Career Accomplishments of Uniformed Services University of the Health Sciences Medical Graduates: Classes 1980-2017.

BACKGROUND: The current study reports career accomplishments of Uniformed Services University (USU) graduates in four areas: (1) positions held over the course of their entire career, (2) military awards, decorations, and rank, (3) first residency completed, and (4) academic achievements. METHOD: Utilizing the responses to the alumni survey sent to USU graduates in the Class 1980 to 2017, we extracted relevant data and reported descriptive statistics. RESULTS: 1,848 out of 4,469 responded to the survey (41%). 86% (n = 1,574) of respondents indicated having served as a full-time clinician (seeing patients at least 70% of the time during a typical week), while many of them serve in leadership such as educational, operational, or command leadership roles. 87% (n = 1,579) of respondents are ranked from O-4 to O-6, and 64% (n = 1,169) of the respondents received a military award or medal. Family medicine, internal medicine, and pediatrics were the most chosen medical specialties, which is similar to the national patterns reported by AAMC. 45% (n = 781) held an academic appointment. CONCLUSION: USU graduates continue to make significant contributions to military medicine. USU graduates' medical specialty preferences are similar to the past, which calls for further investigation to identify driving factors on such preference.

"Primum Non Nocere"-First, Do No Harm: A Retrospective Review of the Impact of Curricular Reform on USUHS Graduates' Performance During Their PGY-1 Year.

PURPOSE: To determine whether medical school curricular change impacted the assessment of graduates in their first year of postgraduate training. METHODS: The authors examined for differences in the survey of postgraduate year one (PGY-1) program directors for Uniformed Services University (USU) medical school graduates from the Classes of 2011 and 2012 (pre-curriculum reform, pre-CR), Classes of 2015, 2016, and 2017 (curriculum transition), and Classes of 2017, 2018, and 2019 (post-curriculum reform, post-CR). Multivariate analysis of variance was used to explore for differences among the cohorts in the 5 previously identified factors on the PGY-1 survey (Medical Expertise; Professionalism; Military Unique Practice, Deployments and Humanitarian Missions; System-Based Practice and Practiced-Based Learning; Communication and Interpersonal Skills). Nonparametric tests were used when the error variance between cohorts was found to be unequal across samples. Kruskal-Wallis (a rank ordered analysis of variance) and Tamhan's T2 were used to characterize specific differences. RESULTS: There were 801 students included: 245 (pre-CR); 298 (curricular transition); and 212 (post-CR). Multivariate analysis of variance demonstrated significant differences in all survey factors among the comparison groups. From pre-CR to the curricular transition, ratings in all factors declined, but none reached the level of a statistical significance. Ratings of all 5 factors showed significant improvement from the curricular transition to post-CR, and scores from pre-CR to post-CR trended in the positive direction with Practice-Based Learning (effect size 0.77), showing significant gains. CONCLUSION: Ratings by PGY-1 program directors of USU graduates over time demonstrated a very small decline soon after curriculum reform but later showed a large improvement in domains reflecting areas of emphasis in the curriculum. In the eyes of a key stakeholder, the USU curriculum reform did no harm and led to improved PGY-1 assessments.

Profiles of Military Medical Students' Well-being, Burnout, and Retention.

BACKGROUND: Well-being concerns among medical students are more prevalent than their age-matched peers in the United States. It remains unknown, however, if individual differences in well-being exist among U.S. medical students serving in the military. In this study, we sought to identify profiles (i.e., subgroups) of well-being in military medical students and examine the associations between these well-being profiles and burnout, depression, and intended retention in military and medical fields. METHODS: Using a cross-sectional research design, we surveyed military medical students and then conducted latent class analysis to explore profiles of well-being, and applied the three-step latent class analysis method to assess predictors and outcomes of well-being profiles. RESULTS: Heterogeneity in well-being was identified among the 336 military medical students surveyed, portraying medical students' falling into three distinct subgroups: High well-being (36%), low well-being (20%), and moderate well-being (44%). Different subgroups were associated with different risks of outcomes. Students in the subgroup of low well-being were at the highest risk of burnout, depression, and leaving medicine. In contrast, students in the moderate well-being group were at the highest risk of leaving military service. CONCLUSIONS: These subgroups may be clinically important as burnout, depression, and intention to leave medical field and/or military service occurred with varying likelihoods among medical students across the different well-being subgroups. Military medical institutions may consider improving recruitment tools to identify the best alignment between students' career goals and the military setting. Besides, it is crucial for the institution to address diversity, equity, and inclusion issues that may lead to alienation, anxiety, and a sense of wanting to leave the military community.

Prior Enlisted Medical Students at the Uniformed Services University: Outcomes During Four Years of Medical School.

