Privileges, Immunities, and Affirmative Action in Medical Education.

In Students for Fair Admissions v. President and Fellows of Harvard College and Students for Fair Admissions v. University of North Carolina, the Supreme Court ruled that affirmative action in university admissions, in which an applicant of a particular race or ethnicity receives a plus factor, is unconstitutional. This ruling was based on both the Equal Protection Clause of the Fourteenth Amendment and Title VI of the Civil Rights Act of 1964. This article argues that a more natural fit as the basis for constitutional analysis would be a different clause in the Fourteenth Amendment, the Privileges or Immunities Clause. In the article, a legal analysis based on the clause is applied to medical school admissions. Depending on whether a fundamental rights reading or an antidiscrimination (equality) reading of the clause is applied, opposite conclusions are reached on the constitutionality of affirmative action in medical school admissions. This analysis demonstrates why affirmative action in admissions--in this case medical school admissions, which directly affect the composition of the Nation's physician workforce--is a complex and difficult constitutional question.

Knowledge sharing among academics from Egyptian medical schools during the COVID-19 pandemic.

BACKGROUND: Sharing knowledge among scientists during global health emergencies is a critical issue. So, this study investigates knowledge-sharing behavior and attitude among staff members of 19 Medical schools in Egyptian universities during the COVID-19 pandemic. METHODS: Across-sectional study was conducted using a web-based questionnaire. A total of 386 replies from the 10,318 distributed questionnaires were analyzed. Descriptive statistics were computed using SPSS (version 22) to summarize the demographic data. Inferential statistics such as the independent and chi-square test were used to achieve the study aims. RESULTS: More than half of the respondents (54.4%) indicated that their levels of knowledge of COVID-19 were good. Most participants (72.5%) reported that scientific publications and international websites were the most reliable source of their knowledge concerning COVID-19. More than 46% stated they sometimes share their knowledge. The lack of time to share and organizational culture were the most important factors that could affect their knowledge sharing. Additionally, about 75% of participants shared knowledge about treatment.

The association between applicant gender and racial or ethnic identity and success in the admissions process at a Canadian medical school: a prospective cohort study.

Background: Canadian data suggests that Black candidates may be less successful than other groups when applying to medical school. We sought to comprehensively describe the racial and/or ethnic identity, gender identity, sexual orientation, and ability of applicants to a single Canadian medical school. We also examined for an association between success at each application stage and applicant gender and racial identity. Methods: Class of 2024 applicants to a single Canadian medical school were invited to complete a demographics survey. The odds of achieving each application stage (offered an interview, offered a position, and matriculating) were determined for each demographic group. Results: There were 595 participants (32.4% response rate). The demographics of the applicant pool and matriculating class were similar. There was no difference in interview offers or matriculation between BIPOC and white candidates. Cisgender men were overrepresented in interviews compared to cisgender women (OR 0.64; 95%CI 0.43-0.95; p = 0.03) but not in matriculation. BIPOC cisgender women received more interview invitations compared to other groups (OR 2.74, 95%CI 1.20-6.25; p = 0.02). Conclusions: Differences in applicant success for differing demographic groups were most pronounced being offered an interview.

Contexte: Des données canadiennes portent à croire que les candidats noirs peuvent avoir moins de succès que d'autres groupes lorsqu'ils postulent à une faculté de médecine. Nous avons cherché à décrire de manière exhaustive l'identité raciale et/ou ethnique, l'identité de genre, l'orientation sexuelle et les capacités des candidats à une seule faculté de médecine canadienne. Nous avons également cherché à établir un lien entre la réussite à chaque étape de la candidature et le sexe et l'identité raciale du candidat ou de la candidate. Méthodes: Les candidats de la promotion 2024 à une faculté de médecine canadienne ont été invités à répondre à une enquête démographique. Les chances d'atteindre chaque étape de la candidature (entrevue offerte, place offerte et inscription) ont été déterminées pour chaque groupe démographique. Résultats: Il y a eu 595 participants (taux de réponse de 32,4 %). Les caractéristiques démographiques des candidats à l'admission et des étudiants admis étaient similaires. Il n'y avait pas de différence entre les candidats blancs et les candidats autochtones, noirs et de couleur (PANDC) en ce qui concerne les offres d'entrevue ou les admissions. Les hommes cisgenres étaient surreprésentés dans les entrevues par rapport aux femmes cisgenres (OR 0,64; 95%CI 0,43-0,95 ; p=0,03) mais pas dans les admissions. Les femmes cisgenres appartenant au groupe des PANDC ont reçu plus d'offres d'entrevue que les autres groupes (OR 2,74, 95%CI 1,20-6,25 ; p=0,02). Conclusions: Les différences les plus marquées dans la réussite des candidats à l'admission parmi les différents groupes démographiques étaient quant aux offres d'entrevue.

