Educational programs in US medical schools, 2000-2001.

We used data from the 2000-2001 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and other sources to describe the status of medical education programs in the United States. In 2000-2001, the number of full-time medical school faculty members was 103, 553, a 1.1% increase from 1999-2000. The 37, 092 applicants for the class entering in 2000 represented a 3.7% decrease from the number of applicants in 1999. The majority of medical schools (58%) were in the process of major curriculum review and change during 2000-2001. In 72 schools (58%), students were required to pass both Steps 1 and 2 of the United States Medical Licensing Examinations to advance or graduate. The availability of patients to participate in clinical teaching during 2000-2001 decreased in almost half of schools compared with 1999-2000. Many schools reported difficulty in recruiting or retaining volunteer faculty members to provide clinical education in the community. Forty medical schools provided monetary payment to some or all community volunteer faculty members.

US graduate medical education, 2000-2001.

For the last three quarters of a century, the American Medical Association's national collection of graduate medical education (GME) data has evolved in its scope and methods. This year's GME survey involved new technology. The National GME Census for 2000-2001, jointly administered by the American Medical Association and the Association of American Medical Colleges, was part of an Internet-based product called GME Track. Because of technical problems, data collection was less complete than in previous years. Similar to the 1999-2000 survey, we observed an increase in the number of subspecialty programs, with 79 more than last year (2.1% increase), and a decrease in the number of specialty programs, with 40 (0.9%) fewer. Parallel to this continuing trend was a decrease in the number of graduates of US medical schools who were matched into primary care residencies, particularly family practice programs (20% decrease compared with 1996-1997). The number of graduates of osteopathic medical schools training in allopathic programs continued to rise, increasing 7.9% from last year. Numbers of Hispanic and Asian graduates from US allopathic medical schools (USMDs) in graduate year 1 (GY1) positions increased numerically to 887 and 2356, respectively, and proportionally by 7.2% and 17.3%, respectively. Although the number of white USMDs in GY1 positions increased, their proportion decreased slightly among those with known race or ethnicity from 72.2% to 71.7%, and the number of black USMD GY1 residents, numbering 859, declined from the previous year. Although we observed an overall decline in the average number of on-duty hours expected of residents in their first year in a program (from 55 in 1996-1997 to 54 in 2000-2001; P<.001), the average number of hours reported by the majority of programs that typically report the most on-duty hours did not decrease. The issues of resident work hours and the diversity and specialty distribution of the physician workforce continue to foster debate.

Educational programs in US medical schools, 1999-2000.

We used data from the 1999-2000 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and other sources to describe the status of medical education programs in the United States. In 1999-2000, the number of full-time faculty members was 102,446, a 4.3% increase from 1998-1999. The number of basic science faculty increased by less than 0.5%, while the number of clinical faculty increased by about 5%. There were 38,529 medical school applicants in 1999, a 6% decrease from 1998. Women constituted 45.8% and underrepresented minorities made up 12.1% of the 1999-2000 first-year class. New content, such as alternative medicine and cultural competence, and new methods of instruction, such as computer-based learning, are being incorporated by many schools. Seventy schools (56% of the total) require students to pass both Step 1 and Step 2 of the US Medical Licensing Examination for advancement or graduation, an increase from 62 schools (50%) in 1998-1999. The use of standardized methods of assessment, such as objective structured clinical examinations, to evaluate students' clinical performance was highly variable among schools. JAMA. 2000;284:1114-1120

Dispersion of the temperature dependence of the retardance in SiO(2) and MgF(2).

We have directly measured the retardance versus temperature for single-crystal quartz (SiO(2)) and magnesium fluoride (MgF(2)) at wavelengths of 633, 788, 1318, and 1539 nm and over a temperature range of 24-80 degrees C. To our knowledge, the temperature dependence of retardance for these two materials has not been directly measured. We compared our direct measurements of the normalized temperature derivative of the retardance gamma with derived values from previously reported indirect measurements and found our results to be in agreement and our measurement uncertainties to be typically a factor of 4 smaller. Our overall mean value for gamma(SiO(2)) is -1.23 x 10(-4) with a combined standard uncertainty of 0.02 x 10(-4) and little wavelength dependence over the 633-1539-nm range. Our overall mean value for gamma(MgF(2)) is -5.37 x 10(-5) with a combined standard uncertainty of 0.17 x 10(-5) and with a small wavelength dependence over the 633-1539-nm range.

