Matching Against Men: 5 Years of Residency Match Data Show Disparities Still Exist.

OBJECTIVES: Despite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties. METHODS: Deidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant. RESULTS: Of the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty. CONCLUSIONS: In this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.

Association of an Early Interest in Orthopedic Surgery with Match Rate into Orthopedic Surgery.

OBJECTIVES: Orthopedic surgery residency is considered one of the most competitive specialties in which to match. Studies examining the factors associated with a successful match have neglected whether participation in an orthopedic interest group (OIG) improves the chances of orthopedic residency match. The goal of this study was to test the hypothesis that participation in the OIG would improve matching into an orthopedic surgery residency. METHODS: We performed a retrospective cohort study between May 2017 and 2019 at one state-funded medical school. All of the applicants in orthopedic surgery from 2004 to 2019 were identified and contacted for OIG membership status. The Office of Student Affairs provided academic performance data (US Medical Licensing Examination scores and third-year clinical clerkship grades), Alpha Omega Alpha and Gold Humanism Honor Society status, and demographics (race and sex) of applicants. RESULTS: Between 2004 and 2019, 67 students (56 OIG and 11 non-OIG) applied for orthopedic surgery residency match. The match rate for the OIG was 86% compared with 64% for the non-OIG group, resulting in an adjusted odds ratio (adjusted for academic performance) of 10.23 (95% confidence interval 1.14-92.3, P = 0.038). CONCLUSIONS: OIG membership was associated with a significantly higher rate of orthopedic surgery residency matches. The higher rate of match associated with OIG membership may be the result of opportunities to diversify a residency application. Future studies are needed to further evaluate the potential association between OIG involvement and orthopedic surgery match.

Differences in medical student self-evaluations of clinical and professional skills.

BACKGROUND: The skill of self-assessment is critical to medical students. We sought to determine whether there were differences between student self-assessments and their faculty assessments and if they were modified by gender. Additionally, we sought to determine the differences in these assessments between students in a traditional (core) versus an enhanced (SELECT) medical school curriculum. METHODS: In this retrospective study, mid-term and final assessment and feedback forms from the first-year Doctoring 1 course were analyzed from three academic years: 2014-2015 through 2016-2017. Data were abstracted from the forms and de-identified for analysis. Class year, student gender, and class type were also abstracted from this "on the shelf" data from program assessment. The level of agreement between faculty and student assessments was investigated using Wilcoxon signed ranks test. The gender differences (male versus female students) between student assessments and their assessment by their faculty were investigated by using the Kruskal Wallis test. RESULTS: Five hundred and thirty-five student self-assessments were analyzed. Fifty-six percent (301/535) were male while 44% (234/535) were female. Faculty assessments (P-value <0.001) were higher than students and this was not modified by student gender. Compared to the domain of "participation" in the core program, there was no difference between the student/faculty ratings based on student gender (P-value: 0.48); there was a difference in the SELECT program cohort (P-value: 0.02). Specifically, the female students appear to rate themselves lower (female student: mean/standard deviation: 2.07/0.52) compared to their faculty (faculty: mean/standard deviation: 2.42/0.55). CONCLUSION: Faculty consistently assessed the students at a higher rating than the students rated themselves. The level of difference between student self-assessments and their assessment by their faculty was not modified by student gender. With the minor exception of "participation," there was no difference between students in the two different doctoring class curriculums.

Preparticipation cardiovascular screening among National Collegiate Athletic Association Division I institutions.

