A Capstone Course for Senior Medical Students: from Innovative Elective to Required Core Curriculum.

We describe our institution's development and implementation of our Capstone course from a small elective course to the only required fourth-year course. The course's structure evolved from mostly didactic to one including various workshops and simulation sessions. Course content has become increasingly specialty-specific. Implementation requires high faculty and resident involvement. Evaluations indicate a positive impact of the course on participants' self-reported confidence and residency preparedness. Assessment remains pass/fail with more specialty-specific questions. As steadily increasing numbers of medical schools are developing transition to residency courses, we share our Capstone course's evolution and lessons learned over the past nine years. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01880-2.

Piloting a National Curricular Resource for the Transition to Surgical Residency: Characteristics of Participating Schools and Their Students.

OBJECTIVE: To determine the extent to which U.S. Liaison Committee of Medical Education (LCME)-accredited medical schools chose to participate in piloting a national curricular resource, the American College of Surgeons/Association of Program Directors in Surgery/Association of Surgical Education Resident Prep Curriculum ("ACS-surgery-prep curriculum"), and implications of such participation for student access nationally to this resource. DESIGN: We examined the significance of school-level differences in ACS-surgery-prep curriculum pilot participation and student-level differences in curriculum access based on medical school attended in bivariate analysis. SETTING: U.S. medical schools choosing to participate in the ACS-surgery-prep curriculum through 2021. Students graduating from U.S. LCME-accredited medical schools in 2020-2021 were invited to complete the Association of American Medical Colleges 2021 Graduation Questionnaire (GQ). PARTICIPANTS: Our study included data for 2569 students intending surgery specialties (16% of 16,353 2021 GQ respondents) from ACS-surgery-prep curriculum pilot and non-pilot schools. RESULTS: Of 148 medical schools attended by 2021 GQ respondents, 93 (63%) were identified as ACS-surgery-prep curriculum pilot schools. Pilot participation varied by school region, community-based designation, and research intensity (each p < 0.05) but not by ownership or transition to residency (TTR) course requirements (each p > 0.05). Of 2569 GQ respondents nationally intending surgery specialties, 1697 (66%) attended an ACS-surgery-prep curriculum pilot school; this proportion did not vary by gender or race/ethnicity (each p > 0.05) but varied by students' school TTR course requirements (p < 0.001). Findings were similar among the 1059 students intending general surgery specialties specifically (41% of all 2569 students intending surgery specialties). CONCLUSIONS: Many U.S. LCME-accredited medical schools piloted this national TTR surgery curriculum. School-level characteristics associated with pilot participation can inform outreach efforts to encourage the participation of interested schools in piloting this TTR resource. With this curriculum distribution model, we observed no gender or racial/ethnic disparities in curriculum access nationally among students intending surgery specialties.

Graduating Medical Students' Perceptions of the COVID-19 Pandemic's Impact on Their Medical School Experiences and Preparation for Careers as Physicians: A National Study.

PURPOSE: The COVID-19 pandemic resulted in unprecedented changes to the medical education learning environment. The graduating class of 2021 was particularly affected. To better understand how students were affected, the authors explored positive and negative experiences described by graduating U.S. medical students. METHOD: Using the conceptual framework of affordances, the authors examined narrative responses to 2 new open-ended questions on the Association of American Medical Colleges 2021 Graduation Questionnaire in which graduating students described the pandemic's positive and negative effects on their medical school experiences and career preparation. Conventional content analysis was used to identify affordances and themes in responses. RESULTS: Of 16,611 Graduation Questionnaire respondents, 8,926 (54%) provided narrative responses. Of these 8,926 respondents, responses from 2,408 students (27%) were analyzed. Students described positive and negative perceptions of affordances, centering around virtual learning, social connection, and transition to residency. Fewer in-person and increased virtual clinical rotations offered students flexible scheduling, allowing them greater opportunity to explore academic and professional interests. Additionally, students' sense of isolation from their medical school was alleviated when schools exercised intentional open communication and student involvement in decision making. Although many described a diminished sense of preparedness for residency due to limited access to in-person clinical experiences and to assessing residencies largely through virtual away rotations and interviews, the sense of community, adaptability, and resiliency gained through varied activities reinforced students' professional identity and commitment to medicine during a time of much uncertainty. CONCLUSIONS: This national exploration of students' pandemic experiences highlights what students value as fundamental elements of medical education and student support and describes how innovation can improve long-standing practices. These findings, guided by students' insights, can help inform the work of educational leaders as they consider which innovations should remain to continue enhancing student learning, engagement, and well-being.

