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Building on the initial accelerated pathway programs in the 1970s to increase workforce, nearly 30 schools have launched accelerated 3-year pathways (A3YP) during the past decade. The authors based on their educational roles, experiences, and scholarship with A3YP provide this perspective of the argument for A3YP and potential disadvantages for each group-students, schools, residencies, departments, and community. When schools consider innovations, they might consider A3YPs for multiple reasons; this perspective helps provide justification for the program and broadly considers return on investment (ROI). The ROI for students includes decreased debt, reduced costs and stress associated with the fourth-year residency applications, and a directed pathway with facilitated transition into a residency program with accompanying professional identity development. Disadvantages for students include early specialty commitment, risk of deceleration, and condensed curriculum. The ROI for schools includes recruiting and retaining students, who will then transition more easily into residency and stimulating innovation. Residency programs gain residents with known skills, who have been a part of the department for 3 years. In addition, fewer residency slots for interviewing leads to saving recruitment administrative costs and time. Finally, many programs are intended to increase the workforce, since students who come to the region for medical school and transition directly into residency are likely to stay in the region. Disadvantages include increased curricular complexity for the medical school, increased administrative support, and advising resources. Finally, several of the accelerated programs attract matriculants from diverse backgrounds contributing to the diversity of the medical school, residency program, and community workforce.
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PURPOSE: Accelerated 3-year programs (A3YPs) at medical schools were developed to address student debt and mitigate workforce shortage issues. This study investigated whether medical school length (3 vs 4 years) was associated with early residency performance. The primary research question was as follows: Are the Accreditation Council for Graduate Medical Education Milestones (MS) attained by A3YP graduates comparable to graduates of traditional 4-year programs (T4YPs) at 6 and 12 months into internship? METHOD: The MS data from students entering U.S. medical schools in 2021 and 2022 from the 6 largest specialties were used: emergency medicine, family medicine, internal medicine, general surgery, psychiatry, and pediatrics. Three-year and 4-year graduates were matched for analysis (2,899 matched learners: 182 in A3YPs and 2,717 in T4YPs). The study used a noninferiority study design to examine data trends between the study cohort (A3YP) and control cohort (T4YP). To account for medical school and residency program effects, the authors used cross-classified random-effects regression to account for clustering and estimate group differences. RESULTS: The mean Harmonized MS ratings for the midyear and end-year reporting periods showed no significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = 0.01 [0.02], P = .77). Mean MS ratings across internal medicine MS for the midyear and end-year reporting periods showed no significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = -0.03 [0.03], P = .31). Similarly, for family medicine, there were no statistically significant differences between the A3YP and T4YP groups (mean [SE] cross-classified coefficient = 0.01 [0.02], P = .96). CONCLUSIONS: For the specialties studied, there were no significant differences in MS performance between 3-year and 4-year graduates at 6 and 12 months into internship. These results support comparable efficacy of A3YPs in preparing medical students for residency.
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Accelerated medical school curricula, such as three-year programs, have gained attention in recent years but studies evaluating their impact are still scarce. This study examines the Fully Integrated Readiness for Service Training (FIRST) program, a three-year accelerated pathway, to assess its impact on students' academic performance preparedness for residency. In this observational study, we compared the academic outcomes of FIRST program students to traditional four-year curriculum students from 2018 to 2023. We analyzed multiple metrics, including exam performance (United States Medical Licensing Examination Step scores, shelf exam scores, and pre-clinical course scores) and clinical performance scores during the application and individualization phases. Analysis of Variance was used to examine the effect of accelerated pathway program experience relative to traditional 4-year medical school curriculum on the learning outcomes. FIRST program students were on average 1.5 years younger upon graduation than their traditional peers. While FIRST program students scored slightly lower on Step 2 Clinical Knowledge (CK), they exhibited no significant differences in other exam scores or clinical performance relative to the traditional students. Notably, FIRST students achieved equivalent clinical performance ratings during critical clerkships and rotations. Our findings suggest that a three-year medical school curriculum can effectively prepare students for residency and produce graduates with comparable medical knowledge and clinical skills, offering potential benefits in terms of financial relief and personal well-being for medical students.
