Matching Against Men: 5 Years of Residency Match Data Show Disparities Still Exist.

OBJECTIVES: Despite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties. METHODS: Deidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant. RESULTS: Of the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty. CONCLUSIONS: In this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.

Understanding of 'generalist medical practice' in South African medical schools.

BACKGROUND: In South Africa, medical students are expected to have acquired a generalist competence in medical practice on completion of their training. However, what the students and their preceptors understand by 'generalist medical practice' has not been established in South African medical schools. AIM: This study aimed to explore what the students and their preceptors understood by 'generalist medical practice'. SETTING: Four South African medical schools: Sefako Makgatho Health Sciences University, University of KwaZulu-Natal, Walter Sisulu University and the University of the Witwatersrand. METHODS: The exploratory descriptive qualitative design was used. Sixteen focus group discussions (FGDs) and 27 one-on-one interviews were conducted among students and their preceptors, respectively. Participants were recruited through purposive sampling. The inductive and deductive data analysis methods were used. The MAXQDA 2020 (Analytics Pro) software was used to arrange data, yielding 2179 data segments. RESULTS: Ten themes were identified: (1) basic knowledge of medicine, (2) first point of contact with all patients regardless of their presenting problems, (3) broad field of common conditions prevalent in the community, (4) dealing with the undifferentiated patient without a diagnosis, (5) stabilising emergencies before referral, (6) continuity, (7) coordinated and (8) holistic patient care, necessitating nurturance of doctor-patient relationship, (9) health promotion and disease prevention, and (10) operating mainly in primary health care settings. CONCLUSION: The understanding of 'generalist medical practice' in accordance with internationally accepted principles augurs well in training undergraduate medical students on the subject. However, interdepartmental collaboration on the subject needs further exploration.Contribution: The study's findings can be used as a guide upon which the students' preceptors and their students can reflect during the training in generalist medical practice.

Exploring the stability of the gender gap in faculty perceptions of gender climate at a rural regional university.

Increasing awareness of gender barriers and biases in academic institutions is an essential component of institutional change strategies to promote equity and inclusion. There is an established perception gap in recognizing gender inequities in the workplace, whereby men faculty under acknowledge the stressors, barriers, and biases faced by their women faculty colleagues. This study explored the gender gap in faculty perceptions of institutional diversity climate at a rural comprehensive regional university in the United States. In addition to gender, differences across academic discipline and time were explored using 2 (men and women) x 2 (STEM and other) x 2 (2017 and 2022) between-groups ANOVAs. Results revealed a gender gap that persisted across time and perceptions of stressors, diversity climate, student behavior, leadership, and fairness in promotion/tenure procedures, with marginalized (women) faculty consistently reporting greater barriers/concern for women faculty relative to the perceptions of their men faculty colleagues. These findings are largely consistent with the extant literature and are discussed both with regard to future research directions and recommendations for reducing the perception gap and addressing institutional barriers to gender equity.

Eviatar Yemini.

Interview with Eviatar Yemini, who studies how neurobehavioral circuits grow and evolve to meet the needs at different stages of development at UMass Chan Medical School.

Perceptions and experiences of undergraduate medical students regarding social accountability: a cross-sectional study at a Subsaharan African medical school.

