scholarly journals A transparent and defensible process for applicant selection within a Canadian emergency medicine residency program

CJEM ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. 215-223 ◽  
Author(s):  
Quinten S. Paterson ◽  
Riley Hartmann ◽  
Rob Woods ◽  
Lynsey J. Martin ◽  
Brent Thoma
Keyword(s):  
Emergency Medicine ◽  
Selection Process ◽  
Heat Maps ◽  
Medical Graduates ◽  
Social Events ◽  
Process Outcomes ◽  
Rank List ◽  
Z Scores ◽  
The Difference ◽  
Resident Selection

ABSTRACTObjectivesThe Canadian Resident Matching Service (CaRMS) selection process has come under scrutiny due to the increasing number of unmatched medical graduates. In response, we outline our residency program's selection process including how we have incorporated best practices and novel techniques.MethodsWe selected file reviewers and interviewers to mitigate gender bias and increase diversity. Four residents and two attending physicians rated each file using a standardized, cloud-based file review template to allow simultaneous rating. We interviewed applicants using four standardized stations with two or three interviewers per station. We used heat maps to review rating discrepancies and eliminated rating variance using Z-scores. The number of person-hours that we required to conduct our selection process was quantified and the process outcomes were described statistically and graphically.ResultsWe received between 75 and 90 CaRMS applications during each application cycle between 2017 and 2019. Our overall process required 320 person-hours annually, excluding attendance at the social events and administrative assistant duties. Our preliminary interview and rank lists were developed using weighted Z-scores and modified through an organized discussion informed by heat mapped data. The difference between the Z-scores of applicants surrounding the interview invitation threshold was 0.18-0.3 standard deviations. Interview performance significantly impacted the final rank list.ConclusionsWe describe a rigorous resident selection process for our emergency medicine training program which incorporated simultaneous cloud-based rating, Z-scores, and heat maps. This standardized approach could inform other programs looking to adopt a rigorous selection process while providing applicants guidance and reassurance of a fair assessment.

scholarly journals Resident selection for emergency medicine specialty training in Canada: A survey of existing practice with recommendations for programs, applicants, and references

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 829-835
Author(s):  
Michael K. P. Hale ◽  
Jason R. Frank ◽  
Warren J. Cheung
Keyword(s):  
Emergency Medicine ◽  
Best Practices ◽  
Online Survey ◽  
Selection Process ◽  
Rank Order ◽  
Residency Programs ◽  
Selection Processes ◽  
High Level ◽  
Resident Selection ◽  
Current Selection

ABSTRACTObjectiveLittle is known about how the Royal College of Emergency Medicine (RCEM) residency programs are selecting their residents. This creates uncertainty regarding alignment between current selection processes and known best practices. We seek to describe the current selection processes of Canadian RCEM programs.MethodsAn online survey was distributed to all RCEM program directors and assistant directors. The survey instrument included 22 questions and sought both qualitative and quantitative data from the following six domains: application file, letters of reference, elective selection, interview, rank order, and selection process evaluation.ResultsWe received responses from 13 of 14 programs for an aggregate response rate of 92.9%. A candidate's letters of reference were identified as the most important criterion from the paper application (38.5%). Having a high level of familiarity with the applicant was the most important characteristic of a reference letter author (46.2%). In determining rank order, 53.8% of programs weighed the interview more heavily than the paper application. Once final candidate scores are established following the interview stage, all program respondents indicated that further adjustment is made to the final rank order list. Only 1 of 13 program respondents reported ever having completed a formal evaluation of their selection process.ConclusionWe have identified elements of the selection process that will inform recommendations for programs, students, and referees. We encourage programs to conduct regular reviews of their selection process going forward to be in alignment with best practices.

Delivering CaRMS Transparency: Applicant Review and Selection Process of a Single-Center Diagnostic Radiology Residency Training Program

2020 ◽  
pp. 084653712095762
Author(s):  
Lindsay Cherpak ◽  
Jason Chan ◽  
Raman Verma ◽  
Matthew D. F. McInnes ◽  
Rebecca Hibbert
Keyword(s):  
Selection Process ◽  
Group Discussion ◽  
Residency Training Program ◽  
Diagnostic Radiology ◽  
Current Application ◽  
Medical Graduates ◽  
Selection Processes ◽  
Rank List ◽  
Radiology Residency ◽  
The University

Purpose: To report the current application review and selection process in our Canadian diagnostic radiology program at the University of Ottawa for both Canadian and international medical graduates. Application Review and Selection Process: Submitted applications fulfilling institutional requirements were selected for a detailed file review after preliminary screening. A diverse group of file reviewers and interviewers was selected. Interviews were offered based on file review score sheet outcomes. Each interviewer generated a postinterview rank list. Applicants were reviewed and discussed from highest to lowest rank based on a preliminary compiled rank list generated from the average of the postinterview rank lists. Group discussion and a consensus model were used to create a final applicant rank list. Conclusions: We outlined our systematic, consistent selection process which aligns with current best practices. This description may inform other programs wishing to adopt or optimize strategies to improve candidate assessments and selection processes.