The Resident Readiness Survey: A National Process for Program Directors to Provide Standardized Feedback to Medical Schools About Their Graduates.

Background The process for program directors (PDs) to provide feedback to medical schools about their graduates' readiness for postgraduate year 1 (PGY-1) training is burdensome and does not generate national benchmarking data. Objective The Association of American Medical Colleges (AAMC) tested the feasibility of administering a standardized Resident Readiness Survey (RRS) to PDs nationally about their PGY-1 residents' preparedness for residency. Methods In 2020 and 2021, the AAMC invited PDs via email to complete RRSs for their PGY-1s who graduated from participating schools; the AAMC provided schools with reports of identified RRS data for their graduates. Outcome measures included school participation rates, PD response rates, PGY-1s' coverage rates (RRSs completed/RRSs PDs invited to complete), RRS completion time (time-stamp difference: RRS opening-submission), and participating schools' feedback about the process collected via AAMC evaluation questionnaires sent to school leaders. Chi-square tested significance of differences between proportions. Results School participation increased from 43.8% (2020: 77 of 176) to 72.4% (2021: 131 of 181). PD response rates, similar in both years overall (2020: 1786 of 2847 [62.7%]; 2021: 2107 of 3406 [61.9%]; P=.48), varied by specialty (P<.001; range 65 of 154 [42.2%], neurology; 109 of 136 [80.1%], internal medicine-pediatrics, both years combined). PGY-1s' coverage rates were similar (P=.21) in 2020 (5567 of 10 712 [52.0%]) and 2021 (9688 of 18 372 [52.7%]). RRS completion time averaged less than 3 minutes. Numerous school leaders reported that RRS data stimulated new, or supported ongoing, curricular quality improvement. Conclusions Administration of a standardized RRS to PDs nationally about PGY-1s preparedness for residency is feasible and will continue.

Is it Time for Competency-Based Education to Move Forward in Pharmacy Education?

Competency-based education is rapidly emerging as a paradigmatic shift in health professions education, as we grapple with the realities of ever-changing and increasing demands of society and health systems. While pharmacy educators are becoming more familiar with this paradigm, colleagues in medical education have been exploring models and methods of competency-based education for many years, and their experiences can be illuminating for us. The persistent question that drives continuous quality improvement in pharmacy education and the development of initiatives within American Association of Colleges of Pharmacy might be stated as "Is there a better (more effective, more efficient) way to prepare pharmacists (future and current) to meet the medication-related needs of the public?"

Entrustable professional activities as a training and assessment framework in undergraduate medical education: A case study of a multi-institutional pilot.

In 2014, the Association of American Medical Colleges (AAMC) published 13 Core Entrustable Professional Activities (EPAs) that graduating students should be able to perform with indirect supervision when entering residency. A ten-school multi-year pilot was commissioned to test feasibility of implementing training and assessment of the AAMC's 13 Core EPAs. In 2020-21, a case study was employed to describe pilot schools' implementation experiences. Teams from nine of ten schools were interviewed to identify means and contexts of implementing EPAs and lessons learned. Audiotapes were transcribed then coded by investigators using conventional content analysis and a constant comparative method. Coded passages were organized in a database and analyzed for themes. Consensus among school teams regarding facilitators of EPA implementation included team commitment to piloting EPAs; agreement that: proximal EPA adoption with curriculum reform facilitates EPA implementation; EPAs 'naturally fit' in clerkships and provided opportunity for schools to reflect on and adjust curricula and assessments; and inter-school collaboration bolstered individual school progress. Schools did not make high-stakes decisions about student progress (e.g., promotion, graduation), yet EPA assessment results complemented other forms of assessment in providing students with robust formative feedback about their progress. Teams had varied perceptions of school capability to implement an EPA framework, influenced by various levels of dean involvement, willingness, and capability of schools to invest in data systems and provide other resources, strategic deployment of EPAs and assessments, and faculty buy-in. These factors affected varied pace of implementation. Teams agreed on the worthiness of piloting the Core EPAs, but substantial work is still needed to fully employ an EPA framework at the scale of entire classes of students with enough assessments per EPA and with required data validity/reliability. Recommendations stemming from findings may help inform further implementation efforts across other schools adopting or considering an EPA framework.

