Association Between ERAS Application Changes and Unfilled Positions in the 2024 Family Medicine Match.

BACKGROUND AND OBJECTIVES: The number of family medicine positions unfilled in the Main Match has increased from 2019 to 2023. In the 2023-2024 family medicine application season, the specialty adopted the changes in the Electronic Residency Application Service (ERAS or MyERAS), which included geographic preferences and offered applicants five program signals. We compared the number of unfilled positions from prior years to results of the 2024 family medicine Match after the adoption of these changes. METHODS: We analyzed publicly available data from the National Resident Matching Program to compare the number of positions filled in the Main Match from 2019 to 2024. We estimated the number of expected positions filled using multiple linear regression and application data from ERAS and the number of available positions in the Match. RESULTS: A total of 636 positions were unfilled in the 2024 family medicine Main Match. Our statistical analysis, based only on the number of applicants and the number of available positions, predicted 630.65 unfilled slots with a 95% confidence interval from 605.53 to 655.77. The 2024 family medicine position fill rate decreased slightly at 87.8% compared to 88.7% in the 2023 Match. The number of family medicine programs that did not fill in the Main Match increased in 2024 to 241 (30.3% of programs) compared to 217 (28.1%) in 2023. CONCLUSIONS: MyERAS changes in the 2023-2024 family medicine application season, including geographic preferences and program signaling, were not associated with a change in the number of programs or positions filled in the family medicine Main Match.

The Association Between Length of Training and Family Medicine Residents' Clinical Knowledge: A Report From the Length of Training Pilot Study.

BACKGROUND AND OBJECTIVE: The associations between training length and clinical knowledge are unknown. We compared family medicine in-training examination (ITE) scores among residents who trained in 3- versus 4-year programs and to national averages over time. METHODS: In this prospective case-control study, we compared the ITE scores of 318 consenting residents in 3-year programs to 243 who completed 4 years of training between 2013 through 2019. We obtained scores from the American Board of Family Medicine. The primary analyses involved comparing scores within each academic year according to length of training. We used multivariable linear mixed effects regression models adjusted for covariates. We performed simulation models to predict ITE scores after 4 years of training among residents who underwent only 3 years of training. RESULTS: At baseline postgraduate year-1 (PGY1), the estimated mean ITE scores were 408.5 for 4-year programs and 386.5 for 3-year programs, a 21.9 point difference (95% CI=10.1-33.8). At PGY2 and PGY3, 4-year programs scored 15.0 points higher and 15.6 points higher, respectively. When extrapolating an estimated mean ITE score for 3-year programs, 4-year programs would still score 29.4 points higher (95% CI=15.0-43.8). Our trend analysis revealed those in 4-year programs had a slightly lesser slope increase compared to 3-year programs in the first 2 years. Their drop-off in ITE scores is less steep in later years, though these differences were not statistically significant. CONCLUSIONS: While we found significantly higher absolute ITE scores in 4 versus 3-year programs, these increases in PGY2, PGY3 and PGY4 may be due to initial differences in PGY1 scores. Additional research is needed to support a decision to change the length of family medicine training.

The Importance of and the Complexities Associated With Measuring Continuity of Care During Resident Training: Possible Solutions Do Exist.

BACKGROUND AND OBJECTIVES: Evolutions in care delivery toward the patient-centered medical home have influenced important aspects of care continuity. Primary responsibility for a panel of continuity patients is a foundational requirement in family medicine residencies. In this paper we characterize challenges in measuring continuity of care in residency training in this new era of primary care. METHODS: We synthesized the literature and analyzed information from key informant interviews and group discussions with residency faculty and staff to identify the challenges and possible solutions for measuring continuity of care during family medicine training. We specifically focused on measuring interpersonal continuity at the patient level, resident level, and health care team level. RESULTS: Challenges identified in accurately measuring interpersonal continuity of care during residency training include: (1) variability in empanelment approaches for all patients, (2) scheduling complexity in different types of visits, (3) variability in ability to attain continuity counts at the level of the resident, and (4) shifting make-up of health care teams, especially in residency training. Possible solutions for each challenge are presented. Philosophical issues related to continuity are discussed, including whether true continuity can be achieved during residency training and whether qualitative rather than quantitative measures of continuity are better suited to residencies. CONCLUSIONS: Measuring continuity of care in residency training is challenging but possible, though improvements in precision and assessment of the comprehensive nature of the relationships are needed. Definitions of continuity during training and the role continuity measurement plays in residency need further study.

Vaccine schedules and procedures, 2007.

This article reviews the 2007 recommended childhood and adolescent immunization schedules; the catch-up immunization schedules for children and adolescents; the 2006-2007 recommended adult immunization schedule; recommended and minimum ages and intervals between vaccine doses; contraindications for immunization; and general guidelines on immunization procedures. With the exception of some formulations of influenza vaccines, all recommended childhood vaccines are thimerosal-free. Since 2005, changes in vaccine schedules affect the following vaccinations: hepatitis A, rotavirus, human papillomavirus, varicella, meningococcal, adult tetanus and diphtheria toxoids and acellular pertussis, and influenza. Minimal intervals between vaccines and vaccine precautions, contraindications, administration, and storage are reviewed. Sources of up-to-date vaccine information are presented.

Vaccine schedules and procedures.

This article presents the 2005 Recommended Childhood and Adolescent Immunization Schedule; the catch-up schedule; the 2004-2005 Recommended Adult Immunization Schedule, which will stay in effect for 2005; contraindications for immunization; and general guidelines on immunization procedures. Recent changes for children include institution of thimerosal-free hepatitis B vaccination either before hospital discharge or as soon after birth as possible and the recommendation to give inactivated influenza vaccine to all children who will be between the ages of 6 and 23 months during the influenza season. Minimal intervals between vaccines and vaccine precautions, contraindications, administration, and storage are reviewed. Sources of vaccine information are presented and discussed.

Vaccine schedules and procedures, 2003.

Recent, rapid changes in recommendations regarding vaccination represent challenges for busy clinicians who need to be familiar with new developments. This article reviews the current age-based recommendations that are fundamental to the United States vaccine program, as well as current recommendations regarding contraindications, precautions, administration techniques, and storage procedures for routinely administered vaccines. The 2003 Recommended Childhood Immunization Schedule, the 2002-2003 Recommended Adult Immunization Schedule, contraindications for immunization, and general guidelines on immunization procedures are presented. Recent changes in recommendations for children are instituting thimerosal-free hepatitis B vaccine as soon after birth as possible (before hospital discharge) and encouraging immunization of all children aged 6 to 23 months against influenza.