Revisiting Hull's Evolutionary Model of Science

2021 ◽  
Vol 13 (2) ◽  
pp. 145-152
Author(s):  
Mohammad Mahdi Hatef ◽  
Keyword(s):  
Natural Selection ◽  
Selection Process ◽  
Biological Evolution ◽  
Evolutionary Model ◽  
Scientific Change ◽  
Evolutionary Models ◽  
Natural Evolution ◽  
The Difference

Evolutionary models for scientific change are generally based on an analogy between scientific changes and biological evolution. Some dissimilarity cases, however, challenge this analogy. An issue discussed in this essay is that despite natural evolution, which is currently considered to be non-globally progressive, science is a phenomenon that we understand as globally progressive. David Hull's solution to this disanalogy is to trace the difference back to their environments, in which processes of natural selection and conceptual selection occur. I will provide two arguments against this solution, showing that Hull's formulation of natural selection prohibits him from removing the environment from the selection process. Then I point to a related tension in his theory, between realism and externalism in science, and give some suggestions to solve these tensions.

scholarly journals MP23: Giving medical students what they deserve - a rigorous, equitable and defensible CaRMS selection process

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S50
Author(s):  
Q. Paterson ◽  
R. Hartmann ◽  
R. Woods ◽  
L. Martin ◽  
B. Thoma
Keyword(s):  
Medical Students ◽  
Selection Process ◽  
Rank Order ◽  
Intraclass Correlation ◽  
Data Entry ◽  
Weighted Average ◽  
Correlation Coefficients ◽  
Visual Aid ◽  
Z Scores ◽  
The University

Innovation Concept: The fairness of the Canadian Residency Matching Service (CaRMS) selection process has been called into question by rising rates of unmatched medical students and reports of bias and subjectivity. We outline how the University of Saskatchewan Royal College emergency medicine program evaluates CaRMS applications in a standardized, rigorous, equitable and defensible manner. Methods: Our CaRMS applicant evaluation methods were first utilized in the 2017 CaRMS cycle, based on published Best Practices, and have been refined yearly to ensure validity, standardization, defensibility, rigour, and to improve the speed and flow of data processing. To determine the reliability of the total application scores for each rater, single measures intraclass correlation coefficients (ICCs) were calculated using a random effects model in 2017 and 2018. Curriculum, Tool or Material: A secure, online spreadsheet was created that includes applicant names, reviewer assignments, data entry boxes, and formulas. Each file reviewer entered data in a dedicated sheet within the document. Each application was reviewed by two staff physicians and two to four residents. File reviewers used a standardized, criterion-based scoring rubric for each application component. The file score for each reviewer-applicant pair was converted into a z-score based on each reviewer's distribution of scores. Z-scores of all reviewers for a single applicant were then combined by weighted average, with the group of staff and group of residents each being weighted to represent half of the final file score. The ICC for the total raw scores improved from 0.38 (poor) in 2017 to 0.52 (moderate) in 2018. The data from each reviewer was amalgamated into a master sheet where applicants were sorted by final file score and heat-mapped to offer a visual aid regarding differences in ratings. Conclusion: Our innovation uses heat-mapped and formula-populated spreadsheets, scoring rubrics, and z-scores to normalize variation in scoring trends between reviewers. We believe this approach provides a rigorous, defensible, and reproducible process by which Canadian residency programs can appraise applicants and create a rank order list.