Graduating Medical Students' Experiences with Away (In-Person and Virtual) Rotations During COVID-19: Analysis of the Association of American Medical Colleges (AAMC) 2021 Graduation Questionnaire (GQ).

OBJECTIVE: The COVID-19 pandemic disrupted students' opportunities for away rotations (ARs). Schools and specialty organizations innovated by supplementing in-person ARs (ipARs) with virtual ARs (vARs). We sought to determine how ipAR and vAR completion varied by intended specialty among 2021 graduates. DESIGN: Using de-identified Association of American Medical Colleges 2021 Graduation Questionnaire (GQ) data, we examined AR completion by specialty and community-based school attendance (among other variables) in univariate analysis and multivariable logistic regression models. SETTING: Students graduating from MD-degree granting U.S. medical schools were invited to complete the 2021 GQ, administered electronically on a confidential basis. PARTICIPANTS: Our study included data for 15,451 GQ respondents (74% of all 2021 graduates). RESULTS: Among GQ respondents, 18% (2,787/15,451) completed ARs: 8% (1,279/15,451) ipAR only, 8% (1,218/15,451) vAR only, and 2% (290/15,541) both. In univariate analysis, specialty and community-based school attendance (each p < 0.001), among other variables, were associated with ipAR and with vAR. In multivariable logistic regression, surgical specialties associated with greater odds of AR completion (vs. general surgery reference) included neurological surgery (ipAR: adjusted odds ratio [AOR]=1.9, 95% confidence interval [CI]=1.1-3.3; vAR AOR=3.1, 95% CI=1.9-4.9), ophthalmology (ipAR: AOR=2.3, 95% CI=1.6-3.3; vAR: AOR=2.5, 95% CI=1.7-3.7), orthopedic surgery (ipAR: AOR=2.5, 95% CI=1.8-3.4; vAR: AOR=12.4, 95%CI=9,2-16.5), otolaryngology (ipAR: AOR=1.8, 95% CI=1.2-2.8; vAR: AOR=4,8, 95% CI=3.4-6.9), plastic surgery (ipAR: AOR=2.1, 95% CI=1.2-3.5; vAR: AOR=13.9, 95% CI=9.3-20.7) and urology (ipAR: AOR=2,1, 95% CI=1.4-3.2; vAR: AOR=11.9, 95% CI=8.4-16.8). Community-based medical school attendance was also associated with greater odds of ipAR (AOR=4.6, 95% CI=3.1-6.7) and vAR (AOR=1.8, 95% CI=1.4-2.3). CONCLUSIONS: The prevalence of AR completion was low. Differences we observed by specialty and medical school type aligned well with recommended circumstances for ipARs for the class of 2021. Substantial specialty-specific differences in vAR completion suggest that various surgical specialties were among the early innovators in this regard.

Physicians' continuing medical education activities and satisfaction with their ability to stay current in medical information and practice: A cross-sectional study.

Background and Aims: Little is known about physicians' approaches to continuing medical education (CME) for continuing professional development despite the rapid evolution of CME offerings. We sought to identify the extent to which demographic, career, and experiential CME-activity variables were independently associated with physicians' satisfaction with their ability to stay current on medical information and practice. Methods: Using the 2019 Association of American Medical Colleges' National Sample Survey of Physicians data, we ran multivariable logistic regression models examining demographic, career, and experiential (participation in 11 CME activities in the past year) variables for their associations with physicians' satisfaction (satisfied vs. not satisfied/neutral) with their ability to stay current. Results: Of 5926 respondents, 90% (5341/5926) were satisfied with their ability to stay current. Significant (each two-sided p < 0.05) predictors of respondents who were satisfied included (among others) a surgery specialty (vs. primary care; adjusted odds ratio [AOR] = 1.41, 95% confidence interval [CI] = 1.06-1.88), an academic affiliation (vs. none; AOR = 1.35, 95% CI = 1.10-1.66), and participation (vs. no participation) in each of professional meetings (AOR = 1.31, 95% CI = 1.07-1.60) and journal-based CME (AOR = 1.29, 95% CI = 1.07-1.56). Respondents who self-identified as a race/ethnicity underrepresented in medicine (vs. white; AOR = 0.68, 95% CI = 0.48-0.97) and were between ages 40 and 49 years (vs. 50-59; AOR = 0.74; 95% CI = 0.58-0.94) were less likely to be satisfied. Gender, board certification status, and medical degree type did not independently predict satisfaction (each p > 0.05). Conclusion: We observed independent associations between physicians' satisfaction with their ability to stay current in medical information and practice and each specialty, academic affiliation, race/ethnicity, age, and CME activity type (for 2 of 11 examined). Findings may be relevant to organizations and institutions designing and implementing CME activities in the current context of COVID-19 pandemic-related in-person activity limitations and can inform targeted interventions addressing differences in the satisfaction we observed to better support physicians' CME.

