculum. The interviewees felt like they had been clinically well prepared to work as doctors and in particular had graduated with good clinical and communication skills and had a good knowledge of what the role of doctor entailed. They also felt they had good self directed learning and research skills. They did feel their basic science knowledge level was weaker than traditional graduates and perceived they had to work harder to pass postgraduate exams. Whilst many had enjoyed the curriculum and in particular the clinical skills resource centre and the clinical exposure of the final year including the "shadowing" and A & E attachment they would have liked more "structure" alongside the PBL when learning the basic sciences. According to the graduates themselves many of the aims of curriculum reform have been met by the reformed curriculum and they were well prepared clinically to work as doctors. However, further reforms may be needed to give confidence to science knowledge acquisition.

Regional universities and rural clinical schools contribute to rural medical workforce, a cohort study of 2002 to 2013 graduates.

PubMed

Shires, Lizzi; Allen, Penny; Cheek, Colleen; Deb, Wilson

2015-01-01

Rural clinical schools and regionally based medical schools have a major role in expanding the rural medical workforce. The aim of this cohort study was to compare location of practice of graduates from the University of Tasmania School of Medicine's clinical schools based in the larger cities of Hobart and Launceston (UTAS SoM), with those graduates who spent at least 1 year at the University of Tasmania School of Medicine's Rural Clinical School based in the smaller regional city of Burnie (UTAS RCS) in Australia. Specifically, the aim was to quantify the proportion who worked in an Australian regional or remote location, or in the regional cities and smaller towns within Tasmania. The 2014 locations of practice of all graduates from the UTAS SoM and UTAS RCS between 2002 and 2013 were determined using the postcode listed in the Australian Health Practitioners Authority database. These postcodes were mapped against the Australian Bureau of Statistics Australian Standard Geographic Classification - Remoteness Areas (ASGC-RA) and the 2011 Census population data for Tasmania to define Modified Monash Model classifications. The study tracked 974 UTAS SoM graduates; 202 (21%) spent at least 1 year at the Rural Clinical School (UTAS RCS graduates). Students who had spent a year at the UTAS RCS were five times more likely to be working in RA3 to RA5 than those who hadn't spent a clinical year there (28% vs 7%, χ2(1)=59.5, p<0.0001) (odds ratio (OR) 4.9, 95% confidence interval (CI) 3.2-7.6). Using the Modified Monash Model, it was found that UTAS RCS graduates were nine times more likely (OR 9.0, 95%CI 4.7-17.2) to be working in the regional cities and smaller towns of Tasmania. This study adds to the growing evidence that training medical students in rural areas delivers graduates that work rurally. The additional year spent in a rural area, even when their medical school is in a regional city, significantly affects their workplace choices over the first 3 years post-graduation.

COGME 1995 Physician Workforce Funding Recommendations for Department of Health and Human Services' Programs. Council on Graduate Medical Education, 7th Report.

ERIC Educational Resources Information Center

Council on Graduate Medical Education.

This report presents specific recommendations to the Department of Health and Human Services and Congress from the Council on Graduate Medical Education that address Medicare's direct and indirect graduate medical education (GME) payments and the monies allocated by the Public Health Service that is targeted toward physician education and primary…

Global Health and Graduate Medical Education: A Systematic Review of the Literature

PubMed Central

Bills, Corey B.; Ahn, James

2016-01-01

Background  Global health (GH) interest is increasing in graduate medical education (GME). The popularity of the GH topic has created growth in the GME literature. Objective  The authors aim to provide a systematic review of published approaches to GH in GME. Methods  We searched PubMed using variable keywords to identify articles with abstracts published between January 1975 and January 2015 focusing on GME approaches to GH. Articles meeting inclusion criteria were evaluated for content by authors to ensure relevance. Methodological quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI), which has demonstrated reliability and validity evidence. Results  Overall, 69 articles met initial inclusion criteria. Articles represented research and curricula from a number of specialties and a range of institutions. Many studies reported data from a single institution, lacked randomization and/or evidence of clinical benefit, and had poor reliability and validity evidence. The mean MERSQI score among 42 quantitative articles was 8.87 (2.79). Conclusions  There is significant heterogeneity in GH curricula in GME, with no single strategy for teaching GH to graduate medical learners. The quality of literature is marginal, and the body of work overall does not facilitate assessment of educational or clinical benefit of GH experiences. Improved methods of curriculum evaluation and enhanced publication guidelines would have a positive impact on the quality of research in this area. PMID:28018532

An Exploration into Learner Experiences with Mandated Learning Portfolios in Graduate Medical Education

ERIC Educational Resources Information Center

Mulligan, Margaret H.

2009-01-01

In 1999, the Accreditation Council of Graduate Medical Education (ACGME) began the Outcome Project which re-focused program accreditation decisions. Six competency areas detailed new standards, calling for programs to measure and provide evidence of learner's acquisition of the knowledge and skills for independent practice in a specific specialty.…

Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: observational study.

PubMed

Tsugawa, Yusuke; Jena, Anupam B; Orav, E John; Jha, Ashish K

2017-02-02

 To determine whether patient outcomes differ between general internists who graduated from a medical school outside the United States and those who graduated from a US medical school.  Observational study.  Medicare, USA.  20% national sample of data for Medicare fee-for-service beneficiaries aged 65 years or older admitted to hospital with a medical condition in 2011-14 and treated by international or US medical graduates who were general internists. The study sample for mortality analysis included 1 215 490 admissions to the hospital treated by 44 227 general internists.  Patients' 30 day mortality and readmission rates, and costs of care per hospital admission, with adjustment for patient and physician characteristics and hospital fixed effects (effectively comparing physicians within the same hospital). As a sensitivity analysis, we focused on physicians who specialize in the care of patients admitted to hospital ("hospitalists"), who typically work in shifts and whose patients are plausibly quasi-randomized based on the physicians' work schedules.  Compared with patients treated by US graduates, patients treated by international graduates had slightly more chronic conditions. After adjustment for patient and physician characteristics and hospital fixed effects, patients treated by international graduates had lower mortality (adjusted mortality 11.2% v 11.6%; adjusted odds ratio 0.95, 95% confidence interval 0.93 to 0.96; P<0.001) and slightly higher costs of care per admission (adjusted costs $1145 (£950; €1080) v $1098; adjusted difference $47, 95% confidence interval $39 to $55, P<0.001). Readmission rates did not differ between the two types of graduates. Similar differences in patient outcomes were observed among hospitalists. Differences in patient mortality were not explained by differences in length of stay, spending level, or discharge location.  Data on older Medicare patients admitted to hospital in the US showed that patients

GIS residency footprinting: analyzing the impact of family medicine graduate medical education in Hawai'i.

PubMed

Hixon, Allen L; Buenconsejo-Lum, Lee E; Racsa, C Philip

2012-04-01

Access to care for patients in Hawai'i is compromised by a significant primary care workforce shortage. Not only are there not enough primary care providers, they are often not practicing in locations of high need such as rural areas on the neighbor islands or in the Pacific. This study used geographic information systems (GIS) spatial analysis to look at practice locations for 86 University of Hawai'i Family Medicine and Community Health graduates from 1993 to the 2010. Careful alumni records were verified and entered into the data set using the street address of major employment. Questions to be answered were (1) what percentage of program graduates remain in the state of Hawai'i and (2) what percentage of graduates practice in health professional shortage areas (HPSAs) throughout the United States. This study found that 73 percent of graduates remain and practice in Hawai'i with over 36 percent working in Health Professional Shortage Areas. Spatial analysis using GIS residency footprinting may be an important analytic tool to ensure that graduate medical education programs are meeting Hawai'i's health workforce needs.

Impact of problem-based, active learning on graduation rates for 10 generations of Dutch medical students.

PubMed

Schmidt, Henk G; Cohen-Schotanus, Janke; Arends, Lidia R

2009-03-01

We aimed to study the effects of active-learning curricula on graduation rates of students and on the length of time needed to graduate. Graduation rates for 10 generations of students enrolling in the eight Dutch medical schools between 1989 and 1998 were analysed. In addition, time needed to graduate was recorded. Three of the eight schools had curricula emphasising active learning, small-group instruction and limited numbers of lectures; the other five had conventional curricula to varying degrees. Overall, the active-learning curricula graduated on average 8% more students per year, and these students graduated on average 5 months earlier than their colleagues from conventional curricula. Four hypotheses potentially explaining the effect of active learning on graduation rate and study duration were considered: (i) active-learning curricula promote the social and academic integration of students; (ii) active-learning curricula attract brighter students; (iii) active-learning curricula retain more poor students, and (iv) the active engagement of students with their study required by active-learning curricula induces better academic performance and, hence, lower dropout rates. The first three hypotheses had to be rejected. It was concluded that the better-learning hypothesis provides the most parsimonious account for the data.

