The Relationship Between Method of Viewing Lectures, Course Ratings, and Course Timing.

BACKGROUND: In recent years, medical schools have provided students access to video recordings of course lectures, but few studies have investigated the impact of this on ratings of courses and teachers. This study investigated whether the method of viewing lectures was related to student ratings of the course and its components and whether the method used changed over time. METHODS: Preclinical medical students indicated whether ratings of course lectures were based primarily on lecture attendance, video capture, or both. Students were categorized into Lecture, Video, or Both groups based on their responses to this question. The data consisted of 7584 student evaluations collected over 2 years. RESULTS: Students who attended live lectures rated the course and its components higher than students who only viewed the video or used both methods, although these differences were very small. Students increasingly watched lectures exclusively by video over time: in comparison with first-year students, second-year students were more likely to watch lectures exclusively by video; in comparison with students in the first half of the academic year, students in the second half of the academic year were more likely to watch lectures exclusively by video. CONCLUSIONS: With the increase in use of lecture video recordings across medical schools, attention must be paid to student attitudes regarding these methods.

Who's misbehaving? Perceptions of unprofessional social media use by medical students and faculty.

BACKGROUND: Social media use by physicians offers potential benefits but may also be associated with professionalism problems. The objectives of this study were: 1) to examine and compare characteristics of social media use by medical students and faculty; 2) to explore the scope of self- and peer-posting of unprofessional online content; and 3) to determine what actions were taken when unprofessional content was viewed. METHODS: An anonymous, web-based survey was sent to medical students and faculty in October, 2013 at the Albert Einstein College of Medicine in Bronx, New York. RESULTS: Three-quarters of medical students reported using social media "very frequently" (several times a day), whereas less than one-third of faculty did so (p < .001). Medical students reported using privacy settings more often than faculty (96.5 % v. 78.1 %, p < .001). Most medical students (94.2 %) and faculty (94.1 %) reported "never" or "occasionally" monitoring their online presence (p = 0.94). Medical students reported self-posting of profanity, depiction of intoxication, and sexually suggestive material more often than faculty (p < .001). Medical students and faculty both reported peer-posting of unprofessional content significantly more often than self-posting. There was no association between year of medical school and posting of unprofessional content. CONCLUSION: Medical students reported spending more time using social media and posting unprofessional content more often than did faculty.

Payback time: the associations of debt and income with medical student career choice.

CONTEXT: With impending health care reform in the USA, there is an imperative to increase the number of students choosing primary care (PC) careers. Research is needed to better understand the roles of economic factors in medical student career choice. The objective of this study was to examine the relationships among debt, income and career choice by comparing students planning PC careers with those aspiring to one of the 12 non-PC fields in which median income exceeds US$300 000 ('high-paying non-primary care' [HPNPC]). METHODS: Surveys (response rate = 81%) were administered to Year 1 students scheduled to graduate between 1996 and 2012, and Year 4 students graduating between 1993 and 2010. Respondents were students at New York Medical College and East Carolina University's Brody School of Medicine. Analyses focused on the 2674 Year 1 respondents choosing a PC (n = 1437, 54%) or HPNPC (n = 1237, 46%) career, and the 2307 Year 4 respondents intending to pursue PC (n = 992, 43%) or HPNPC (n = 1315, 57%). Longitudinal analyses examining changes in career goals during medical school were based on students who completed surveys in both Years 1 and 4. The outcome measures studied were self-reported debt, anticipated income and self-rated value placed on income. RESULTS: Relative to their PC counterparts, students intending to pursue HPNPC careers anticipated an average of US$24 904 (Year 4 students) or US$29 237 (Year 1 students) greater debt, placed a higher importance value on income, and anticipated earning an average of US$58 463 (Year 1 students) and US$89 909 (Year 4 students) more in annual income after graduation. Debt was associated with the value placed on income in the choice of career and the amount of future income anticipated. Students who valued income highly were especially inclined to switch from PC during medical school. The switch away from PC was associated with debt, as well as with a marked increase in anticipated income. CONCLUSIONS: Debt and anticipated income are important concerns which may shape future supplies of PC doctors.

