High dives and parallel plans: Relationships between medical student elective strategies and residency match outcomes.

BACKGROUND: Medical students are anxious about not getting a preferred residency position. We described elective patterns of two recent cohorts and examined associated match outcomes. METHODS: We conducted a retrospective review of the final-year electives of all students who participated in the residency match (first iteration) at one school for 2017 and 2018. We categorized elective patterns and associated them with aggregated match outcomes. We examined high-demand/low-supply (HDLS) disciplines separately. RESULTS: We described three elective patterns: High Dive, Parallel Plan(s), and No Clear Pattern. Many students had High Dive and Parallel Plans patterns; only a few showed No Clear Pattern. Match rates for High Dive and Parallel Plan patterns were high but many students matched to Family and Internal Medicine. When we separated out HDLS predominance, the match rate remained high but a significant number matched to disciplines in which they did not have a majority of electives. Most High Dive and Parallel Plan students who went unmatched did so with HDLS discipline electives. CONCLUSION: Many students chose High Dive and Parallel Plan strategies to both high-capacity and HDLS disciplines. Match rates were high for both patterns but students also matched to non-primary disciplines. Back-up planning may reside in the entire application, and not just electives selection.

CONTEXTE: Les étudiants en médecine sont anxieux à l'idée de ne pas obtenir le poste de résidence souhaité. Nous avons décrit les profils de stages à optionde deux cohortes récentes et examiné les résultats des jumelages associés. MÉTHODES: Nous avons mené une évaluation rétrospective des stages à option d'externat senior effectués par l'ensemble des étudiants qui ont participé au jumelage de résidence (premier tour) dans un programme de médecine pour 2017 et 2018. Nous avons classé les profils de stage et les avons associés aux résultats de jumelage agrégés. Nous avons examiné les disciplines à demande élevée et à offre faible (DEOF) séparément. RÉSULTATS: Nous avons décrit trois profils de stages à option : le « grand saut ¼, le plan parallèle B et aucun schéma précis. De nombreux étudiants présentaient des profils de type « grand saut ¼ et plans parallèles. Seuls quelques-uns ne présentaient aucun profil précis. Les taux de jumelage pour les schémas grand saut et plan parallèle étaient élevés, mais de nombreux étudiants étaient jumelés à Médecine familiale et Médecine interne. Quand nous avons séparé la prédominance DEOF, le taux de jumelage restait élevé, mais un nombre important d'étudiants obtenaient un poste dans des disciplines pour lesquelles ils n'avaient pas fait une majorité de stages à option. La plupart des étudiants avec profils « grand saut ¼ et plan parallèle qui n'avaient pas été jumelés avaient fait des stages à option dans des disciplines DEOF. CONCLUSION: De nombreux étudiants avaient choisi des stratégies « grand saut ¼ et plan parallèle pour des disciplines à haute capacité ainsi que des disciplines DEOF. Les taux de jumelage étaient élevés pour les deux profils, mais les étudiants se jumelaient également à des disciplines autres que leur premier choix. Une solution de rechange peut se trouver dans l'ensemble du processus, et non pas seulement dans la sélection des stages à option.

Heartfelt images: learning cardiac science artistically.

There are limited curricular options for medical students to engage in art-making during their training. Yet, it is known that art-making confers a variety of benefits related to learning. This qualitative study utilises a visual methodology to explore students' art-making in the context of the cardiovascular sciences. The existence of a multiyear repository of medical/dental student generated, cardiac-inspired art, collected over 6 years, provided the opportunity to explore the nature of the art made. The aim was to categorise the art produced, as well as the depth and breadth of understanding required to produce the art. The data set included a wide variety of titled art (paintings, photographs, sketches, sculptures, collages, poetry and music/dance). Systematic curation of the collection, across all media, yielded three main categories: anatomical renderings, physiology/pathophysiology renderings and kinesthetic creations (music/dance/tactile). Overall (medical and dental) student-generated art suggested a high level of content/process understanding, as illustrated by attention to scientific detail, integration of form and function as well as the sophisticated use of visual metaphor and word play. Dental students preferentially expressed their understanding of anatomy and physiology kinesthetically, creating art that required manual dexterity as well as through choreography and dance. Combining art-making with basic science curricular learning invited the medical and dentistry students to link their understanding to different modes of expression and a non-biomedical way of knowing. Subsequent incorporation of the student-generated cardiac art into lectures exposed the entire class to creative pictorial expressions of anatomy, physiology and pathophysiology.

Should efforts in favor of medical student diversity be focused during admissions or farther upstream?

PURPOSE: Traditional medical school admissions assessment tools may be limiting diversity. This study investigates whether the Multiple Mini-Interview (MMI) is diversity-neutral and, if so, whether applying it with greater weight would dilute the anticipated negative impact of diversity-limiting admissions measures. METHOD: Interviewed applicants to six medical schools in 2008 and 2009 underwent MMI. Predictor variables of MMI scores, grade point average (GPA), and Medical College Admission Test (MCAT) scores were correlated with diversity measures of age, gender, size of community of origin, income level, and self-declared aboriginal status. A subset of the data was then combined with variable weight assigned to predictor variables to determine whether weighting during the applicant selection process would affect diversity among chosen applicants. RESULTS: MMI scores were unrelated to gender, size of community of origin, and income level. They correlated positively with age and negatively with aboriginal status. GPA and MCAT correlated negatively with age and aboriginal status, GPA correlated positively with income level, and MCAT correlated positively with size of community of origin. Even extreme combinations of MMI and GPA weightings failed to increase diversity among applicants who would be selected on the basis of weighted criteria. CONCLUSIONS: MMI could not neutralize the diversity-limiting properties of academic scores as selection criteria to interview. Using academic scores in this way causes range restriction, counteracting attempts to enhance diversity using downstream admissions selection measures such as MMI. Diversity efforts should instead be focused upstream. These results lend further support for the development of pipeline programs.

Internal medicine residents' perceptions of the Mini-Clinical Evaluation Exercise.

BACKGROUND: The mini-clinical evaluation exercise (mini-CEX) is a 30 minute observed clinical encounter which allows assessment of a resident's clinical competence with feedback on their performance. AIMS: To assess residents' perceptions of the mini-CEX using qualitative methods. METHODS: After introducing the mini-CEX into the University of British Columbia's Internal Medicine Residency Program, a one hour semi-structured focus group with voluntary first and second year residents was undertaken. The focus groups were conducted by an independent moderator, audio-taped, and transcribed verbatim. Using a phenomenological approach, the comments made by the focus group participants were read independently by the three authors and organized into major themes. RESULTS: The major themes included Education, Assessment and Exam Preparation. Residents described a conflict between the mini-CEX's role as a method of assessment and its utility as an educational tool. During initial mini-CEX encounters, they perceived the assessment format as anxiety-provoking. Over time, they felt that the mini-CEX provided insight into their clinical competence. Participants believed that the mini-CEX experience would benefit them in preparation and successful completion of their national specialty exam. CONCLUSIONS: Residents' perceptions of the mini-CEX reflected a tension between the tool's dual roles of assessment and education.