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Desempenho Acadêmico , Competência Clínica , Currículo , Educação de Graduação em Medicina , Estudantes de Medicina , Humanos , Desempenho Acadêmico/estatística & dados numéricos , Estudantes de Medicina/psicologia , Educação de Graduação em Medicina/organização & administração , Avaliação Educacional , Estágio Clínico/organização & administração , Internato e Residência , Masculino , FemininoRESUMO
[This corrects the article DOI: 10.1007/s40670-023-01825-9.].
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A core clinical skill medical students need to learn is obtaining an accurate blood pressure (BP) reading. We developed a standardized BP curriculum for first-year medical students. Medical students completed online modules and a hands-on skills session to learn BP skills. Pre- and post-surveys and an observed structured clinical encounter (OSCE) assessed student confidence and ability to accurately measure BP. Student confidence and mean OSCE scores (pre = 2.63, post = 6.51; p < 0.001) improved upon completion of the curriculum. The curriculum was feasible, well received, and improved student's skills for taking an accurate BP.
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Mentorship is critical to develop research scholars. Current literature provides mentorship guidance for biomedical research; however, mentorship for educational research is scarce. We explored literature to offer evidence-based guidance for medical education research mentors. A librarian searched peer-reviewed literature from 2001 to 2021 to identify guidelines for research mentors. Thirty-five articles were included in this narrative review. Our results identified attributes of mentors, overlapping roles, and barriers and benefits of mentoring. The structures and processes related to mentoring are reviewed and applicability to medical education research mentorship is summarized. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-022-01565-2.
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PURPOSE: To compare perception of accelerated and traditional medical students, with respect to satisfaction with education quality, and the learning environment, residency readiness, burnout, debt, and career plans. METHOD: Customized 2017 and 2018 Medical School Graduation Questionnaires (GQs) were analyzed using independent samples t tests for means and chi-square tests for percentages, comparing responses of accelerated MD program graduates (accelerated pathway [AP] students) from 9 schools with those of non-AP graduates from the same 9 schools and non-AP graduates from all surveyed schools. RESULTS: GQ completion rates for the 90 AP students, 2,573 non-AP students from AP schools, and 38,116 non-AP students from all schools in 2017 and 2018 were 74.4%, 82.3%, and 83.3%, respectively. AP students were as satisfied with the quality of their education and felt as prepared for residency as non-AP students. AP students reported a more positive learning climate than non-AP students from AP schools and from all schools as measured by the student-faculty interaction (15.9 vs 14.4 and 14.3, respectively; P < .001 for both pairwise comparisons) and emotional climate (10.7 vs 9.6 and 9.6, respectively; P = .004 and .003, respectively) scales. AP students had less debt than non-AP students (P < .001), and more planned to care for underserved populations and practice family medicine than non-AP students from AP schools (55.7% vs 33.9% and 37.7% vs 9.4%; P = .002 and < .001, respectively). Family expectations were a more common influence on career plans for AP students than for non-AP students from AP schools and from all schools (26.2% vs 11.3% and 11.7%, respectively; P < .001 for both pairwise comparisons). CONCLUSIONS: These findings support accelerated programs as a potentially important intervention to address workforce shortages and rising student debt without negative impacts on student perception of burnout, education quality, or residency preparedness.
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Esgotamento Profissional/psicologia , Escolha da Profissão , Educação de Graduação em Medicina/organização & administração , Educação de Graduação em Medicina/estatística & dados numéricos , Educação de Graduação em Medicina/normas , Internato e Residência/estatística & dados numéricos , Estados UnidosRESUMO
PROBLEM: The U.S. primary care workforce remains inadequate to meet the health needs of the U.S. population. Effective programs are needed to provide workforce development for rural and other underserved areas. APPROACH: At the University of North Carolina (UNC) School of Medicine (SOM), between November 2014 and July 2015, the authors developed and implemented the Fully Integrated Readiness for Service Training (FIRST) Program, an accelerated curriculum focused on rural and underserved care that links 3 years of medical school with a conditional acceptance into UNC's 3-year family medicine residency, followed by 3 years of practice support post-graduation. Students are recruited to the FIRST Program during the fall of their first year of medical school. The FIRST Program promotes close faculty mentorship and familiarity with the health care system, includes a longitudinal quality improvement project with an assigned patient panel, includes early integration into the clinic, and fosters a close cohort of fellow students. OUTCOMES: As of March 2020, the FIRST Program had successfully recruited 5 classes of medical students, and 3 of those classes had matched into residency. In total, as of March 2020, 18 students had participated in the FIRST Program. NEXT STEPS: The FIRST Program will be expanded to additional clinical sites across North Carolina and to specialties beyond family medicine, including pediatrics, general surgery, and psychiatry.