Incubating the research independence of a medical scientist training program graduate: a case study.

PubMed

Dzirasa, Kafui; Krishnan, Ranga R; Williams, R Sanders

2015-02-01

Physician-scientists play a critical role in discovering new biological knowledge and translating findings into medical practices that can improve clinical outcomes. Collectively, the National Institutes of Health (NIH) and its affiliated Medical Scientist Training Programs (MSTPs) invest upwards of $500,000 to fully train each of the 900+ MD/PhD students enrolled in these programs. Nevertheless, graduates face the challenges of navigating fragmented intervals of clinical training and research engagement, reinitiating research upon completing their residencies, managing financial pressures, and competing for funding following what is typically four or more years of research inactivity. Together, these barriers contribute to the high attrition rate of MSTP graduates from research careers. The authors designed and implemented (2009-2014), for a single trainee, an alternative postgraduate training model characterized by early research engagement, strategic mentoring, unyoked clinical and research milestones, and dedicated financial support. The pilot training experiment was so successful that the trainee secured an NIH project grant and completed his transition to research independence 3.5 years after starting the experimental training schedule-nearly 9 years earlier (based on age) than is typical for MD/PhDs transitioning from mentored to independent research. This success has demonstrated that unyoking research engagement from conventional calendar-based clinical training milestones is a feasible, effective means of incubating research independence in MSTP graduates. The authors encourage the design and application of similar unconventional approaches that interweave residency training with ongoing research activity for appropriate candidates, especially in subspecialties with increased MSTP graduate enrollment.

Graduates from vertically integrated curricula.

PubMed

Wijnen-Meijer, Marjo; ten Cate, Olle; van der Schaaf, Marieke; Harendza, Sigrid

2013-06-01

  Vertical integration (VI) has been recommended as an undergraduate medical curriculum structure that fosters the transition to postgraduate training. Our definition of VI includes: (1) the provision of early clinical experience; (2) the integration of biomedical sciences with clinical cases; (3) long clerkships during the final year; and (4) increasing levels of clinical responsibility for students. The aim of the current study is to support the hypothesis that medical graduates from VI programmes meet the expectations of postgraduate supervisors better than those from non-VI curricula.   A questionnaire study was carried out among supervisors of postgraduate training programmes run at Utrecht (the Netherlands, VI; n = 128) and Hamburg (Germany, non-VI; n = 114). The supervisors were asked about their medical graduates' preparedness for work, knowledge and capabilities to manage some specific parts of the work as a doctor. They evaluated their performances on a five-point Likert scale.   The two groups of supervisors did not differ in their judgment of their graduates' preparedness for work and level of knowledge. However, supervisors in Utrecht evaluated their graduates higher with respect to capability to work independently, solving medical problems, managing unfamiliar medical situations, prioritising tasks, collaborating with other people, estimating when they need to consult their supervisors and reflecting on their activities.   Graduates from VI medical curricula appeared to be more capable in several facets of a doctor's job. Research into the actual performance of graduates from VI and non-VI curricula is needed to further support a firm recommendation for VI curricula. © 2013 John Wiley & Sons Ltd.

Perceptions of UK medical graduates' preparedness for practice: a multi-centre qualitative study reflecting the importance of learning on the job.

PubMed

Illing, Jan C; Morrow, Gill M; Rothwell nee Kergon, Charlotte R; Burford, Bryan C; Baldauf, Beate K; Davies, Carol L; Peile, Ed B; Spencer, John A; Johnson, Neil; Allen, Maggie; Morrison, Jill

2013-02-28

There is evidence that graduates of different medical schools vary in their preparedness for their first post. In 2003 Goldacre et al. reported that over 40% of UK medical graduates did not feel prepared and found large differences between graduates of different schools. A follow-up survey showed that levels of preparedness had increased yet there was still wide variation. This study aimed to examine whether medical graduates from three diverse UK medical schools were prepared for practice. This was a qualitative study using a constructivist grounded theory approach. Prospective and cross-sectional data were collected from the three medical schools.A sample of 60 medical graduates (20 from each school) was targeted. They were interviewed three times: at the end of medical school (n = 65) and after four (n = 55) and 12 months (n = 46) as a Year 1 Foundation Programme doctor. Triangulated data were collected from clinicians via interviews across the three sites (n = 92). In addition three focus groups were conducted with senior clinicians who assess learning portfolios. The focus was on identifying areas of preparedness for practice and any areas of lack of preparedness. Although selected for being diverse, we did not find substantial differences between the schools. The same themes were identified at each site. Junior doctors felt prepared in terms of communication skills, clinical and practical skills and team working. They felt less prepared for areas of practice that are based on experiential learning in clinical practice: ward work, being on call, management of acute clinical situations, prescribing, clinical prioritisation and time management and dealing with paperwork. Our data highlighted the importance of students learning on the job, having a role in the team in supervised practice to enable them to learn about the duties and responsibilities of a new doctor in advance of starting work.

How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014

PubMed Central

Grundy, Lisa; Mann, Mala; John, Zoe; Panagoulas, Eleni; Bullock, Alison; Mattick, Karen

2017-01-01

Objective To understand how prepared UK medical graduates are for practice and the effectiveness of workplace transition interventions. Design A rapid review of the literature (registration #CRD42013005305). Data sources Nine major databases (and key websites) were searched in two timeframes (July–September 2013; updated May–June 2014): CINAHL, Embase, Educational Resources Information Centre, Health Management Information Consortium, MEDLINE, MEDLINE in Process, PsycINFO, Scopus and Web of Knowledge. Eligibility criteria for selecting studies Primary research or studies reporting UK medical graduates' preparedness between 2009 and 2014: manuscripts in English; all study types; participants who are final-year medical students, medical graduates, clinical educators, patients or NHS employers and all outcome measures. Data extraction At time 1, three researchers screened manuscripts (for duplicates, exclusion/inclusion criteria and quality). Remaining 81 manuscripts were coded. At time 2, one researcher repeated the process for 2013–2014 (adding six manuscripts). Data were analysed using a narrative synthesis and mapped against Tomorrow's Doctors (2009) graduate outcomes. Results Most studies comprised junior doctors' self-reports (65/87, 75%), few defined preparedness and a programmatic approach was lacking. Six themes were highlighted: individual skills/knowledge, interactional competence, systemic/technological competence, personal preparedness, demographic factors and transitional interventions. Graduates appear prepared for history taking, physical examinations and some clinical skills, but unprepared for other aspects, including prescribing, clinical reasoning/diagnoses, emergency management, multidisciplinary team-working, handover, error/safety incidents, understanding ethical/legal issues and ward environment familiarity. Shadowing and induction smooth transition into practice, but there is a paucity of evidence around assistantship efficacy

Variation in passing standards for graduation-level knowledge items at UK medical schools.

PubMed

Taylor, Celia A; Gurnell, Mark; Melville, Colin R; Kluth, David C; Johnson, Neil; Wass, Val

2017-06-01

Given the absence of a common passing standard for students at UK medical schools, this paper compares independently set standards for common 'one from five' single-best-answer (multiple-choice) items used in graduation-level applied knowledge examinations and explores potential reasons for any differences. A repeated cross-sectional study was conducted. Participating schools were sent a common set of graduation-level items (55 in 2013-2014; 60 in 2014-2015). Items were selected against a blueprint and subjected to a quality review process. Each school employed its own standard-setting process for the common items. The primary outcome was the passing standard for the common items by each medical school set using the Angoff or Ebel methods. Of 31 invited medical schools, 22 participated in 2013-2014 (71%) and 30 (97%) in 2014-2015. Schools used a mean of 49 and 53 common items in 2013-2014 and 2014-2015, respectively, representing around one-third of the items in the examinations in which they were embedded. Data from 19 (61%) and 26 (84%) schools, respectively, met the inclusion criteria for comparison of standards. There were statistically significant differences in the passing standards set by schools in both years (effect sizes (f 2 ): 0.041 in 2013-2014 and 0.218 in 2014-2015; both p < 0.001). The interquartile range of standards was 5.7 percentage points in 2013-2014 and 6.5 percentage points in 2014-2015. There was a positive correlation between the relative standards set by schools in the 2 years (Pearson's r = 0.57, n = 18, p = 0.014). Time allowed per item, method of standard setting and timing of examination in the curriculum did not have a statistically significant impact on standards. Independently set standards for common single-best-answer items used in graduation-level examinations vary across UK medical schools. Further work to examine standard-setting processes in more detail is needed to help explain this variability and develop methods to reduce

Association of MCAT scores obtained with standard vs extra administration time with medical school admission, medical student performance, and time to graduation.

