Analysis of Performance Trends from 2010–2019 on the American Board of Internal Medicine Nephrology Certifying Exam

BackgroundThe pass rate on the American Board of Internal Medicine (ABIM) nephrology certifying exam has declined and is among the lowest of all internal medicine (IM) subspecialties. In recent years, there have also been fewer applicants for the nephrology fellowship match.MethodsThis retrospective observational study assessed how changes between 2010 and 2019 in characteristics of 4094 graduates of US ACGME-accredited nephrology fellowship programs taking the ABIM nephrology certifying exam for the first time, and how characteristics of their fellowship programs were associated with exam performance. The primary outcome measure was performance on the nephrology certifying exam. Fellowship program pass rates over the decade were also studied.ResultsLower IM certifying exam score, older age, female sex, international medical graduate (IMG) status, and having trained at a smaller nephrology fellowship program were associated with poorer nephrology certifying exam performance. The mean IM certifying exam percentile score among those who subsequently took the nephrology certifying exam decreased from 56.7 (SD, 27.9) to 46.1 (SD, 28.7) from 2010 to 2019. When examining individuals with comparable IM certifying exam performance, IMGs performed less well than United States medical graduates (USMGs) on the nephrology certifying exam. In 2019, only 57% of nephrology fellowship programs had aggregate 3-year certifying exam pass rates ≥80% among their graduates.ConclusionsChanges in IM certifying exam performance, certain trainee demographics, and poorer performance among those from smaller fellowship programs explain much of the decline in nephrology certifying exam performance. IM certifying exam performance was the dominant determinant.

Comprehensive Reform and Greater Equity in Applying to Residency—Trainees' Mixed Responses to a Pass/Fail USMLE Step 1

ABSTRACT Background Pass/fail USMLE Step 1 score reporting may have varying implications for trainees of different demographic and training backgrounds. Objective To characterize the perspectives of a diverse cohort of trainees on the impact of pass/fail Step 1 score reporting. Methods In 2020, 197 US and international medical school deans and 822 designated institutional officials were invited to distribute anonymous electronic surveys among their trainees. Separate surveys for medical students and residents/fellows were developed based on the authors' prior work surveying program directors on this topic. Underrepresented in medicine (UiM) was defined in accordance with AAMC definitions. Descriptive and comparative analyses were performed, and results were considered statistically significant with P < .05. Results A total of 11 633 trainees responded (4379 medical students and 7254 residents/fellows; 3.3% of an estimated 285 000 US trainees). More students favored the score reporting change than residents/fellows (43% vs 31%; P < .001; 95% CI 0–24). Trainees identifying as UiM were more likely to favor the change (50% vs 34%; P < .001; 95% CI 0–32) and to agree it would decrease socioeconomic disparities (44% vs 25%; P < .001; 95% CI 0–38) relative to non-UiM trainees. Nearly twice as many osteopathic and international medical graduate students felt they would be disadvantaged compared to MD students because of pass/fail score reporting (61% vs 31%; P < .001; 95% CI 0–60). Conclusions Trainee perspectives regarding USMLE Step 1 score reporting are mixed. UiM trainees were more likely to favor the score reporting change, while osteopathic and international medical students were less in favor of the change.

The Impact of Virtual Interviews on the Geographic Distribution of Ophthalmology Match Results in the 2020–2021 Cycle

Background Instead of the traditional in-person interviews, the 2020 to 2021 ophthalmology application cycle was conducted with virtual interviews due to coronavirus disease 2019 (COVID-2019). Little is known about differences between the results of this application cycle with previous years. Objectives The aim of this study was to determine the effect of virtual interviews on the geographic distribution of matched ophthalmology residency applicants. Methods Information was collected on the medical school location and matched residency program location for 2020 to 2021 applicants as well as applicants during the 2016 to 2017, 2017 to 2018, and 2018 to 2019 cycles from publicly available Web sites. Pearson chi-squared tests were conducted to determine whether there was a significant difference in the proportion of applicants matching in the same region, state, and institution as their medical schools in the 2020 to 2021 interview cycle when compared with past cycles. Results Three-hundred seventy-five applicants from 2020 to 2021 and 1,190 applicants from 2016 to 2019 application cycles were analyzed. There was no difference in the type of medical school attended (allopathic vs. osteopathic vs. international medical graduate) (p = 0.069), the likelihood of attending a residency program in the same region as the home medical school (54% for 2020–2021 vs. 57% for 2016–2019 applicants, p = 0.3), and the likelihood of attending a residency program in the same state as the home medical school (31 vs. 28%, p = 0.2). There was a higher likelihood of applicants during the 2020 to 2021 cycle matching at a residency program affiliated with their home medical school than previous cycles (23 vs. 18%, p = 0.03). Conclusions Virtual interviews did not increase the likelihood of medical students staying in the same region or state as their medical school, while there was a higher likelihood of applicants matching at residency programs at institutions affiliated with their medical schools. A hybrid approach to maintain geographic diversity of applicants' final residency programs involving virtual interviews with the addition of in-person away rotations is suggested.