RUNS OF AMINO ACIDS ARE LONGER THAN EXPECTED IN PROTEINS BASED ON A GRAPH THEORY REPRESENTATION OF THE GENETIC CODE

2002 ◽  
Vol 10 (04) ◽  
pp. 319-335
Author(s):  
DAVID DIGBY ◽  
WILLIAM SEFFENS ◽  
FISSEHA ABEBE
Keyword(s):  
Amino Acids ◽  
Graph Theory ◽  
Genetic Code ◽  
Protein Sequences ◽  
Test Statistic ◽  
Coding Sequences ◽  
Reverse Complement ◽  
In Silico Study ◽  
Z Scores ◽  
The Difference

An in silico study of mRNA secondary structure has found a bias within the coding sequences of genes that favors "in-frame" pairing of nucleotides. This pairing of codons, each with its reverse-complement, partitions the 20 amino acids into three subsets. The genetic code can therefore be represented by a three-component graph. The composition of proteins in terms of amino acid membership in the three subgroups has been measured, and sequence runs of members within the same subgroup have been analyzed using a runs statistic based on Z-scores. In a GENBANK database of over 416,000 protein sequences, the distribution of this runs-test statistic is negatively skewed. To assess whether this statistical bias was due to a chance grouping of the amino acids in the real genetic code, several alternate partitions of the genetic code were examined by permuting the assignment of amino acids to groups. A metric was constructed to define the difference, or "distance", between any two such partitions, and an exhaustive search was conducted among alternate partitions maximally distant from the natural partition of the genetic code, to select sets of partitions that were also maximally distant from one another. The statistical skewness of the runs statistic distribution for native protein sequences were significantly more negative under the natural partition than they were under all of the maximally different partition of codons, although for all partitions, including the natural one, the randomized sequences had quite similar skewness. Hence under the natural graph theory partition of the genetic code there is a preference for more protein sequences to contain fewer runs of amino acids, than they do under the other partitions, meaning that the average run must be longer under the natural partition. This suggests that a corresponding bias may exist in the coding sequences of the actual genes that code for these proteins.

scholarly journals Dermatology Residency Selection Criteria with an Emphasis on Program Characteristics: A National Program Director Survey

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Farzam Gorouhi ◽  
Ali Alikhan ◽  
Arash Rezaei ◽  
Nasim Fazel
Keyword(s):  
Medical School ◽  
Selection Criteria ◽  
Selection Process ◽  
Cross Sectional ◽  
Advanced Degrees ◽  
Residency Programs ◽  
Residency Selection ◽  
Program Characteristics ◽  
Reported Data ◽  
Resident Selection

Background. Dermatology residency programs are relatively diverse in their resident selection process. The authors investigated the importance of 25 dermatology residency selection criteria focusing on differences in program directors’ (PDs’) perception based on specific program demographics.Methods. This cross-sectional nationwide observational survey utilized a 41-item questionnaire that was developed by literature search, brainstorming sessions, and online expert reviews. The data were analyzed utilizing the reliability test, two-step clustering, andK-means methods as well as other methods. The main purpose of this study was to investigate the differences in PDs’ perception regarding the importance of the selection criteria based on program demographics.Results. Ninety-five out of 114 PDs (83.3%) responded to the survey. The top five criteria for dermatology residency selection were interview, letters of recommendation, United States Medical Licensing Examination Step I scores, medical school transcripts, and clinical rotations. The following criteria were preferentially ranked based on different program characteristics: “advanced degrees,” “interest in academics,” “reputation of undergraduate and medical school,” “prior unsuccessful attempts to match,” and “number of publications.”Conclusions. Our survey provides up-to-date factual data on dermatology PDs’ perception in this regard. Dermatology residency programs may find the reported data useful in further optimizing their residency selection process.

scholarly journals QOLP-01. THE DISCREPANCY IN GROWTH PROBLEMS BETWEEN PATIENTS WITH INTRACRANIAL GERM CELL TUMOURS ORIGINATING FROM DIFFERENT LOCATIONS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi197-vi197
Author(s):  
Bo Li ◽  
Youqi Li ◽  
Jiayi Wang ◽  
Xiaoguang Qiu
Keyword(s):  
Germ Cell ◽  
Linear Regression Analysis ◽  
Germ Cell Tumours ◽  
Paired Data ◽  
Suprasellar Region ◽  
Z Scores ◽  
The Difference ◽  
Radiotherapy Dose ◽  
Lost To Follow Up

