Temporal Trends in Childhood Household Income Among Applicants and Matriculants to Medical School and the Likelihood of Acceptance by Income, 2014-2019.

This study examines trends in childhood household income among applicants and matriculants to medical school and the likelihood of acceptance by income.

Downstream funding success of early career researchers for resubmitted versus new applications: A matched cohort.

BACKGROUND: Early career researchers face a hypercompetitive funding environment. To help identify effective intervention strategies for early career researchers, we examined whether first-time NIH R01 applicants who resubmitted their original, unfunded R01 application were more successful at obtaining any R01 funding within 3 and 5 years than original, unfunded applicants who submitted new NIH applications, and we examined whether underrepresented minority (URM) applicants differentially benefited from resubmission. Our observational study is consistent with an NIH working group's recommendations to develop interventions to encourage resubmission. METHODS AND FINDINGS: First-time applicants with US medical school academic faculty appointments who submitted an unfunded R01 application between 2000-2014 yielded 4,789 discussed and 7,019 not discussed applications. We then created comparable groups of first-time R01 applicants (resubmitted original R01 application or submitted new NIH applications) using optimal full matching that included applicant and application characteristics. Primary and subgroup analyses used generalized mixed models with obtaining any NIH R01 funding within 3 and 5 years as the two outcomes. A gamma sensitivity analysis was performed. URM applicants represented 11% and 12% of discussed and not discussed applications, respectively. First-time R01 applicants resubmitting their original, unfunded R01 application were more successful obtaining R01 funding within 3 and 5 years than applicants submitting new applications-for both discussed and not discussed applications: discussed within 3 years (OR 4.17 [95 CI 3.53, 4.93]) and 5 years (3.33 [2.82-3.92]); and not discussed within 3 years (2.81 [2.52, 3.13]) and 5 years (2.47 [2.22-2.74]). URM applicants additionally benefited within 5 years for not discussed applications. CONCLUSIONS: Encouraging early career researchers applying as faculty at a school of medicine to resubmit R01 applications is a promising potential modifiable factor and intervention strategy. First-time R01 applicants who resubmitted their original, unfunded R01 application had log-odds of obtaining downstream R01 funding within 3 and 5 years 2-4 times higher than applicants who did not resubmit their original application and submitted new NIH applications instead. Findings held for both discussed and not discussed applications.

The Accelerating Change in Medical Education Consortium: Key Drivers of Transformative Change.

The American Medical Association's (AMA's) Accelerating Change in Medical Education (ACE) initiative, launched in 2013 to foster advancements in undergraduate medical education, has led to the development and scaling of innovations influencing the full continuum of medical training. Initial grants of $1 million were awarded to 11 U.S. medical schools, with 21 schools joining the consortium in 2016 at a lower funding level. Almost one-fifth of all U.S. MD- and DO-granting medical schools are represented in the 32-member consortium. In the first 5 years, the consortium medical schools have delivered innovative educational experiences to approximately 19,000 medical students, who will provide a potential 33 million patient care visits annually. The core initiative objectives focus on competency-based approaches to medical education and individualized pathways for students, training in health systems science, and enhancing the learning environment. At the close of the initial 5-year grant period, AMA leadership sought to catalogue outputs and understand how the structure of the consortium may have influenced its outcomes. Themes from qualitative analysis of stakeholder interviews as well as other sources of evidence aligned with the 4 elements of the transformational leadership model (inspirational motivation, intellectual stimulation, individualized consideration, and idealized influence) and can be used to inform future innovation interventions. For example, the ACE initiative has been successful in stimulating change at the consortium schools and propagating those innovations broadly, with outputs involving medical students, faculty, medical schools, affiliated health systems, and the broader educational landscape. In summary, the ACE initiative has fostered a far-reaching community of innovation that will continue to drive change across the continuum of medical education.

Modelagem de custeio para mensuração de custos na graduação médica com base em um projeto político-pedagógico de uma instituição pública: estudo metodológico / Cost modeling for cost measurement in medical graduation based on a political-pedagogical project of a public institution: a methodological study

A Constituição da República Federativa do Brasil, de 1988, tem entre seus direitos fundamentais a educação e a saúde, temas sociais que são assegurados às pessoas que se encontram dentro do território nacional. Os tópicos são inseridos no ordenamento jurídico brasileiro através das leis infraconstitucionais, ao longo da sua história. A educação está amparada pelas Diretrizes e Bases da Educação Nacional, que legalizaram o tema em três níveis, entre os quais o nível superior, que se baseia nas Diretrizes Curriculares Nacionais direcionadas às instituições de ensino superior. A promulgação da Lei nº 8.080/1990 criou o Sistema Único de Saúde brasileiro, assegurando a todos o acesso universal e igualitário. A importância dos enunciados requer recursos públicos humanos, materiais, físicos e financeiros na prestação do serviço, alinhados aos elementos básicos necessários ao estudo de custo, o qual se volta para eficiência, eficácia e economicidade, ancorados pelas prerrogativas legais de cunho econômico, financeiro e fiscal. Assim, com a perspectiva de unir os temas educação, saúde e custo, este trabalho teve como questionamento central mensurar o custo da formação em medicina, com base no projeto político-pedagógico de uma instituição de ensino superior. Para responder a essa indagação, a pesquisa objetivou criar uma modelagem de custeio para mensurar o custo da formação acadêmica, através da lógica acadêmica. O trabalho teve características descritivas; qualitativa; de estudo de caso; empírica e dedutiva. A metodologia empregada levantou os instrumentos pedagógicos das escolas públicas federais e algumas estaduais das capitais brasileiras, visando identificar elementos mensuráveis pelo método de custo. Entre os projetos que apresentaram elementos necessários, os dados encontrados no projeto pedagógico da Faculdade de Ciências Médicas da Universidade do Estado do Rio de Janeiro foram utilizados no estudo proposto. A modelagem sugerida quantificou o custo da formação médica de forma lógica segundo as características acadêmicas, dentro do Plano de Periodização da instituição. Concluiu-se que é possível mensurar os custos da formação médica com base nos projetos pedagógicos, aglutinando os recursos disponíveis institucionais consumidos na carga horária das disciplinas.

