Regional Population-Based Workforce Shortages in General Surgery by Practicing Surgeon and Resident Trainee

Background The physician shortage in the United States (US) continues to become more apparent. We aimed to evaluate the relationship between the US physician distribution from 2012-2019 by specialty at the state/regional level relative to the corresponding population growth. Methods US matched residents and practicing physicians from 2012-2019 were extracted from the National Resident Matching Program and Association of American Medical College databases, respectively. Residents and practicing physicians were divided by geographic regions (West, Midwest, South, Northeast), states, and specialties (anesthesiology, emergency medicine, family medicine, general surgery (GS), internal medicine, obstetrics/gynecology and pediatrics). Results Entering residents and physicians increased across 7 specialties from 2012-2019 with the exception of GS, which showed .2% decrease in practicing physicians. GS experienced decreases in entering residents in all US regions except the South. All specialties showed a decrease in the people-per-physician (PPP) except GS and pediatrics, which had a 4.1% and 71.3% increase, respectively. EM showed the largest growth overall, both in entering residents and overall workforce. Conclusion GS experienced slow growth of residents, decreases in practicing physicians and workforce overall, and an increase in PPP from 2012-2019. Our findings suggest that current population growth rate is exceeding the rate of physicians entering the field of GS and highlights the need for interventions to promote the recruitment of GS residents and retainment of attending physicians, particularly for rural areas. Future research to measure surgeon distribution in relation to patient outcomes and the efficacy of recent policy to address shortages can help define additional interventions to address physician shortages moving forward.

Disciplining empathy: Differences in empathy with U.S. medical students by college major

Citing their students’ low levels of empathy, medical educators have scrambled to implement curricula with the hopes of buffering against the corrosive effects of biomedical and clinical experiences in medical school. The assumption undergirding these studies by social scientists and medical educators alike is that immersion in biomedical education and clinical experience erodes students’ empathic capacities, and that exposure to humanities and social sciences content will amend these losses. But we do not know if this assumption is correct. In this project, we empirically assess this assumption by utilizing a unique data set constructed from student applicant and survey data from the American Medical College Application Service (AMCAS) and the Association of American Medical Colleges (AAMC). We test whether medical school students ( N = 8255) from the United States (U.S.) with different academic backgrounds represented by their college major have different levels of empathy, net of demographic control variables. We report two findings. First, we find that students who majored in humanities or interpretive social sciences disciplines have higher empathy scores than their peers who majored in the positivistic social sciences and STEM (science, technology, engineering, and mathematics) disciplines. Second, we find that the relationship between empathy and time in medical school is more nuanced than we would expect from the existing literature.

ENTRUSTABLE PROFESSIONAL ACTIVITIES (EPAS) FROM CLINICAL TO BASIC SCIENCE DISCIPLINES: A METHODOLOGICAL PROPOSAL

Competence-based education has gained in popularity at many countries. Competence is regarded as the possession and development of integrated skills, knowledge, appropriate attitudes, and experience for the successful performance of ones life roles. A new concept is gaining great relevance in the clinic medical education context: Entrustable Professional Activities (EPAs) these activities allow curricular development of competencies, no longer in the classroom. EPAS have been identified for many graduate clinical education programmes, but none for basic sciences disciplines. With the idea of transfer EPA concept to the development and assessment of basic science competencies, this work offers: (1) a EPAS-competencies matrix to work the competency E2 described by the Association of American Medical College (linked with research skills) (2) the development of a complete EPA model. The proposal opens a line to discuss the implications and challenges that this concept-transfer offers.

Trends in Subspecialization: A Comparative Analysis of Rural and Urban Clinical Education