Scoping review of current challenges and circumstances impacting Indigenous applications to Canadian medical schools.

Introduction: Considering the relevant 2015 Truth and Reconciliation Commission recommendations, this paper reviews the current state of Canadian medical schools' Indigenous admissions processes and explores continued barriers faced by Indigenous applicants. Methods: A summary of literature illustrating disadvantages for Indigenous applicants of current admissions tools is presented. A grey literature search of current admissions requirements, interview processes, and other relevant data from each medical school was performed. Tables comparing differences in their approaches are included. A calculation of Indigenous access to medical school seats compared to the broader Canadian population was conducted. Gaps in execution are explored, culminating in a table of recommendations. Results: Despite formal commitments to reduce barriers, Indigenous applicants to medical school in Canada still face barriers that non-Indigenous applicants do not. Most programs use tools for admission known to disadvantage Indigenous applicants. Indigenous applicants do not have equitable access to medical school seats. Facilitated Indigenous stream processes first ensure Indigenous applicants meet all minimum requirements of Canadian students, and then require further work. Discussion: Seven years after the Truth and Reconciliation Commission called on Canadian universities and governments to train more Indigenous health care providers, there has been limited progress to reduce the structural disadvantages Indigenous students face when applying to medical school. Based on best practices observed in Canada and coupled with relevant Indigenous-focused literature, recommendations are made for multiple stakeholders. Conclusions: The study was limited by the data available on numbers of Indigenous applicants and matriculants. Where available, data are not encouraging as to equitable access to medical school for Indigenous populations in Canada. These findings were presented at the International Congress of Academic Medicine 2023 Conference, April 2023, Quebec City, Canada.

Introduction: Compte tenu des recommandations pertinentes de la Commission de vérité et réconciliation de 2015, cet article examine l'état actuel des processus d'admission des Autochtones dans les facultés de médecine canadiennes et explore les obstacles persistants auxquels sont confrontés les candidats autochtones. Méthodes: Un résumé de la littérature illustrant les désavantages des outils d'admission actuels pour les candidats autochtones est présenté. Une recherche de la littérature grise a été effectuée sur les exigences d'admission actuelles, les processus d'entrevue et d'autres données pertinentes de chaque faculté de médecine. Des tableaux comparant les différences entre leurs approches sont inclus. Un calcul de l'accès des Autochtones aux places dans les facultés de médecine par rapport à l'ensemble de la population canadienne a été effectué. Les lacunes dans l'exécution sont explorées, aboutissant à un tableau de recommandations. Résultats: Malgré les engagements officiels visant à réduire les obstacles, les candidats autochtones qui appliquent aux facultés de médecine canadiennes se heurtent encore à des obstacles auxquels les candidats non autochtones ne sont pas confrontés. La plupart des programmes utilisent des outils d'admission connus pour désavantager les candidats autochtones. Les candidats autochtones n'ont pas un accès équitable aux places dans les facultés de médecine. Des processus d'accès facilités pour les autochtones permettent d'abord de s'assurer que les candidats autochtones satisfont à toutes les exigences minimales des étudiants canadiens, puis nécessitent d'autres travaux. Discussion: Sept ans après que la Commission de vérité et réconciliation ait demandé aux universités et aux gouvernements canadiens de former davantage de prestataires de soins en santé autochtone, les progrès réalisés pour réduire les désavantages structurels auxquels les étudiants autochtones sont confrontés lorsqu'ils posent leur candidature à une faculté de médecine sont limités. Sur la base des meilleures pratiques observées au Canada et de la littérature autochtone pertinente, des recommandations sont formulées à l'intention de multiples parties prenantes. Conclusions: L'étude est limitée par les données disponibles sur le nombre de candidats et d'étudiants autochtones. Lorsqu'elles sont disponibles, les données ne sont pas encourageantes en ce qui concerne l'accès équitable aux études de médecine pour les populations autochtones au Canada. Ces conclusions ont été présentées lors de l'édition 2023 du Congrès international de médecine universitaire (CIMU) qui s'est déroulé en avril 2023 dans la ville de Québec, au Canada.

