Factors affecting admission to anesthesiology residency in the United States: choosing the future of our specialty.

BACKGROUND: Admission to an anesthesiology residency in the United States is competitive, and the odds associated with a successful match based on the applicants' characteristics have not been determined. The objective of this study was to examine factors associated with admission to anesthesiology residency in the United States. METHODS: The study was a retrospective cohort evaluation of the 2010 to 2011 residency applicants. Applicants' characteristics and objective factors used to select trainees were extracted. The primary outcome was a successful match to an anesthesiology residency. Data were analyzed using conditional inference tree analysis and propensity score matching. RESULTS: Data available from 1,976 applications were examined corresponding to 58% of the national sample. The odds (99% CI) for successful match were 3.6 (3.1-4.2) for U.S. medical school graduates, 2.6 (2.3 to 3.0) for applicants with United States Medical Licensing Examination Step 2 scores more than 210, and 1.2 (1.1 to 1.3) for female applicants. The odds (99% CI) for a successful match for international and U.S. graduate applicants younger than 29 yr was 3.3 (2.0-5.4) and (1.9 to 4.2), respectively, even after propensity matching for medical school, exam scores, and gender. The average applicant had no peer-reviewed scholarly productivity. CONCLUSION: Although anesthesiology residency acceptance was primarily associated with U.S. medical school attendance and United States Medical Licensing Examination Step 2 scores, our study suggest an influence of age and gender bias in the selection process. Peer-reviewed scholarly production among applicants and prior graduate education did not appear to influence candidate selection.

Comparison of diagnostic criteria for female bladder outlet obstruction.

PURPOSE: There is no universally accepted definition of bladder outlet obstruction in women. We compared 5 contemporary urodynamic definitions and determined how well they correlated with each other and with clinical suspicion of bladder outlet obstruction. MATERIALS AND METHODS: A total of 154 women who underwent videourodynamics were prospectively evaluated. Clinical obstruction was suspected when history, physical examination, symptoms and basic testing before urodynamics raised the suspicion. Women were classified as having obstruction based on 5 contemporary definitions, including 3 pressure flow cutoff point criteria, videourodynamic criteria and the Blaivas-Groutz nomogram. The McNemar Test was used to compare each definition to the others and to suspicion of clinical obstruction. RESULTS: Of the women 91 were evaluable, including 26 (29%) with obstruction by videourodynamic criteria, 28 (31%) with obstruction by 1998 cut point criteria, 18 (20%) with obstruction by 2000 cut point criteria, 13 (14%) with obstruction by 2004 cut point criteria and 38 (42%) with obstruction by the Blaivas-Groutz nomogram. Videourodynamic and 1998 cut point criteria were not significantly different from each other (78.9% concordance) and each agreed with the clinically obstructed category in the comparison. Compared to the other criteria, the Blaivas-Groutz nomogram overestimated obstruction, while 2004 cut point criteria tended to underestimate it. CONCLUSIONS: Each urodynamic definition of female bladder outlet obstruction has merit. Videourodynamic criteria and 1998 cut point criteria have the highest concordance. The Blaivas-Groutz nomogram overestimates obstruction compared to the other criteria. Therefore, it should not be used as the sole or standard definition of obstruction in women.