BACKGROUND: Medical schools are called to be socially accountable by medical education and healthcare system stakeholders. Social accountability is a feature of excellent medical education. Medical students are essential to the development of socially accountable medical schools. Therefore, understanding the perceptions and experiences of medical students regarding social accountability is critical for efforts to improve social accountability practices and outcomes. METHODS: This cross-sectional online questionnaire-based survey used Google Forms and involved medical students in their fourth and fifth years of study at the Makerere University School of Medicine. The survey was conducted between September 2022 and October 2023. We used a study questionnaire and a validated toolkit designed by students as part of The Training for Health Equity Collaborative to gauge a school's progress towards social accountability in medical schools to collect data on demographics, perceptions and experiences and evaluate social accountability. RESULTS: Out of 555 eligible medical students, 426 responded to the online questionnaire. The response rate was 77%. The mean age of the students was 25.24 ± 4.4 years. Almost three fourths of the students were male (71.3%), and slightly less than two thirds were in their fourth year of study (65%). Almost half of the students (48.1%%) evaluated the school as doing well with regard to social accountability. The evaluation items referring to community-based research and positive impact on the community had the highest mean scores. Only 6 (3.6%) students who reported hearing of social accountability had a clear understanding of social accountability. Students receiving career guidance in secondary school was associated with evaluating social accountability in the medical school as strong (p-0.003). CONCLUSIONS: Medical students evaluated the medical school favorably forsocial accountability despite lacking a clear understanding of social accountability. Receiving career guidance in secondary school was significantly associated with a positive evaluation of social accountability.

Navigating the Roadmap for Trauma-Informed Medical Education: Application of Undergraduate Medical Education Competencies.

BACKGROUND: Trauma is common in the United States, increases risk of long-term adverse health effects, and individuals who experience it often find seeking medical care difficult. Trauma-informed care (TIC) builds trust and fosters healing relationships between clinicians and patients; however medical education has lacked consistent training in TIC. Using recently published competencies for undergraduate medical education (UME), this manuscript provides curricular examples across 8 domains to assist faculty in developing educational content. METHODS: The authors identified published curricula for each of the 8 competency domains using a published search strategy and publicly available database. Inclusion criteria were published works focused on UME in the United States; abstracts and curricula not focused on UME were excluded. The authors used a consensus-based process to review 15 eligible curricula for mapping with the competencies. RESULTS: Of 15 published UME curricula, 11 met criteria and exemplify each of the 8 UME competency domains. Most of the available curricula fall into the Knowledge for Practice and Patient Care domains. Most were offered in the first 2 years of medical school. CONCLUSION: Competency-based medical education for TIC is new, and most current educational offerings are foundational in nature. Additional innovation is needed in the competency domains of Professionalism, Systems-Based Practice, Interprofessional Collaboration, and Personal/Professional Development. This manuscript offers a set of curricular examples that can be used to aid efforts at implementing TIC competencies in UME; future work must focus on improving assessment methods and developmental sequencing as more students are exposed to TIC principles.

Exploring clinical teachers' beliefs about teaching in a newly established medical school in Southern Switzerland.

Academic social contexts and educational beliefs may influence teaching practices and teaching intentions. Insight into such beliefs represents an important source of information for medical schools to improve the quality of teaching and to guide content of faculty development programs. The aim of this study was to explore beliefs about teaching among prospective clinical teachers at a newly established medical school in Southern Switzerland and to estimate the relationship between these beliefs and intention to commit to teaching in the newly established medical curriculum using Fishbein's integrative model of behaviour prediction. We targeted a purposive sample of physicians working in hospital departments potentially involved in the clinical immersion of medical students enrolled in the program. We designed a cross-sectional quantitative study using an online questionnaire. The questionnaire included both items developed by the authors and items belonging to a previously validated questionnaire. Participants showed a high intention to commit to teaching in the newly established curriculum. We found that self-efficacy beliefs and two sets of behavioural beliefs, namely perceived importance and expectations, had a positive correlation with the intention to commit. On the other hand, we pointed out a number of normative beliefs that in the long run could hinder the maintenance of this commitment, which should be addressed both at the levels of both faculty development and institutional policy rules. Our study also highlights the importance of reinforcing teachers' perceived self-efficacy in providing clinical supervision, strengthening their perceived importance of the clinical supervision, and incentivising the commitment of teachers by ensuring they have protected time to devote to this activity.

The emergence of the Medical University of Vienna 20 years ago.