Needs and gaps of faculty development for medical schools.

PURPOSE: Current faculty development (FD) programs are mostly limited to medical education and often lack a comprehensive and systematic structure. Therefore, the present study aimed to explore the current status and needs of FD programs in medical schools to provide a basis for establishing FD strategies. METHODS: We conducted an online survey of medical school FD staff and professors regarding FD. Frequency, regression, and qualitative content analyses were conducted. FD programs were categorized into the classification frameworks. RESULTS: A total of 17 FD staff and 256 professors at 37 medical schools participated. There are gaps between the internal and external FD programs offered by medical schools and their needs, and there are gaps between the programs the professors participated in and their needs. Recent internal and external FD programs in medical schools have focused on educational methods, student assessment, and education in general. Medical schools have a high need for leadership and self-development, and student assessment. Furthermore, professors have a high need for leadership and self-development, and research. The number of participants, topics, and needs of FD programs varied depending on the characteristics of individual professors. CONCLUSION: Medical schools should expand their FD programs to meet the needs of individuals and the changing demands of modern medical education. The focus should be on comprehensive and responsive programs that cover various topics, levels, and methods. Tailored programs that consider professors' professional roles, career stages, and personal interests are essential for effective FD.

Differences in fear of failure and college adjustment by type of medical school entrance extrinsic motivation using a latent profile analysis.

PURPOSE: The decision to enroll in medical school is largely influenced by extrinsic motivation factors. It is necessary to explore the factors that affect pre-med students' motivation to enter medical school and their college adjustment, and to develop measures to help them adjust. METHODS: A total of 407 pre-med students were surveyed regarding their motivation to enter medical school, fear of failure, and college adjustment. We analyzed the latent profiles of extrinsic motivation factors using latent profile analysis. One-way analysis of variance was conducted to examine the differences in fear of failure and adaptation to university life according to the latent groups. RESULTS: After analyzing the latent profiles of entrance motivation, three latent profiles were selected. They were divided into high, medium, and low extrinsic motivation groups. Three profiles scored the highest on job security, followed by good grades and social status. Sophomores were more likely to be high extrinsic motivators than freshmen were. Fear of failure was high in the group with high extrinsic motivation, and adaptation to college life was highest in the group with low extrinsic motivation. CONCLUSION: Job security was the most important extrinsic motivator for entering medical school, and extrinsic entrance motivation influenced fear of failure and college adjustment. Given the high level of extrinsic motivation among medical students, it is meaningful to analyze the extrinsic motivation profile of entering medical students and how it affects failure motivation and college adjustment.

Exploring the responses of preclinical medical students and professors to flipped learning for the development of clinical reasoning.

PURPOSE: This study developed and implemented case-based flipped learning using illness script worksheets and investigated the responses of preclinical students and professors to the intervention in terms of its effectiveness, design, and implementation. METHODS: The study was conducted at a medical school in Korea, where the "clinical reasoning method" course, originally a lecture-oriented course, was redesigned into a flipped learning. In total, 42 second-year medical students and 15 professors participated in this course. After the class, online surveys were conducted, and a focus group interview was held with seven students to explore the students' experiences in more detail. RESULTS: In total, 37 students and seven professors participated in the survey. The mean score for all items is 3.12/4 for the student survey and 3.43/4 for the professor survey. The focus group interview results were categorized as the beneficial aspects and challenges for the development of clinical reasoning. CONCLUSION: The findings indicated that their responses to the intervention were generally positive, and it is thought to be an effective instructional method for fostering clinical reasoning skills in preclinical medical students.