PubMed

Searcy, Cynthia A; Dowd, Keith W; Hughes, Michael G; Baldwin, Sean; Pigg, Trey

2015-06-09

Individuals with documented disabilities may receive accommodations on the Medical College Admission Test (MCAT). Whether such accommodations are associated with MCAT scores, medical school admission, and medical school performance is unclear. To determine the comparability of MCAT scores obtained with standard vs extra administration time with respect to likelihood of acceptance to medical school and future medical student performance. Retrospective cohort study of applicants to US medical schools for the 2011-2013 entering classes who reported MCAT scores obtained with standard time (n = 133,962) vs extra time (n = 435), and of students who matriculated in US medical schools from 2000-2004 who reported MCAT scores obtained with standard time (n = 76,262) vs extra time (n = 449). Standard or extra administration time during MCAT. Primary outcome measures were acceptance rates at US medical schools and graduation rates within 4 or 5 years after matriculation. Secondary outcome measures were pass rates on the United States Medical Licensing Examination (USMLE) Step examinations and graduation rates within 6 to 8 years after matriculation. Acceptance rates were not significantly different for applicants who had MCAT scores obtained with standard vs extra time (44.5% [59,585/133,962] vs 43.9% [191/435]; difference, 0.6% [95% CI, -4.1 to 5.3]). Students who tested with extra time passed the Step examinations on first attempt at significantly lower rates (Step 1, 82.1% [344/419] vs 94.0% [70,188/74,668]; difference, 11.9% [95% CI, 9.6% to 14.2%]; Step 2 CK, 85.5% [349/408] vs 95.4% [70,476/73,866]; difference, 9.9% [95% CI, 7.8% to 11.9%]; Step 2 CS, 92.0% [288/313] vs 97.0% [60,039/61,882]; difference, 5.0% [95% CI, 3.1% to 6.9%]). They also graduated from medical school at significantly lower rates at different times (4 years, 67.2% [285/424] vs 86.1% [60,547/70,305]; difference, 18.9% [95% CI, 15.6% to 22.2%]; 5 years, 81.6% [346/424] vs 94.4% [66

Study of working experience in remote rural areas after medical graduation.

PubMed

Thapa, K R; Shrestha, B K; Bhattarai, M D

2014-01-01

Posting of doctors in remote rural areas has always been a priority for Government; however data are scarce in the country about experience of doctors of working in remote areas after medical graduation. A questionnaire survey of doctors was planned to analyze their experience of working after graduation in remote rural areas in various parts of the country. The cross-sectional survey was done by convenience sampling method. A one-page questionnaire with one partially closed-end and five open-end type questions was distributed to the doctors who had worked in remote rural areas after graduation under various governments' postings. Two-third of participants had their home in urban areas and 89.8% had stayed for 1 to 5 years. About half of the participants had difficulty in getting the posting in the remote areas of their choice. Most participants indicated provision of opportunities for Residential (postgraduate) Training as their reasons of going to remote areas as well as their suggestions to encourage young graduates to go there. Similarly most also suggested appropriate career, salary and incentives to encourage doctors to go to work in remote areas. About 85% of participants pointed out the major problem faced while posted in remote areas as difficulty in handling varied situations with no guidance or seniors available around. The notable points indicated by the participants are centered on the opportunity for Residential Training and difficulties faced without such training. Residential Training is a priority to be considered while planning the health policy for optimum health care of people.

Bullying in the American Graduate Medical Education System: A National Cross-Sectional Survey

PubMed Central

2016-01-01

Objectives To deliver an estimate of bullying among residents and fellows in the United States graduate medical education system and to explore its prevalence within unique subgroups. Design/Setting/Participants A national cross-sectional survey from a sample of residents and fellows who completed an online bullying survey conducted in June 2015. The survey was distributed using a chain sampling method that relied on electronic referrals from 4,055 training programs, with 1,791 residents and fellows completing the survey in its entirety. Survey respondents completed basic demographic and programmatic information plus four general bullying and 20 specific bullying behavior questions. Between-group differences were compared for demographic and programmatic stratifications. Main Outcomes/Measures Self-reported subjected to workplace bullying from peers, attendings, nurses, ancillary staff, or patients in the past 12 months. Results Almost half of the respondents (48%) reported being subjected to bullying although both those subjected and not subjected reported experiencing ≥ 1 bullying behaviors (95% and 39% respectively). Attendings (29%) and nurses (27%) were the most frequently identified source of bullying, followed by patients, peers, consultants and staff. Attempts to belittle and undermine work and unjustified criticism and monitoring of work were the most frequently reported bullying behaviors (44% each), followed by destructive innuendo and sarcasm (37%) and attempts to humiliate (32%). Specific bullying behaviors were more frequently reported by female, non-white, shorter than < 5’8 and BMI ≥ 25 individuals. Conclusions/Relevance Many trainees report experiencing bullying in the United States graduate medical education programs. Including specific questions on bullying in the Accreditation Council for Graduate Medical Education annual resident/fellow survey, implementation of anti-bullying policies, and a multidisciplinary approach engaging all

Standard Setting for Clinical Competence at Graduation from Medical School: A Comparison of Passing Scores across Five Medical Schools

ERIC Educational Resources Information Center

Boursicot, Katharine A. M.; Roberts, Trudie E.; Pell, Godfrey

2006-01-01

While Objective Structured Clinical Examinations (OSCEs) have become widely used to assess clinical competence at the end of undergraduate medical courses, the method of setting the passing score varies greatly, and there is no agreed best methodology. While there is an assumption that the passing standard at graduation is the same at all medical…

How sequestration cuts affect primary care physicians and graduate medical education.

PubMed

Chauhan, Bindiya; Coffin, Janis

2013-01-01

On April 1, 2013, sequestration cuts went into effect impacting Medicare physician payments, graduate medical education, and many other healthcare agencies. The cuts range from 2% to 5%, affecting various departments and organizations. There is already a shortage of primary care physicians in general, not including rural or underserved areas, with limited grants for advanced training. The sequestration cuts negatively impact the future of many primary care physicians and hinder the care many Americans will receive over time.

The geography of graduate medical education: imbalances signal need for new distribution policies.

PubMed

Mullan, Fitzhugh; Chen, Candice; Steinmetz, Erika

2013-11-01

Graduate medical education (GME) determines the overall number, specialization mix, and geographic distribution of the US physician workforce. Medicare GME payments-which represent the largest single public investment in health workforce development-are allocated based on an inflexible system whose rationale, effectiveness, and balance are increasingly being scrutinized. We analyzed Medicare cost reports from teaching hospitals and found large state-level differences in the number of Medicare-sponsored residents per 100,000 population (1.63 in Montana versus 77.13 in New York), total Medicare GME payments ($1.64 million in Wyoming versus $2 billion in New York), payments per person ($1.94 in Montana versus $103.63 in New York), and average payments per resident ($63,811 in Louisiana versus $155,135 in Connecticut). Ways to address these imbalances include revising Medicare's GME funding formulas and protecting those states that receive less Medicare GME support in case funding is decreased and making them a priority if it is increased. The GME system badly needs a coordinating body to deliberate and make policy about public investments in graduate medical education.

Development and Validation of the "iCAN!"--A Self-Administered Questionnaire Measuring Outcomes/Competences and Professionalism of Medical Graduates

ERIC Educational Resources Information Center

Dimoliatis, Ioannis D. K.; Lyrakos, Georgios N.; Tseretopoulou, Xanthippi; Tzamalis, Theodoros; Bazoukis, George; Benos, Alexis; Gogos, Charalambos; Malizos, Konstantinos; Pneumatikos, Ioannis; Thermos, Kyriaki; Kaldoudi, Eleni; Tzaphlidou, Margaret; Papadopoulos, Iordanis N.; Jelastopulu, Eleni

2014-01-01

The Tuning-Medicine Project produced a set of "level one" and "level two" learning outcomes/competences to be met by European medical graduates. In the learner-centered era self-assessment becomes more and more important. Our aim was to develop a self-completion questionnaire ("iCAN!") evaluating graduates' learning…

Playing doctor, seriously: graduation follies at an American medical school.