BACKGROUND: Sudden cardiac arrest is the leading cause of death in competitive athletes during sport, and screening strategies for the prevention of sudden cardiac death are debated. The purpose of this study was to assess the incorporation of routine non-invasive cardiovascular screening (NICS), such as ECG or echocardiography, in Division I collegiate preparticipation examinations. METHODS: Cross-sectional survey of current screening practices sent to the head athletic trainer of all National Collegiate Athletic Association (NCAA) Division I football programmes listed in the National Athletic Trainers' Association directory. RESULTS: Seventy-four of 116 (64%) programmes responded. Thirty-five of 74 (47%) of responding schools have incorporated routine NICS testing. ECG is the primary modality for NICS in 31 (42%) of schools, and 17 (49%) also utilise echocardiography. Sixty-four per cent of the programmes that do NICS routinely screen their athletes only once as incoming freshmen. Of institutions that do not conduct NICS, American Heart Association guidelines against routine NICS and cost were the most common reasons reported. CONCLUSIONS: While substantial debate exists regarding protocols for cardiovascular screening in athletes, nearly half of NCAA Division I football programmes in this study already incorporate NICS into their preparticipation screening programme. Additional research is needed to understand the impact of NICS in collegiate programmes.

An innovative clerkship module focused on patients with disabilities.

Lack of medical training results in physicians being unprepared to provide care to people with disabilities, which, in turn, contributes to the substantial health disparities that are evident in this population. Few medical schools or primary care residencies address the care of adults with disabilities. Competencies and guidelines to assist American physicians in caring for patients with physical or intellectual disabilities have yet to be established, thus making educational goals unclear. This article describes one novel training module regarding people with disabilities that was developed at the University of South Florida Health, Morsani College of Medicine (USF) and inserted into the primary care clerkship during a major curriculum redesign in 2005. Since then, all USF third-year medical students have been required to participate in this disability-related course component. The authors describe the module's development and integration into the primary care clerkship, as well as the specific elements of their curriculum. By using a variety of teaching modalities in the classroom and community, and especially by involving people with disabilities themselves, the medical students have a very comprehensive learning experience regarding people who have physical, sensory, or intellectual disabilities. The authors have been able to show that USF medical students, on completion of this module, demonstrate improved knowledge, attitudes, and comfort in caring for people with disabilities, which the authors believe will lead to improved health and health care access for this underserved population. Suggestions for program replication, including common challenges, are also discussed.

Office-based ultrasound in sports medicine practice.

Increasing knowledge, interest, and visibility in the field of sports medicine has equipped clinicians in the field with a novel array of diagnostic and therapeutic options but has also provided a higher level of complexity in patient care. True understanding of the vast spectrum of radiographic technology available to the sports clinician has become more critical than ever. Advances particularly in the areas of magnetic resonance imaging, diagnostic office ultrasound, and 3-dimensional reconstruction computed tomography, as well as nuclear medicine, offer the clinician a myriad of diagnostic options in patient evaluation. As these advances accumulate, the challenge to optimize care, contain cost, and interpret the extensive data generated becomes even more difficult to manage. Improving technology, education, and application of office ultrasound offers an interesting new tool for the bedside evaluation in real time of dynamic motion and pathology of sports-related injuries. As studies continue to validate ultrasound's effectiveness in diagnosing injuries to the upper and lower extremities compared with more costly magnetic resonance imaging and more invasive exploratory surgery, its promise as a cost-effective diagnostic tool is growing. A particularly promising development in the care of sports injuries is the expansion of injection therapies, and in-office ultrasound provides assurance that prolotherapy, platelet-rich plasma, dry needling, corticosteroid, and viscosupplementation are delivered accurately and safely. Communication with patients continues to increase in complexity because a greater understanding of the presence of radiographic abnormalities irrelevant to the current complaint is gained. All the accumulated data must then be interpreted and communicated to the patient with a firm understanding of not only the patient history and physical examination but also the availability, indications, contraindications, sensitivity, specificity, and even the cost implications of the spectrum of diagnostic options.

Smoking cessation in family medicine: effects of an area health education center training program.