The Impact and Implications of the Flexner Report on Medical Education in Korea.

The recent debate surrounding the expansion of enrollment in Korean medical schools has reignited interest in the Flexner Report, published in the United States in 1910. Historically, medical education in the United States transitioned from small proprietary schools to university-affiliated institutions, emphasizing basic science and clinical experience. The Flexner Report advocated for scientific medicine and led to significant reforms in medical education, including standardization of curricula and strengthened admission requirements. The influence of this report extended to Korean medical education, shaping its curriculum, accreditation system, and emphasis on academic excellence. The expansion of medical school enrollment has led to a crucial dilemma. Should we prioritize the training of physicians who provide practical medical services or continue to emphasize academic medicine as we do now? There has been insufficient discussion of the individualized curricula, necessary investments, and societal efforts to accommodate these changes. It is imperative to move beyond mere enrollment expansion debates and collectively determine the future trajectory of Korean medical education, devising actionable plans to achieve overarching goals.

Doctoral theses at the medical faculty of Tunis from 2015 to 2017: Scientific publication rates and associated factors.

INTRODUCTION: Medical doctoral thesis publication is a way to ensure knowledge dissemination and to increase the scientific research visibility. AIM: To determine thesis-related publication's rate at the Faculty of Medicine of Tunis (FMT), and identify associated factors. METHODS: Cross-sectional retrospective study including medical theses registered at the FMT over the study period (2015-2017). All publications related to the defended thesis were collated by scanning Scopus and Google scholar databases, up to April 2022. Binary logistic regression was performed to assess associated factors to publication. Adjusted Odds Ratios (AOR) were presented with 95% confidence interval. RESULTS: Out of 878 defended theses, 11.8% (n=104) were published. Out of 130 publications in total, 90 (69.2%) interested Scopus-indexed journals with a mean Scimago Journal Rank (SJR) of 0.70. The publication was in English in 73.1% of cases. The median time between the thesis defense and the first scientific publication was 15 months. In multivariable analysis, associated factors to "at least one thesis-related publication" were the resident status of the candidate (AOR=2.35 [1.2-4.7]) and the grade assistant professor of the thesis supervisor (AOR=2.48 [1.1-5.6]). CONCLUSION: Compared to the number of defended theses, the thesis-related publication's rate at the FMT is relatively low. Thus, enhanced support for doctoral students to optimize their engagement in research and to consequently promote scientific publication is highly recommended.

Historical Inequities in Medical Education - Commitment to Opportunity, Diversity, and Equity at the University of Hawai'i School of Medicine.

Medical education in the US has contributed to institutionalized racism through historically exclusionary practices, which has led to health disparities and inequities in health care today. The 1910 Flexner report, which favored schools with greater resources, led to the closure of nearly half of medical schools in the Us, which were mostly small schools located in rural communities that served economically disadvantaged, ethnic minority, and female populations. Closing these schools ultimately limited the availability of physicians willing to serve disadvantaged and minority populations in impoverished and underserved communities. In order to transform medical education to be more equitable, medical schools must be proactive in opportunity, diversity, and equity efforts. This not only includes efforts in admissions and faculty hiring, but also curricula related to social and health disparities, interracial interactions between students and faculty, and service learning activities that engage and work with marginalized communities. The University of Hawai'i John A. Burns School of Medicine has a longstanding commitment to diversity, which is integral to the school's mission. Providing opportunities to underserved populations has been a priority since establishment of the school. As one of the most diverse univeristies in the US, the school of medicine continues to focus on opportunity, diversity, and equity priorities in both its strategic planning and overall mission.

Perceptions of the Minority Tax Experienced by Faculty and Students Underrepresented in Medicine at the University of Wisconsin.

