Entry of US medical school graduates into family practice residencies: 1997-1998 and 3-year summary

This is the 17th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school's graduates entering family practice residency programs. Approximately 16.6% of the 15,894 graduates of US medical schools between July 1996 and June 1997 were first-year family practice residents in October 1997, compared with 15.9% in 1996 and 14.6% in 1995. This is the highest percentage since this series of studies began in 1980-1981 (12.8%). Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1997 than were residents from privately funded schools, 19.8% compared with 11.8%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1997 at 25.8%; the Middle Atlantic and New England regions reported the lowest percentages at 11.7% and 10.7%, respectively. Nearly half of the medical school graduates (48.1%) entering a family practice residency program as first-year residents in October 1997 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates of colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine.     

Resident attrition from family practice residencies: United States versus international medical graduates

BACKGROUND: Attrition of residents from family practice residency programs may cause significant problems for faculty, residents, and patients. The objective of this study was to determine international medical graduates' attrition rate from family practice residencies, compared with US medical school graduates. METHODS: Surveys were sent to all family practice residency program directors asking them to calculate their attrition rate for a 10-year period. RESULTS: The overall response rate was 56.6%, but interpretable responses were received from 45% of all civilian, continental US family practice residencies. Responding programs did not differ from all family practice programs with respect to program overall. Of those residents leaving, 63% did so to enter other specialties. The attrition rate was 18.5% for international graduates, compared with 7.8% for US graduates (P < .0001). International graduates enrolled outside of the National Resident Matching Program (NRMP) were most likely to leave programs before completion. CONCLUSIONS: Attrition rates from family practice residency programs are higher for international medical graduates than for US graduates. International graduates enrolled outside of the NRMP were most likely to leave a program.     

Educational programs in US medical schools, 1996-1997

We use data from the 1996-1997 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, to describe medical education programs in the United States. In the 1996-1997 academic year, there were 95 568 full-time medical school faculty members, a 4.5% increase from 1995-1996. In clinical departments, the largest increases were in emergency medicine (a 29% increase from 1995-1996) and family medicine (a 13% increase). Of all full-time faculty members in clinical departments, 76.9% have an MD or DO as the highest degree, 4.5% have both an MD and PhD, 13.9% have a PhD, and 4.7% have an academic or professional bachelor's or master's degree as their final degree. The total number of applicants for the class entering in 1996 was 46968 (0.8% increase from 1995), while the number of first-time applicants decreased 1% from 1995. First-year medical students who were members of underrepresented minority groups numbered 2236, a 4% decrease from 1995. In 1996-1997, the total number of medical students was 66712 (0.3% less than in 1995-1996). For students graduating during the 1995-1996 academic year, 13% took longer than 4 years to complete the program. There were 47 medical schools that reported that 1 or more hospitals used for required clinical clerkships had changed ownership, merged, or closed during 1996. Medical schools used an average of 6 (range, 1-36) hospitals for core clinical clerkship. Ninety-five schools required a passing grade on Step 1 of the US Medical Licensing Examination (USMLE) for promotion or graduation; 54 schools required a passing grade on Step 2 of the USMLE.     

Review of US medical school finances, 1995-1996

We discussed the rational extent of the lymph node dissection for carcinoma of the lower third of the esophagus of T2 or T3 stage with abdominal lymph node metastasis. Lymph node metastasis developed in 89.5% of patients. Cervical lymph node metastasis was seen in 35.8%. In the cases with positive abdominal lymph node, 40.9% of the patients had cervical node metastasis. The most frequent site of the positive node in the neck is the area along the right recurrent laryngeal nerve. On the stand point of removal of metastatic lymph node, neck dissection should be required. Three-field dissection yielded better survival rate than two-field dissection but statistical significance was not obtained. When the patients have cervical lymph node metastasis, they have greater possibility of developing blood borne metastasis. However, this observation does not deny the validity of the three-field dissection. Because this dissection may help reducing nodal spread and nodal recurrence. We have to wait for accumulation of the patients to analyze the definite extent of node dissection for T2 or T3 stage of carcinoma of the lower third of the esophagus with positive abdominal lymph node.     

