Correlation of United States Medical Licensing Examination and Internal Medicine In-Training Examination performance

The Internal Medicine In-Training Examination (ITE) is administered during residency training in the United States as a self-assessment and program assessment tool. Performance on this exam correlates with outcome on the American Board of Internal Medicine Certifying examination. Internal Medicine Program Directors use the United States Medical Licensing Examination (USMLE) to make decisions in recruitment of potential applicants. This study was done to determine a correlation of USMLE Steps 1, 2 and 3 results with ITE scores in each level of Internal Medicine training. A retrospective review of all residents graduating from an Internal Medicine program from 1999 to 2006 was done. Subjects included had data for all USMLE Steps and ITE during all years of training. Thirty-one subjects were included in the study. Correlations of USMLE Steps 1, 2 and 3 were done with ITE scores (percent correct) in each year of training. Pearson’s correlation coefficient (r) was determined for each pairing and a t test to determine statistical significance of the correlation was done. Statistical significance was defined as P value <0.05. The r values for USMLE Step 1 and ITE percent correct in PGY I, II and III were 0.46, 0.55 and 0.51 respectively. Corresponding r values for USMLE Step 2 and ITE percent correct were 0.79, 0.70 and 0.72; for USMLE Step 3 these values were 0.51, 0.37 and 0.51 respectively for each training year. USMLE scores are correlated with ITE scores. This correlation was strongest for USMLE Step 2.     

Residency selection: do the perceptions of US programme directors and applicants match?

Medical Education 2012: 46 : 491–500 Objectives This study sought to evaluate the practices and perceptions of US residency programme directors (PDs) and residency applicants with reference to the use of social media and Internet resources in the resident doctor selection process. Methods A survey was distributed via e‐mail (SurveyMonkey^®) to 2592 PDs of programmes in 22 specialties accredited by the Accreditation Council for Graduate Medical Education. A separate survey was distributed to all residency candidates applying for postgraduate year 1 (PGY1) positions at the Saint Barnabas Medical Center, Livingston, New Jersey. Results A total of 1200 (46.3%) PDs completed the survey. Overall, 16.3% (n = 196) of respondents reported visiting Internet resources to gain more information about applicants, 38.1% (74 of 194) of whom had ranked an applicant lower as a result. American medical graduates (AMGs), US international medical graduates (USIMGs) and non‐USIMGs all felt that performance on Step 1 of the US Medical Licensing Examination (USMLE) was a critical aspect of a residency application. More AMGs than USIMGs and non‐USIMGs believed that PDs made use of social media resources when evaluating applicants and that their online profiles might influence their rankings. Conclusions Residency candidates universally understand the importance of USMLE Step 1 scores in maintaining a competitive application. However, significant differences exist among AMGs, USIMGs and non‐USIMGs in their perceptions of the value of other applicant criteria, which may place some applicants at a disadvantage. A small but growing number of PDs currently use Internet resources to learn more about applicants and base their recruitment decisions in part on the information they encounter. At present, applicants are generally unaware of the implications their online activity may have on their selection for residency. Content guideline programmes that raise awareness of the possible impact of social media on the residency recruitment process are needed and should be delivered early in medical education.     

The effect of three commercial coaching courses on Step One USMLE performance

BACKGROUND: A substantial industry exists to provide formal review courses for Step 1 of the United States Medical Licensing Examination (USMLE). There are limited data on the usefulness of these courses. AIM: To determine whether or not student participation in a commercial coaching course improves performance on Step 1 of the USMLE. METHODS: Scores achieved by 468 students on the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE) were used to predict a score on Step 1 of the USMLE. The NBME is the organisation that prepares and administers the USMLE. Predicted USMLE scores were then regressed against the actual scores achieved by the students on Step 1. The students were divided into 2 groups: those who took a 3-4-week live commercial coaching course and those who studied on their own. RESULTS: The regression lines for the 369 students who studied on their own and the 99 students who took a commercial coaching course were statistically indistinguishable. The analysis was powerful enough to have picked up a difference of 1% on average (P = 0.05) or 2 questions out of the 350 constituting Step 1 of the USMLE. Neither the students who performed above average nor those who performed below average on the CBSE improved their performance on Step 1 as a result of the coaching courses. CONCLUSIONS: Students who take a live, 3-4-week commercial coaching course to improve performance on Step 1 of the USMLE do not achieve higher scores than students who study on their own. Students should strongly consider whether or not a substantial investment in time and money for a commercial coaching course is justified in the light of such meagre returns.     