INTRODUCTION: The minority tax in academic medicine can be defined as the additional responsibilities placed on underrepresented in medicine (URiM) faculty, staff, and students in the name of diversity. Often this looks like participating in additional diversity committees, recruitment efforts, and mentorship activities. These extra responsibilities often are not recognized, not included in promotions, and take time from other clinical, research, and traditional scholarly responsibilities. OBJECTIVES: There is a significant gap in the literature examining the experiences of URiM-identifying faculty and students in relation to the minority tax. Our goal was to do a quality improvement project to explore this gap through interviewing URiM-identifying faculty and conducting focus groups with URiM-identifying students, with the goal of making recommendations to help reduce the minority tax burdens to this community. METHODS: A scoping literature review on the minority tax burden in academic medicine was used to inform the development of questions to use in focus groups of URiM University of Wisconsin School of Medicine and Public Health (UWSMPH) students and interviews of URiM UWSMPH faculty members. After development of a facilitation guide, we conducted three 1-hour focus groups with 14 students who identified as URiM and did eight 30-minute interviews with faculty who identified as URiM. A codebook was generated using inductive analysis after reviewing transcripts. Coding was performed independently with 2 separate coders in order to ensure inter-coder reliability. RESULTS: Ninety-one percent of students and 62.5% of faculty endorsed experiencing the minority tax at UWSMPH. Faculty also reported increasing feelings of support due to UWSMPH programs that support URiM faculty. Students reported the minority tax being central to their role as URiM students. Both students and faculty reported that the additional burdens of the minority tax took time away from traditional scholarly activities that were essential for promotion (faculty) or residency (students). CONCLUSIONS: The minority tax burden experienced by URiM faculty and students may negatively affect their careers, as they note spending more time on activities that may not be valued for promotion. It is essential to address these burdens in order to achieve equity within the medical institution.

Students' and junior doctors' perspectives on radiology education in medical school: a qualitative study in the Netherlands.

BACKGROUND: Modern medicine becomes more dependent on radiologic imaging techniques. Over the past decade, radiology has also gained more attention in the medical curricula. However, little is known with regard to students' perspectives on this subject. Therefore, this study aims to gain insight into the thoughts and ideas of medical students and junior doctors on radiology education in medical curricula. METHODS: A qualitative, descriptive study was carried out at one medical university in the Netherlands. Participants were recruited on social media and were interviewed following a predefined topic list. The constant comparative method was applied in order to include new questions when unexpected topics arose during the interviews. All interviews were transcribed verbatim and coded. Codes were organized into categories and themes by discussion between researchers. RESULTS: Fifteen participants (nine junior doctors and six students) agreed to join. From the coded interviews, four themes derived from fifteen categories arose: (1) The added value of radiology education in medical curricula, (2) Indispensable knowledge on radiology, (3) Organization of radiology education and (4) Promising educational innovations for the radiology curriculum. CONCLUSION: This study suggests that medical students and junior doctors value radiology education. It provides insights in educational topics and forms for educational improvement for radiology educators.

The effects of language proficiency and awareness of time limit in animated vs. text-based situational judgment tests.

BACKGROUND: Situational Judgment Tests (SJTs) are commonly used in medical school admissions. However, it has been consistently found that native speakers tend to score higher on SJTs than non-native speakers, which can be particularly problematic in the admission context due to the potential risk of limited fairness. Besides type of SJT, awareness of time limit may play a role in subgroup differences in the context of cognitive load theory. This study examined the influence of SJT type and awareness of time limit against the background of language proficiency in a quasi high-stakes setting. METHODS: Participants (N = 875), applicants and students in healthcare-related study programs, completed an online study that involved two SJTs: one with a text-based stimulus and response format (HAM-SJT) and another with a video-animated stimulus and media-supported response format (Social Shapes Test, SST). They were randomly assigned to a test condition in which they were either informed about a time limit or not. In a multilevel model analysis, we examined the main effects and interactions of the predictors (test type, language proficiency and awareness of time limit) on test performance (overall, response percentage). RESULTS: There were significant main effects on overall test performance for language proficiency in favor of native speakers and for awareness of time limit in favor of being aware of the time limit. Furthermore, an interaction between language proficiency and test type was found, indicating that subgroup differences are smaller for the animated SJT than for the text-based SJT. No interaction effects on overall test performance were found that included awareness of time limit. CONCLUSION: A SJT with video-animated stimuli and a media-supported response format can reduce subgroup differences in overall test performance between native and non-native speakers in a quasi high-stakes setting. Awareness of time limit is equally important for high and low performance, regardless of language proficiency or test type.

