The Impact of the COVID-19 Pandemic on Cardiac Electrophysiology Training: A Survey Study.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant decrease in volume of electrophysiology (EP) procedures. There has been concern that trainees may not achieve the procedural numbers required to graduate as independent electrophysiologists within the usual timeline. We sought to determine the impact of the COVID-19 pandemic on the percentage of clinical cardiac EP (CCEP) fellows in jeopardy of not meeting procedural volume requirements and overall sentiments regarding preparedness of fellows for independent practice. METHODS: We surveyed CCEP fellows and program directors about baseline procedural volumes, curriculum changes due to the pandemic, and attitudes about preparedness for board examinations and independent practice. RESULTS: Ninety-nine fellows and 27 program directors responded to the survey. Ninety-eight percent of responding fellows reported a decrease in procedural volume as a result of the pandemic. Program directors reported an overall decrease in annual number of ablations and device procedures performed by each fellow during the 2019-2020 academic year compared to the preceding year. Despite this, a minority of fellows and program directors reported concerns about meeting Accreditation Council for Graduate Medical Education procedural requirements for devices (9% and 4%, respectively) and ablation (19% and 9%) or preparedness for independent practice after a 2-year fellowship. CONCLUSIONS: The COVID-19 pandemic has resulted in a decrease in procedural volume for CCEP trainees, but the majority of fellows and program directors do not anticipate major barriers to timely graduation. This may change with COVID-19 resurgence and further interruptions in training.

An Overview of the Allopathic Match.

The number of allopathic emergency medicine (EM) programs has been progressively increasing over the years. In 2018, allopathic EM postgraduate year-1 spots, compared with 2012, increased by around 60% to reach 2278 positions. EM is considered a competitive specialty and therefore, in this article we help guide students interested in EM through the allopathic match requirements, application process, interviews, and ranking EM programs. Additionally, we tackle the combined emergency medicine residency programs, namely the combined EM-Family Medicine (FM), EM-Anesthesiology, EM-Internal Medicine (IM), EM-IM-Critical Care Medicine, and EM-Pediatrics residency programs. Finally, we explain the increased likelihood of matching with the single graduate medical education accreditation system expected to happen in the year 2020.

The Osteopathic Applicant.

The number of osteopathic students choosing emergency medicine (EM) as a specialty is continuously increasing. However, EM remains a competitive specialty. Accordingly, in this article we guide osteopathic students interested in EM through the Comprehensive Osteopathic Medical Licensing Examination (COMLEX), the United States Medical Licensing Examination (USMLE), third- and fourth-year rotations, and the match process. Additionally, we provide tips on the process of applying to allopathic programs and we discuss the timeline of both the allopathic and osteopathic match. Finally, we discuss the effect of the Single Accreditation System and the Memorandum of Understanding, an agreement to merge the allopathic and osteopathic graduate medical education systems into a single graduate medical education accreditation system. This is expected to be completed as of July 1, 2020. Therefore, we elucidate the expectations for osteopathic applicants (particularly with regards to the USMLE and COMLEX examinations).

Trends in US Medical School Contributions to the Family Physician Workforce: 2018 Update From the American Academy of Family Physicians.

BACKGROUND AND OBJECTIVES: The United States needs more family physicians. Projections based on current trends show a deficit of 52,000 primary care physicians by 2025. Eight national family medicine (FM) organizations have set an ambitious goal of increasing the proportion of US medical school graduates who enter FM residencies to 25% by 2030. This paper describes the most recent number and percentage of students from each US medical school entering Accreditation Council for Graduate Medical Education (ACGME)-accredited FM residency programs, long-term trends in the contribution of allopathic and osteopathic medical schools to the FM workforce, and medical school characteristics associated with higher proportions of FM graduates. METHODS: Data about graduates entering US ACGME-accredited FM residency programs were collected using an annual program census and supplemental sources. Longitudinal census data from allopathic and osteopathic schools were combined to examine trends over time. ANOVA analyses were conducted to compare schools by percent of graduates entering FM, public/private ownership, allopathic/osteopathic, size, and presence of FM department. Medical school length of operation was correlated with percentage of students entering FM. RESULTS: The overall proportion of US students entering ACGME-accredited FM programs has increased modestly over the past decade. Currently, only 12.6% of US allopathic and osteopathic seniors enter ACGME-accredited FM programs. Individual medical schools' contributions to the FM workforce are described. CONCLUSIONS: The proportion of US medical students beginning ACGME-accredited FM residency programs has increased slightly over the last decade. However, significant changes to undergraduate medical education are needed to meet the nation's primary care needs.