Core Entrustable Professional Activities for Entering Residency: A National Survey of Graduating Medical Students' Self-Assessed Skills by Specialty.

BACKGROUND: The Association of American Medical Colleges described 13 Core Entrustable Professional Activities (EPAs) that graduating students should be prepared to perform under indirect supervision on day one of residency. Surgery program directors recently recommended entrustability in these Core EPAs for incoming surgery interns. We sought to determine if graduating students intending to enter surgery agreed they had the skills to perform these Core EPAs. STUDY DESIGN: Using de-identified, individual-level data collected from and about 2019 Association of American Medical Colleges Graduation Questionnaire respondents, latent profile analysis was used to group respondents based on their self-assessed Core EPAs skills' response patterns. Associations between intended specialty, among other variables, and latent profile analysis group were assessed using independent sample t -tests and chi-square tests and multivariable logistic regression methods. RESULTS: Among 12,308 Graduation Questionnaire respondents, latent profile analysis identified 2 respondent groups: 7,863 (63.9%) in a high skill acquisition agreement (SAA) group and 4,445 (36.1%) in a moderate SAA group. Specialty was associated with SAA group membership (p < 0.001), with general surgery, orthopaedic surgery, and emergency medicine respondents (among others) overrepresented in the high SAA group. In the multivariable logistic regression models, each of anesthesiology, ophthalmology, pediatrics, psychiatry, and radiology (vs general surgery) specialty intention was associated with a lower odds of high SAA group membership. CONCLUSION: Graduating students' self-assessed Core EPAs skills were higher for those intending general surgery than for those intending some other specialties. Our findings can inform collaborative efforts to ensure graduates' acquisition of the skills expected of them at the start of residency.

Comparing Entrustment Decision-Making Outcomes of the Core Entrustable Professional Activities Pilot, 2019-2020.

Importance: Gaps in readiness for indirect supervision have been identified for essential responsibilities encountered early in residency, presenting risks to patient safety. Core Entrustable Professional Activities (EPAs) for entering residency have been proposed as a framework to address these gaps and strengthen the transition from medical school to residency. Objective: To assess progress in developing an entrustment process in the Core EPAs framework. Design, Setting, and Participants: In this quality improvement study in the Core EPAs for Entering Residency Pilot, trained faculty made theoretical entrustment determinations and recorded the number of workplace-based assessments (WBAs) available for each determination in 2019 and 2020. Four participating schools attempted entrustment decision-making for all graduating students or a randomly selected subset of students. Deidentified, individual-level data were merged into a multischool database. Interventions: Schools implemented EPA-related curriculum, WBAs, and faculty development; developed systems to compile and display data; and convened groups to make theoretical summative entrustment determinations. Main Outcomes and Measures: On an EPA-specific basis, the percentage of students for whom an entrustment determination could be made, the percentage of students ready for indirect supervision, and the volume of WBAs available were recorded. Results: Four participating schools made 4525 EPA-specific readiness determinations (2296 determinations in 2019 and 2229 determinations in 2020) for 732 graduating students (349 students in 2019 and 383 students in 2020). Across all EPAs, the proportion of determinations of "ready for indirect supervision" increased from 2019 to 2020 (997 determinations [43.4%] vs 1340 determinations [60.1%]; 16.7 percentage point increase; 95% CI, 13.8-19.6 percentage points; P < .001), as did the proportion of determinations for which there were 4 or more WBAs (456 of 2295 determinations with WBA data [19.9%] vs 938 [42.1%]; 22.2 percentage point increase; 95% CI, 19.6-24.8 percentage points; P < .001). The proportion of EPA-specific data sets considered for which an entrustment determination could be made increased from 1731 determinations (75.4%) in 2019 to 2010 determinations (90.2%) in 2020 (14.8 percentage point increase; 95% CI, 12.6-16.9 percentage points; P < .001). On an EPA-specific basis, there were 5 EPAs (EPA 4 [orders], EPA 8 [handovers], EPA 10 [urgent care], EPA 11 [informed consent], and EPA 13 [patient safety]) for which few students were deemed ready for indirect supervision and for which there were few WBAs available per student in either year. For example, for EPA 13, 0 of 125 students were deemed ready in 2019 and 0 of 127 students were deemed ready in 2020, while 0 determinations in either year included 4 or more WBAs. Conclusions and Relevance: These findings suggest that there was progress in WBA data collected, the extent to which entrustment determinations could be made, and proportions of entrustment determinations reported as ready for indirect supervision. However, important gaps remained, particularly for a subset of Core EPAs.