At the beginning of the 2000s the Austrian public universities were characterized by staffing rigidities, little competitive research, outdated study curricula and free access to all fields of study, the latter combined with high dropout rates and long study durations. As a countermeasure the universities were granted full legal capacity. For new employees the status of civil servants was herewith cancelled and, being now subject to the Employment Act, tenured employments for anyone who wanted to stay at the university were no longer possible. Medical faculties always had special provisions which would be difficult to reconcile with the full legal capacity of the universities: (i) the requirements of the hospitals affiliated to universities for research and teaching in addition to patient care had to be reimbursed to the Austrian federal states maintaining the hospitals, (ii) the physicians of university-affiliated hospitals were largely employed by the respective university and (iii) to ensure financing of clinical research and teaching at the hospital, the medical faculties received a budget separated from the rest of the university. As it was neither politically possible nor foreseeable that universities would be able to form a subcorporation with the affiliated hospital (integration model) or at least a close cooperation with the hospital if that has legal capacity per se (cooperation model), the necessary budgetary sovereignty of the medical faculties could only be guaranteed by their transition to medical universities. Nonetheless, reservations about this spin-off of medicine were enormous, but quickly fell silent, as the newly established medical universities maintained close cooperations with their parent as well as other universities and achieved, for Austrian standards, favorable positions in international rankings.

Sociodemographic disadvantage in the burden of stress and academic performance in medical school: implications for diversity in medicine.

BACKGROUND: Nontraditional students bring to medicine inherent characteristics and perspectives that enrich the learning environment and contribute to expanding diversity in medicine. However, research has shown that these students, by virtue of their sociodemographic backgrounds, face unique challenges in medical education, which ultimately place them at a disadvantage compared to their peers. The purpose of this study is to explore relationships between sociodemographic characteristics, stress, and academic performance, in the context of outcomes that may be undermining efforts to diversify the physician workforce. METHODS: Using a retrospective observational cohort methodology, we examined institutional and USMLE exam performance data in conjunction with Perceived Stress Scale-4 survey results from six cohorts of students at Kirk Kerkorian School of Medicine at UNLV (n = 358). Using independent samples t-test, mean stress and academic performance were compared between four sociodemographic groups: first-generation college students, underrepresented in medicine (URM), socioeconomically disadvantaged, and age 30 + at matriculation. Results were considered significant where P ≤ .05. RESULTS: First-generation college students had significantly higher stress at the end of third year clerkships (mean 7.8 vs. 6.8, P* = .03). URM students had significantly lower scores on preclinical exams (mean 81.37 vs. 83.07, P* = .02). The students who were age 30 + at matriculation had significantly lower exam scores on all academic performance measures. CONCLUSION: Our results echo historic trends in academic performance for racial and ethnic minority students, and we present recent evidence of academic performance disparities based on age at matriculation. Residency program directors continue to use test scores as a primary metric to screen applicants and thus, poor academic performance has profound consequences on career trajectory. Finally, significantly higher stress in the first-generation students may be evidence of underlying psychological distress. Expanding the sociodemographic diversity among physicians, and by extension, medical students, has long been recognized as fundamental to addressing inequities in healthcare. However, results from our study suggest that aspects of medical education are unfavorable and disadvantageous for first-generation, URM, and older medical students. A deeper understanding of the interplay between sociodemographic characteristics and success in medical school is paramount as we pursue diversity in medicine.

Swiss medical schools' experiences with online teaching during the COVID-19 pandemic in light of international experiences.