Abstract BACKGROUND Growth problems are common in patients with intracranial germ cell tumours. However, the characteristics were not fully profiled, especially when stratified by orientation. Thus, we conducted this study. METHODS Patients newly diagnosed, ≤19 years, with confirmed pathology or tumour markers elevation were included. Patients with bifocal lesions or lost to follow-up were excluded. WHO AnthroPlus software, which was developed for the global application of the WHO Reference 2007 to monitor growth in children aged 5–19 years, was used. Based on age, sex, and height, the Z-scores of height(ZSOH) were calculated. A ZSOH< -1 indicates a slower physical development than that in peers, while a ZSOH >1 indicates faster growth than peers. RESULTS Among the 200 included patients, 75 had primary lesions originating from the sellar/suprasellar region(S/SS), 73 from the pineal gland(PG), and 52 from the basal ganglia/thalamus region(BG/T). At initial diagnosis, the median ZSOH in S/SS was -0.66(-3.76–3.05), which was significantly lower than that in PG(0.76,-2.23–5.19) and BG/T(0.64,-3.05–5.32)(p=0.001). However, the difference in ZSOH between PG and BG/T was comparable(p=0.61). In patients with S/SS who had paired data(n=36), the median ZSOH decreased from -0.22(-3.76–3.05) at diagnosis to -1.01(-3.42–1.89) at the last follow-up(p=0.001). The median ZSOHs in PG(n=38) and BG/T(n=28) remained in the normal range at last follow-up although the changes were statistically significant(p< 0.001). Linear regression analysis showed that, in S/SS, age at diagnosis(β=0.115,p=0.033), sex(β=1.337,p=0.002), radiotherapy dose(β=-0.061,p=0.007), and number of chemotherapy cycles(β=-0.177,p=0.038) were correlated with changes in median ZSOH. In BG/T, only the radiotherapy dose(β=-0.064,p=0.041) and number of chemotherapy cycles(β=-0.551,p=0.026) were correlated. However, none of the above were validated in PG. CONCLUSIONS Compared to intracranial germ cell tumours in the PG or BG/T, the growth problems in S/SS was more prominent and aggravated after treatments, especially in those with younger age, female sex, higher radiotherapy dose, and more chemotherapy cycles.

scholarly journals Comparative Reliability of Structured Versus Unstructured Interviews in the Admission Process of a Residency Program

2011 ◽  
Vol 3 (4) ◽  
pp. 517-523 ◽  
Author(s):  
Danielle Blouin ◽  
Andrew G. Day ◽  
Andrey Pavlov
Keyword(s):  
Residency Program ◽  
Variance Components ◽  
Critical Incident ◽  
Selection Process ◽  
Job Analysis ◽  
Structured Interview ◽  
Structured Interviews ◽  
Admission Process ◽  
Resident Selection ◽  
Overall Reliability

Abstract Background Although never directly compared, structured interviews are reported as being more reliable than unstructured interviews. This study compared the reliability of both types of interview when applied to a common pool of applicants for positions in an emergency medicine residency program. Methods In 2008, one structured interview was added to the two unstructured interviews traditionally used in our resident selection process. A formal job analysis using the critical incident technique guided the development of the structured interview tool. This tool consisted of 7 scenarios assessing 4 of the domains deemed essential for success as a resident in this program. The traditional interview tool assessed 5 general criteria. In addition to these criteria, the unstructured panel members were asked to rate each candidate on the same 4 essential domains rated by the structured panel members. All 3 panels interviewed all candidates. Main outcomes were the overall, interitem, and interrater reliabilities, the correlations between interview panels, and the dimensionality of each interview tool. Results Thirty candidates were interviewed. The overall reliability reached 0.43 for the structured interview, and 0.81 and 0.71 for the unstructured interviews. Analyses of the variance components showed a high interrater, low interitem reliability for the structured interview, and a high interrater, high interitem reliability for the unstructured interviews. The summary measures from the 2 unstructured interviews were significantly correlated, but neither was correlated with the structured interview. Only the structured interview was multidimensional. Conclusions A structured interview did not yield a higher overall reliability than both unstructured interviews. The lower reliability is explained by a lower interitem reliability, which in turn is due to the multidimensionality of the interview tool. Both unstructured panels consistently rated a single dimension, even when prompted to assess the 4 specific domains established as essential to succeed in this residency program.

“Hybrid” medical leadership emergency medicine training for international medical graduates

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Prakash Subedi ◽  
Jill Aylott ◽  
Naushad Khan ◽  
Niki Shrestha ◽  
Dayaram Lamsal ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Health System ◽  
International Medical Graduates ◽  
Content Type ◽  
Medical Graduates ◽  
Health System Improvement ◽  
New Learning ◽  
System Improvement ◽  
The Uk ◽  
Medical Leadership