Quality Improvement Virtual Practicum: The QI Simulator.

Introduction: In recent years, undergraduate and graduate medical education has been rightfully emphasizing education in quality improvement and patient safety (QIPS). However, the best methods for teaching the foundational principles of QIPS and associated skills are unknown. Methods: In collaboration with the Institute for Healthcare Improvement Open School, we developed an approachable simulation for teams of health care trainees at any level and any discipline. The simulation is based on the investigation of a case regarding a psychiatric patient admitted to a fictional hospital for medical treatment who has eloped. In teams, participants investigate the incident by collecting data and using basic QI principles to brainstorm and design interventions. Participants are guided through this paper-based simulation by QI facilitators who have working knowledge of basic QI principles and techniques. Results: The simulation has been successfully used with hundreds of medical students and other health professional trainees. While working in teams, participants gained exposure to patient-safety incident reporting and investigation, process mapping, plan-do-study-act cycles, run charts, intervention design, and interactions with hospital administrators. Surveyed participants reported that they had learned QI principles, gained confidence in their ability to do QI work, and increased their likelihood of leading a QI initiative in the future. Discussion: Simulation has become a standard way to teach many clinical topics in undergraduate and graduate medical education, and QIPS should be no exception. This simulation has been shown to be effective in increasing understanding of and interest in QIPS.

The Single Graduate Medical Education (GME) Accreditation System Will Change the Future of the Family Medicine Workforce.

BACKGROUND: Due to the Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) single-accreditation model, the specialty of family medicine may see as many as 150 programs and 500 trainees in AOA-accredited programs seek ACGME accreditation. This analysis serves to better understand the composition of physicians completing family medicine residency training and their subsequent certification by the American Board of Family Medicine. METHODS: We identified residents who completed an ACGME-accredited or dual-accredited family medicine residency program between 2006 and 2016 and cross-tabulated the data by graduation year and by educational background (US Medical Graduate-MD [USMG-MD], USMG-DO, or International Medical Graduate-MD [IMG-MD]) to examine the cohort composition trend over time. RESULTS: The number and proportion of osteopaths completing family medicine residency training continues to rise concurrent with a decline in the number and proportion of IMGs. Take Rates for USMG-MDs and USMG-IMGs seem stable; however, the Take Rate for the USMG-DOs has generally been rising since 2011. CONCLUSIONS: There is a clear change in the composition of graduating trainees entering the family medicine workforce. As the transition to a single accreditation system for graduate medical education progresses, further shifts in the composition of this workforce should be expected.

Characteristics and Outcomes of an Innovative Train-in-Place Residency Program.