BACKGROUND AND OBJECTIVES: Many clinicians have not received adequate training in smoking cessation. We examined the effects of a tobacco training program on clinician behavior, attitudes, knowledge, and comfort related to smoking cessation. METHODS: In a prospective cohort study, family medicine residents and faculty completed a pretest, followed by an educational intervention that encompassed presentations on smoking cessation resources, motivational interviewing, and the neurobiology of addiction and pharmacotherapy. After 3 months, participants completed a postintervention survey. Results were analyzed using chi-square tests to examine the effects of training. RESULTS: Thirty-three residents and faculty completed the pretraining survey and 25 completed the posttraining survey. Following training, participants were more familiar and comfortable with Public Health Service Clinical Practice Guidelines (P < .0001). No significant differences were found in performance of the 5 As (Ask, Advise, Assess, Assist, and Arrange) or other behaviors, including providing assistance with counseling, cessation plans, resources, or pharmacotherapy. There were no improvements in knowledge of specific intervention plans or attitudes related to identifying and counseling smokers. CONCLUSION: A multidisciplinary tobacco training program increases clinician familiarity and comfort with practice guidelines, and may contribute to improving care activities that promote a healthy lifestyle. Future research should explore other interventions that have the potential of changing practice patterns on a larger scale. Future studies should also assess the effect of training programs on patient-oriented outcomes.

Gastrointestinal temperature trends in football linemen during physical exertion under heat stress.

CONTEXT: Exertional heat stroke is the third leading cause of death in US athletes. Elevations in core temperature in the digestive tract (TGI) have correlated with core temperature and are possible indicators of those at increased risk of heat stroke. OBJECTIVE: The primary objective was to compare a.m. vs. p.m. TGI variation in collegiate football linemen during intense "two-a-day" preseason practice. A secondary objective was to compare longitudinal TGI in offensive and defensive linemen. DESIGN: Cross-sectional observational study. SETTING: Division I Intercollegiate Athletics Football Program. INTERVENTIONS: TGI was monitored during consecutive preseason sessions. MAIN OUTCOME MEASUREMENTS: TGI, heat illness, weight changes, environmental stress, and subjective symptoms. RESULTS: Mean TGI were 37.8°C and 38.3°C during a.m. and p.m. practices, respectively. The a.m. practices revealed higher TGI gain (1.8°C) compared to p.m. (1.4°C). The p.m. practices had higher maximum TGI than a.m. practices (39.1°C versus 38.8, P=0.0001). Mean time to maximum temperature (Tmax) was 1 hr and 30 min for a.m. and 1 hr and 22 min for p.m. practices. Offensive linemen trended toward higher mean TGI than defensive players (38.0°C vs. 36.7°C, P = 0.069). The rate of rise in TGI was significantly greater in a.m. practices. A decrease in rate of TGI rise was seen from the first to last a.m. practices of the week (P = 0.004). CONCLUSION: Significant TGI elevations in asymptomatic athletes are common in extreme heat during football practice. Intense a.m. practices in full gear result in higher net temperature gain and rate of temperature gain than p.m. practices. Offensive linemen trended toward higher TGI than defensive linemen. As players acclimatized, a decrease in the rate of TGI increase was appreciable, particularly in a.m. practices. Appreciating cumulative heat stress and variations in heat stress related to scheduling of practice is critical.

Imaging in sports medicine: an overview.

Increasing sports participation, and the inevitable sports injury, is a significant contributor to total healthcare expenditure in the United States. With sports-related injury ever increasing, and technology rapidly expanding in the areas of diagnosis and treatment of musculoskeletal trauma, a continual revisiting of the latest in technology is critical for the sports physician. Advances particularly in the areas of magnetic resonance imaging, diagnostic office ultrasound, and 3-dimensional reconstruction computed tomography, offer the clinician a myriad of diagnostic options in patient evaluation. Care must be exercised, however, as one pursues additional radiographic data in the patient care arena. The information must be interpreted with a firm foundation and understanding of not only the patient history and physical examination, but also the availability, indications, contraindications, sensitivity, specificity, and even the cost implications of the great spectrum of diagnostic options.