Publication of pediatric theses defended at the Tunis Faculty of Medicine: A 15-year study.

INTRODUCTION: The valorisation of thesis through its publication is necessary to enhance its visibility. Few data exist concerning the characteristics of theses defended at the Tunis faculty of medicine. AIM: Examine the publication rate of pediatric theses and identify factors associated with an increased publication rate. METHODS: We conducted a cross-sectional descriptive bibliometric study of pediatric theses defended at the Faculty of Medicine of Tunis over 15 years, from 2006 to 2020. Theses were retrieved from the catalog of the faculty library. Publications had been searched in databases "Pub Med ", and "Google Scholar" until December2021. RESULTS: The study involved 235 pediatric theses. Sixty-eight theses were published, representing 29% of the total. The main topics of published theses were neonatology (16%) and hematology (15%). The language of publication was French and English in 55% and 45% of cases, respectively. All publications in Q1 and Q2 journals were written in English. The only independent factor predicting publication of theses was the very honourable mention with congratulations of the jury and proposal for the thesis prize (p=0,007). CONCLUSION: Additional assessments will be necessary to identify the obstacles to the publication of theses.

Stop the Bleed® in medical schools: Early advocacy and promising results.

OBJECTIVE: We hypothesized that medical students would be empowered by hemorrhage-control training and would support efforts to include Stop the Bleed® (STB) in medical education. DESIGN: This is a multi-institution survey study. Surveys were administered immediately following and 6 months after the course. SETTING: This study took place at the Association of American Medical Colleges-accredited medical schools in the United States. PARTICIPANTS: Participants were first-year medical students at participating institutions. A total of 442 students completed post-course surveys, and 213 students (48.2 percent) also completed 6-month follow-up surveys. INTERVENTION: An 1-hour, in-person STB course. MAIN OUTCOMES MEASURES: Student empowerment was measured by Likert-scale scoring, 1 (Strongly Disagree) to 5 (Strongly Agree). The usage of hemorrhage-control skills was also measured. RESULTS: A total of 419 students (95.9 percent) affirmed that the course taught the basics of bleeding control, and 169 (79.3 percent) responded positively at follow-up, with a significant decrease in Likert response (4.65, 3.87, p < 0.001). Four hundred and twenty-three students (97.0 percent) affirmed that they would apply bleeding control skills to a patient, and 192 (90.1 percent) responded positively at follow-up (4.61, 4.19, p < 0.001). Three hundred and sixty-one students (82.8 percent) believed that they were able to save a life, and 109 (51.2 percent) responded positively at follow-up (4.14, 3.56, p < 0.001). Four hundred and twenty-five students (97.0 percent) would recommend the course to another medical student, and 196 (92.0 percent) responded positively at follow-up (4.68, 4.31, p < 0.001). Six students (2.8 percent) used skills on live patients, with success in five of the six instances. CONCLUSIONS: Medical students were empowered by STB and have used hemorrhage-control skills on live victims. Medical students support efforts to include STB in medical education.

Medical schools as cisgendered organizations.

Organizations and their practices contribute to the marginalization of transgender and gender diverse (TGD) populations by rewarding gender normativity and punishing gender transgression. The present study draws on data gleaned from four focus groups completed in 2023 with a total of 19 participants to explore TGD U.S. medical students' perceptions of TGD content inclusion in their medical school curricula. Using abductive analysis, I argue that curricular oversights which omit socio-political contexts regarding TGD health and healthcare, as well as continued pathologization of TGD communities and people, contribute to a hostile learning environment for TGD medical students and residents. I conceptualize medical schools as cisgendered organizations where inequities devaluing TGD people and experiences are embedded in the organizational structure, including curriculum development and implementation. I provide recommendations for medical schools and stakeholders to align their formal, informal, and hidden curricula through practical means (e.g., incorporating TGD standardized patients throughout) and structural means (e.g. hiring and supporting TGD faculty across disciplines to assist with curriculum development and training), and argue for governing bodies to push back against legislative restriction and criminalization of TGD medical care.