PubMed

Segal, D

1984-01-01

In American medical schools, the period of time between the announcement of internships and graduation is known as FYBIGMI, for "Fuck You Brother I Got My Internship." At University Medical School (pseudonym), as at most American medical schools, this period culminates in an elaborate musical comedy (attended by faculty and relatives) in which faculty are abused, patients are represented in terms of stigmatized stereotypes, and the students demonstrate a profane familiarity with cultural taboos. Using the analytic methods of cultural anthropology, this examination of the FYBIGMI performance at U.M.S. focuses primarily on the seniors' presentation of their newly acquired professional identity, which is constituted in the skits by recurring oppositions to socially stigmatized, medically self-destructive patients. In this oppositional logic, racial stereotypes play a particularly large role. In addition, the seniors establish their new social status by inverting their relationship to their (former) supervisors on a personal basis, and by confronting the audience with their professional ability to treat cultural taboos with profane familiarity. The FYBIGMI theatrical, and its representation of professional identity, is analyzed in relation to a proposed model of the underlying structure of the process of medical education, that is, an escalating dialectic of intimidation and self-congratulation.

Direct Supervision in Outpatient Psychiatric Graduate Medical Education.

PubMed

Galanter, Cathryn A; Nikolov, Roumen; Green, Norma; Naidoo, Shivana; Myers, Michael F; Merlino, Joseph P

2016-02-01

The authors describe a stimulus case that led training staff to examine and revise the supervision policy of the adult and child and adolescent psychiatry clinics. To inform the revisions, the authors reviewed the literature and national policies. The authors conducted a literature review in PubMed using the following criteria: Supervision, Residents, Training, Direct, and Indirect and a supplemental review in Academic Psychiatry. The authors reviewed institutional and Accreditation Council for Graduate Medical Education resident and fellow supervision policies to develop an outpatient and fellow supervision policy. Research is limited in psychiatry with three experimental articles demonstrating positive impact of direct supervision and several suggesting different techniques for direct supervision. In other areas of medicine, direct supervision is associated with improved educational and patient outcomes. The authors present details of our new supervision policy including triggers for direct supervision. The term direct supervision is relatively new in psychiatry and medical education. There is little published on the extent of implementation of direct supervision and on its impact on the educational experience of psychiatry trainees and other medical specialties. Direct supervision has been associated with improved educational and patient outcomes in nonpsychiatric fields of medicine. More research is needed on the implementation of, indications for, and effects of direct supervision on trainee education and on patient outcomes.

Osteopathic distinctiveness in osteopathic predoctoral education and its effect on osteopathic graduate medical education.

PubMed

Ching, Leslie Mae-Geen; Burke, William J

2011-10-01

The number of colleges of osteopathic medicine (COMs), osteopathic medical students, and osteopathic physicians in practice has been consistently growing since the 1960s. In recent years, the growth of the profession has been exponential. Despite this growth, graduates of COMs are increasingly choosing allopathic residencies. The authors believe that this trend may stem from a lack of focus on osteopathic principles and practice in COMs, as well as geographic and specialty limitations of available osteopathic residency positions. The present article will briefly examine the history of AOA accreditation and the current accreditation process and the current state of osteopathic predoctoral education and postdoctoral training. The authors call on osteopathic physicians to help bring osteopathic distinctiveness to osteopathic predoctoral education by mentoring and volunteering at COMs. In addition, the authors urge the osteopathic profession to increase the number of osteopathic residencies to account for the number of and distribution of osteopathic medical school graduates.

A Longitudinal Study of Commonly Used Admissions Measures and Disenrollment from Medical School and Graduate Medical Education Probation or Termination from Training.

PubMed

Dong, Ting; Gilliland, William R; Cruess, David; Hutchinson, Jeffrey; Morres, Lisa; Curtis, Jerri; Hewitt-Clarke, Gail-Selina; Durning, Steven J

2018-04-27

This is an empirical study to better understand commonly used medical school admission measures and disenrollment decisions during undergraduate medical education as well as graduate medical education (GME) probation or termination decisions. Based on the data of USUHS medical students matriculating between 1998 and 2011 (N = 2,460), we compared medical school graduates and those disenrolled from medical school on MCAT scores, undergraduate BCPM (Biology, Chemistry, Physics, Math) GPA, and undergraduate overall GPA. We also reported more specific reasons for disenrollment decisions. Next, we compared the students who were referred to the student promotion committee (SPC) with other students on these measures. Moving onto GME, we compared trainees who were put on probation or terminated from training with those who were not on MCAT and undergraduate GPA measures. In addition, we examined the association between being referred to the SPC and GME probation or termination. There were 2,347 graduates and 113 disenrolled students from medical school (4.8%). For the disenrolled students, 43 (38.7%) students were disenrolled for exclusively (or primarily) non-academic reasons, and 68 (61.3%) were disenrolled for exclusively (or primarily) academic reasons. The t-tests showed statistically significant differences on the MCAT score of the first attempt (t(2,449) = 7.22, P < 0.01, Cohen's d = 0.70), average MCAT score (t(2,449) = 4.22, P < 0.01, Cohen's d = 0.41), and highest MCAT score (t(2,449) = 3.51, P < 0.01, Cohen's d = 0.34). Logistic regression model selection also revealed that the best predictor for disenrollment was the first MCAT score (exp(b) = 0.83, 95% CI = (0.78, 0.88)). No significant differences on these measures were found from the group comparisons on SPC and GME probation or termination. There was no significant association between SPC appearance and GME probation or termination. Academic difficulties, especially in the basic sciences, appear to be the

Reflection as a Learning Tool in Graduate Medical Education: A Systematic Review.

PubMed

Winkel, Abigail Ford; Yingling, Sandra; Jones, Aubrie-Ann; Nicholson, Joey

2017-08-01

Graduate medical education programs employ reflection to advance a range of outcomes for physicians in training. However, the most effective applications of this tool have not been fully explored. A systematic review of the literature examined interventions reporting the use of reflection in graduate medical education. The authors searched Medline/PubMed, Embase, Cochrane CENTRAL, and ERIC for studies of reflection as a teaching tool to develop medical trainees' capacities. Key words and subject headings included reflection , narrative , residents/GME , and education / teaching / learning . No language or date limits were applied. The search yielded 1308 citations between inception for each database and June 15, 2015. A total of 16 studies, encompassing 477 residents and fellows, met eligibility criteria. Study quality was assessed using the Critical Appraisal Skills Programme Qualitative Checklist. The authors conducted a thematic analysis of the 16 articles. Outcomes studied encompassed the impact of reflection on empathy, comfort with learning in complex situations, and engagement in the learning process. Reflection increased learning of complex subjects and deepened professional values. It appears to be an effective tool for improving attitudes and comfort when exploring difficult material. Limitations include that most studies had small samples, used volunteers, and did not measure behavioral outcomes. Critical reflection is a tool that can amplify learning in residents and fellows. Added research is needed to understand how reflection can influence growth in professional capacities and patient-level outcomes in ways that can be measured.

Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey.

PubMed

Lam, Christy Y Y; Cheung, Charleen S Y; Hui, Annie S Y

2016-04-01

The trend of declining interest of medical graduates in pursuing obstetrics and gynaecology as a career has been observed in many overseas studies. This study aimed to evaluate the career interest of the most recent medical graduates in Hong Kong, especially their level of interest in obstetrics and gynaecology, and to identify key influential factors for career choice and career interest in obstetrics and gynaecology. All medical graduates from the Chinese University of Hong Kong and the University of Hong Kong who attended the pre-internship lectures in June 2015 were invited to participate in this cross-sectional questionnaire survey. The main outcome measures were the level of career interest in obstetrics and gynaecology, the first three choices of specialty as a career, key influential factors for career choice, and key influential factors for career interest in obstetrics and gynaecology. Overall, 73.7% of 323 new medical graduates participated in the study and 233 questionnaires were analysed. The median score (out of 10) for the level of career interest in obstetrics and gynaecology was 3. There were 37 (16.2%) participants in whom obstetrics and gynaecology was among their first three choices, of whom 29 (78.4%) were female. Obstetrics and gynaecology ranked as the eighth most popular career choice. By factor analysis, the strongest key influential factor for career interest in obstetrics and gynaecology was clerkship experience (variance explained 28.9%) and the strongest key influential factor for career choice was working style (variance explained 26.4%). The study confirmed a low level of career interest in obstetrics and gynaecology among medical graduates and a decreasing popularity of the specialty as a career choice. The three key influential factors for career interest in obstetrics and gynaecology and career choice were working style, clerkship experience, and career prospects.

Analysis of stress levels among medical students, residents, and graduate students at four Canadian schools of medicine.