Educational programs in US medical schools, 1998-1999.

To describe the current status of medical education programs in the United States and to trace trends in medical education over this century, we used data from the 1998-1999 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and data from other sources. In 1998-1999, total full-time faculty members numbered 98202, a 1.5% increase from 1997-1998. The number of applicants to medical school declined for the second consecutive year, from 43020 in 1997 to 41004 in 1998, but the academic qualifications of entering students remained steady. The number of applicants from underrepresented minority groups decreased 1.3% from 1997 to 1998, compared with an 11.1% decrease between 1996 and 1997. Women constituted 43.4% of applicants in 1998, slightly more than the 42.5% in 1997. The total number of required hours in the first and second years of the curriculum and the number of scheduled hours per week have declined over the past 15 years, while the average lengths of clinical clerkships remained about the same. The number of schools requiring students to pass Steps 1 and 2 of the United States Medical Licensing Examination continued to increase in 1998-1999, with 50% of schools requiring passing both examinations, compared with 46% in 1997-1998.

Educational programs in US medical schools, 1997-1998.

To describe the current status of medical education programs in the United States, we used data from the 1997-1998 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and from other sources. There were 96733 full-time medical school faculty members, a 1.2% increase from 1996-1997. The 43020 applicants for the class entering in 1997 represents an 8.4% decrease from 1996. The number of 1997 applicants who were members of underrepresented minority groups decreased 11.1 % from 1996, and the number of entering underrepresented minority group students decreased 8.4%. More than half of medical schools reported that the number of inpatients available for medical student education had decreased in at least some of their clinical sites or in some disciplines during the past 2 years. Thirty-nine medical schools (31.2%) reported having more difficulty recruiting or retaining volunteer clinical faculty to participate in medical student teaching in 1997 than in 1995.

Educational programs in US medical schools, 1996-1997.

We use data from the 1996-1997 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, to describe medical education programs in the United States. In the 1996-1997 academic year, there were 95 568 full-time medical school faculty members, a 4.5% increase from 1995-1996. In clinical departments, the largest increases were in emergency medicine (a 29% increase from 1995-1996) and family medicine (a 13% increase). Of all full-time faculty members in clinical departments, 76.9% have an MD or DO as the highest degree, 4.5% have both an MD and PhD, 13.9% have a PhD, and 4.7% have an academic or professional bachelor's or master's degree as their final degree. The total number of applicants for the class entering in 1996 was 46968 (0.8% increase from 1995), while the number of first-time applicants decreased 1% from 1995. First-year medical students who were members of underrepresented minority groups numbered 2236, a 4% decrease from 1995. In 1996-1997, the total number of medical students was 66712 (0.3% less than in 1995-1996). For students graduating during the 1995-1996 academic year, 13% took longer than 4 years to complete the program. There were 47 medical schools that reported that 1 or more hospitals used for required clinical clerkships had changed ownership, merged, or closed during 1996. Medical schools used an average of 6 (range, 1-36) hospitals for core clinical clerkship. Ninety-five schools required a passing grade on Step 1 of the US Medical Licensing Examination (USMLE) for promotion or graduation; 54 schools required a passing grade on Step 2 of the USMLE.

Education programs in US medical schools, 1995-1996.

We present herein data on US medical education programs and describe how medical schools are adapting to a changing health care environment. The data mainly derive from the 1995-1996 Liaison Committee on Medical Education Medical School Questionnaire, which had a 100% response rate. The data indicate that in the 1995-1996 academic year there were 91 451 full-time faculty members in basic science and clinical departments, a 1.6% increase from 1994-1995. In clinical departments, major increases occurred in emergency medicine (a 10.6% increase in full-time faculty) and family medicine (a 13.5% increase). Applicants for the class entering in 1995 numbered 46 591, an increase of 2.7% from 1994; however, the number of first-time applicants decreased slightly (0.6%). Of the 17 357 applicants accepted, 2179 (12.6%) were members of underrepresented minority groups. Health system changes are affecting medical school clinical affiliations. During the past 2 years, 42 schools saw a merger, acquisition, or closure involving medical school-owned or medical school-affiliated hospitals used for core clinical clerkships. At 15 sites, this change affected the distribution of students across clinical sites. In 1995-1996, 40 medical schools or their universities owned a health maintenance organization or other managed care organization, 93 schools contracted with a managed care organization to provide primary care services, and 96 schools contracted with managed care to provide specialty services. During the past year, 57 schools acquired primary care physician practices, and 70 started primary care clinics in the community.

