Academic Medicine最新文献

Abstract: Labor unions represent an increasing number of graduate medical education (GME) trainees in the United States. Most GME and other leaders at academic medical centers lack familiarity with resident/fellow unions, including what to expect, what decisions need to be made, and the processes involved in a unionization effort. It is important for designated institutional officials (DIOs), GME program directors, teaching faculty, and other institutional leaders to understand the drivers of resident/fellow unionization, the union organizing campaign and election process, and what follows a vote to unionize, including collective bargaining. Careful consideration of the role of educational and other institutional leaders during the unionization process is important to prevent any loss of trust between residents/fellows and those they view as their advocates. In this Commentary, the authors describe these considerations from their perspective as DIOs and GME leaders.

Purpose: This study describes graduate medical education (GME) placement outcomes for recent U.S. medical school graduates and examines racial and ethnic differences in GME placement among these graduates.

Method: This retrospective, observational study used data collected from and about U.S. medical school graduates for academic years 2015-2016 through 2021-2022. An individual-level, deidentified database was constructed to examine GME placement at graduation in association with race and ethnicity, as well as other demographic and academic and professional development variables. Multilevel (nested by school) logistic regression models identified variables independently associated with GME placement at graduation, reporting unadjusted odds ratios (UORs) and adjusted odds ratios (AORs) with 95% CIs.

Results: The study sample included 140,072 of 140,073 eligible graduates (> 99.9%; 1 graduate missing gender information was excluded), of whom 136,022 (97.1%) were placed in GME at graduation. Proportions of graduates placed in GME varied by race and ethnicity and by each covariable examined. In addition, proportions of graduates placed in GME varied by school (N = 152; mean [SD], 96.9% [3.4%]; P < .001). In multilevel (nested by school) models, GME placement UORs were lower for (among other groups examined) Asian (UOR, 0.76; 95% CI, 0.70-0.83), Black or African American (UOR, 0.44; 95% CI, 0.39-0.49), and Hispanic (UOR, 0.70; 95% CI, 0.60-0.80) graduates (vs White). The GME placement AORs, adjusted for all covariables, were similar for Asian (AOR, 0.96; 95% CI, 0.87-1.07), Black or African American (AOR, 0.89; 95% CI, 0.77-1.02), and Hispanic (AOR, 1.06; 95% CI, 0.89-1.25) graduates (vs White).

Conclusions: The proportion of graduates placed in GME at graduation during the 7 years of the study was high. However, there were racial and ethnic differences in this outcome during the study period.

Purpose: For accelerated 3-year MD (3YMD) pathways to be fully adopted in medical education, a comprehensive analysis of outcome data is needed. This study includes 7 accelerated 3YMD graduating classes at NYU Grossman School of Medicine (NYUGSOM) and reports on outcomes from both medical school and internship compared with their 4-year MD (4YMD) counterparts.

Method: Outcomes across the undergraduate-graduate medical education continuum for the first 7 classes of NYUGSOM graduates (matriculated from 2013-2019) from the accelerated 3YMD (n = 136) and 4YMD pathways (n = 681) were compared. For the internship outcomes, 3YMD interns were compared with 4YMD interns who graduated from NYUGSOM and all 4YMD interns (4YMD graduates from NYUGSOM and any other medical school) at NYUGSOM residencies.

Results: Accelerated 3YMD students were approximately 5 months older at admission and had higher multiple mini-interview scores than 4YMD students. Overall, accelerated 3YMD students performed similarly to 4YMD students during medical school and internship. Significant differences included higher performance by 3YMD students on preclerkship exams and lower performance on Steps 1 and 2 (average: 5.6 and 5.4 fewer points, respectively) and the physical examination portion of the NYUGSOM Comprehensive Clinical Skills Exam. Internship data indicated comparable team assessments across all residencies, statistically significant higher performance on Step 3 when compared with all 4YMD interns, and, in internal medicine, comparable clinical reasoning between 3YMD and all 4YMD interns. When comparing 3YMD interns to all 4YMD interns in the internal medicine residency program, 3YMD interns had a statistically significantly higher performance on milestones.

Conclusions: The outcomes from 7 years of graduating accelerated 3YMD students at NYUGSOM show similar performance in medical school and early residency to 4YMD graduates. Long-term study of accelerated 3YMD students from NYUGSOM and other medical schools is needed to further validate the success of this innovative medical education pathway.