PubMed

Toews, J A; Lockyer, J M; Dobson, D J; Simpson, E; Brownell, A K; Brenneis, F; MacPherson, K M; Cohen, G S

1997-11-01

To assess stress in medical students, residents, and graduate science students at four Canadian schools of medicine. Four schools with different curricula in three different parts of Canada participated in the study: the University of Calgary Faculty of Medicine, the University of Alberta Faculty of Medicine, the Dalhousie University Faculty of Medicine, and the McMaster University Faculty of Health Sciences. All the medical students, residents, and graduate science students at each school were surveyed in 1994-95. The three instruments used were the University of Calgary Stress Questionnaire, the Social Readjustment Rating Scale (SRRS), and the Symptom Checklist-90. Demographic data were compared across all four schools. Analysis of variance was calculated for all test-item scores, utilizing a four (school) by three (program) by two (gender) design, which were all between subject factors. Significant main effects were followed up by using planned comparisons (Newman-Keuls, with a probability level of p < .05). Significant interaction effects were followed up by using an analysis of simple effects. A total of 1,681 questionnaires were returned as follows: 621 of 1,304 (48%) from the medical students, 645 of 1,495 (43%) from the residents, and 415 of 829 (50%) from the graduate science students. There were significant differences between the three groups in the natures and degrees of stress, with the graduate students reporting higher levels of stress. There were significant gender differences as well, with the women reporting higher levels of stress. Overall, stress levels were found to be mild, based on the University of Calgary Stress Questionnaire and the SRRS. This study suggests that medical students and residents experience stress at levels that appear acceptable, but ongoing monitoring and the provision of appropriate support systems will continue to be important.

Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study

PubMed Central

Illing, Jan; Kasim, Adetayo S; McLachlan, John C

2014-01-01

Objective To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as evaluated at Annual Review of Competence Progression (ARCP), between UK based doctors who qualified overseas and those who obtained their primary medical qualification from UK universities. Design Observational study linking ARCP outcome data from the UK deaneries with PLAB test performance and demographic data held by the UK General Medical Council (GMC). Setting Doctors in postgraduate training for a medical specialty or general practice in the UK and doctors obtaining GMC registration via the PLAB system. Participants 53 436 UK based trainee doctors with at least one competency related ARCP outcome reported during the study period, of whom 42 017 were UK medical graduates and 11 419 were international medical graduates who were registered following a pass from the PLAB route. Main outcome measure Probability of obtaining a poorer versus a more satisfactory category of outcome at ARCP following successful registration as a doctor in the UK. Results International medical graduates were more likely to obtain a less satisfactory outcome at ARCP compared with UK graduates. This finding persisted even after adjustment for the potential influence of sex, age, years of UK based practice, and ethnicity and exclusion of outcomes associated with postgraduate examination failure (odds ratio 1.63, 95% confidence interval 1.30 to 2.06). However, international medical graduates who scored in the highest twelfth at part 1 of the PLAB (at least 32 points above the pass mark) had ARCP outcomes that did not differ significantly from those of UK graduates. Conclusions These findings suggest that the PLAB test used for registration of international medical graduates is not generally equivalent to the requirements for UK graduates. The

Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine

PubMed Central

2014-01-01

Background There is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students’ perspectives on specialization training in Malawi. Methods We conducted semi-structured interviews of medical students in the final year of their degree program. We developed an interview guide through an iterative process, and recorded and transcribed all interviews for analysis. Two independent coders coded the manuscripts and assessed inter-coder reliability, and the authors used an “editing approach” to qualitative analysis to identify and categorize themes relating to the research aim. The University of Pittsburgh Institutional Review Board and the University of Malawi College of Medicine Research and Ethics Committee approved this study and authors obtained written informed consent from all participants. Results We interviewed 21 medical students. All students reported a desire for specialization training, with 12 (57%) students interested in specialties not currently offered in Malawi. Students discussed reasons for pursuing specialization training, impressions of specialization training in Malawi, reasons for staying or leaving Malawi to pursue specialization training and recommendations to improve training. Conclusions Graduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country’s healthcare workforce and the needs of their

Specialization training in Malawi: a qualitative study on the perspectives of medical students graduating from the University of Malawi College of Medicine.

PubMed

Sawatsky, Adam P; Parekh, Natasha; Muula, Adamson S; Bui, Thuy

2014-01-06

There is a critical shortage of healthcare workers in sub-Saharan Africa, and Malawi has one of the lowest physician densities in the region. One of the reasons for this shortage is inadequate retention of medical school graduates, partly due to the desire for specialization training. The University of Malawi College of Medicine has developed specialty training programs, but medical school graduates continue to report a desire to leave the country for specialization training. To understand this desire, we studied medical students' perspectives on specialization training in Malawi. We conducted semi-structured interviews of medical students in the final year of their degree program. We developed an interview guide through an iterative process, and recorded and transcribed all interviews for analysis. Two independent coders coded the manuscripts and assessed inter-coder reliability, and the authors used an "editing approach" to qualitative analysis to identify and categorize themes relating to the research aim. The University of Pittsburgh Institutional Review Board and the University of Malawi College of Medicine Research and Ethics Committee approved this study and authors obtained written informed consent from all participants. We interviewed 21 medical students. All students reported a desire for specialization training, with 12 (57%) students interested in specialties not currently offered in Malawi. Students discussed reasons for pursuing specialization training, impressions of specialization training in Malawi, reasons for staying or leaving Malawi to pursue specialization training and recommendations to improve training. Graduating medical students in Malawi have mixed views of specialization training in their own country and still desire to leave Malawi to pursue further training. Training institutions in sub-Saharan Africa need to understand the needs of the country's healthcare workforce and the needs of their graduating medical students to be able to

[Health personnel: graduates from the medical school of the University of the Republic, Uruguay].

PubMed

Meerhoff, R

1987-01-01

The article summarizes the initial findings of a study of the medical labor market, done by the Uruguayan Planning Office and cofinanced by PAHO. The survey, starting in 1880 for graduates and in 1915 for students, brings out the exponential growth of their numbers, the growing participation of women--who are now a majority in the profession--and other indicators that affect health services. The conclusion is that there should be an explicit policy on the training of medical manpower.

Web course on medication administration strengthens nursing students' competence prior to graduation.

PubMed

Mettiäinen, Sari; Luojus, Katja; Salminen, Satu; Koivula, Meeri

2014-08-01

Nursing students' competence has been found inadequate in mastering of pharmacotherapy regulations and prescriptions, pharmacology, medical calculations, fractional and decimal numbers, and mathematics on the whole. The study investigated the efficacy of an additional medication administration web course in increasing nursing students' self-evaluated competence on medication administration. Finnish nursing students self-evaluated their medication administration competence before and after the web-based medication course. Design was quasi-experimental. 244 students answered the questionnaire before and 192 after the web course. An online self-evaluation questionnaire was developed to measure students' competence on basic pharmacotherapy, intravenous medication and infusion, blood transfusion and epidural medication. The data was analysed with SPSS 18.0 software using descriptive analyses and comparing sum variables with Man-Whitney U-test. The medication administration web course, which took 8 h on average, significantly improved self-evaluated competence of nursing students in all the fields. Prior to the education most defects were found in matters concerning compatibility and adverse effects of pharmaceuticals and solutions and in epidural medication competency. The education strengthened all these competencies. It is necessary to revise medication administration before graduation and web-based learning can be used in it. Copyright © 2014 Elsevier Ltd. All rights reserved.

Graduate Medical Education Training in Clinical Epidemiology, Critical Appraisal, and Evidence-Based Medicine: A Critical Review of Curricula.

ERIC Educational Resources Information Center

Green, Michael L.

1999-01-01

A study systematically reviewed published literature on graduate medical-education curricula in clinical epidemiology, critical appraisal, and evidence-based medicine (EBM). The 18 reports found in the search provide useful guidelines for medical educators but many suffer from incomplete descriptions and inadequate curriculum evaluations.…

Improving oversight of the graduate medical education enterprise: one institution's strategies and tools.

