Unintended Consequences? Assessing the Impact of Curricular Change on Medical Student Participation in a Student-Run Free Clinic.

INTRODUCTION: In a prior qualitative study of the impact of a new (ACE) medical school curriculum, students and faculty reported decreased participation in the student-run free clinic (SRFC) attributed to more intensive scheduling and more frequent testing compared to the previous (Legacy) curriculum. MATERIALS AND METHODS: To verify and understand this perception formed during curriculum reform, we conducted a mixed method study to measure student participation in the SRFC before and after curricular change and assessed student beliefs and motivations about SRFC participation using focus groups. RESULTS: Overall SRFC participation did not decrease among students in the ACE cohort following curriculum change. Additionally, both Legacy and ACE groups showed lower participation during test weeks, but the decrease was not significantly different between the ACE and Legacy cohorts. Focus groups confirmed the pervasive misbelief that SRFC participation was indeed lower among ACE students and attributed to reduced student discretionary time plus increased preparation time for frequent testing. Focus groups also revealed several "values" about volunteering at the SRFC which should be endorsed and promoted by schools considering curricular change. Participants valued the SRFC for educational items that were most effectively taught in the SRFC, notably social determinants of health, interprofessional practice, and interviewing with medical interpreters. They also valued the SRFC for professional validation, opportunities to apply course content, practice clinical skills, form important professional relationships, and provide community service. CONCLUSIONS: Our findings validate the value of SRFC experience as reported by students and demonstrate that, contrary to misbeliefs, participation was not negatively impacted by curricular reform.

Time and Financial Costs for Students Participating in the National Residency Matching Program (the Match©): 2015 to 2020.

INTRODUCTION: The purpose of this study was to provide information to assist students, faculty, and staff in making critical career-determining decisions regarding the residency NRMP "Match©" process. METHODS: A 47-item survey questionnaire was developed and piloted on a regional medical school campus in 2015. The revised questionnaire was distributed each year from 2016 to 2020 to fourth-year medical students after rank lists had been submitted. The questionnaire incorporated a request for comments about the interviewing experience and suggestions to improve the process. This narrative feedback was coded using a thematic analysis. RESULTS: The overall response rate was 86.1% (897/1,042). Annual response rates ranged from 70.0% in 2020 to 97.0% in 2018. Respondents' average age was 27.3 (± 2.7) years and 50.0% (448/897) were male. Most applied to family medicine (164/897; 18.2%) and internal medicine (140/897; 15.6%). Eight specialties had fewer than ten applicants over the six-year period. The number of students applying to individual specialties fluctuated annually, but no specialty showed a consistent upward or downward trend over the study period. CONCLUSIONS: This study found huge differences in numbers of applications, expenses, and days interviewing. Students crave more guidance, a more efficient system, transparent communication with programs, and less pressure during the process. Reducing escalating volumes of applications is central to improving the system. Despite efforts to inform applicants better, student behavior is unlikely to change until they feel safe in the belief that lower and more realistic numbers of applications and interviews are likely to result in securing an appropriate residency position.

Issues Faced by Senior Women Physicians: A National Survey.

Background: As the first large numbers of female physicians complete their careers, information is needed to enable institutions and individuals to optimize the final career phase and transition to retirement of these women, as well as to help younger women physicians prepare for later phases of their careers. Materials and Methods: To identify the leading issues for older female physicians, a 34-item electronic questionnaire covering heath, finances, preparation for and attitudes about retirement, caretaking responsibilities, life-work integration, various aspects of discrimination and harassment, professional isolation, and work-related stress and burnout-incorporating standardized measures of career satisfaction was distributed through the Kansas Medical Society and nationally through the American Medical Association Senior Physicians Section newsletter to female physicians older than 60 years in 2018. A total of 155 physicians self-identified as eligible and completed at least half of the survey. Results: Respondents were 60-87 years of age, mean 70.4 (±6.4) years. The majority reported good health and being financially well prepared for retirement. Twenty percent were caretakers for grandchildren, parents, or spouses. Measures of career and job satisfaction were reasonably high, despite negative work environment and burnout scores. Problems with family/career balance, age- and gender-based discrimination and harassment, salary inequity, and professional isolation persisted throughout their careers, but diminished in frequency for senior women. Conclusions: Issues faced by younger women physicians do not disappear with age or seniority. To recruit and support female physicians, issues such as balancing family/work responsibilities, combating harassment and bias, and promoting healthy work environments must be addressed throughout their entire careers.

Tenure Appointments for Faculty of Clinical Departments at U.S. Medical Schools: Does Specialty Designation Make a Difference?

PURPOSE: To describe differences and trends among clinical specialty departments in number and percentage of tenure-related appointments for full-time faculty. METHOD: Association of American Medical Colleges Faculty Roster annual snapshot reports were used to calculate percentages of full-time faculty holding tenure-related appointments in each of the database's 17 groupings of clinical specialty departments. Faculty numbers and percentages by track were compared to investigate trends for 2006 to 2016. RESULTS: In the decade 2006-2016, the number of individuals on tenure-related tracks in clinical departments declined by 0.8% (276/33,610), but those on nontenure appointments increased by 60.5% (36,444/60,195). The number reporting "tenure not available" rose by 58.9% (4,467/7,574). Currently, 62% to 82% of full-time faculty in clinical departments are on nontenure tracks. Specialties differ significantly in current percentage and in rate of change in both numbers and percentage of tenure-related appointments. In 2016, faculty on tenure-related tracks ranged from 34.5% (295/855) in public health and preventive medicine to 13.5% (654/5,654) in family medicine. The most significant drops in percentage of tenure-related appointments in 2006-2016 were in surgery, pediatrics, and internal medicine. CONCLUSIONS: Dramatic changes in size and track distribution of faculty are occurring at significantly different rates across clinical specialty departments. The number of individuals on tenure-related tracks remains relatively stable, but the percentage of such faculty in clinical specialty departments continues to drop dramatically in almost all specialties. The growing dominance of nontenure appointments has important implications for career development and academic promotion policies and practices in all specialties.

Social networks and links to isolation and loneliness among elderly HCBS clients.

OBJECTIVES: The purpose of this study was to explore the network types of HCBS clients based on the structural characteristics of their social networks. We also examined how the network types were associated with social isolation, relationship quality and loneliness. METHOD: Forty personal interviews were carried out with HCBS clients to assess the structure of their social networks as indicated by frequency of contact with children, friends, family and participation in religious and community organizations. Hierarchical cluster analysis was conducted to identify network types. RESULTS: Four network types were found including: family (n = 16), diverse (n = 8), restricted (n = 8) and religious (n = 7). Family members comprised almost half of participants' social networks, and friends comprised less than one-third. Clients embedded in family, diverse and religious networks had significantly more positive relationships than clients embedded in restricted networks. Clients embedded in restricted networks had significantly higher social isolation scores and were lonelier than clients in diverse and family networks. DISCUSSION: The findings suggest that HCBS clients' isolation and loneliness are linked to the types of social networks in which they are embedded. The findings also suggest that clients embedded in restricted networks are at high risk for negative outcomes.