INTRODUCTION: The Uniformed Services University (USU) implemented the Enlisted to Medical Degree Preparatory Program (EMDP2) with the goal of enhancing the diversity of the military physician corps. Programs like EMDP2 can assist students in making the social and intellectual transition from undergraduate studies to medical school and beyond. These types of programs are also opportunities to reduce health disparities and prepare students to work in multicultural settings. The purpose of this study was to evaluate whether there was any significant difference in performance between USU medical students who had attended the EMDP2 and those who had not. MATERIALS AND METHODS: We compared the results of National Board of Medical Examiners (NBME) Clinical Science Subjects, United States Medical Licensing Examination (USMLE) Step 1, and USMLE Step 2 Clinical Knowledge exams of EMDP2 learners from the School of Medicine classes of 2020 to 2023 to those of four similarly sized cohorts of their peers who varied by age and prior military service. RESULTS: We found that the performance of EMDP2 graduates was comparable to their peers who followed more traditional and other alternative paths to medical school. For example, regression models showed that EMDP2 status was not a statistically significant predictor of average clerkship NBME exam score, nor of USMLE Step 1 failure. CONCLUSION: EMDP2 graduates performed on a par with their medical school peers, and EMDP2 status does not appear to influence NBME or USMLE performance. EMDP2 provides a focused curriculum and addresses the mandate to make medical education opportunities available to a more diverse population.

Extending growth curves: a trajectory monitoring approach to identification and interventions in struggling medical student learners.

Given gaps in both identifying and providing targeted interventions to struggling learners, the purpose of this study is to both improve rapid identification and to improve individualized academic advising for learners using this visual representation of performance. Across three graduating classes, individual growth curves were calculated for each student on National Board of Medical Examiners customized assessments during the pre-clerkship period using their deviation from the class average at each assessment point. These deviation scores were cumulatively summed over time and were regressed onto the sequence of exams. We analyzed the difference between the regression slopes of those students placed on Academic Probation (AP) versus not, as well as differences in slopes based on the timing of when a struggling learner was placed on AP to explore learner trajectory after identification. Students on AP had an average growth slope of - 6.06 compared to + 0.89 for those not on AP. Findings also suggested that students who were placed on AP early during pre-clerkship showed significant improvement (positive changes in trajectory) compared to students identified later in the curriculum. Our findings suggest that earlier academic probation and intervention with struggling learners may have a positive effect on academic trajectory. Future research can better explore how academic trajectory monitoring and performance review can be regularly used in advising sessions with students.

When will I get my paper back? A replication study of publication timelines for health professions education research.

INTRODUCTION: Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists' careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown. METHODS: This study replicates Himmelstein's work with a sample of 14 HPE journals published between 2008-2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded. RESULTS: Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72). DISCUSSION: This study presents publication metadata for journals that openly provide it-a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.

It's a matter of trust: exploring the basis of program directors' decisions about whether to trust a resident to care for a loved one.

There has been increased attention to and emphasis on competency-based medical education and the transformation from highly supervised medical students towards independent, entrustable physicians. We explored how program directors (PDs) justify decisions about whether they would trust finishing Post Graduate Year 1 (PGY1) residents to care for the PD or a loved one. Using an end of year survey with validity evidence, we assessed PDs' responses (Yes, No, Not Sure) and written comments about this entrustment decision for USUHS medical students from graduating classes of 2013-2015 (PGY1). We performed a qualitative inductive content analysis to identify themes in how PDs justified their decisions as well as descriptive statistics and a contingency table analysis to examine associations between trust decisions and election to membership in Alpha Omega Alpha (AOA), or conversely, referral to the Student Promotions Committee (SPC) for remediation. Qualitative analyses revealed five themes related to this trust decision about medical residents: personal, interpersonal, knowledge, competence, and developmental. Neither AOA status, nor SPC referral status was significantly associated with the trust measure, overall, but positive trust decisions were significantly higher among those elected to AOA than in those who were not. Positive trust decisions were significantly associated with AOA status but negative trust decisions were not significantly associated with referral to the SPC. This study offers insights into what attributes may underpin trust decisions by PDs. Our findings suggest that PDs' frequent use of personal and interpersonal characteristics to justify trust decisions contrasts with the use of clinical and knowledge based assessments during undergraduate medical education (UME), and emphasize the importance of critical intrinsic abilities.

Uniformed Services University Women's Enrollment and Career Choices in Military Medicine: A Retrospective Descriptive Analysis.