BACKGROUND: During the pandemic, all universities had to switch to digital learning and teaching (DLT), the experiences were diverse. The advantages and obstacles of DLT are well reported in research. To ensure a sustainable DLT implementation, the requirements of institutions, educators and students should be aligned. OBJECTIVE: This paper aims at identifying and describing the experiences made at the Swiss medical schools after having to switch from on-site to on-line teaching; in particular, the experienced issues, requirements, and solutions were investigated and compared to international literature. METHODS: We conducted a literature review to derive themes and subthemes regarding the central aspects of the transition from on-site to on-line teaching. Also, we conducted semi-structured interviews with people responsible for the medical curricula at the Swiss Medical Schools. We used a purposive sampling method and invited eleven curriculum managers at the seven Swiss Medical Schools. The interviews were conducted in English, audio-recorded and transcribed. Subsequently the data was analysed with the software NVivo. We used a qualitative, deductive, content analysis to explore faculty experiences. RESULTS: Twenty-four articles met the eligibility criteria and were included for full text screening. Of the included articles, 15 reported on DLT in general and nine articles reported on DLT during the Pandemic. The thematic analysis of the interviews resulted in four overall themes, requirements, obstacles, facilitators and advantages. Curriculum managers reported that institutions were relatively unprepared for the quick transition from onsite to online at the onset of the pandemic. CONCLUSIONS: Our research reports a lack of institutional structures, communication, digital competences and literacy, teaching strategies, as well as a theoretical foundation for DLT implementation. A conceptual framework for DLT adapted to the Swiss universities beyond the current situation is needed.

How professional and academic pre-qualifications relate to success in medical education: Results of a multicentre study in Germany.

OBJECTIVE: Every year, many applicants want to study medicine. Appropriate selection procedures are needed to identify suitable candidates for the demanding curriculum. Although research on medical school admissions has shown good predictive validity for cognitive selection methods (undergraduate GPA, aptitude tests), the literature on applicants with professional and/or academic experience prior to entering medical school remains slim. In our study, we therefore aimed to examine the association between academic success in medical school and having previously completed vocational training in the medical field, voluntary service (≥11 months) or an academic degree. METHODS: Data were collected in a multicentre, cross-sectional study at five medical schools in Germany (Baden-Wuerttemberg) from students during medical school (i.e. 3rd-, 6th-, and 10th-semester and final-year students). Academic success was assessed according to scores on the first and second state examinations, the total number of examinations repeated and the number of semesters beyond the standard period of study. For the analysis we calculated ordinal logistic regression models for each outcome variable of academic success. RESULTS: A total of N = 2,370 participants (response rate: RR = 47%) participated in the study. Having completed vocational training was associated with a higher amount of repeated examinations (small effect), while having an academic degree was associated with worse scores on the second state examination (medium effect). No significant association emerged between voluntary service and academic success. CONCLUSION: The results indicate that professional and academic pre-qualifications pose no advantage for academic success. Possible associations with the financing of study and living conditions of students with pre-qualifications were analysed and discussed in an exploratory manner. However, the operationalisation of academic success from objective and cognitive data should be critically discussed, as the benefits of prior experience may be captured by personal qualities rather than examination results.

A blueprint for success: lessons learned from developing the official guide to Iranian undergraduate medical education accreditation.

We are excited to contribute our thoughts and insights to the discussion initiated by Gandomkar et al. in their article on the accreditation system in Iran (Gandomkar et al., BMC Med Educ 23:379, 2023). As individuals who have been directly involved in the process of meta-accreditation and possess a comprehensive understanding of the various stages of Undergraduate Medical Education (UME) accreditation in Iran, we would like to highlight additional points that were identified through a rigorous hermeneutic phenomenology process proposed by Gadamer (Gadamer, Truth and Method, 2013) and offer a complementary point of view to the previous work. By sharing our insights, we hope to contribute to the ongoing discourse surrounding UME accreditation.

Clearing the confusion about post-accreditation monitoring, meta-evaluation and meta-accreditation.