Entrustment Decision Making in the Core Entrustable Professional Activities: Results of a Multi-Institutional Study.

PURPOSE: In 2014, the Association of American Medical Colleges defined 13 Core Entrustable Professional Activities (EPAs) that all graduating students should be ready to do with indirect supervision upon entering residency and commissioned a 10-school, 5-year pilot to test implementing the Core EPAs framework. In 2019, pilot schools convened trained entrustment groups (TEGs) to review assessment data and render theoretical summative entrustment decisions for class of 2019 graduates. Results were examined to determine the extent to which entrustment decisions could be made and the nature of these decisions. METHOD: For each EPA considered (4-13 per student), TEGs recorded an entrustment determination (ready, progressing but not yet ready, evidence against student progressing, could not make a decision); confidence in that determination (none, low, moderate, high); and the number of workplace-based assessments (WBAs) considered (0->15) per determination. These individual student-level data were de-identified and merged into a multischool database; chi-square analysis tested the significance of associations between variables. RESULTS: The 2,415 EPA-specific determinations (for 349 students by 4 participating schools) resulted in a decision of ready (n = 997/2,415; 41.3%), progressing but not yet ready (n = 558/2,415; 23.1%), or evidence against student progression (n = 175/2,415; 7.2%). No decision could be made for the remaining 28.4% (685/2,415), generally for lack of data. Entrustment determinations' distribution varied across EPAs (chi-square P < .001) and, for 10/13 EPAs, WBA availability was associated with making (vs not making) entrustment decisions (each chi-square P < .05). CONCLUSIONS: TEGs were able to make many decisions about readiness for indirect supervision; yet less than half of determinations resulted in a decision of readiness to perform this EPA with indirect supervision. More work is needed at the 10 schools to enable authentic summative entrustment in the Core EPAs framework.

Core Entrustable Professional Activities (EPAs) and the Transition from Medical School to Residency: the Postgraduate Year One Resident Perspective.

INTRODUCTION: The Association of American Medical Colleges (AAMC) proposed thirteen core Entrustable Professional Activities (EPAs) that all graduates should be able to perform under indirect supervision upon entering residency. As an underlying premise is that graduates ready to do so will be better prepared to transition to the responsibilities of residency, we explored the relationship between postgraduate year (PGY)-1 residents' self-assessed preparedness to perform core EPAs under indirect supervision at the start of residency with their ease of transition to residency. METHODS: Using response data to a questionnaire administered in September 2019 to PGY-1 residents who graduated from AAMC core EPA pilot schools, we examined between-group differences and independent associations for each of PGY-1 position type, specialty, and "EPA-preparedness" score (proportion of EPAs the resident reported as prepared to perform under indirect supervision at the start of residency) and ease of transition to residency (from 1 = much harder to 5 = much easier than expected). RESULTS: Of 274 questionnaire respondents (19% of 1438 graduates), 241 (88% of 274) had entered PGY-1 training and completed all questionnaire items of interest. EPA-preparedness score (mean 0.71 [standard deviation 0.26]) correlated with ease of transition (3.1 [0.9]; correlation = .291, p < .001). In linear regression controlling for specialty (among other variables), EPA-preparedness score (ß-coefficient 1.08; 95% confidence interval .64-1.52; p < .001) predicted ease of transition to residency. CONCLUSION: Graduates who felt prepared to perform many of the core EPAs under indirect supervision at the start of PGY-1 training reported an easier-than-expected transition to residency. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01370-3.

Revisiting the Core Entrustable Professional Activities for Entering Residency.