Validity of the Medical College Admission Test for predicting MD–PhD student outcomes

The Medical College Admission Test (MCAT) is a quantitative metric used by MD and MD–PhD programs to evaluate applicants for admission. This study assessed the validity of the MCAT in predicting training performance measures and career outcomes for MD–PhD students at a single institution. The study population consisted of 153 graduates of the Vanderbilt Medical Scientist Training Program (combined MD–PhD program) who matriculated between 1963 and 2003 and completed dual-degree training. This population was divided into three cohorts corresponding to the version of the MCAT taken at the time of application. Multivariable regression (logistic for binary outcomes and linear for continuous outcomes) was used to analyze factors associated with outcome measures. The MCAT score and undergraduate GPA (uGPA) were treated as independent variables; medical and graduate school grades, time-to-PhD defense, USMLE scores, publication number, and career outcome were dependent variables. For cohort 1 (1963–1977), MCAT score was not associated with any assessed outcome, although uGPA was associated with medical school preclinical GPA and graduate school GPA (gsGPA). For cohort 2 (1978–1991), MCAT score was associated with USMLE Step II score and inversely correlated with publication number, and uGPA was associated with preclinical GPA (mspGPA) and clinical GPA (mscGPA). For cohort 3 (1992–2003), the MCAT score was associated with mscGPA, and uGPA was associated with gsGPA. Overall, MCAT score and uGPA were inconsistent or weak predictors of training metrics and career outcomes for this population of MD–PhD students.     

The multiple mini-interview for selection of international medical graduates into family medicine residency education

Context The multiple mini‐interview (MMI) was used to measure professionalism in international medical graduate (IMG) applicants for family medicine residency in Alberta for positions accessed through the Alberta International Medical Graduate (AIMG) Program. This paper assesses the evidence for the MMI’s reliability and validity in this context. Methods A group of 71 IMGs participated in our 12‐station MMI designed to assess professionalism competency. A 10‐point scale evaluated applicants on ability to address the objectives of the situation, interpersonal skills, suitability for a residency and for family medicine, and overall performance. We conducted generalisability and decision studies to assess the reliability of MMI scores. We assessed the validity by examining the differences in MMI scores associated with session, track and socio‐demographic characteristics of applicants and by measuring the correlations between MMI scores and scores on compulsory examinations, including the AIMG objective structured clinical examination, the Medical Council of Canada Evaluating Examination (MCCEE) and the Medical Council of Canada Qualifying Examination Part I (MCCQE I). We measured the correlation between MMI and non‐requisite MCCQE Part II (MCCQE II) scores that were provided. Results The reliability as indicated by the generalisability coefficient associated with average station scores was 0.70 with one interviewer per station. There were no statistically significant differences in total MMI scores or mean station sum scores based on session, track, applicant age, gender, years since medical school completion, or language of medical school. There were low, non‐significant correlations with OSCE overall (r = 0.15), MCCEE (r = 0.01) and MCCQE I (r = 0.06) scores and a higher non‐significant correlation with MCCQE II scores (r = 0.33). Conclusions There is evidence that the MMI offers a reliable and valid assessment of professionalism in IMG doctors applying for Canadian family medicine residencies and that this clinically situated MMI assessed facets of competency other than those assessed by the OSCE.     

Which metric of relative weight best captures body fatness in children?

OBJECTIVE: To evaluate the relative merits of BMI (kilograms per meter squared) and age- and gender-adjusted BMI, age- and gender-specific z score of BMI, and age- and gender-specific percentiles of BMI as surrogate measures of body fatness among a sample of youth. RESEARCH METHODS AND PROCEDURES: The sample comprised 596 children and adolescents 5 to 18.7 years old and was 40% male and 55% white. Height and weight were measured by trained research staff. DXA was used to determine body fat mass. BMI, age- and gender-specific percentile of BMI, and age- and gender-specific z scores of BMI were computed, and these metrics were compared with measured body fatness. RESULTS: The BMI values in the sample ranged from 12.9 to 55.0 kg/m(2), with a mean of 24.9 kg/m(2). The Spearman correlations with percentage body fat were similar for all of the BMI metrics (r = 0.82 to 0.88). Linear regression models with age- and gender-specific percentiles of BMI explained significantly less of the variance (65%) than models with log-transformed BMI (81%) or age- and gender-specific z scores of BMI (75% to 79%). z scores were the most accurate at classifying children who were overfat (sensitivity = 0.84, specificity = 0.96 for z score > or = 1). However, using a BMI > or = 85th percentile or a BMI > or = 20 kg/m(2) was also accurate at classifying youth. DISCUSSION: The BMI metrics had similar correlations with body fatness, but age- and gender-specific percentiles of BMI were the least accurate proxy measure of body fatness. However, a BMI z score > or = 1, BMI percentile > or = 85, and BMI> or = 20 kg/m(2) are all useful for identifying children who may be overfat.     