My journey into mental healthcare as an international medical graduate (IMG)

Over half of doctors who joined the General Medical Council's (GMC) medical register in the UK in 2020 were from Black, Asian and minority ethnic (BAME) background, and I am one of them. Having experienced clinical settings across three different countries, I think my journey deserves to be shared with others as a unique experience. My story will help medical students and early career doctors have a general idea of different clinical settings and hopefully will encourage them to chase their dreams. I hope to inspire people.

Manualising the induction of higher trainees in psychiatry for North Wales: The CiSGC Guide (“Croeso i Seiciatreg Gogledd Cymru”)

AimsThere is a significant period of adjustment for new higher trainees in psychiatry given the presence of inter-trust differences in the National Health Services (NHS). It may take some time for a trainee to become familiar with the new administrative system and workflow of the new environment, which may be even longer for an international medical graduate (IMG). Although there is an existing induction system, having a written structured manual will assist the trainees to get through this process more easily. Hence, this Quality Improvement Project (QIP) outlined the creation of an induction manual that serves as a starter pack to facilitate the settling-in process of new North Wales higher trainees in psychiatry, i.e. the “Croeso i Seiciatreg Gogledd Cymru” (CiSGC) guide (means Welcome to North Wales Psychiatry in Welsh).MethodThe induction manual was initially drafted by the authors based on the available printed policies and information online. Further input and from different stakeholders were obtained to triangulate and enrich the manual. Specific links and further references were included in the manual for the reference of prospective manual users. Authors’ contact details were included for any further clarification, suggestions or input.ResultThe manual consisted of four sections: A) General Process before, during and after Reporting Duty, B) Trainees’ Duty, 3) Speciality-specific Guidance, and 4) Health Board-related Information. The General Process section covered the visa-related information, post-acceptance paperwork process, access to email and hospital informative system, medical practice-related issues (including section 12(2) approval and medical indemnity). The Trainees’ Duty section briefed on time-tabling and clinical duty. The Specialty-specific Guide provided important information related to training. Lastly, the section of Health Board-related Information highlighted the administrative structure of the NHS Health Board, important contact numbers, link to information. Specialty specific sections were created for general adult psychiatry and old age psychiatry as there is no other higher training of psychiatry in North Wales at the moment. Further sections in the pipeline include substance misuse and liaison psychiatry.ConclusionThis induction manual is neither prescriptive nor exhaustive. It serves as a generic reference to facilitate new trainees in their adjustment process. Further review and revision will be conducted before every induction process to ensure the information is up-to-date and incorporating new input from the trainees.

Road to CESR (Article 14)- Is it for me?

“What lies behind us & what lies ahead of us are tiny matters to what lies within us!” – Ralph Waldo Emerson Many clinicians across the world aspire to come to United Kingdom and work in NHS. Initial months could be challenging to work in completely new healthcare system. With some help from good colleagues, transition for overseas doctors can be less overwhelming. As an International Medical Graduate (IMG), there are several options for career progression in UK. Many doctors enter in the UK formal training program, however, Certificate of Eligibility for Specialist Registration (CESR) is an alternative pathway to achieve CCT. The CESR route could be helpful for clinicians trained in countries outside the UK or European Union as their training from their country of origin might not be recognized equivalent to CCT by General Medical Council (GMC). After obtaining CESR certification, your name is added to specialist register which is a absolute necessity to obtain a substantive consultant position in UK. There is ever increasing requirement for doctors in the UK due to staff shortages and now Covid-19 pandemic has pushed many trusts against the wall to fill these positions. Apart from recruiting overseas doctors, CESR certification has proven to be helpful in filling up these positions. The GMC made some favorable changes in the CESR process in recent years which has encouraged and many career grade/staff grade doctors to progress. On other hand, trainees who fail to obtain training post after several attempts are opting for CESR as an alternative route to progress. Annual statistics published by the GMC indicate that there is rising trend in number of applications for CESR certification in all specialties. There is a gradual change in the perception of CESR as an equally attractive route for career progression. However, there are many unknowns in this pathway as this has been a path less travelled. There is a general perception that CESR certification is difficult t