PubMed

Afrin, Lawrence B; Arana, George W; Medio, Franklin J; Ybarra, Angela F N; Clarke, Harry S

2006-05-01

Accreditation organizations, financial stakeholders, legal systems, and regulatory agencies have increased the need for accountability in educational processes and curricular outcomes of graduate medical education. This demand for greater programmatic monitoring has placed pressure on institutions with graduate medical education (GME) programs to develop greater oversight of these programs. Meeting these challenges requires development of new GME management strategies and tools for institutional GME administrators to scrutinize programs, while still allowing these programs the autonomy to develop and implement educational methods to meet their unique training needs. At the Medical University of South Carolina (MUSC), senior administrators in the college of medicine felt electronic information management was a critical strategy for success and thus proceeded to carefully select an electronic residency management system (ERMS) to provide functionality for both individual programs and the GME enterprise as a whole. Initial plans in 2002 for a phased deployment had to be changed to a much more rapid deployment due to regulatory issues. Extensive communication and cooperation among MUSC's GME leaders resulted in a successful deployment in 2003. Evaluation completion rates have substantially improved, duty hours are carefully monitored, patient safety has improved through more careful oversight of residents' procedural privileges, regulators have been pleased, and central GME administrative visibility of program performance has dramatically improved. The system is now being expanded to MUSC's medical school and other health professions colleges. The authors discuss lessons learned and opportunities and challenges ahead, which include improving tracking of development of procedural competency, establishing and monitoring program performance standards, and integrating the ERMS with GME reimbursement systems.

Resident and Staff Satisfaction of Pediatric Graduate Medical Education Training on Transition to Adult Care of Medically Complex Patients.

PubMed

Weeks, Matthew; Cole, Brandon; Flake, Eric; Roy, Daniel

2018-04-11

This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike.

Expected surgical competencies of an Indian medical graduate: a gap analysis using a cross-sectional survey.

PubMed

Jamkar, Arun; Bansal, Payal; Patrikar, Seema; Baxi, Gaurang

2015-01-01

In 2010, the Medical Council of India published the Vision 2015 document, which sought to create an 'Indian Medical Graduate' as a 'physician of first contact of the community while being globally relevant'. This vision for undergraduate medical education is proposed to be realised through a competency-based curriculum. We conducted a gap analysis using a cross-sectional survey to document surgeons' perceptions regarding competencies identified in surgery. Eight competencies specific to surgery are proposed, which formed the basis for the study. We defined sub-competencies for each of these and developed a questionnaire containing ratings of importance and ability for the sub-competencies from low to very high on a 4-point Likert scale. The questionnaire was administered to 450 surgeons attending a state-level annual conference in surgery asking them to provide the importance ratings and their own ability on those (sub) competencies when they graduated. The importance and ability ratings were ranked and a gap analysis was done. The study response rate was 69.8%. While most competencies were perceived by the surgeons as being highly important, their self-ratings revealed a statistically significant gap between importance and ability when they graduated. They also rated themselves as being more competent on some than on others. Some competencies were high on importance as well as on ability, while others were high on importance but low on ability, revealing a gap. A low importance-high ability relationship was seen for a few competencies. Competencies related to emergency and trauma care and communication had the largest gaps. The gaps identified in surgical competencies for graduating physicians are specific and have implications for the competency-based curriculum and implementation in terms of teaching, assessment and faculty development. It also has implications for seamless transition between undergraduate and postgraduate competencies, as all of these are

Graduate medical students' perception of obstetrics and gynaecology as a future career specialty.

PubMed

Ismail, S I M F; Kevelighan, E H

2014-05-01

The aim of this study was to explore the perceptions of graduate-entry medical students of obstetrics and gynaecology as a specialty, in order to understand how to increase its appeal to them, and therefore enhance recruitment to the specialty. A total of 90 questionnaires were returned out of 145 questionnaires distributed to years 2 and 4 graduate-entry medical students (62% response rate). Although fewer than 4% of respondents are considering the specialty as their career choice, more than half of the respondents would consider the specialty as a second option, which shows that there is room to persuade them to have a second look. Gender was the only factor that significantly affected views regarding obstetrics and gynaecology. There is a need for more information about the specialty and its training opportunities and exposure to areas of special interest and subspecialisation, as well as role models, rather than focussing on labour ward in timetables. Areas of apprehension about the specialty, such as the risk of litigation, need to be aired and addressed through career days, as well as formal tutorials within teaching programmes.

Jewish Medical Students and Graduates at the Universities of Padua and Leiden: 1617–1740*

PubMed Central

Collins, Kenneth

2013-01-01

The first Jewish medical graduates at the University of Padua qualified in the fifteenth century. Indeed, Padua was the only medical school in Europe for most of the medieval period where Jewish students could study freely. Though Jewish students came to Padua from many parts of Europe the main geographical sources of its Jewish students were the Venetian lands. However, the virtual Padua monopoly on Jewish medical education came to an end during the seventeenth century as the reputation of the Dutch medical school in Leiden grew. For aspiring medieval Jewish physicians Padua was, for around three hundred years, the first, simplest, and usually the only choice. PMID:23908853

The trend of governmental support from post-graduated Iranian students in medical fields to study abroad.

PubMed

Haghdoost, Aa; Ghazi, M; Rafiee, Z; Afshari, M

2013-01-01

To explore the trend and composition of post-graduate Iranian students who received governmental scholarship during the last two decades. Detailed information about the awarded scholarships and also about the number of post graduate students in clinical and basic sciences in domestic universities were collected from the related offices within the ministry of health and medical education and their trends were triangulated. A sharp drop was observed in the number of awarded scholarships, from 263 in 1992 to 46 in 2009. In the beginning, almost all of scholarships fully supported students for a whole academic course; while in recent years most of scholarships supported students for a short fellowship or complementary course (more than 80%). Students studied in a wide range of colleges within 30 countries; more than 50% in Europe. Although one third of students studied in UK in the first years, only 4% of students selected this country in recent years. conversely, the number of scholarships to Germany and sweden have increased more than 10 and 3 times during this period. In parallel, the capacity of domestic universities for training of post-graduate students has been expanded dramatically. Although expanding post-graduate education has been one of the main strategic objectives of the ministry of health and medical education in last two decades, it was obtained using different approaches. By time, more attention was to expanding the capacities of Iranian universities, and choosing less but more targeted students to continue their studies abroad.

Institutional Oversight of the Graduate Medical Education Enterprise: Development of an Annual Institutional Review

PubMed Central

Amedee, Ronald G.; Piazza, Janice C.

2016-01-01

Background: The Accreditation Council for Graduate Medical Education (ACGME) fully implemented all aspects of the Next Accreditation System (NAS) on July 1, 2014. In lieu of periodic accreditation site visits of programs and institutions, the NAS requires active, ongoing oversight by the sponsoring institutions (SIs) to maintain accreditation readiness and program quality. Methods: The Ochsner Health System Graduate Medical Education Committee (GMEC) has instituted a process that provides a structured, process-driven improvement approach at the program level, using a Program Evaluation Committee to review key performance data and construct an annual program evaluation for each accredited residency. The Ochsner GMEC evaluates the aggregate program data and creates an Annual Institutional Review (AIR) document that provides direction and focus for ongoing program improvement. This descriptive article reviews the 2014 process and various metrics collected and analyzed to demonstrate the program review and institutional oversight provided by the Ochsner graduate medical education (GME) enterprise. Results: The 2014 AIR provided an overview of performance and quality of the Ochsner GME program for the 2013-2014 academic year with particular attention to program outcomes; resident supervision, responsibilities, evaluation, and compliance with duty‐hour standards; results of the ACGME survey of residents and core faculty; and resident participation in patient safety and quality activities and curriculum. The GMEC identified other relevant institutional performance indicators that are incorporated into the AIR and reflect SI engagement in and contribution to program performance at the individual program and institutional levels. Conclusion: The Ochsner GME office and its program directors are faced with the ever-increasing challenges of today's healthcare environment as well as escalating institutional and program accreditation requirements. The overall commitment of

Feasibility and psychometric analysis of graduate satisfaction survey of medical students graduating from the Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI Bahrain).

PubMed

Strachan, Kathryn; Ansari, Ahmed Al

2016-01-01

To assess the satisfaction levels of graduates of the Royal College of Surgeons in Ireland University of Bahrain (RCSI Bahrain). The graduate survey was administered to four groups of graduates of the RCSI Bahrain who graduated between the years 2010 and 2014. The graduate survey assessed five major domains and comprised 41 items. The RCSI Bahrain opened its doors in 2004, with the first class graduating in 2010. The graduate cohorts used in this study were working in various countries at the time of survey completion. Out of 599 graduates, 153 responded to the graduate survey. The total mean response rate of the graduate survey was 26 %, including 102 females, 44 males, and 7 students who did not indicate their gender. 49 students graduated in 2012, and 53 students graduated in 2013. Of these graduates, 83 were working in Bahrain at the time of survey administration, 11 in the USA, 4 in Malta, and 3 in the UK; the total number of countries where graduates were working was 14. Reliability analysis found high internal consistency for the instrument (with a Cronbach's α of 0.97). The whole instrument was found to be suitable for factor analysis (KMO = 0.853; Bartlett test significant, p < 0.00). Factor analysis showed that the data on the questionnaire decomposed into five factors, which accounted for 72.3 % of the total variance: future performance, career development, skills development, graduate as collaborator, and communication skills. The survey results found that graduates of the RCSI Bahrain program who responded to this questionnaire are generally satisfied with their experience at the university, feel well prepared to join the field and feel ready to compete with graduates of competing universities. Furthermore, the graduate survey was found to be a reliable instrument and we provided some evidence to support the construct validity of the instrument.