Does self‐reported clinical experience predict performance in medical school and internship?

Medical Education 2012: 46 : 172–178 Context Medical school admissions committees attempt to select the most qualified applicants. In addition to traditional performance measures, committees often look favourably upon applicants who report previous clinical experience. Objectives This study aimed to determine if self‐reported clinical experience is a valid indicator of future performance in medical school and internship. Methods We collected data for seven year groups (1993–1999; n = 1112) and operationalised trainee performance in terms of five outcomes: cumulative medical school grade point average (GPA); US Medical Licensing Examination (USMLE) Step 1 and 2 scores, and scores on a validated programme director’s evaluation measuring intern expertise and professionalism. We then conducted a series of analyses of covariance to compare outcomes in applicants who self‐reported previous clinical experience with outcomes in those who did not. In these analyses, the independent variable was self‐reported clinical experience (yes/no), the covariate was undergraduate GPA, and the dependent variables were the five performance outcomes. Results In four of five analyses, we found no differences in the performance of the two groups (clinical experience versus no clinical experience). However, on the cumulative medical school GPA outcome, applicants who reported previous clinical experience had statistically significantly lower cumulative GPAs upon graduation than those who did not report such experience (F_1,940 = 9.35, p = 0.002, partial η² = 0.01 [small effect size]). Conclusions Our results suggest that applicants who self‐report previous clinical experience may not be better candidates. In fact, on some measures of performance, these applicants may actually perform worse than those who report no clinical experience.     

Correlation of Problem-Based Learning Facilitators' Scores with Student Performance on Written Exams

Problem-based learning (PBL) is widely used in medical education. In some cases, facilitators assign a grade to reflect a student's performance in small-group sessions. In our PBL track, facilitators were asked to assess student knowledge base independent of their group participatory skills. To determine if facilitators' grades were correlated with student performance in written exams, a retrospective study of data from our PBL track was undertaken. Data from 156 students and 107 facilitators in six years of a PBL track at Penn State College of Medicine was analyzed by the Pearson correlation after pairing facilitator grades with written exam grades for each of the eight blocks of the curriculum. Exam reliability and validity were assessed by Cronbach's α and correlation with USMLE I board scores. The mean α was 0.549± 0.221. The mean correlation with USMLE scores was 0.558 ± 0.151. Facilitators' scores for knowledge were positively associated with students' exam grades. The corresponding significant Pearson correlation coefficients were between 0.342–0.622. However, the coefficients of determination showed that the correlation was not significant. Coefficients of determination showed that the knowledge scores explained only 12 to 39% of the variance in exam scores. Overestimation by facilitators was significantly (p < 0.0001) greater for students in the bottom 25% of the class by exam score than for students in the top 25% of the class. On the basis of this study, we concluded that facilitator assessment of student knowledge base is not useful. This revised version was published online in June 2006 with corrections to the Cover Date.     

Preparation courses for a medical admissions test: effectiveness contrasts with opinion

Objectives The Undergraduate Medicine and Health Sciences Admissions Test (UMAT) is used to rank applicants for admission to many medical schools. This study aimed to determine the effects of preparation courses on UMAT performance and on students’ perceptions of their performance. Methods We asked students who sat the UMAT twice across two consecutive years to complete an online survey. The survey was administered in 2010 and 2011 to gather information on preparation activities, costs of preparation activities and students’ opinions regarding their expected performance. Survey responses were compared with student scores on the second taking of the UMAT, adjusted for prior UMAT scores and university performance. Results The study (cohort: n = 263) was sufficiently powered to investigate two forms of preparation: courses offered by MedEntry (a UMAT preparation provider), and tutoring offered by the students’ halls of residence. Neither was found to significantly affect UMAT score (p = 0.09 for MedEntry courses; p = 0.50 for halls of residence tutoring). There was no relationship between total time or money spent preparing and UMAT performance. However, students taking MedEntry courses and students spending more money on UMAT preparation were more likely to predict an improved score (p < 0.001 for both). A total of 85% of students improved their score on the second sitting, irrespective of preparation. Conclusions The use of either of two common forms of UMAT preparation does not translate to an improvement in UMAT score. However, in accordance with confirmation bias theory, the association between money spent on preparatory courses and self‐assessed predicted score suggests that students’ belief in the effectiveness of such courses may be confounded by their financial outlay.     