We have recently published the experience of the accreditation body of undergraduate medical education in Iran on developing and validating standards based on the WFME framework (Gandomkar et al., BMC Med Educ 23:379, 2023). Agabagheri et al. extended our work and proposed a blueprint for post-accreditation monitoring based on their experience in developing an official guide in their Matters Arising (Aghabagheri et al., BMC Med Educ). The authors have used post-accreditation monitoring as a process of monitoring and controlling accreditation activities, procedures often referred to as meta-evaluation or meta-accreditation (depending on the objectives of evaluation) in the literature. On the contrary, post-accreditation monitoring alludes to the process of continuous quality improvement of educational programs after accreditation. We would like to make clarifications between post-accreditation monitoring, meta-evaluation and meta-accreditation which have been used interchangeably in their paper. Considering the emerging interests in scholarship and non-scholarship activities and reports in undergraduate medical education accreditation, this clarification provides a better understanding of the roles of these crucial concepts in the accreditation process.

Sociocultural factors affecting first-year medical students' adjustment to a PBL program at an African medical school.

BACKGROUND: Besides regulatory learning skills, learning also requires students to relate to their social context and negotiate it as they transition and adjust to medical training. As such, there is a need to consider and explore the role of social and cultural aspects in student learning, particularly in problem-based learning, where the learning paradigm differs from what most students have previously experienced. In this article, we report on the findings of a study exploring first-year medical students' experiences during the first semester of an undergraduate problem-based learning medical program at an African medical school. METHOD: We employed a qualitative case study approach using in-depth interviews with 23 first-year medical students. Participants ranged in age from 18 to 25 years. All students were bi/multilingual (some spoke three to five languages), with English as the learning language. We conducted an inductive thematic analysis to systematically identify and analyze patterns in the data using the Braun and Clarke framework. RESULTS: Before medical school, students worked hard to compete for admission to medical school, were primarily taught using a teacher-centered approach, and preferred working alone. At the beginning of medical school, students found it challenging to understand the problem-based learning process, the role of the case, speaking and working effectively in a group, managing a heavy workload, and taking increased responsibility for their learning. By the end of the first semester, most students were handling the workload better, were more comfortable with their peers and facilitators, and appreciated the value of the problem-based learning approach. CONCLUSIONS: Our study highlights the importance of interrogating contextual sociocultural factors that could cause tension when implementing problem-based learning in non-western medical schools. Adjustment to problem-based learning requires a conceptual and pedagogic shift towards learner-centered practice, particularly concerning self-direction, the role of the case, and collaborative learning. As such, there is a need to develop and implement research-informed learning development programs that enable students to reflect on their sociocultural beliefs and practices, and enhance their regulatory learning competence to optimize meaningful and early engagement with the problem-based learning process.

Combatting the occurrence of needle-stick injuries in a medical school: why is it still an issue?

BACKGROUND: Needle-stick injuries (NSIs) pose a safety risk for healthcare workers with great potential for serious infections. The aim was to determine numbers and causes of NSIs as well as the frequency with which medical students report NSIs in the final stages of study. METHODS: An online questionnaire was developed and made available in January and February 2023 to all undergraduate medical students (n = 423) in the last 1.5 years of their degree course at Würzburg University, Germany. RESULTS: The response rate was 19.6% (n = 84). Among respondents, 27.4% (n = 23) reported at least one NSI. Occurrence was particularly frequent in surgery, obstetrics and gynaecology, and internal medicine. Assisting with procedures, suturing, and blood sampling were considered high-risk activities. Lack of concentration, distraction, and time pressure played a role in incidents. Respondents did not report 18.8% of NSIs with the main reasons being fear of the consequences, self-assessment of the injury as minor, or the opinion of supervisors that reporting was unnecessary. Students with previous practice on simulators or patients were significantly more likely to suffer NSIs. Instructions from occupational health specialists beforehand correlated with fewer NSIs. CONCLUSION: We assume that trained students are more experienced in handling invasive procedures, leading to a greater adoption of corresponding activities and thus an increased risk of injuries in absolute numbers. This does not counter the need for didactic interventions prior to workplace-based training to raise awareness of NSI risks. Simultaneously, concepts must be developed and implemented to support reporting and alleviate fears regarding consequences.