Alternate list matriculants: outcome data from those medical students admitted from the alternate list.

BACKGROUND: Medical schools are increasing class size to meet future health care needs for our nation. This may lead to more students being accepted from an alternate list (vs. primary acceptances). Given these trends, performance outcomes were compared for alternate list matriculants and primary acceptances. Our hypothesis was that those students accepted from an alternate list would perform equally to the primary acceptances on these outcomes. METHOD: We compared medical school performance of students who received a primary recommendation of "accept" and compared them to those who received a recommendation of "alternate" over a 10-year period. Given the small sample size of this alternate list group (N = 23), descriptive statistics are reported. RESULTS: No consistent differences between alternate and primary acceptance matriculants in terms of cumulative medical school grade point average, United States Medical Licensing Examination (USMLE) Step 1 scores and USMLE Step 2 Clinical Knowledge scores were found. Only three alternates (13.0%) were presented to student promotion committee compared to 17.2% for matriculants who were primary acceptances. Three alternates were required to repeat a year (average percentage of 8.7%) compared to 5.6% of matriculants who were primary acceptances. CONCLUSIONS: This observational study provides some reassurance that as long as the qualifications of the applicant pool remain adequate, admissions policies that provide for alternate list acceptances may not produce poorer performing students, at least by our current outcome measures.

Residents as Mentors: The Development of Resident Mentorship Milestones.

BACKGROUND: Mentorship of residents by more senior colleagues has been identified as important for stress management and creating an ideal learning environment. OBJECTIVE: We set out to define the attributes of an ideal resident mentor and explore ways to develop these attributes during residency training. METHODS: A 28-member, multi-specialty counsel of residents and fellows used 2 phases of a small group exercise. In the first phase, the group developed desirable attributes of resident mentors and explored means of developing these attributes. In the second phase, the group identified trends in the results, and in a second small group exercise with participants at a major national conference, refined these trends into Resident Mentorship Milestones. RESULTS: The exercises identified 3 common themes: availability, competence, and support of the mentee. We defined milestones for mentorship in each of these areas. CONCLUSIONS: The Resident Mentorship Milestones, developed by a national panel of residents, describe 3 key dimensions of mentorship: availability, defined as making time for mentorship; competence for and success in mentoring; and support of the mentee. These milestones may serve as a novel tool to develop and assess successful resident mentorship models.

Promotion of Wellness and Mental Health Awareness Among Physicians in Training: Perspective of a National, Multispecialty Panel of Residents and Fellows.

BACKGROUND: Physicians in training are at high risk for depression, and physicians in practice have a substantially elevated risk of suicide compared to the general population. The graduate medical education community is currently mobilizing efforts to improve resident wellness. OBJECTIVE: We sought to provide a trainee perspective on current resources to support resident wellness and resources that need to be developed to ensure an optimal learning environment. METHODS: The ACGME Council of Review Committee Residents, a 29-member multispecialty group of residents and fellows, conducted an appreciative inquiry exercise to (1) identify existing resources to address resident wellness; (2) envision the ideal learning environment to promote wellness; and (3) determine how the existing infrastructure could be modified to approach the ideal. The information was aggregated to identify consensus themes from group discussion. RESULTS: National policy on resident wellness should (1) increase awareness of the stress of residency and destigmatize depression in trainees; (2) develop systems to identify and treat depression in trainees in a confidential way to reduce barriers to accessing help; (3) enhance mentoring by senior peers and faculty; (4) promote a supportive culture; and (5) encourage additional study of the problem to deepen our understanding of the issue. CONCLUSIONS: A multispecialty, national panel of trainees identified actionable goals to broaden efforts in programs and sponsoring institutions to promote resident wellness and mental health awareness. Engagement of all stakeholders within the graduate medical education community will be critical to developing a comprehensive solution to this important issue.