Twenty Years of the Ryan Residency Training Program in Abortion and Family Planning

ObjectiveTo summarize the effects of routine, opt-out abortion and family planning residency training on obstetrics and gynecology (ob-gyn) residents’ clinical skills in uterine evacuation and intentions to provide abortion care after residency.MethodsData from ob-gyn residency programs supported during the first 20 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Postrotation surveys assessed residents’ training experiences and acquisition of abortion care skills. Residency program director surveys assessed benefits of the training to residents and the academic department from the educators’ perspectives.ResultsA total of 2775 residents in 89 ob-gyn programs completed postrotation surveys for a response rate of 72%. During the rotation, residents – including those who only partially participated – gained exposure to and skills in first- and second-trimester abortion care. Sixty-one percent intended to provide abortion care in their postresidency practice. More than 90% of residency program directors (97.5% response rate) reported that training improved resident competence in abortion and contraception care and 81.3% reported that the training increased their own program's appeal to residency applicants.ConclusionOver 20 years, the Ryan Program has supported programs to integrate abortion training to give ob-gyn residents the skills and inspiration to provide comprehensive reproductive health care, including uterine evacuation and abortion care, in future practice. Residency program directors noted that this integrated training meets resident applicants’ expectations.ImplicationsRyan Program residents are trained to competence and are prepared, both clinically and in their professional attitudes, to care for women's reproductive health.     

Blood concentrations of selected volatile organic compounds and neurobehavioral performance in a population-based sample

The authors analyzed data from a national sample to examine the relationships between blood concentrations of selected volatile organic compounds (VOCs) and the assessment scores of neurobehavioral evaluation tests. They calculated summary statistics to describe blood concentrations of 30 VOCs. For instance, the 95th percentiles were as follows: 1,1,1-trichloroethane, 0.799 microg/l; 1,4-dichlorobenzene, 11.081 microg/l; benzene, 0.476 microg/l; and toluene, 0.281 microg/l. For 1,4-dichlorobenzene, benzene, dibromochloromethane, and trichloroethene, a blood level higher than the 95th percentile was associated with a poorer neurobehavioral assessment score than was a blood level up to the 95th percentile. The authors found a linear relationship between blood toluene concentration and the Serial Digit Learning Test score. The findings suggest that exposure to certain VOCs may result in poor neurobehavioral performance. The study was exploratory and precludes a conclusive statement, so further investigation is warranted.     

Multiple mini-interviews predict clerkship and licensing examination performance

OBJECTIVE: The Multiple Mini-Interview (MMI) has previously been shown to have a positive correlation with early medical school performance. Data have matured to allow comparison with clerkship evaluations and national licensing examinations. METHODS: Of 117 applicants to the Michael G DeGroote School of Medicine at McMaster University who had scores on the MMI, traditional non-cognitive measures, and undergraduate grade point average (uGPA), 45 were admitted and followed through clerkship evaluations and Part I of the Medical Council of Canada Qualifying Examination (MCCQE). Clerkship evaluations consisted of clerkship summary ratings, a clerkship objective structured clinical examination (OSCE), and progress test score (a 180-item, multiple-choice test). The MCCQE includes subsections relevant to medical specialties and relevant to broader legal and ethical issues (Population Health and the Considerations of the Legal, Ethical and Organisational Aspects of Medicine[CLEO/PHELO]). RESULTS: In-programme, MMI was the best predictor of OSCE performance, clerkship encounter cards, and clerkship performance ratings. On the MCCQE Part I, MMI significantly predicted CLEO/PHELO scores and clinical decision-making (CDM) scores. None of these assessments were predicted by other non-cognitive admissions measures or uGPA. Only uGPA predicted progress test scores and the MCQ-based specialty-specific subsections of the MCCQE Part I. DISCUSSION: The MMI complements pre-admission cognitive measures to predict performance outcomes during clerkship and on the Canadian national licensing examination.     