Factors influencing the choice of specialty of Australian medical graduates.

PubMed

Harris, Mary G; Gavel, Paul H; Young, Jeannette R

2005-09-19

To identify the relative importance of extrinsic determinants of doctors' choice of specialty. A self-administered postal questionnaire. Australian vocational training programs. 4259 Australian medical graduates registered in September 2002 with one of 16 Australian clinical colleges providing vocational training programs. Choice of specialist vocational training program; extrinsic factors influencing choice of program, and variation by sex, age, marital status and country of birth. In total, 79% of respondents rated "appraisal of own skills and aptitudes" as influential in their choice of specialty followed by "intellectual content of the specialty" (75%). Extrinsic factors rated as most influential were "work culture" (72%), "flexibility of working arrangements" (56%) and "hours of work" (54%). We observed variation across training programs in the importance ascribed to factors influencing choice of specialty, and by sex, age and marital status. Factors of particular importance to women, compared with men, were "appraisal of domestic circumstances" (odds ratio [OR], 1.9), "hours of work" (OR, 1.8) and "opportunity to work flexible hours" (OR, 2.6). Partnered doctors, compared with single doctors, rated "hours of work" and "opportunity to work flexible hours" as more important (OR, 1.3), while "domestic circumstances" was more important to doctors with children than those without children (OR, 1.7). In total, 80% of doctors had chosen their specialty by the end of the third year after graduation. Experience with discipline-based work cultures and working conditions occurs throughout medical school and the early postgraduate years, and most doctors choose their specialty during these years. It follows that interventions to influence doctors' choice of specialty need to target these critical years.

Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines.

PubMed

McGaghie, William C; Siddall, Viva J; Mazmanian, Paul E; Myers, Janet

2009-03-01

Simulation technology is widely used in undergraduate and graduate medical education as well as for personnel training and evaluation in other healthcare professions. Simulation provides safe and effective opportunities for learners at all levels to practice and acquire clinical skills needed for patient care. A growing body of research evidence documents the utility of simulation technology for educating healthcare professionals. However, simulation has not been widely endorsed or used for continuing medical education (CME). This article reviews and evaluates evidence from studies on simulation technology in undergraduate and graduate medical education and addresses its implications for CME. The Agency for Healthcare Research and Quality Evidence Report suggests that simulation training is effective, especially for psychomotor and communication skills, but that the strength of the evidence is low. In another review, the Best Evidence Medical Education collaboration supported the use of simulation technology, focusing on high-fidelity medical simulations under specific conditions. Other studies enumerate best practices that include mastery learning, deliberate practice, and recognition and attention to cultural barriers within the medical profession that present obstacles to wider use of this technology. Simulation technology is a powerful tool for the education of physicians and other healthcare professionals at all levels. Its educational effectiveness depends on informed use for trainees, including providing feedback, engaging learners in deliberate practice, integrating simulation into an overall curriculum, as well as on the instruction and competence of faculty in its use. Medical simulation complements, but does not replace, educational activities based on real patient-care experiences.

The threat of funding cuts for graduate medical education: survey of decision makers.

PubMed

Kozak, R J; Kazzi, A A; Langdorf, M I; Martinez, C T

1997-07-01

To assess the potential actions of medical school deans, graduate medical education (GME) committee chairs, and hospital chief executive officers (CEOs) regarding future funding reductions for residency training. Specifically, institutions with emergency medicine (EM) residencies were surveyed to see whether EM training was disproportionally at risk for reductions. An anonymous 2-page survey was used. Ninety-eight EM residency programs were identified using the American Medical Association Graduate Medical Education Directory 1994-95. Seventy deans, 102 GME chairs, and 97 hospital CEOs were identified. The survey posed a hypothetical 25% forced reduction in residency positions and asked the decision makers for their responses. Options included: 1) proportional reductions of training positions from all residencies, 2) proportional reductions in either primary care or specialty residency positions, or 3) reduction or elimination of specific training programs. The survey asked for a first and second choice of residencies to be reduced or eliminated from an alphabetical list of 17. The survey elicited explanations for each program reduction. 200 (74%) of 269 surveys were returned. Eighty-four responders selected specific residencies to be reduced or eliminated. EM was selected 8 times, making EM the seventh most vulnerable residency to be targeted for reductions. The decision makers who selected proportional reductions chose to reduce across all residencies 32 times, among only the specialty residencies 129 times, and among only the primary care residencies 3 times. In the setting of anticipated residency cuts, favored proportional reductions in specialty residencies would likely affect EM training. However, most GME decision makers with an existing EM residency program do not consider the EM residency a top choice to be reduced or eliminated.

A qualitative assessment of internal medicine resident perceptions of graduate medical education following implementation of the 2011 ACGME duty hour standards

PubMed Central

2014-01-01

Background In 2011, the Accreditation Council of Graduate Medical Education implemented updated guidelines for medical resident duty hours, further limiting continuous work hours for first-year residents. We sought to investigate the impact of these restrictions on graduate medical education among internal medicine residents. Methods We conducted eight focus groups with internal medicine residents at the University of Alabama at Birmingham in 06/2012-07/2012. Discussion questions included, “How do you feel the 2011 ACGME work hour restrictions have impacted your graduate medical education?” Transcripts of the focus groups were reviewed and themes identified using a deductive/inductive approach. Participants completed a survey to collect demographic information and future practice plans. Results Thirty-four residents participated in our focus groups. Five themes emerged: decreased teaching, decreased experiential learning, shift-work mentality, tension between residency classes, and benefits and opportunities. Residents reported that since implementation of the guidelines, teaching was often deferred to complete patient-care tasks. Residents voiced concern that PGY-1 s were not receiving adequate clinical experience and that procedural and clinical reasoning skills are being negatively impacted. PGY-1 s reported being well-rested and having increased time for independent study. Conclusions Residents noted a decline in teaching and are concerned with the decrease in “hands-on” clinical education that is inevitably impacted by fewer hours in the hospital, though some benefits were also reported. Future studies are needed to further elucidate the impact of decreased resident work hours on graduate medical education. PMID:24755276

34 CFR 600.55 - Additional criteria for determining whether a foreign graduate medical school is eligible to...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Admission Test (MCAT) and to have reported their scores to the foreign graduate medical school; and (2) A..., on request, to the Secretary, the scores on the MCAT or successor examination, of all students...

Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation.

PubMed

Puddey, Ian B; Mercer, Annette; Playford, Denese E; Riley, Geoffrey J

2015-04-14

We have previously demonstrated that both coming from a rural background and spending a year-long clinical rotation in our Rural Clinical School (RCS) have independent and additive effects to increase the likelihood of medical students practicing rurally following graduation. The current study assesses the extent to which medical school selection criteria and/or the socio-demographic profile of medical students may further facilitate or hamper the selection of students ultimately destined for the rural medical workforce. The study comprised 729 students, admitted from secondary school since 1999 and having graduated by 2011, whose actual workplace location in 2014 was classified as either urban or rural using the Australian Health Practitioner Regulation Agency database. Selection factors on entry (score from a standardised interview, percentile scores for the 3 components of the Undergraduate Medicine and Health Sciences Admission Test (UMAT) and prior academic performance as assessed by the Australian Tertiary Admissions Rank) together with socio-demographic factors (age, gender, decile for the Index of Relative Socioeconomic Advantage and Disadvantage (IRSAD)), were examined in relation to ultimate rural destination of practice. In logistic regression, those practicing in a rural location in 2014 were more likely to have come from the lower 6 IRSAD deciles (OR 2.75, 95% CI 1.44, 5.23, P = 0.002), to be older (OR 1.86, 95% CI 1.09, 3.18, p = 0.023) and to have a lower UMAT-3 (Non-verbal communication) score (OR 0.98, 95% CI 0.97, 0.99, P = 0.005). After further controlling for either rural background or RCS participation, only age and UMAT-3 remained as independent predictors of current rural practice. In terms of the socio-demographic profiles of those selected for medical school entry from secondary school, only older age weakly augmented the selection of graduates likely to ultimately work in a rural destination. Among the selection factors, having achieved