Prevalence of harassment and discrimination among 1996 medical school graduates: a survey of eight US schools

CONTEXT: Harassing and discriminating behaviors on the part of instructors or supervisors are known to affect the quality of work performed by medical students, influence their career decisions, and have other undetermined long-term consequences. OBJECTIVE: To assess the prevalence and forms of harassment and discrimination experienced by 1996 medical school graduates. DESIGN: A self-administered survey of harassment and discrimination mailed to graduating medical students. SETTING AND PARTICIPANTS: A total of 1001 graduating medical students at 8 US medical schools (4 public and 4 private), chosen from each of the 4 regions designated by the Association of American Medical Colleges for geographic categorization. OUTCOME MEASURE: The number of reported experiences of various forms of harassment and discrimination while attending medical school. RESULTS: Of 1001 surveys, 548 (55%) were returned. Overall, 46% of the students reported experiencing some form of harassment and 41% some form of discrimination from instructors or supervisors while attending medical school. Nonsexual verbal harassment was reported by 41%; sexual verbal harassment was reported by 10%. Discrimination based on gender was reported by 29% of students; discrimination based on race was reported by 12%. CONCLUSIONS: Harassment and discrimination of medical students by instructors and supervisors continue to occur frequently, and new approaches are needed to address these problems.     

A summary of the 1996-1997 Canadian FluWatch program

We studied systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse frequency (P.F) and mean blood pressure (MBP) among 30 pregnant women in 39.5 +/- 0.3 gestational weeks of pregnancy, age 23 +/- 0.9 years, height 162.0 +/- 1.4 cm and weight 75.5 +/- 2.55 kg. The above indices were studied dynamically in the Ist, 2nd, 3rd, 5th, 7th, 9th, 12th and 15th minute from the onset of the analgesia. We founded that SBP an DBP in the 7th min (the time for spinal block) were lowest. PF and MBP also decreased significantly in the 7th minute in comparison to the inmal values. We can conclude that the haemodynamic indices of the pregnant woman decrease wrong initiation of spinal analgesia for c.s., but remain in the region of normal reference values.     

Lafayette's family practice residency program: practice patterns of graduates

The Lafayette Family Practice Residency Program graduated 25 physicians prior to 1995. This project was undertaken to support our assumption that graduates establish their practices in communities near their residency programs. Further we surveyed the graduates to determine graduate satisfaction and practice characteristics. The vast majority (88%) of these physicians were practicing in Louisiana at the time of this survey. Over half the graduates were practicing in Acadiana. The results suggest that these physicians are indeed satisfied in their careers as family physicians.     

Evidence of discrimination against international medical graduates applying to family practice residency programs

BACKGROUND AND OBJECTIVES: The purpose of the study was to test the hypothesis that discrimination exists against international medical graduates (IMGs) applying to US family practice residency programs. METHODS: Two sets of letters were sent to 146 family practice residency programs randomly selected from the Directory of Graduate Medical Education Programs. The letters requested information and an application. All letters were identical except that the author of the first set was described as "a foreign medical graduate." The author of the second set was described as "a fourth-year medical student at the University of Nebraska Medical Center." Replies were monitored for 6 weeks after the second mailing. Response rates to each "candidate" were measured. In addition, responses were evaluated for the presence of a brochure describing the residency program, an application, cover letter, invitation for interview, eligibility criteria, and other material. RESULTS: A total of 113 programs (79%) responded. Of these, 102 responded to the fourth-year medical student and 57 responded to the IMG. Of the 46 programs replying to both candidates, only 20 provided identical mailings. Nine of the 46 programs required IMGs to meet standards that exceeded requirements set by the Educational Commission for Foreign Medical Graduates for residency training in the United States. CONCLUSIONS: A pattern of dissimilarity exists in the way family practice residency programs respond to requests for application materials, and the differences appear to depend on whether the candidate is a US medical graduate or an IMG. These results raise questions about the fairness of current methods of resident selection.     

Evidence-based parent and family interventions in school psychology: State of scientifically based practice.

