Medical School Rankings-Bad for the Health of the Profession and the Public.

This Viewpoint discusses the limitations of medical school ranking in attracting a diverse student population and urges administrators to holistically communicate their mission, goals, and learning environment as an alternative strategy.

Selection or education? Medical school ranking and medical students' speciality choice preferences in the United States.

Limited research exists on the influence of top-ranked medical schools on students' speciality choice. We surveyed medical students (n = 468) at eight medical schools in the United States including two ranked in the top 10. Significance tests and logistic regressions were used to determine the relationship between school ranking and preferences for various speciality attributes. An analysis was conducted separately for students in lower (1st and 2nd) years versus higher (3rd and 4th) years of medical school. Among students in lower years, speciality preferences by students in top-ranked schools were less likely to be influenced by the length of training or work-life balance compared to students in non-top-ranked schools. Among higher year students, speciality preference of students in top-ranked schools was more likely to be influenced by prestige than their peers, with no difference in the influence of other factors. We also found evidence that students in top-ranked schools were less likely to be interested in primary care specialities, and this was more pronounced among those in higher years. Our findings suggest that top-ranked schools may influence speciality choice through both selection and education, and initiatives aimed at changing the emphasis on speciality prestige at top-ranked schools could increase primary care physician output.

The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review.

BACKGROUND: National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning. METHODS: A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators. RESULTS: The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where all prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning. CONCLUSION: The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders.

Medical school research ranking is associated with gender inequality in MSTP application rates.

BACKGROUND: The number of female trainees in MD and biomedical PhD programs has reached near parity with their male counterparts for several years. However, a gender disparity persists for enrollment in Medical Scientist Research Programs (MSTPs). Several studies suggest women underestimate their abilities compared with male colleagues. If this phenomenon applies, we might expect there to be a gender disparity in applicants to MSTPs, which are typically considered more competitive compared to MD or PhD programs. In this report, we explored this hypothesis by evaluating whether female applicants who do apply to MSTP programs disproportionately apply to lower ranking programs when compared to male applicants. METHODS: For each institution, we identified their 2016 U.S. News and World Report "Best Medical Schools: Research" ranking and examined trends across rankings using linear regression models, such as relationships between the percentage of female applicants and other factors that may influence where applicants apply. RESULTS: The female applicants who do apply to MSTP programs apply disproportionately to lower ranking programs. Despite this, women seem to have the same success rate for gaining admission to MSTPs, as indicated by matriculation rates across programs, regardless of program rank. CONCLUSIONS: Our findings of gender disparity in applications to high-ranking but not low-ranking programs support prior hypotheses that under-confidence or lack of encouragement may drive this inequality. This analysis highlights the need for further systematic studies of gender differences in MSTP applicants and the relationship to career trajectories in order to improve the gender disparity that exists in academic medicine.

Creation and Implementation of a Taxonomy for Educational Activities: A Common Vocabulary to Guide Curriculum Mapping.

PROBLEM: Undergraduate medical education (UME) has trended toward outcomes-based education, unveiling new issues for UME program organization and leadership. Using a common language for categorizing and linking all program components is essential. The Emory Curriculum Alignment Taxonomy (ECAT) was designed as a common vocabulary for curriculum mapping in the outcomes-based environment of the Emory University School of Medicine. APPROACH: The ECAT, developed in 2016, uses a set of 291 controlled identifiers, or "tags," to describe every educational activity's content, instruction, assessment, and outcomes, and thereby to align teaching inputs with student outcomes. Tags were drawn from external frameworks or developed by local stakeholders. A key feature is the arrangement of tags into eight categories, with the aim of balancing specificity and parsimony. Tags from multiple categories can be combined using Boolean operators to search for specific topics across the curriculum. OUTCOMES: In 2016-2017, all educational activities were tagged, including classroom events, workplace learning, mentored research, and student assessments. Tagging was done by two assistant deans and course/clerkship directors, which reinforced the importance of aligning instruction with assessment and aligning both of these with student outcomes. NEXT STEPS: Using the ECAT tags has linked instruction with achievement of student outcomes, has shown the compromises between specificity and parsimony were workable, and has facilitated comprehensive program management and evaluation. As the ECAT tags can be modified, other programs could adapt this approach to suit their context. Next steps will include aggregating data into a centralized repository to support reporting and research.

Characteristics of Japanese medical students associated with their intention for rural practice.