Educational programs in US medical schools, 1994-1995.

This is a time of considerable uncertainty about the future of medical education. There are threats to medical school finances from state and federal levels. While medical schools derive only an average of about 11% of total revenues from state and local sources, these funds potentially give states the basis for imposing specific mandates on medical schools, in areas such as enrollment levels, curriculum content, and a desired specialty mix of graduates. Medical schools appear to be changing at varying rates in response to the health care system, including the growth of managed care. While the total number of full-time faculty members continues to increase, there are regional differences. It is unclear how the faculty size and composition ultimately will be affected or what implications this will have for educational programs. A number of medical schools are expanding into the community to ensure a patient base, and educational opportunities for medical students appear to be increasing in the community, including some limited use of managed care organizations. as educational settings. Medical school practice sites in the community have the potential to exacerbate "town-gown" tensions in the increasingly competitive health care environment. This, in turn, could jeopardize community-based medical education by the large number of practicing physicians who serve as volunteer faculty members and who are a valuable resource. Care will need to be taken to minimize these tensions as much as possible. As the health care system becomes even more competitive, concerns are being raised about whether volunteer faculty will continue to serve without compensation. The ability to begin to compensate community physicians who serve as teachers could be affected by decreasing medical school revenues from patient care, which, in the past, have been used to support activities such as community-based education. This is a time for strong and visionary academic leadership: medical schools must not only adapt to a changing health care system, but also maintain excellence in education, research, and patient care. This annual article will continue to describe the efforts of educational programs to do so.

Educational programs in US medical schools, 1993-1994.

From the data on faculty, students, and curriculum, is it possible to identify any responses to actual or anticipated health system changes? While one could foresee medical school downsizing in response to a potentially more competitive environment in which income from faculty practice would be reduced, what has occurred, on average, is steady growth in the number of faculty members across departments, with a large increase in the past year. However, expansion is not consistent across states. Between 1992-1993 and 1993-1994, the number of full-time faculty members decreased 1.5% in California medical schools, increased 3% in Minnesota medical schools, increased 6% in North Carolina medical schools, and increased 10% in New York and Pennsylvania medical schools. These differences may reflect the fiscal situation at the state level as well as differences in the practice environment in different areas. For example, managed care has not had a major effect in many markets. It will be important to monitor trends in faculty at both the national and regional levels to understand the full impact of health system changes. There is considerable diversity among US medical schools: in goals, in student profiles, and in curriculum structure. A number of schools have goals or objectives that contain a reference to the training of primary care physicians. The majority of these are public institutions, but a number of private schools have chosen to address the issue as well. Many schools, both public and private, are under external scrutiny related to the performance and specialty and practice location choices of their graduates.(ABSTRACT TRUNCATED AT 250 WORDS)

[The Kartagener syndrome]. / Das Kartagenersyndrom.

A 25-year-old woman with Kartagener's syndrome was admitted to hospital for laparoscopy because of sterility. Kartagener's syndrome is a rare disorder involving the combination of situs inversus, bronchiectasis and sinusitis. A dynein deficiency leads to ciliary dyskinesia. When general anaesthesia is to be induced in a patient with Kartagener's syndrome the following points must be borne in mind: ascertainment of the preoperative pulmonary status, antibiotic coverage, recognition of dextrocardia, necessity for aseptic techniques because of the possibility of abnormal neutrophil chemotaxis. Anticholinergic and antitussive medications are relatively contraindicated, as are nasal tubes. In the present case an intubation anaesthesia with thiopental, nitrous oxide, enflurane and succinylcholine was carried out; cefoxitin was administered for antibiotic treatment, and the patient made an uneventful recovery.

Educational programs in US medical schools.

