Evaluating the Impact of the Novel Geographic Preferences Section on Interview Rate and Residency Match Outcomes.

BACKGROUND: The American Association of Medical Colleges trialed residency application initiatives including geographic preferences and preference signals in 2022. OBJECTIVE: To assess the impact of geographic preferences on application outcomes during the 2022 residency match year. DESIGN: Cross-sectional. PARTICIPANTS: Applicants to categorical and preliminary internal medicine during the 2022 application cycle who completed the Texas Seeking Transparency in Applications to Residency survey. MAIN MEASURES: The primary outcome was interview rate (interview offers/total applications) and whether an application resulted in a match. The key dependent variables were geographic preferences and program-specific preference signals. We also assessed differences in utilization of geographic preferences between specialties. KEY RESULTS: A total of 970 applicants into categorical (n = 884) and preliminary (n = 86) internal medicine were included in our study. A total of 704 (72.6%) applicants submitted at least one geographic preference and 424 (43.7%) submitted three preferences. On average, applicants who submitted a geographic preference had a higher interview rate than those who did not (46.0% vs. 41.8%). Applications submitted with both a preference signal and geographic preference were significantly more likely to receive an interview offer (OR: 3.2, p < 0.01) and match (OR: 6.4, p < 0.01) than applications with neither a preference signal nor a geographic preference. Geographic preferences were associated with an increase in the odds of an application receiving an interview offer, even in the setting of a preference signal (OR: 1.4, p < 0.01). CONCLUSIONS: Both preference signals and geographic preferences have significant associations with odds of an application receiving an interview and matching for both categorical and preliminary internal medicine applicants. This study can be used to inform applicants, advisors, and programs how novel application strategies can affect important application outcomes for US medical school graduates. As more specialties pilot alternative processes, it will be important to study all application outcomes among varying applicant populations.

Impact of Applicants' Characteristics and Geographic Connections to Residency Programs on Preference Signaling Outcomes in the Match.

PURPOSE: To assess the impact of applicant and residency program characteristics on preference signaling outcomes in the Match during the first 2 years of implementation across 6 specialties. METHOD: Data were obtained from the Texas Seeking Transparency in Application to Residency survey for applicants applying into otolaryngology during the 2020-2021 and 2021-2022 application cycles and into dermatology, internal medicine (categorical and preliminary year), general surgery, and urology during the 2021-2022 application cycle. The primary outcome was signal yield, defined as the number of interviews at signaled programs divided by the total number of signals sent. Associations with applicant-reported characteristics and geographic connections to residency programs were assessed using Wilcoxon rank sum testing, Spearman's rank correlation testing, and ordinary least squares regression. RESULTS: 1,749 applicants with preference signaling data were included from internal medicine (n = 884), general surgery (n = 291), otolaryngology (n = 217), dermatology (n = 147), urology (n = 124), and internal medicine preliminary year (n = 86). On average 60.9% (standard deviation 32.3%) of signals resulted in an interview (signal yield). There was a stepwise increase in signal yield with the percentage of signals sent to programs with a geographic connection (57.3% for no signals vs. 68.9% for 5 signals, P < .01). Signal yield was positively associated with applicant characteristics, such as United States Medical Licensing Exam Step 1 and 2 scores, honors society membership, and number of publications ( P < .01). Applicants reporting a lower class rank quartile were significantly more likely to have a higher percentage of their interviews come from signaled programs ( P < .01). CONCLUSIONS: Signal yield is significantly associated with geographic connections to residency programs and applicant competitiveness based on traditional metrics. These findings can inform applicants, programs, and specialties as preference signaling grows.

Protecting Family Physicians from Burnout: Meaningful Patient-Physician Relationships Are "More than Just Medicine".

PURPOSE: Meaning in work has been identified as an important factor promoting physician resilience against burnout. However, research has only minimally explored meaningful patient-physician relationships in relation to physician burnout, and has largely focused on patient perspectives. To address this knowledge gap, this study explored the elements of relationships with patients that physicians find meaningful, as well as physicians' perceptions of how those relationships influence experiences of burnout. METHODS: In this qualitative study, 20 family medicine physicians recruited via convenience and snowball sampling participated in semistructured interviews. The research team then engaged in an iterative process of thematic analysis. RESULTS: 5 main themes emerged in participants' descriptions of meaningful relationships with their patients: Patient-centered care, continuity, effective care, trust, and purpose and mission. Participants described meaningful relationships as situated within a professional mission to connect with patients and make a difference in their lives. Meaning in these relationships centered around a trusting therapeutic relationship formed through continuity, person-centered care, and effective care. Participants strongly felt that meaningful relationships with patients are protective against burnout. CONCLUSIONS: Though many burnout interventions have targeted change at the individual (physician) level, a growing amount of evidence points to the need for change at the health system level. The findings of this study suggest that system-level interventions aimed at enhancing and prioritizing physicians' experiences of continuity and connection with their patients may be particularly impactful in efforts to reduce and prevent burnout.

Senior Medical Student-Led Interactive Small-Group Module on Acute Fracture Management.

INTRODUCTION: Medical students receive insufficient training in musculoskeletal diagnosis and management. To address this deficiency, a senior medical student at our institution designed and moderated small-group interactive discussions with third-year medical students on acute fracture management during their family medicine clerkship. METHODS: In these sessions, students learned how to diagnose and comprehensively work up a case of a suspected fracture, how to effectively communicate findings from physical exam and X-ray, and when to appropriately consult a surgeon for treatment. RESULTS: This module was piloted with a total of 14 students in two separate small groups. One hundred percent of students regarded the module as very useful, and there was a 50% improvement in pre- versus posteducational assessment. DISCUSSION: Our experience suggests that students can quickly improve clinical skills for fracture management in a focused smallgroup interactive session. In addition, these sessions can be effectively designed and implemented by senior medical students. This module may be used with either clinical or preclinical students, but we believe that this information would be best received by clinical students on family medicine, emergency medicine, or orthopedic rotations.

Evaluation of a web-based family medicine case library for self-directed learning in a third-year clerkship.

BACKGROUND AND OBJECTIVES: Web-based cases are well accepted by medical students and enable faculty to deliver equivalent educational experiences to all students. A 2009 literature search revealed no study investigating student use patterns of Web-based case libraries for self-directed learning. We investigated third-year students' use of a Web-based case program for self-directed learning in a family medicine clerkship. METHODS: We analyzed Design A Case usage patterns of 210 medical students during academic year 2008--2009. We compared board score differences between these students and those from the previous 5 years who did not use Design A Case. We analyzed data from a 13-item survey, administered to a subgroup of 85 students, about the strengths, weaknesses, and acceptability of the program. RESULTS: Students completed, on average, four cases, which was beyond the requirement of three. They reported that the content was highly relevant to cases they saw in clinic. Almost 75% preferred the self-directed Web-based learning over didactics, and most (64%) felt they learned more electronically. Use of the cases was associated with equivalent Board scores versus didactic lectures. CONCLUSIONS: In our setting, self-directed learning using a Web-based case program was highly acceptable to students. Web-based cases may provide an option for family medicine educators who wish to deliver equivalent educational experiences across sites.