The purpose of this special issue was to examine the scientific base that supports the use of parent and family interventions that are implemented in schools or coordinated with school settings, and to demonstrate a change in the school-related behaviors and learning problems of children and youth. Reviews have been conducted in the six sub-domains: parent education, parent involvement, parent consultation, family-school collaboration/partnership, family systems therapy and parent training, and early childhood family-focused interventions. To our knowledge this is the first time standard criteria have been applied across these subdomains to examine the empirical base for the broader family and parent intervention domain. From this review, it would be erroneous to conclude that there is no evidence for the use of parent and family interventions as methods for changing the school-related behavior and learning problems of children and youth. From this review, it is evident that parent and family interventions are multidimensional. In this review, we asked the question, "Do we find evidence that parent and family interventions change children's behavior and learning at school?" Our answer is "yes, but." (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A survey of changes in the proportions of ambulatory training in internal medicine clerkships and residencies from 1986-87 to 1996-97

PURPOSE: To determine changes from 1986-87 to 1996-97 in the proportions of time devoted to education in ambulatory settings within clerkships and internal medicine residencies. METHOD: In 1997, a questionnaire was sent to the departments of internal medicine of all 125 U.S. medical schools. The response rate was 73%. RESULTS: Training in ambulatory settings increased greatly over the decade. The percentages of time in ambulatory settings increased for clerkships from 6% to 28%, and for residencies from 14% to 30%. In 1986-87, two thirds of clerkships provided no ambulatory training; by 1996-97, only 5% were exclusively inpatient. In 1986-87, 56% of residencies devoted 10% or less of their time to ambulatory education. By 1996-97, no residency program was in this category, while 87% devoted at least 20% of their time to ambulatory training. All programs used hospital clinics for ambulatory education; more than half used private physicians' offices, while fewer used health centers, home care services, and HMOs. Problems in expanding ambulatory training included inadequate numbers of sites or patient volumes (58% of programs), insufficient instructors (55%), and costs. CONCLUSION: There has been a major increase in the proportions of time devoted to ambulatory education in clerkships and residencies. Significant problems impede the reported desire of program directors further to increase these proportions.     

Factors affecting likelihood of applicants being offered a place in medical schools in the United Kingdom in 1996 and 1997: retrospective study

OBJECTIVE: To assess the relation between a range of measures and the likelihood of applicants to medical schools in the United Kingdom being offered a place overall and at each medical school, with particular emphasis on ethnic minority applicants. DESIGN: Data provided by the Universities and Colleges Admissions Service on 92 676 applications to medical schools from 18 943 candidates for admission in 1996 and 1997. Statistical analysis was by multiple logistic regression. MAIN OUTCOME MEASURES: Receipt of a conditional or unconditional offer of a place at medical school. RESULTS: Eighteen separate measures were independently associated with the overall likelihood of receiving an offer. Applicants from ethnic minority groups were disadvantaged, as were male applicants, applicants applying late in the selection season, applicants making non-medical (so called insurance) choices, applicants requesting deferred entry (so called gap year), and applicants at further or higher education or sixth form colleges. Analysis at individual medical schools showed different patterns of measures that predicted offers. Not all schools disadvantaged applicants from ethnic minority groups and the effect was stable across the two years, suggesting structural differences in the process of selection. The degree of disadvantage did not relate to the proportion of applicants from ethnic minority groups. CONCLUSIONS: The data released by the Council of Heads of Medical Schools allow a detailed analysis of the selection process at individual medical schools. The results suggest several areas in which some candidates are disadvantaged, in particular those from ethnic minority groups. Similar data in the future will allow monitoring of changes in selection processes.     

Trends along the debt-income axis: implications for medical students'' selections of family practice careers

Even elderly patients > or = 75 years of age with coronary artery disease have modest improvements in lipid levels and marked improvements in exercise capacity, behavioral characteristics, and quality-of-life parameters after cardiac rehabilitation and exercise training programs. These data support that even very elderly patients with coronary artery disease should be routinely referred to and vigorously encouraged to pursue formal outpatient cardiac rehabilitation and exercise training programs following major coronary events.