The Core EPAs for Entering Residency Pilot project aimed to test the feasibility of implementing 13 entrustable professional activities (EPAs) at 10 U.S. medical schools and to gauge whether the use of the Core EPAs could improve graduates' performance early in residency. In this manuscript, the authors (members of the pilot institutions and Association of American Medical Colleges staff supporting the project evaluation) describe the schools' capacity to collect multimodal evidence about their students' performance in each of the Core EPAs and the ability of faculty committees to use those data to make decisions regarding learners' readiness for entrustment. In reviewing data for each of the Core EPAs, the authors reflected on how each activity performed as an EPA informed by how well it could be assessed and entrusted. For EPAs that did not perform well, the authors examined whether there are underlying practical and/or theoretical issues limiting its utility as a measure of student performance in medical school.

The Physician-Investigator Workforce: Looking Ahead.

Support of the U.S. health professions investigator workforce is critically important to the continued advancement of health care nationally. Physician-investigators comprise one segment of this health professions investigator workforce, which also includes investigators in the nursing, pharmacy, and dentistry professions, and others. Among physician health professionals in particular, the term "physician-investigator" has been described as encompassing physicians engaged in research in various ways including "clinical researchers" (physicians with clinical duties who do clinical, patient-centered research), "clinician-scientists" (physicians with clinical roles who perform research in laboratories or using computational tools), and "physician-scientists" (physicians focused on research with little or no clinical activity). Broadly defined, physician-investigators are included in various groups of researchers described in several articles recently published in Academic Medicine; these articles provide details on a range of approaches, with supporting outcomes data, being taken to train, support, and retain physicians in the health professions investigator workforce. The authors of this commentary examine selected literature, including several articles in this issue among others, along with Association of American Medical Colleges data, to offer observations about programs that train physician-investigators. Evidence-informed single-program approaches for early-career researchers can sustain continued research interest and foster the career development of the emerging physician-investigator workforce. Collaborative multi-institutional approaches offer the benefit of multisite work to power outcomes studies and to increase generalizability beyond a specific institutional program. System-wide institutional approaches may be particularly critical in supporting physician-investigators across all career stages. Although the articles discussed in this commentary are largely (although not exclusively) focused on various initiatives and programs designed to develop and sustain the physician-investigator workforce, such initiatives and programs may have value in addressing shared challenges of developing, supporting, and retaining the broader investigator workforce across all health professions.

MD-PhD Program Graduates' Engagement in Research: Results of a National Study.

PURPOSE: To determine if specialty, among other professional development and demographic variables, predicted MD-PhD program graduates' research engagement. METHOD: The authors merged the 2015 Association of American Medical Colleges (AAMC) National MD-PhD Program Outcomes Survey database with selected data from the AAMC Student Records System, Graduation Questionnaire, and Graduate Medical Education (GME) Track Resident Survey. At the person level, they tested variables of interest for independent associations with MD-PhD graduates' research engagement using chi-square, Pearson correlations, and analysis of variance tests and logistic and linear regressions. RESULTS: Of 3,297 MD-PhD graduates from 1991-2010 who were no longer in GME training in 2015, 78.0% (2,572/3,297) reported research engagement. In models controlling for several variables, a neurology (vs internal medicine; adjusted odds ratio [AOR]: 2.48; 95% confidence interval [CI]: 1.60-3.86) or pathology (vs internal medicine; AOR: 1.89; 95% CI: 1.33-2.68) specialty, full-time faculty/research scientist career intention at graduation (vs all other career intentions; AOR: 3.04; 95% CI: 2.16-4.28), and ≥ 1 year of GME research (vs no GME research year[s]; AOR: 2.45; 95% CI: 1.96-3.06) predicted a greater likelihood of research engagement. Among graduates engaged in research, the mean percentage of research time was 49.9% (standard deviation 30.1%). Participation in ≥ 1 year of GME research (beta [ß] coefficient: 7.99, P < .001) predicted a higher percentage of research time, whereas a radiation oncology (ß: -28.70), diagnostic radiology (ß: -32.92), or surgery (ß: -29.61) specialty, among others, predicted a lower percentage of research time (each P < .001 vs internal medicine). CONCLUSIONS: Most MD-PhD graduates were engaged in research, but the extent of their engagement varied substantially among specialties. Across specialties, participation in research during GME may be one factor that sustains MD-PhD graduates' subsequent early- to midcareer research engagement.

Developing an Entrustment Process: Insights from the AAMC CoreEPA Pilot.