Impact of AOA status and perceived lifestyle on career choices of medical school graduates.

BACKGROUND: Based upon student ratings of such factors as predictable work hours and personal time, medical specialties have been identified as lifestyle friendly, intermediate, or unfriendly. Lifestyle friendly programs may be more desirable, more competitive, and for students elected to the Alpha Omega Alpha (AOA) Honor Medical Society, more attainable. OBJECTIVE: The objective of this study was to evaluate whether AOA students increasingly entered lifestyle friendly residency programs and whether trends in program selection differed between AOA and non-AOA graduates. DESIGN: This retrospective cohort study examined PGY-2 data from the Association of American Medical Colleges and the 12 allopathic schools in the Associated Medical Schools of New York. PARTICIPANTS: Data on 1987-2006 graduates from participating schools were evaluated. MAIN MEASURES: Residency program selection over the 20-year period served as the main outcome measure. KEY RESULTS: AOA graduates increasingly entered lifestyle-friendly residencies--from 12.9% in 1987 to 32.6% in 2006 (p < 0.01). There was also a significant decrease in AOA graduates entering lifestyle unfriendly residencies, from 31.6% in 1987 to 12.6% in 2006 (p < 0.01). Selection of lifestyle intermediate residencies among AOA graduates remained fairly stable at an average of 53%. Similar trends were found among non-AOA students. However, within these categories, AOA graduates increasingly selected radiology, dermatology, plastic surgery and orthopedics while non-AOA graduates increasingly selected anesthesiology and neurology. CONCLUSIONS: While lifestyle factors appear to influence residency program selection, AOA graduates differentially were more likely to either choose or attain certain competitive, lifestyle-friendly specialties. Health care reform should be targeted to improve lifestyle and decrease income disparities for specialties needed to meet health manpower needs.

Money, lifestyle, or values? Why medical students choose subspecialty versus general pediatric careers.

Although there are many published studies on factors associated with medical student career choice, few are specific to pediatric careers, and even fewer address the choice between general and subspecialty pediatric training. Fourth-year medical students surveyed at 2 schools reported their demographics, anticipated future income, the factors influencing their career choice, and their anticipated career. This study included the subset of 337 students planning pediatric careers. Results indicated that marital status, anticipated income, and career values are associated with pediatric career plans. Specifically, married students were more likely than unmarried students to pursue general pediatric careers (P < .01). Compared with students planning subspecialties, those intending to pursue general pediatric careers anticipated lower incomes ($110,906 vs $135,984; P < .001) and rated lifestyle, comprehensive patient care, and working with the poor as more important (P < .05) when choosing a career. Students planning subspecialty pediatric careers placed more value (P < .05) on prestige, income, and research opportunities.

Mid-career research training for the generalist physician: case study of a balancing act.

BACKGROUND: Although generalist physician faculty typically lack the skills needed to conduct research, few medical schools offer on-site faculty development programs that teach research skills. DESCRIPTION: To address this dilemma, our medical school introduced a part-time Primary Care Research Fellowship offering full-day classes once a week over 10 months. EVALUATION: We asked the 22 general internists, general pediatricians, and family physicians who participated in the program to rate their experience, and we measured their research productivity during the 3 years before and 3 years after completing the program, using a group of matched controls for comparison. Participants rated the program highly and increased their aggregate research productivity from 1 publication before completing the program to 6 publications afterward, although this increase did not reach statistical significance (p = .09). Controls exhibited substantially higher baseline productivity than fellows (10 publications vs. 1 publication, p = .03), but controls' productivity changed little between the first and second measurement periods (10 and 7 publications, respectively). CONCLUSION: Our mid-career research training program enabled primary care academic faculty to gain confidence in their ability to conduct a scientific study with minimal disruption to their teaching and clinical activities.

The variable influence of lifestyle and income on medical students' career specialty choices: data from two U.S. medical schools, 1998-2004.