As described in the introduction, the data presented in this report can be viewed in both a historical and an environmental context. From a historical perspective, there has been change in many areas of medical education. The number of applicants to medical schools has risen sharply in the past few years, a result seemingly inconsistent with the dissatisfaction with medicine expressed by many physicians and with the uncertainties about the eventual outcomes of health system reform. The number of minority applicants and enrollees is slowly rising, but at rates below the goals identified by such initiatives as the Association of American Medical Colleges' "Project 3000 by 2000." Even with the expansion of the applicant pool, however, most medical schools do not anticipate enrollment increases. Medical school tuition also continues to increase significantly, in both public and private schools. The number of faculty members in the clinical disciplines also has continued to rise, although the rate of increase has become less marked. The decrease in the number of basic science faculty members that occurred this year will need to be monitored to ensure that appropriate faculty resources are available for teaching, especially with the initiatives to introduce more active learning formats during the basic science years. The medical curriculum continues to evolve at differing rates across schools. Many "innovations" have become part of the curricular repertoire; for example, medical schools have incorporated educational formats, such as problem-based learning or computer-assisted instruction, which emphasize active student learning, although in a number of cases they are limited to a small portion of the curriculum. In addition, the availability of clinical experiences during the first 2 years of the curriculum, especially those located in ambulatory settings, gives students an early glimpse of the world of actual medical practice. The use of standardized patients provides system and structure in the teaching and evaluation of clinical skills. Therefore, a look at medical education as a whole in the historical context reveals many positive changes (for example, an increase in student diversity over time, the introduction of alternative instructional formats, and attempts to evaluate student clinical competence more reliably). Within the context of environmental expectations, however, many challenges still remain. Medical schools are experiencing pressure to solve perceived problems with the specialty distribution of their graduates and with the specialty distribution of the general physician population, even though factors outside the control of the medical school, such as reimbursement and the practice environment, also influence specialty choice.(ABSTRACT TRUNCATED AT 400 WORDS)

Educational programs in US medical schools.

Trends of the past few years indicate that the 1990s will be a time of intense activity in medical education reform. A number of areas described in this annual review of medical education are grounds for optimism, tempered, however, by caution. The applicant pool has been increasing rapidly over the past 2 years and has reached the levels of the early 1980s. The average proportion of women and some minorities also has been rising. While these are positive signs, efforts to ensure diversity in the student population should not be abandoned. The number of faculty members continues to rise, especially in the clinical disciplines. The increases, occurring in the context of stable medical student enrollments, raise questions about the various roles and responsibilities of medical school faculty. Many medical schools are in the process of curriculum review and revision; while these changes respond to identified problems, they may have implications for faculty and other resources. External financial support fueled previous waves of curriculum innovation, and some of these gains could not be maintained when that support was withdrawn. The revisions in the examinations of the NBME are being well received, and the single pathway to licensure through USMLE has been initiated. This system does, however, affect graduates' options for licensure. Finally, the increased interest in program evaluation, especially the definition of goals and the measurement of educational outcomes to assess their attainment, demonstrates that medical schools are serious about educational accountability. Some schools also are being asked to address externally imposed objectives, related specifically to specialty choice, creating a potential for conflict between the objectives that the medical school sets for itself and those mandated by its external constituencies. While this analysis may imply that medical education is now in a "good news/bad news" situation, the message is that planning and careful assessment of options are perhaps even more important today than they were in the past. Change has its costs and its implications, but it must nonetheless be undertaken.

Educational programs in US medical schools.

One noteworthy finding for the 1990-1991 academic year is the increasing number of applicants to medical school, coupled with stabilization in the credentials of accepted applicants. This increase appears to be reversing the downward trend of the 1980s. The percentages of women and total minority students in the entering class increased from the previous year. The prevalence of instructional formats such as problem-based learning and computer-assisted instruction illustrates that medical schools are willing to experiment with educational innovation. A number of schools are in the process of curriculum review, which may lead to important changes. The financial support offered by private foundations interested in curriculum innovation, for some, will be an added stimulus for change. While the majority of medical schools continue to require that students take the examinations and the subject tests of the NBME, evaluation formats that test clinical skills are receiving increased attention. The number of schools using multiple station examinations (often with standardized patients) is rising. The impact of the new US Medical Licensing Examination on medical school curricula should be analyzed in the future. Although steady increases have been reported in the number of medical school faculty members, especially clinical faculty, there is little information about how these faculty members apportion their time between teaching, research, and patient care. The assumption is that the increases are primarily driven by medical schools' need to provide clinical services, which are a source of income. Another explanation for faculty increases could relate to the need for more faculty involvement in educational innovations such as problem-based learning and new methods of clinical skills evaluation, which are relatively more faculty-intensive. Continued monitoring of the growth in clinical faculty will be necessary, as will more careful analysis of how medical school faculty spend their time. Since medical school faculty who have heavy involvements in teaching frequently do not receive appropriate recognition or reward, it will also be interesting to examine the effectiveness of diverse incentives used by the schools to reward teaching faculty. An appropriate reward system for teaching is important if undergraduate medical education is to command a high priority in institutions awarding the doctor of medicine degree.