One of the main goals of the CoreEPA pilot has been to determine the feasibility of developing a process to make summative entrustment decisions regarding entrustable professional activities (EPAs). Five years into the pilot, we report results of a research study we conducted to explore approaches to the entrustment process undertaken by our ten participating schools. We sought to identify the choices that participating schools made regarding the entrustment process and why these decisions were made. We are sharing these results, highlighting ongoing challenges that were identified with the intent of helping other medical schools that are moving toward EPA-based assessment. We conducted semi-structured interviews with representatives of all 10 medical schools in the CoreEPA pilot to understand their choices in designing the entrustment process. Additional information was obtained through follow-up communication to ensure completeness and accuracy of the findings. Several common themes are described. Our results indicate that, while approaches to the entrustment process vary considerably, all schools demonstrated consistent adherence to the guiding principles of the pilot. Several common barriers to the entrustment process emerged, and there was a consensus that more experience is needed with the process before consequential entrustment decisions can be made. The CoreEPA pilot schools continue to address challenges identified in implementing entrustment processes and making entrustment decisions for our students graduating in the Class of 2020.

Is Dedicated Research Time During Surgery Residency Associated With Surgeons' Future Career Paths?: A National Study.

OBJECTIVE: We examined associations between participation in ≥1 year of research during general surgery residency and each of full-time academic-medicine faculty appointment and mentored-K and/or Research Project Grant (RPG, including R01 and other) awards. SUMMARY BACKGROUND DATA: Many surgeons participate in ≥1 year of research during residency; however, the relationship between such dedicated research during general surgery residency and surgeons' career paths has not been investigated in a national study. METHODS: We analyzed deidentified data through August 2014 from the Association of American Medical Colleges, American Board of Medical Specialties, and the National Institutes of Health Information for Management, Planning, Analysis, and Coordination II grants database for 1997 to 2004 US medical-school graduates who completed ≥5 years of general surgery graduate medical education (GME) and became board-certified surgeons. Using multivariable logistic regression models, we identified independent predictors of faculty appointment and K/RPG award, reporting adjusted odds ratios (AOR) and 95% confidence intervals (CI) significant at P < 0.05. RESULTS: Of 5328 board-certified surgeons, there were 1848 (34.7%) GME-research participants, 1658 (31.1%) faculty appointees, and 58 (1.1%) K/RPG awardees. Controlling for sex, debt, MD/PhD graduation, and other variables, GME-research participants were more likely to have received faculty appointments (AOR 1.790; 95% CI 1.573-2.037) and federal K/RPG awards (AOR 4.596; 95% CI 2.355-8.969). CONCLUSIONS: Nationally, general surgery GME-research participation was independently associated with faculty appointment and K/RPG award receipt. These findings serve as benchmarks for general surgery residency programs aiming to prepare trainees for careers as academicians and surgeon-scientists.

Competing Risks Analysis of Promotion and Attrition in Academic Medicine: A National Study of U.S. Medical School Graduates.

PURPOSE: Competing risk methodology was used to identify variables associated with promotion and attrition of newly appointed full-time instructors or assistant professors in U.S. MD-granting medical schools. METHOD: A national sample of U.S. MD-granting medical school graduates in calendar years 1997-2004 who received initial full-time instructor or assistant professor appointments from January 1, 2000 through December 31, 2012, was followed through December 31, 2013. Adjusted proportional subdistribution hazard ratios (aSHRs) measured the effects of demographic, educational, and institutional variables on promotion and attrition. RESULTS: The final study sample included 27,219 full-time instructors (n = 10,470) and assistant professors (n = 16,749). In all models (entire sample and stratified by initial rank), faculty who reported all other (vs. full-time faculty) career intentions at graduation and were underrepresented racial/ethnic minority (vs. white) faculty had lower aSHRs for promotion and greater aSHRs for attrition, whereas research-intensive (vs. non-research-intensive) medical school graduates, faculty at schools without a tenure track, and mentored K awardees had greater aSHRs for promotion and lower aSHRs for attrition. In all models, faculty with ≥ $100,000 (vs. no) debt at graduation had greater aSHRs for attrition. Among instructors, women had lower aSHRs for attrition than men, but among assistant professors, women had greater aSHRs for attrition. CONCLUSIONS: This study adds new knowledge about career trajectories of academic medicine faculty initially appointed as full-time instructors. Career development interventions and research mentoring during and after medical school and debt reduction programs could help increase academic medicine faculty retention and promotion.