INTRODUCTION: The purpose of this study was to examine Uniformed Services University (USU) women graduates in terms of percent of graduates', specialty choices and practice choices as compared to civilian women who graduate and practice medicine in the USA. This is a perspective that is currently not well understood. MATERIALS AND METHODS: We conducted a retrospective cohort study of all USU women graduates (1980-2015) using the 2016 American Medical Association (AMA) Physician Masterfile that included data from the American Board of Medical Specialties (ABMS). To describe USU women graduates' current practice status we queried for: (1) medical school; (2) year of graduation; (3) practice state; (4) primary specialty board; and (5) major professional activity (office-based practice vs. full-time hospital staff). Data were analyzed using descriptive statistics. RESULTS: Our findings indicate that the percentage of USU women graduates has increased over time and stands at 29% for the 2010-2015 cohort as compared to 48% for women graduating from all U.S. medical schools. USU women graduates have a slightly higher board certification rate (89%) than the national cohort (88%). USU women graduates also have a higher percentage in family medicine (19%) than the national cohort (14%). USU women graduates practice in 48 states and were equally split between full-time hospital staff and office-based practice which differs from the national cohort that has a much higher proportion in office-based practice (85%). CONCLUSIONS: Women are making significant gains in enrollment at USU, obtaining board certification at similar, and in some cases, higher rates than their civilian peers, and practicing in diverse specialties. This study provides a descriptive picture of women's enrollment and practice characteristics from a military-based medical school. Future work could examine underlying factors that may influence their school choice, career experiences, and trajectories. Future research could also focus on women's experiences of mentoring and support to better understand these factors.

Behavioral, emotional, and situational context of purging episodes in anorexia nervosa.

OBJECTIVE: The current study examined behavioral, emotional, and situational factors involved in purging among women with anorexia nervosa (AN). METHOD: Women with AN (n=118) completed a two-week ecological momentary assessment protocol involving daily reports of eating disorder behaviors, mood, and stressful events. Generalized estimating equations examined the likelihood and context of purging following eating episodes involving both overeating and loss of control (binge eating; BE); loss of control only (LOC); overeating only (OE); and neither loss of control nor overeating (non-pathological eating; NE). RESULTS: Relative to NE, purging was more likely to occur following BE, LOC, and OE (Wald chi-square = 18.05; p < .001). BE was more strongly associated with subsequent purging than LOC but not OE; the latter two did not differ from one another. Negative affect predicted purging following NE (Wald chi-square = 7.71; p = .005). DISCUSSION: Binge eating involving large amounts of food was the strongest predictor of purging in AN, which challenges the notion that loss of control is the most salient aspect of experiencing distress in bulimia nervosa and BE disorder. Parallel to findings from the BE literature, negative affect strongly predicted purging following NE. Further research should clarify the function and triggers of purging in AN.

Examining duration of binge eating episodes in binge eating disorder.

OBJECTIVE: The primary goal of this article is to examine and clarify characteristics of binge eating in individuals with binge eating disorder (BED), particularly the duration of binge eating episodes, as well as potential differences between individuals with shorter compared to longer binge eating episodes. METHOD: Two studies exploring binge eating characteristics in BED were conducted. Study 1 examined differences in clinical variables among individuals (N = 139) with BED who reported a short (<2 h) versus long (≥ 2 h) average binge duration. Study 2 utilized an ecological momentary assessment design to examine the duration and temporal pattern of binge eating episodes in the natural environment in a separate sample of nine women with BED. RESULTS: Participants in Study 1 who were classified as having long duration binge eating episodes displayed greater symptoms of depression and lower self-esteem, but did not differ on other measures of eating disorder symptoms, compared to those with short duration binge eating episodes. In Study 2, the average binge episode duration was approximately 42 min, and binge eating episodes were most common during the early afternoon and evening hours, as well as more common on weekdays versus weekends. DISCUSSION: Past research on binge episode characteristics, particularly duration, has been limited to studies of binge eating episodes in bulimia nervosa. This study contributes to the existing literature on characteristics of binge eating in BED.

The role of eating and emotion in binge eating disorder and loss of control eating.

OBJECTIVE: Binge eating, defined as the consumption of large amounts of food during which a sense of loss of control (LOC) is experienced, is associated with negative affect. However, there are no data on the experience of LOC after accounting for the effects of negative affect and caloric intake. METHOD: Nine adult patients with binge eating disorder (BED) and 13 obese nonbinge eating disorder (NBED) participants carried a palmtop computer for 7 days, rating momentary mood and sense of LOC multiple times each day. Electronic food logs were collected once daily. RESULTS: After removing the effects of caloric intake and negative affect, a significant group difference was observed for ratings of LOC between BED and NBED participants. DISCUSSION: These findings suggest the experience of LOC in adults with BED is a salient feature of binge episodes, beyond that explained by caloric intake and momentary affect.