Undergraduate medical education.

The number of applicants to US medical schools, which declined steadily between 1985 and 1988, increased slightly for the class entering in 1989. The profile of entering students showed a small decline from last year in the percentage of students with grade point averages categorized as "A" (3.5 or above on a 4-point scale) and slight declines in four of the six MCAT subtest scores. The percentage of both women and minority students in the entering class increased from the previous year. An interesting observation is the large percentage increase this year in students transferring to LCME medical schools from graduate and professional degree programs and from osteopathic medical schools. While the number of full-time faculty members in medical schools continues to increase, significant vacancy rates exist in some departments. More than 5% of full-time faculty positions are vacant in genetics, pathology, dermatology, family medicine, neurology, obstetrics-gynecology, orthopedics, otolaryngology, pediatrics, and surgery departments. Along with faculty vacancies, there has been a considerable turnover of medical school deans. The curriculum in most medical schools includes some innovative instructional formats, such as problem-based learning and computer-assisted instruction. However, current data do not allow a generalization about the extent to which these are being utilized. It seems that, at least in some institutions, multiple methods are being used to assess the clinical competence of medical students (observation by faculty members and residents, written and oral examinations, and multiple station examinations), including the use of standardized patients. About half of the medical schools require students to pass the NBME Part I examination and about one third require passage of Part II. The subject examinations provided by the NBME seem to be used widely, at least in the clinical disciplines. Within the past year, about 14% of medical schools have reported the presence of students or residents who have been diagnosed with human immunodeficiency virus infection, and 12% have had students or residents diagnosed with hepatitis B virus infection. It is critical that medical schools teach students how to prevent occupational exposure to these infections, as well as ensuring that adequate health insurance coverage be provided for these conditions.

Graduate medical education in the United States.

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the 5 years previous to 1989. Because of a change to the new electronic data collection system in 1989, the response rate decreased to 78.3%. To adjust for the lower response rate, a regression model computed from data from previous years was developed that permitted projected estimates for 1989 data. These numbers are included in several key tables. The number of GY-1 positions seems to have decreased for 1990, although this may be an artifact of the response rate. Reported unfilled positions, including GY-1 unfilled positions, have increased each year since 1985. The number of new-entry residents (GY-1) seems to be leveling out after decreasing since 1985. Because of the lower response rate, it is difficult to determine the trend in the total number of residents on duty. While the observed number of residents is lower than in 1988, statistical projections indicate an increase of 5% over the 1988 count. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs has remained relatively stable despite a steady increase in the number of women graduating from US medical schools. The percentage of FMG residents has continued to decrease. The percentage of black non-Hispanic residents remains steady. The number of graduates of osteopathic medical schools in ACGME programs has increased 17% since 1987. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years.

Undergraduate medical education.

The number of applicants to US medical schools continued to decline, while the number of accepted applicants increased slightly. From 1987-1988 to 1988-1989 academic years, the number of first-year medical students (including repeaters) who were white non-Hispanic males decreased 2.5%, the number of black non-Hispanic males decreased 6.3%, and the number of Asians or Pacific Islander males increased 10.3%. During the same period, the number of first-year students who were white non-Hispanic females decreased 0.8%, the number of black non-Hispanic females decreased 4.8%, and the number of Asians or Pacific Islander females increased 13.7%. Women constituted one third of the entering class in the 1988-1989 academic year. During the past 5 years, the ratio of full-time medical school faculty to medical students increased from 0.88 to 1.08. About 4.8% of budgeted full-time faculty positions were unfilled, down from 5% in the 1987-1988 academic year. However, in the 1988-1989 academic year, more than 5% of positions were unfilled in microbiology, anesthesiology, dermatology, family medicine, neurology, obstetrics-gynecology, ophthalmology, orthopedics, pediatrics, and surgery. Many schools are showing signs of adopting new curricular approaches. A majority of medical schools have implemented many recommendations of the GPEP Report, at least at some level. Problem-based learning is present in the curriculum of 82% of schools, mainly as an experience in one or a few courses. In about two-thirds of schools, computer-based instruction is a formal part of one or more courses or laboratories. Thus, the medical schools appear to be addressing the challenges presented by the changing environment of medical education.

