Factors affecting medical students' selection of an internal medicine residency program.

OBJECTIVE: To determine factors that influence medical student selection of internal medicine residency programs by ethnicity and gender. DESIGN/SETTING: A cross-sectional mailed survey of graduating medical students applying to four residency programs in 1999. MEASUREMENTS: A five-point (5=most important) Likert scale was used to evaluate factors and included 14 items on location characteristics, 20 on program features, six on recruitment, three on future plans and three on advising. RESULTS: Of 2,820 surveys, 1,005 were completed (36%). The most important factors to applicants were house staff morale (mean +/- SD, 4.5 +/- 0.7), academic reputation (4.5 +/-0.8), and positive interview experience (4.1 +/- 1.0). Women rated gender diversity of faculty (3.3 vs. 2.3, p=0.0001) and house staff (3.3 vs. 2.5, p=0.0001), location of residency program near spouse (4.2 vs. 3.9, p=0.0001) or spouse's job (3.8 vs. 3.5, p=0.0002) and emphasis on primary care (2.9 vs. 2.4, p=0.0001) more highly than men. Minority applicants were more likely than whites to identify the following factors as more important: ethnic diversity of patients (3.8 vs. 3.4, p=0.008), house staff (3.3 vs. 2.4, p<0.0001) and faculty (3.1 vs. 2.3, p<0.0001); service to the medically indigent (3.8 vs. 3.3, p=0.004); feeling of being wanted (3.8 vs. 3.4, p=0.002); and an academic environment supportive of ethnic minorities (3.5 vs. 2.3, p<0.0001). CONCLUSIONS: Location and program factors are most important in influencing decisions to choose a residency program. However, women and minority applicants also place significant importance on family and diversity factors. Programs need to consider differential factors in recruitment of diverse students.

D-4F decreases brain arteriole inflammation and improves cognitive performance in LDL receptor-null mice on a Western diet.

LDL receptor-null mice on a Western diet (WD) have inflammation in large arteries and endothelial dysfunction in small arteries, which are improved with the apolipoprotein A-I mimetic D-4F. The role of hyperlipidemia in causing inflammation of very small vessels such as brain arterioles has not previously been studied. A WD caused a marked increase in the percent of brain arterioles with associated macrophages (microglia) (P < 0.01), which was reduced by oral D-4F but not by scrambled D-4F (ScD-4F; P < 0.01). D-4F (but not ScD-4F) reduced the percent of brain arterioles associated with CCL3/macrophage inflammatory protein-1alpha (P < 0.01) and CCL2/monocyte chemoattractant protein-1 (P < 0.001). A WD increased (P < 0.001) brain arteriole wall thickness and smooth muscle alpha-actin, which was reduced by D-4F but not by ScD-4F (P < 0.0001). There was no difference in plasma lipid levels, blood pressure, or arteriole lumen diameter with D-4F treatment. Cognitive performance in the T-maze continuous alternation task and in the Morris Water Maze was impaired by a WD and was significantly improved with D-4F but not ScD-4F (P < 0.05). We conclude that a WD induces brain arteriole inflammation and cognitive impairment that is ameliorated by oral D-4F without altering plasma lipids, blood pressure, or arteriole lumen size.