Purpose The purpose of this paper is to outline the “Hybrid” “International” Emergency Medicine (HIEM) programme, which is an ethical pathway for the recruitment, employment and training of Emergency Medicine doctors; with a rotation through the NHS on a two-year medical training initiative with a Tier 5 visa, “earn, learn and return” programme. The HIEM programme offers an advantage to the Tier 2 visa by combining training, education and employment resulting in new learning to help improve the health system in Nepal and provide continued cultural support, clinical and leadership development experience in the UK NHS. Finally, this programme also provides a Return on Investment to the NHS. Design/methodology/approach A shortage of doctors in the UK, combined with a need to develop Emergency Medicine doctors in Nepal, led to a UK Emergency Medicine Physician (PS) to facilitate collaboration between UK/Nepal partners. A mapping exercise of the Royal College of Emergency Medicine curriculum with the competencies for the health system and quality improvement leaders and partners with patients produced a “HIEM programme”. The HIEM programme aims to develop first-class doctors to study in Emergency Departments in the UK NHS while also building trainee capability to improve the health system in Nepal with a research thesis. Findings The HIEM programme has 12 doctors on its programme across years one and two, with the first six doctors working in the UK NHS and progressing well. There are reports of high levels of satisfaction with the trainees in their transition from Nepal to the UK and the hospital is due to save £720,000 (after costs) over two years. Each trainee will earn £79,200 over two years which is enough to pay back the £16,000 cost for the course fees. Nepal as a country will benefit from the HIEM programme as each trainee will submit a health system improvement Thesis. Research limitations/implications The HIEM programme is in its infancy as it is two years through a four-year programme. Further evaluation data are required to assess the full impact of this programme. In addition, the HIEM programme has only focussed on the development of one medical speciality which is Emergency Medicine. Further research is required to evaluate the impact of this model across other medical and surgical specialties. Practical implications The HIEM programme has exciting potential to support International Medical Graduates undertake a planned programme of development while they study in the UK with a Tier 5 visa. IMGs require continuous support while in the UK and are required to demonstrate continued learning through continuous professional development (CPD). The HIEM programme offers an opportunity for this CPD learning to be structured, meaningful and progressive to enable new learning. There is also specific support to develop academic and research skills to undertake a thesis in an area that requires health system improvement in Nepal. Originality/value This is the first time an integrated clinical, leadership, quality improvement and patient partnership model curriculum has been developed. The integrated nature of the curriculum saves precious time, money and resources. The integrated nature of this “hybrid” curriculum supports the development of an evidence-based approach to generating attitudes of collaboration, partnership and facilitation and team building in medical leadership with patient engagement. This “hybrid” model gives hope for the increased added value of the programme at a time of global austerity and challenges in healthcare.

scholarly journals Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a controlled trial

CJEM ◽  
2014 ◽  
Vol 16 (01) ◽  
pp. 34-40 ◽  
Author(s):  
Jonathan Sherbino ◽  
Kulamakan Kulasegaram ◽  
Elizabeth Howey ◽  
Geoffrey Norman
Keyword(s):  
Emergency Medicine ◽  
False Positive ◽  
Cognitive Biases ◽  
Controlled Trial ◽  
Correct Diagnosis ◽  
Educational Interventions ◽  
Diagnostic Error ◽  
Control Group ◽  
Computer Based ◽  
The Difference

ABSTRACT Objectives: Cognitive forcing strategies (CFS)may reduce error arising from cognitive biases. This is the first experimental test to determine the effect of CFS training in medical students. Methods: Students were allocated to CFS training or control during a 4-week emergency medicine rotation (n = 191). At the end of the rotation examination, students were tested using computer-based cases. Application of CFS could enable reduction of diagnostic error, as evidenced by identifying multiple correct diagnoses for the two cases prone to search satisficing bias (SSB) and uncommon diagnoses for the two cases prone to availability bias (AB). Two “false positive” cases were included to test for possible “oversearching.” Results: There were 145 students in the intervention and 46 in the control group. For the SSB cases, 52% of students with CFS training and 48% in the control group initiated a search for the second diagnosis (χ2 = 0.13, df = 1, p = 0.91). More than half (54%) correctly identified the second diagnosis in the CFS group, and 48% identified it in the control group. The difference was not significant (χ2 = 2.25, df = 1, p = 0.13). For the second diagnosis in the false positive cases, 64% of the CFS group and 77% of the control group incorrectly identified it. There were no significant differences between groups (χ2 = 2.38, df = 1, p = 0.12). In the AB cases, only 45% in each group identified the uncommon correct diagnosis (χ2 = 0.001, df = 1, p = 0.98). Conclusions: The educational interventions suggested by experts in clinical reasoning and employed in our study to teach CFS failed to show any reduction in diagnostic error by novices.

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