BACKGROUND: Physicians who make a midcareer specialty change may find their options for formal training are limited. Here, we describe a train-in-place program, with measureable outcomes, created to train midcareer physicians who desire formal training in occupational medicine. OBJECTIVE: We evaluated educational outcomes from a novel residency program for midcareer physicians seeking formal training and board certification in occupational medicine. METHODS: Physicians train in place at selected clinical training sites where they practice, and participate in 18 visits to the primary training site over a 2-year period. Program components include competency-based training structured around rotations, mentored projects, and periodic auditing visits to train-in-site locations by program faculty. Main outcome measures are achievement of Accreditation Council for Graduate Medical Education Occupational Medicine Milestones, American College of Occupational and Environmental Medicine competencies, performance on the American College of Preventive Medicine examinations, diversity in selection, placement of graduates, and the number of graduates who remain in the field. RESULTS: Since inception of this program in 1997, there have been 109 graduates who comprise 7.2% of new American Board of Preventive Medicine diplomates over the past decade. Graduates scored competitively on the certifying examination, achieved all milestones, expressed satisfaction with training, and are geographically dispersed, representing every US region. Most practice outside the 25 largest standard metropolitan statistical areas. More than 95% have remained in the field. CONCLUSIONS: Training in place is an effective approach to provide midcareer physicians seeking comprehensive skills and board certification in occupational medicine formal training, and may be adaptable to other specialties.

Results of the 2017 National Resident Matching Program® and the American Osteopathic Association Intern/Resident Registration Program.

BACKGROUND AND OBJECTIVES: The purpose of medicine as a profession is to meet the health needs of people and communities. Despite empirical evidence worldwide that an appropriate foundation of primary care in a health care system leads to improved health outcomes, improved experience of health care, a reduction in health disparities, and lower overall cost of care, publicly available data from National Resident Matching Program® (NRMP) and the American Osteopathic Association (AOA) Intern/Resident Registration Program show that PGY-1 family medicine and primary care positions offered in the NRMP Match continue to grow, but are losing ground in comparison to the growth of non-primary care specialties. In ACGME-accredited family medicine programs, DO students have been displacing non-US citizen IMGs while the proportion of US seniors has remained stable over the past decade. The impact of the displacement of non-US citizen IMGs by DO students in ACGME programs is unknown and deserves future research. Continuing trends in the growth of non-primary care specialties should raise great concern that the current primary shortage will be exacerbated, not serving the needs of the population. A major overhaul of the graduate medical education (GME) system is required to align the medical education system with the transformation of the health care system needed to improve quality, population health, and cost control.

Entry of Medical School Graduates Into Family Medicine Residencies: 2016-2017.

BACKGROUND AND OBJECTIVES: This annual report is an expansion on previous reports in this series that provides further evidence that the current medical school system is failing, collectively, to produce the primary care workforce that is needed to achieve optimal health in the United States. Inclusion of data on the performance of DO-granting and international medical schools, creates a more complete and complex picture of the contribution of all medical school types to the primary care workforce that should allow stakeholders to set goals, identify institutions with models from which to learn, and develop strategies for continuous improvement. US MD graduates made up 49% of the entering first-year class of family medicine residencies accredited by the Accreditation Council for Graduate Medical Education (ACGME), a percentage that is not statistically changed from the 11-year average of 46%. Over the same time, the percentage of DO graduates in the entering class has been increasing at an annual rate of 1%, while the percentage of international graduates has been decreasing in a reciprocal manner. Production of family medicine graduates has varied widely between and within medical school types. The number of graduates entering family medicine programs accredited by the ACGME underrepresents the overall family medicine output by US medical schools since up to a third of DO graduates have historically entered residencies accredited only by the American Osteopathic Association. While marked differences between public and private continue among US MD-granting medical schools, the percentages are nearly equal between public and private for DO-granting medical schools, with a slightly higher percentage for private schools.

Meeting ACGME Standards Under a Unified Accreditation System: Challenges for Osteopathic Graduate Medical Education Programs.