Graduate medical education in the United States.

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the past 5 years. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. The number of GY-1 positions has not changed significantly during the past 3 years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased slightly in 1988. This decrease may be due to a lower response rate. The number of new entry residents (GY-1) has been decreasing since 1985. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs have remained steady. The percentage of FMG residents decreased slightly to 15.3% in 1988. The number of black non-Hispanic residents decreased in 1988, and the percentage of all residents who are black decreased slightly. The number of graduates of osteopathic medical schools in ACGME programs has increased 39% since 1986. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years, although the number of institutions that are not hospitals has increased since 1983. Ninety-five percent of all types of institutions have some type of affiliation with a US medical school.

Undergraduate medical education.

There were 28,123 applicants to US medical schools for the 1987-1988 academic year, a 10% decrease from the 1986-1987 year. Of this number, 17,027 applicants were accepted by at least one school. First-year enrollment equaled 16,686 students, of whom 639 students were repeating the first year. Thus, the number of first-time enrolled students was 16,047. This represents a decrease of 159 new-entry students from the previous year. Over 46% of the students entering medical school in the 1987-1988 academic year had a premedical GPA of 3.50 or higher (on a four-point scale). Eighty-seven percent of US medical schools academically qualified candidates on the basis of noncognitive criteria. In the past five years the number of first-year white male students has decreased by 13.2%, while the number of black male students has decreased by 1% [corrected]. In the same period, the number of white female students increased by less than one tenth of 1%, while the number of black female students has increased by 31.7%. The number of Asians or Pacific Islanders entering US medical schools has more than doubled: the percentage of male students increased by 106.5% and that of female students by 128.4%. The total number of students enrolled in 127 US medical schools in the 1987-1988 year was 65,742; of this number, 22,539 (34.3%) were women. The estimated number of graduates in the 1987-1988 year was 15,947. The total enrollment of students from underrepresented ethnic/racial groups was 6955 (10.6%), of which 4086 (6.2%) were blacks of non-Hispanic origin. The number of new-entry first-year students from underrepresented groups was 1776 (11.1%), of which 1063 (6.6%) were blacks. The number of full-time medical school faculty members was 66,798; another 130,437 were part-time and volunteer faculty members. The average time needed to complete the curriculum requirements leading to the MD degree is 152 weeks. Twenty-two medical schools offered a combined college-medical school program. The length of these combined programs averaged 256 weeks. The number of schools offering a Fifth Pathway program has decreased, and the number of applicants for these programs has also declined. The net attrition rate, which excludes students who withdrew temporarily to pursue advanced study or research, has remained at about 2%. Students dismissed because of poor academic standing represent 16% of the total student attrition.(ABSTRACT TRUNCATED AT 400 WORDS)

Graduate medical education in the United States.

1. The annual surveys of residency programs on which this report is based have had a response rate higher than 90% for the past five years. 2. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. 3. The number of GY-1 positions has not changed significantly over the past three years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased in 1985 but increased in 1986 and in 1987. This increase is due mainly to the number of residents on duty in the new internal medicine and pediatric subspecialty programs. 4. The number of new-entry (GY-1) residents decreased in 1985, 1986, and 1987. 5. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. 6. The number and percentage of women in residency programs continue to increase, as they have for the past several years. 7. The percentage of foreign medical graduate residents decreased slightly to 15.6% in 1987. 8. The number of black non-Hispanic residents increased in 1987, although the percentage of black residents remained about the same. 9. The number of graduates of osteopathic medical schools in ACGME programs has increased 59% since 1985. 10. The number of institutions involved in graduate medical education has not changed significantly over the past three years, although the number of institutions that are not hospitals has increased since 1983. Ninety percent of all types of institutions have some type of affiliation with a US medical school.