Predictors of Final Specialty Choice by Internal Medicine Residents

PubMed Central

Diehl, Andrew K; Kumar, Vineeta; Gateley, Ann; Appleby, Jane L; O'Keefe, Mary E

2006-01-01

BACKGROUND Sociodemographic factors and personality attributes predict career decisions in medical students. Determinants of internal medicine residents' specialty choices have received little attention. OBJECTIVE To identify factors that predict the clinical practice of residents following their training. DESIGN Prospective cohort study. PARTICIPANTS Two hundred and four categorical residents from 2 university-based residency programs. MEASUREMENTS Sociodemographic and personality inventories performed during residency, and actual careers 4 to 9 years later. RESULTS International medical school graduates (IMGs) were less likely to practice general medicine than U.S. graduates (33.3% vs 70.6%, P<.001). Residents with higher loan indebtedness more often became generalists (P = .001). A corresponding trend favoring general internal medicine was observed among those who perceived General Internists to have lower potential incomes (69.0% vs 53.3%, P = .08). There was a trend for generalists to have lower scores on scales measuring authoritarianism, negative orientation to psychological problems, and Machiavellianism (0.05graduation from a U.S. medical school (odds ratio [OR] 3.02; 95% confidence interval [CI], 1.00 to 9.10, P = .049) and perception of low future income (OR 1.65; 95% CI, 1.06 to 2.56, P = .03) predicted entry into general medicine, with trends apparent for higher debt (P = .05) and greater comfort caring for patients with psychological problems (P = .07). CONCLUSION Recruitment of IMGs may not increase the supply of General Internists. Prospects of lower income, even in the face of large debt, may not discourage residents from becoming generalists. If increasing generalist manpower is a goal, residencies should consider weighing applicants' personal attributes during the selection process. PMID:16836624

Predictors of career progression and obstacles and opportunities for non-EU hospital doctors to undertake postgraduate training in Ireland.

PubMed

Tyrrell, Ella; Keegan, Conor; Humphries, Niamh; McAleese, Sara; Thomas, Steve; Normand, Charles; Brugha, Ruairí

2016-06-30

The World Health Organization's Global Code on the International Recruitment of Health Personnel urges Member States to observe fair recruitment practices and ensure equality of treatment of migrant and domestically-trained health personnel. However, international medical graduates (IMGs) have experienced difficulties in accessing postgraduate training and in progressing their careers in several destination countries. Ireland is highly dependent on IMGs, but also employs non-European Union (EU) doctors who qualified as doctors in Ireland. However, little is known regarding the career progression of these doctors. In this context, the present study assesses the determinants of career progression of non-EU doctors with particular focus on whether barriers to progression exist for those graduating outside Ireland compared to those who have graduated within. The study utilises quantitative data from an online survey of non-EU doctors registered with the Medical Council of Ireland undertaken as part of the Doctor Migration Project (2011-2013). Non-EU doctors registered with the Medical Council of Ireland were asked to complete an online survey about their recruitment, training and career experiences in Ireland. Analysis was conducted on the responses of 231 non-EU hospital doctors whose first post in Ireland was not permanent. Career progression was analysed by means of binary logistic regression analysis. While some of the IMGs had succeeded in accessing specialist training, many experienced slow or stagnant career progression when compared with Irish-trained non-EU doctors. Key predictors of career progression for non-EU doctors working in Ireland showed that doctors who qualified outside of Ireland were less likely than Irish-trained non-EU doctors to experience career progression. Length of stay as a qualified doctor in Ireland was strongly associated with career progression. Those working in anaesthesia were significantly more likely to experience career

Teaching professionalism in graduate medical education: What is the role of simulation?

PubMed

Wali, Eisha; Pinto, Jayant M; Cappaert, Melissa; Lambrix, Marcie; Blood, Angela D; Blair, Elizabeth A; Small, Stephen D

2016-09-01

We systematically reviewed the literature concerning simulation-based teaching and assessment of the Accreditation Council for Graduate Medical Education professionalism competencies to elucidate best practices and facilitate further research. A systematic review of English literature for "professionalism" and "simulation(s)" yielded 697 abstracts. Two independent raters chose abstracts that (1) focused on graduate medical education, (2) described the simulation method, and (3) used simulation to train or assess professionalism. Fifty abstracts met the criteria, and seven were excluded for lack of relevant information. The raters, 6 professionals with medical education, simulation, and clinical experience, discussed 5 of these articles as a group; they calibrated coding and applied further refinements, resulting in a final, iteratively developed evaluation form. The raters then divided into 2 teams to read and assess the remaining articles. Overall, 15 articles were eliminated, and 28 articles underwent final analysis. Papers addressed a heterogeneous range of professionalism content via multiple methods. Common specialties represented were surgery (46.4%), pediatrics (17.9%), and emergency medicine (14.3%). Sixteen articles (57%) referenced a professionalism framework; 14 (50%) incorporated an assessment tool; and 17 (60.7%) reported debriefing participants, though in limited detail. Twenty-three (82.1%) articles evaluated programs, mostly using subjective trainee reports. Despite early innovation, reporting of simulation-based professionalism training and assessment is nonstandardized in methods and terminology and lacks the details required for replication. We offer minimum standards for reporting of future professionalism-focused simulation training and assessment as well as a basic framework for better mapping proper simulation methods to the targeted domain of professionalism. Copyright © 2016 Elsevier Inc. All rights reserved.

The Trend of Governmental Support from Post-Graduated Iranian Students in Medical Fields to Study Abroad

PubMed Central

Haghdoost, AA; Ghazi, M; Rafiee, Z; Afshari, M

2013-01-01

Background: To explore the trend and composition of post-graduate Iranian students who received governmental scholarship during the last two decades. Method: Detailed information about the awarded scholarships and also about the number of post graduate students in clinical and basic sciences in domestic universities were collected from the related offices within the ministry of health and medical education and their trends were triangulated. Results: A sharp drop was observed in the number of awarded scholarships, from 263 in 1992 to 46 in 2009. In the beginning, almost all of scholarships fully supported students for a whole academic course; while in recent years most of scholarships supported students for a short fellowship or complementary course (more than 80%). Students studied in a wide range of colleges within 30 countries; more than 50% in Europe. Although one third of students studied in UK in the first years, only 4% of students selected this country in recent years. conversely, the number of scholarships to Germany and sweden have increased more than 10 and 3 times during this period. In parallel, the capacity of domestic universities for training of post-graduate students has been expanded dramatically. Conclusion: Although expanding post-graduate education has been one of the main strategic objectives of the ministry of health and medical education in last two decades, it was obtained using different approaches. By time, more attention was to expanding the capacities of Iranian universities, and choosing less but more targeted students to continue their studies abroad. PMID:23865032

[Medical terminology and lay users. A quali-quantitative survey of a group of young motivated graduates].

PubMed

Conti, A A

2013-01-01

Medical terms occupy growing spaces in dictionaries and the media daily propose a great number of medical words. Nevertheless scientific data regarding the actual degree of comprehension of medical terminology on the part of lay users are scanty. Aim of this study was the evaluation, in a group of young motivated graduates, of the degree of understanding of a set of medical terms normally adopted by physicians in specialistic language, and also used when speaking with patients. Nine medical terms used by physicians in daily practice were selected (“aphasia”, “edema”, “erythema”, “fibrillation”, “fibroma”, “jaundice”, “paraplegia”, “polypus”, “sclerosis”) and they were administered in paper form to eighteen young graduates, non-health operators who were asked to furnish one definition for each of the terms. A subsequent structured oral discussion integrated the recorded written findings. Erythema and fibrillation were the most well-known and understood terms. Among the selected medical terms, the more difficult ones to understand were sclerosis and jaundice. Interesting features emerged from the characterization of the site attributed to some of the investigated terms, in particular edema was mainly perceived as the pulmonary one, fibroma was more often interpreted as a benign tumor localized in the uterus and polypus was more frequently associated with its collocation in the nose. The participants involved in this quali-quantitative survey demonstrated a general good knowledge and comprehension of the medical terms proposed. Some limits in knowledge documented in this group, however, indicate that the use of medical terminology needs more clarification within the doctor-patient context. Such clarification appears even more mandatory in subjects with low scholastic-education levels.

42 CFR 412.105 - Special treatment: Hospitals that incur indirect costs for graduate medical education programs.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Special treatment: Hospitals that incur indirect costs for graduate medical education programs. 412.105 Section 412.105 Public Health CENTERS FOR... SYSTEMS FOR INPATIENT HOSPITAL SERVICES Special Treatment of Certain Facilities Under the Prospective...

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