INTRODUCTION: In Japan, the maldistribution of physicians between urban and rural areas is increasing. It is important to know the practice location expectations of future physicians. METHODS: The study was designed as a cross-sectional survey. In 2009-2013, students at a medical school in Japan completed a questionnaire containing 50 items with four-point Likert scales. The students rated the importance of specified individual and occupational aspects. Furthermore, students were asked to state their intention to practice in a rural area. RESULTS: The study sample consisted of 368 students (88.2% response rate). Significant variables that were associated with a positively motivated intent for rural practice were 'presence of a role model' (odds ratio (OR), 5.42; 95% confidence interval (CI), 1.58-18.5), 'admission by school recommendation' (OR, 7.68; 95%CI, 2.14-27.6), 'growing up in a rural area' (OR, 6.16; 95%CI, 1.01-37.6), 'general medicine/family medicine as the first career choice' (OR, 5.88; 95%CI, 2.43-14.2), 'interest in the targeted population' (OR, 16.7; 95%CI, 3.97-69.9), 'memorable experience at a class or clinical rotation' (OR, 3.94; 95%CI, 3.73-416), and 'location of their medical school' (OR, 11.4; 95%CI, 2.79-46.2). CONCLUSIONS: The present study suggests that medical schools might recruit students with characteristics associated with intention for rural practice.

Attrition rates in neurosurgery residency: analysis of 1361 consecutive residents matched from 1990 to 1999.

OBJECT: The objective of this study is to determine neurosurgery residency attrition rates by sex of matched applicant and by type and rank of medical school attended. METHODS: The study follows a cohort of 1361 individuals who matched into a neurosurgery residency program through the SF Match Fellowship and Residency Matching Service from 1990 to 1999. The main outcome measure was achievement of board certification as documented in the American Board of Neurological Surgery Directory of Diplomats. A secondary outcome measure was documentation of practicing medicine as verified by the American Medical Association DoctorFinder and National Provider Identifier websites. Overall, 10.7% (n=146) of these individuals were women. Twenty percent (n=266) graduated from a top 10 medical school (24% of women [35/146] and 19% of men [232/1215], p=0.19). Forty-five percent (n=618) were graduates of a public medical school, 50% (n=680) of a private medical school, and 5% (n=63) of an international medical school. At the end of the study, 0.2% of subjects (n=3) were deceased and 0.3% (n=4) were lost to follow-up. RESULTS: The total residency completion rate was 86.0% (n=1171) overall, with 76.0% (n=111/146) of women and 87.2% (n=1059/1215) of men completing residency. Board certification was obtained by 79.4% (n=1081) of all individuals matching into residency between 1990 and 1999. Overall, 63.0% (92/146) of women and 81.3% (989/1215) of men were board certified. Women were found to be significantly more at risk (p<0.005) of not completing residency or becoming board certified than men. Public medical school alumni had significantly higher board certification rates than private and international alumni (82.2% for public [508/618]; 77.1% for private [524/680]; 77.8% for international [49/63]; p<0.05). There was no significant difference in attrition for graduates of top 10-ranked institutions versus other institutions. There was no difference in number of years to achieve neurosurgical board certification for men versus women. CONCLUSIONS: Overall, neurosurgery training attrition rates are low. Women have had greater attrition than men during and after neurosurgery residency training. International and private medical school alumni had higher attrition than public medical school alumni.

A retrospective analysis of the relationship between medical student debt and primary care practice in the United States.

PURPOSE: We undertook a study to reexamine the relationship between educational debt and primary care practice, accounting for the potentially confounding effect of medical student socioeconomic status. METHODS: We performed retrospective multivariate analyses of data from 136,232 physicians who graduated from allopathic US medical schools between 1988 and 2000, obtained from the American Association of Medical Colleges Graduate Questionnaire, the American Medical Association Physician Masterfile, and other sources. Need-based loans were used as markers for socioeconomic status of physicians' families of origin. We examined 2 outcomes: primary care practice and family medicine practice in 2010. RESULTS: Physicians who graduated from public schools were most likely to practice primary care and family medicine at graduating educational debt levels of $50,000 to $100,000 (2010 dollars; P <.01). This relationship between debt and primary care practice persisted when physicians from different socioeconomic status groups, as approximated by loan type, were examined separately. At higher debt, graduates' odds of practicing primary care or family medicine declined. In contrast, private school graduates were not less likely to practice primary care or family medicine as debt levels increased. CONCLUSIONS: High educational debt deters graduates of public medical schools from choosing primary care, but does not appear to influence private school graduates in the same way. Students from relatively lower income families are more strongly influenced by debt. Reducing debt of selected medical students may be effective in promoting a larger primary care physician workforce.

Medical school choice: what influences applicants?

BACKGROUND: Little is known about factors influencing applicants' choice of medical school, yet it is important that both the academic and non-academic needs of medical students are satisfied, and that medical schools attract students suited to the courses provided. Relevant evidence suggests that there are five main factors influencing choice: curriculum; reputation of the school; personal contact; location; and facilities. Aberdeen has the particular challenge of being the most northern medical school in the UK. METHOD: To address this challenge, and learning from the literature, a medical school open day was developed to showcase the medical school, the wider university and the city of Aberdeen. RESULTS: The main messages from this small study were that interactive events were more popular than static displays, and that applicants preferred to interact with student representatives rather than just hear about student life, suggesting that the opportunity to ask questions and hear the 'uncensored' version of what being a student is like are important. DISCUSSION: There are some generalisable messages about what prospective students want from an open day, which along with the prospectus and the website can contribute to informing choice. Further work is needed to identify what is critical in terms of first point of contact, and how much this influences the choice of medical school.