Background and Objectives: Medical students who train in rural communities are often exposed to physicians practicing a broad scope of care, regardless of discipline. We examined how rural education is associated with practice specialization rates for students who match in primary care or general core specialties. Methods: We linked practice and specialty data (2016 AMA Masterfile dataset), demographics (American Medical College Application Service data), and internal college data for 1974-2011 Michigan State University College of Human Medicine graduates who received clinical education on either the Upper Peninsula (rural) or Grand Rapids (urban) campuses. Current practice was verified using internet searches. We compared specialty and practice data by rural or urban campus, controlling for multiple variables. Results: More rurally-trained graduates entered primary care (PC) residencies (128/208, 61.5%) than urban-trained graduates (457/891, 51.3%; P<.01), with rurally-trained graduates being twice as likely to enter family medicine (FM) residencies. Most FM residents remained PC physicians (205/219, 93.6%). Internal medicine residents were least likely to remain in primary care (91/189, 48.1%). Of the general core disciplines, general surgeons were least likely to remain in general surgical practice (45/134, 33.6%). Within each PC or general core discipline, the proportion of graduates who specialized did not differ by type of campus. Conclusions: Rurally-trained graduates are more likely to practice primary care, chiefly due to increased likelihood of choosing a FM residency. Graduates entering PC or general core residencies subspecialize at similar rates regardless of rural or urban education. FM residency match rate may be the best predictor of long-lasting impact on the primary care workforce.

Creation of a Professional Development Program for Women in a Major US Medical School Pathology Department

Background Improving promotion and retention of women in pathology at major medical schools is important, especially in schools and departments that are below Association of American Medical College averages for these metrics. Our objective was to create a professional development program for women within the Department of Pathology at Washington University School of Medicine and to assess its perceived value. Methods A forum for women faculty, residents, and fellows was created and has been in place for 5 years. The forum meets once per month; the content includes various topics, articles, books, and invited speakers and covers a broad range of professional development subjects. The success of the forum was assessed by surveying attendees. A survey was created with Surveymonkey.com and sent to 65 women who had been invited to the forum over the 5-year period. Results Responses were received from 26/65 (40%) women surveyed. Junior faculty constituted 42% of attendees, with fellows, residents, midcareer faculty, and senior faculty attending in the descending order of frequency. All responders found the forum valuable. The most valuable content can be broken into 2 major themes: (a) issues facing women in medicine (such as unconscious bias) and (b) tools for improving professional development (such as negotiation skills for women). Conclusions Survey responses and comments indicate that this forum is perceived as extremely valuable. This format and content could easily be replicated in any academic department. Knowledge of what topics women found the most valuable can help direct the content and enhance successful outcomes of this type of professional development program.

Predicting Medical School and Internship Success: Does the Quality of the Research and Clinical Experience Matter?

ABSTRACT Objectives: This article explores specific aspects of self-reported clinical and research experience and their relationship to performance in medical training. Methods: This is a retrospective cohort study conducted at the Uniformed Services University. The American Medical College Application Service application was used to discern students' self-reported clinical and research experience. Two authors applied a classification scheme for clinical and research experience to the self-reported experiences. Study outcomes included medical school grade point average (GPA), U.S. Medical Licensing Examination (USMLE) scores, and intern expertise and professionalism scores. A linear regression analysis was conducted for each outcome while controlling for prematriculation GPA. Results: Data were retrieved on 1,020 matriculants. There were several statistically significant but small differences across outcomes when comparing the various categories of clinical experience with no clinical experience. The technician-level experience group had a decrease of 0.1 in cumulative GPA in comparison to students without self-reported clinical experience (p = 0.004). This group also performed 5 points lower on the USMLE Step 2 than students who did not report clinical experience (p = 0.013). The various levels of self-reported research experience were unrelated to success in medical school and graduate medical education. Discussion: These findings indicate that self-reported technician-level clinical experience is related to a small reduction in typically reported outcomes in medical school.

Implementing A Criminal Background Check Process

ABSTRACT Motivated by external factors and an interest in providing the highest quality of patient care, the University of Iowa implemented a criminal background check process for all health science students in 2004. The authors detail the principles that guided policies and procedures that were put into place at university and collegiate levels to ensure that applicants and students understand the process; that an individualized review of criminal conduct reported in a background check occurs; and that fair and consistent action is taken in cases considered. The number and type of infractions reviewed by the Carver College of Medicine during a four-year period are conveyed as well as national statistics resulting from the criminal background check pilot operated by the American Medical College Application Service. The authors conclude that criminal background checks are an effective tool to be used for screening purposes before students are allowed patient contact but there must be clear procedures that are communicated to applicants and students as well as considered action taken when problematic behavior is uncovered by the check.