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Educação de Graduação em Medicina/organização & administração , Área Carente de Assistência Médica , Médicos de Atenção Primária/educação , Médicos de Atenção Primária/provisão & distribuição , Desenvolvimento de Programas , População Rural , Currículo , Educação de Pós-Graduação em Medicina/organização & administração , Educação de Pós-Graduação em Medicina/normas , Educação de Graduação em Medicina/normas , Mão de Obra em Saúde , Humanos , Internato e Residência/organização & administração , Internato e Residência/normas , Tutoria , North Carolina , Melhoria de QualidadeRESUMO
A meta-analysis reveals that there may be advantages associated with SGLT-2 inhibitors and GLP-1 agonists that are not associated with DPP-4 inhibitors.
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Diabetes Mellitus Tipo 2 , Inibidores da Dipeptidil Peptidase IV , Peptídeo 1 Semelhante ao Glucagon , Glucose , Humanos , Hipoglicemiantes , Pacientes , SódioRESUMO
BACKGROUND AND OBJECTIVES: Competency-based evaluation of the Accreditation Council for Graduate Medical Education (ACGME) Milestones requires the development of new evaluation tools that can better capture learners' behavior. This study describes the implementation and initial assessment of an innovative point-of-care mobile application, the M3App,© linked to the Family Medicine Milestones. METHODS: Seven family medicine residency programs in North Carolina implemented the M3App.© Program faculty and residents were surveyed prior to implementation regarding current evaluation methods and their quality and use and acceptability of electronic evaluation tools. Surveys were repeated after implementation for comparison. RESULTS: All seven programs successfully implemented the M3App. Most faculty members found the tool well designed, easy to use, beneficial to the quality and efficiency of feedback they provide, and to their knowledge of Milestones. Residents reported significant increases in the volume and quality of written feedback they receive. CONCLUSIONS: The M3App provides an efficient, convenient tool for assessing Milestones that can improve the quantity and quality of feedback residents receive from faculty. Improved faculty perception of knowledge of Milestones after M3App implementation suggests that the tool is also effective for faculty development.
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Competência Clínica/normas , Internato e Residência/normas , Aplicativos Móveis/estatística & dados numéricos , Educação de Pós-Graduação em Medicina , Avaliação Educacional/métodos , Medicina de Família e Comunidade/educação , Retroalimentação , Humanos , North Carolina , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Implementation of the educational milestones benefits from mobile technology that facilitates ready assessments in the clinical environment. We developed a point-of-care resident evaluation tool, the Mobile Medical Milestones Application (M3App), and piloted it in 8 North Carolina family medicine residency programs. OBJECTIVE: We sought to examine variations we found in the use of the tool across programs and explored the experiences of program directors, faculty, and residents to better understand the perceived benefits and challenges of implementing the new tool. METHODS: Residents and faculty completed presurveys and postsurveys about the tool and the evaluation process in their program. Program directors were interviewed individually. Interviews and open-ended survey responses were analyzed and coded using the constant comparative method, and responses were tabulated under themes. RESULTS: Common perceptions included increased data collection, enhanced efficiency, and increased perceived quality of the information gathered with the M3App. Residents appreciated the timely, high-quality feedback they received. Faculty reported becoming more comfortable with the tool over time, and a more favorable evaluation of the tool was associated with higher utilization. Program directors reported improvements in faculty knowledge of the milestones and resident satisfaction with feedback. CONCLUSIONS: Faculty and residents credited the M3App with improving the quality and efficiency of resident feedback. Residents appreciated the frequency, proximity, and specificity of feedback, and faculty reported the app improved their familiarity with the milestones. Implementation challenges included lack of a physician champion and competing demands on faculty time.