PURPOSE: Recent reports on medical students' career choices suggest that lifestyle increasingly influences career decisions. The authors addressed the changing influence of lifestyle and income on career choice, how these influences differ by specialty, and the specific careers students identify as lifestyle friendly. METHOD: From 1998 to 2004, 1,334 (73%) fourth-year medical students from Brody School of Medicine at East Carolina University (no. = 485 graduates) and New York Medical College (no. = 1,348 graduates) completed a questionnaire that addressed career specialty preferences, as well as income and lifestyle concerns. Students were asked to rate career choice influences on a four-point scale (1 = no influence, 4 = major influence). Factor analysis of these influences identified seven factors including one each for lifestyle and income. RESULTS: A total of 1,327 students indicated a career preference. Lifestyle (p = .018) and income (p = .011) were found to increasingly influence medical students' career choices during the study period. Overall, the authors found significant differences between specialties in the relative contribution of these factors. Students' perceptions of specialties existed on a continuum of lifestyle friendly (e.g., radiology) to lifestyle unfriendly (e.g., obstetrics-gynecology). Contrary to previous reports, the students' responses indicate they perceived the primary care specialties as lifestyle intermediate compared to other specialties. CONCLUSIONS: Lifestyle and income have become more important to medical students in their career choice, and the relative influence of these factors varies considerably between specialties. This study suggests that previous efforts to dichotomize careers into those with controllable and uncontrollable lifestyles may mask important complexities.

Incorporating the fourth year of medical school into an internal medicine residency: effect of an accelerated program on performance outcomes and career choice.

BACKGROUND: To counter declining student interest in general internal medicine, New York Medical College and Saint Vincent's Catholic Medical Centers of New York implemented an experimental accelerated internal medicine curriculum that was provisionally approved by the American Board of Internal Medicine. DESCRIPTION: This accelerated program allowed selected 4th-year medical students to obtain credit for their 1st year of an internal medicine residency while completing requirements for the MD degree. EVALUATION: Career and performance outcomes for trainees in the accelerated and traditional internal medicine residency programs were compared for 6 classes of graduates. There were no statistically significant differences between the 2 groups in mean scores on the Intern Clinical Evaluation Exercise, standardized in-service exam, monthly attending evaluations, or in Board pass rates. However, graduates of the accelerated program were more likely to be in general internal medicine practice on completion of residency. CONCLUSIONS: The accelerated program successfully increased the number of trainees entering generalist practice a year earlier, and maintained academic standards.

Trends in career choice by US medical school graduates.

CONTEXT: Trends in career choice among specialties have varied greatly. Most notable is the recent decrease in the percentage of US medical student graduates choosing a primary care career, which has important implications for the US physician workforce. OBJECTIVE: To review temporal trends in career choice by graduates of allopathic US medical schools, focusing on US medical doctors entering residencies since 1987. DATA SOURCES: Three databases, the Association of American Medical Colleges Graduation Questionnaire (AAMC GQ), the National Resident Matching Program, and the national Graduate Medical Education census, were used to review temporal trends in the number of US medical doctors entering residencies in primary care, general or subspecialty surgical, and non-primary care and nonsurgical specialties from 1987 to 2002. DATA SYNTHESIS: In 1987, 49.2% of all medical school graduates matched to one of the generalist residencies (internal medicine, pediatrics, or family medicine). The percentage of students matching to primary care specialties declined in the early 1990s, peaked at 53.2% in 1998, and declined to 44.2% in 2002. Concurrent with the latter decline, AAMC GQ data showed a decrease in medical student interest in primary care careers (35.6% in 1999 to 21.5% in 2002). The total percentage of US medical doctors matching to general or subspecialty surgical residencies remained stable at 11% to 12% from 1987 to 2002. During this same period, emergency medicine and plastic surgery increased as a match choice, while anesthesiology, pathology, and psychiatry were more variable over time. CONCLUSIONS: Distribution of medical students' career choices among specialties varied considerably from 1987 to 2002. The debate will continue regarding the appropriate specialty mix within the physician workforce.