The 1988 Constitution of the Federative Republic of Brazil has among its fundamental rights education and health, social issues that are guaranteed to people within the national territory. The topics are inserted in the Brazilian legal system by infra-constitutional laws throughout its history. Education is supported by the National Education Guidelines and Bases, which legalized the topic at three levels, including the higher level, is based on the National Curriculum Guidelines aimed at higher education institutions. The enactment of Law no. 8.080/1990 created the Brazilian Unified Health System, ensuring universal and equal access to all. The importance of the statements requires public human, material, physical and financial resources in the provision of the service, which are aligned with the basic elements necessary for the cost study, focusing on efficiency, effectiveness, and economy, anchored by legal prerogatives of an economic, financial, and fiscal nature. Thus, with the perspective of uniting the themes of education, health and cost, the central issue of this work is measuring the cost of training in medicine, based on the political-pedagogical project of a higher education institution. To answer this question, the research aimed to create a costing model to measure the cost of academic training, through academic logic. The work had descriptive; qualitative; case study; empirical and deductive characteristics. The methodology used surveyed the pedagogical instruments of federal public schools and some state schools in Brazilian capitals, aiming to identify measurable elements using the cost method. Among the projects that presented necessary elements, the data found in the pedagogical project of the School of Medical Sciences of Rio de Janeiro State University were used in this study. The suggested modeling quantified the cost of medical training in a logical way according to academic characteristics, following the institution's Periodization Plan. It was concluded that it is possible to measure the costs of medical training based on pedagogical projects, bringing together the available institutional resources consumed in the course load.

Salary Disparities in Academic Urogynecology: Despite Increased Transparency, Men Still Earn More Than Women.

OBJECTIVE: To understand the compensation differences between male and female academic urogynecologists at public institutions. METHODS: Urogynecologists at public universities with publicly available salary data as of June 2019 were eligible for the study. We collected characteristics, including sex, additional advanced degrees, years of training, board certification, leadership roles, number of authored scientific publications, and total National Institutes of Health funding projects and number of registered clinical trials for which the physician was a principal or co-investigator. We also collected total number of Medicare beneficiaries treated and total Medicare reimbursement as reported by the Centers for Medicare & Medicaid Services. We used linear regression to adjust for potential confounders. RESULTS: We identified 85 academic urogynecologists at 29 public state academic institutions with available salary data eligible for inclusion in the study. Males were more likely to be an associate or a full professor (81%) compared with females (55%) and were more likely to serve as department chair, vice chair, or division director (59%) compared with females (30%). The mean annual salary was significantly higher among males ($323,227 ± $97,338) than females ($268,990 ± $72,311, P = 0.004). After adjusting for academic rank and leadership roles and years since residency, the discrepancy persisted, with females compensated on average $37,955 less annually. CONCLUSIONS: Salaries are higher for male urogynecologists than female urogynecologists, even when accounting for variables such as academic rank and leadership roles. Physician compensation is complex; the differences observed may be due to variables that are not captured in this study. Nevertheless, the magnitude of disparity found in our study warrants further critical assessment of potential biases within the field.

NIH funding trends to US medical schools from 2009 to 2018.

Total NIH funding dollars have increased from 2009-2018. We questioned whether this growth has occurred proportionately around the country and throughout allopathic medical schools. Therefore, we compared the trend in NIH grant funding from 2009 to 2018 for United States allopathic medical schools among historically top-funded schools, private and public schools, and by region of the country. Changes in both unadjusted and real funding dollars over time revealed a significant difference. Region was the only significant factor for mean percent change in funding from 2009-2018, with the Western region showing a 33.79% increase in purchasing power. The Northeastern region showed a -6.64% decrease in purchasing power while the Central and Southern regions reported changes of 2.46% and -6.08%, respectively. The mean percent increases were more proportional and nonsignificant in the public vs. private institutions comparison, at -3.41% and 4.75%, respectively. Likewise, the top-funded institutions vs. other institutions comparisons demonstrated modest, nonsignificant differences. However, although the relative changes might be proportional, the absolute increases evidence a pattern of growing cumulative advantage that favor the highest-funded institutions and private institutions. The potential consequences of this disproportionate increase include health science education, biomedical research, and patient access disparities in large parts of the country. The NIH and the scientific community should explore potential solutions in its funding models.