In 2014, the American Osteopathic Association (AOA) and the American Association of Colleges of Osteopathic Medicine signed a memorandum of understanding (MOU) with the Accreditation Council for Graduate Medical Education (ACGME) to create a unified accreditation system for graduate medical education (GME) under the ACGME. The AOA will cease to accredit GME programs on June 30, 2020. By then, AOA-accredited programs need to apply for and achieve ACGME initial accreditation. The terms of the MOU also made it advantageous for some formerly nonteaching hospitals to establish AOA programs, chiefly in primary care, as a step toward future ACGME accreditation.In transitioning AOA programs to the ACGME system, hospitals with osteopathic GME can expect to encounter challenges related to major differences between AOA and ACGME standards. The minimum numbers of residents for ACGME programs in most specialties are greater than those for AOA programs, which will require hospitals that may already be at their federal caps to add additional residency positions. ACGME standards are also more faculty- and staff-intensive and require additional infrastructure, necessitating additional financial investments. In addition, greater curricular specificity in ACGME standards will generate new educational and financial challenges.To address these challenges, hospitals may need to reallocate resources and positions among their current AOA programs, reducing the number of programs (and specialties) they sponsor. It is expected that a number of established and new AOA programs will choose not to pursue ACGME accreditation or will fail to qualify for ACGME initial accreditation.

Osteopathic Physicians on the Editorial Boards of Major Medical Journals Over the Past 30 Years.

CONTEXT: With the recent merger of the American Osteopathic Association and the Accreditation Council for Graduate Medical Education, new standards may be established for scholarly activity criteria and designation for each specialty. OBJECTIVE: To determine the percentage of osteopathic physicians on editorial boards in general and specialty medical journals and to compare the participation of osteopathic vs allopathic physicians and other health care researchers in editorial activities. METHODS: The number of osteopathic and allopathic physicians and other health care professionals serving as editor in chief, associate editor, editorial board member, emeritus editor, or in other editorial positions was examined in 8 major medical journals (New England Journal of Medicine, JAMA, Annals of Internal Medicine, Annals of Surgery, Annals of Emergency Medicine, Annals of Family Medicine, Obstetrics and Gynecology, and Pediatrics) published during the past 30 years. RESULTS: The number of editorial board positions increased during the past 30 years, with Annals of Surgery adding the most positions (64). When compared with allopathic physicians in all fields of medicine, the number of osteopathic physicians serving on an editorial board of a medical journal was significantly less (P<.001). When all editorial positions were combined, osteopathic physicians occupied 0.15% of all positions. CONCLUSION: A disparity exists between the numbers of osteopathic vs allopathic physicians in editorial positions in the core disciplines of medicine. Further investigation into the reasons why few osteopathic physicians serve in editorial roles is needed.

Postgraduate education of traditional Japanese (Kampo) medicine: a current survey on the training hospitals in Kanagawa prefecture.

OBJECTIVE: There is no precise survey of postgraduate Kampo education in Japan. We aimed to survey the current status of postgraduate Kampo education and to identify major problems and suggest solutions to promote Kampo education during internship. METHODS: The questionnaire, for the 58 training hospitals, including the 4 university hospitals, in Kanagawa prefecture, was mailed to the director of each hospital and the instructors responsible for clinical training. RESULTS: There were 49 responses (84%): 84% of the instructors recognized clinicians' need to prescribe Kampo medicine; 63% thought Kampo education should be introduced into the clinical training; 55% thought a standardized form of education was necessary; 14% had Kampo education programs; 69%, 13%, and 9% of instructors at hospitals without Kampo educational programs noted the lack of Kampo instructors, time, and need to teach Kampo medicine, respectively; 82% had no plans for Kampo education; 44%, 29%, 24%, and 5% of hospitals permitted future Kampo instruction through voluntary study, lectures sponsored by Kampo manufacturers, study sessions with other hospitals, and independent study, respectively. CONCLUSIONS: Kampo education should be introduced into large training hospitals, where qualified Kampo instructors are more easily found, and where many interns and residents work.

Citation and correction of deficiencies in osteopathic graduate medical education programs: opportunities for improvement.

Since 2008, the American Osteopathic Association has gathered data on osteopathic graduate medical education program compliance with the association's correction of deficiencies processes. The purpose of the current article is to look at those data to discover trends and identify patterns and areas for improvement for osteopathic graduate medical education. In addition to providing quantitative data, the author also uses qualitative data to explain why corrective action plans are recommended for denial.