MCAT Verbal Reasoning score: less predictive of medical school performance for English language learners

Medical Education 2012: 46 : 878–886 Context Medical College Admission Test (MCAT) scores are widely used as part of the decision‐making process for selecting candidates for admission to medical school. Applicants who learned English as a second language may be at a disadvantage when taking tests in their non‐native language. Preliminary research found significant differences between English language learners (ELLs), applicants who learned English after the age of 11 years, and non‐ELL examinees on the Verbal Reasoning (VR) sub‐test of the MCAT. The purpose of this study was to determine if relationships between VR sub‐test scores and measures of medical school performance differed between ELL and non‐ELL students. Methods Scores on the MCAT VR sub‐test and student performance outcomes (grades, examination scores, and markers of distinction and difficulty) were extracted from University of California San Diego School of Medicine admissions files and the Association of American Medical Colleges database for 924 students who matriculated in 1998–2005 (graduation years 2002–2009). Regression models were fitted to determine whether MCAT VR sub‐test scores predicted medical school performance similarly for ELLs and non‐ELLs. Results For several outcomes, including pre‐clerkship grades, academic distinction, US Medical Licensing Examination Step 2 Clinical Knowledge scores and two clerkship shelf examinations, ELL status significantly affects the ability of the VR score to predict performance. Higher correlations between VR score and medical school performance emerged for non‐ELL students than for ELL students for each of these outcomes. Conclusions The MCAT VR score should be used with discretion when assessing ELL applicants for admission to medical school.     

A Commentary on the Use of Cut-Scores to Increase the Emphasis of Non-Cognitive Variables in Medical School Admissions

The academic performance consequences of relying solely on non-cognitive factors for selecting applicants above a GPA and MCAT threshold have not been fully considered in the literature. This commentary considers the impact of using a “threshold approach” on academic performance as assessed with the USMLE Step 1.     

Are family practice residents able to interpret electrocardiograms?

Background: Teaching electrocardiogram (ECG) interpretation is a recommended component of the family practice residency curriculum. Published information concerning the ECG interpretation ability of residents is sparse. This study sought to ascertain the base line knowledge of family practice residents' ECG interpretation skills and extent of improvement after one year of training. Methods: A 15 ECG examination was administered to 38 PG-1 and 14 upper level residents at 5 residency programs at the beginning of the academic year and to residents at the authors' program at the end of the academic year. Pre-test scores among the five programs were compared using an analysis of variance (ANOVA). Pre-test and post-test scores were compared using a paired randomization test. Results: No difference was found between average scores from each site, or between the beginning and end of the academic year. Residents were more likely to misinterpret items such as myocardial infarction, myocardial ischemia, and a trial fibrillation. Conclusions: Residents in family practice have considerable deficiencies in ECG interpretation skills. Further studies are needed to determine effective ECG teaching curricula. This revised version was published online in September 2006 with corrections to the Cover Date.     

Examining changes in certification/licensure requirements and the international medical graduate examinee pool

Changes in certification requirements and examinee characteristics are likely to influence the validity of the evidence associated with interpretations made based on test data. We examined whether changes in Educational Commission for Foreign Medical Graduates (ECFMG) certification requirements over time were associated with changes in internal medicine (IM) residency program director ratings and certification examination scores. Comparisons were made between physicians who were ECFMG-certified before and after the Clinical Skills Assessment (CSA) requirement. A multivariate analysis of covariance was conducted to examine the differences in program director ratings based on CSA cohort and whether the examinees emigrated for undergraduate medical education (national vs. international students). A univariate analysis of covariance was conducted to examine differences in scores from the American Board of Internal Medicine (ABIM) Internal Medicine Certification Examination. For both analyses, United States Medical Licensing Examination (USMLE) Step 1 and Step 2 scores were used as covariates. Results indicate that, of those certified by ECFMG between 1993 and 1997, 17 % (n = 1,775) left their country of citizenship for undergraduate medical education. In contrast, 38 % (n = 1,874) of those certified between 1999 and 2003 were international students. After adjustment by covariates, the main effect of cohort membership on the program director ratings was statistically significant (Wilks’ λ = 0.99, F _{5, 15391} = 19.9, P < 0.001). However, the strength of the relationship between cohort group and the ratings was weak (η = 0.01). The main effect of migration status was statistically significant and weak (Wilks’ λ = 0.98, F _5,15391 = 45.3, P < 0.01; η = 0.02). Differences in ABIM Internal Medicine Certification Examination scores based on whether or not CSA were required was statistically significant, although the magnitude of the association between these variables was very small. The findings suggest that the implementation of an additional evaluation of skills (e.g., history-taking, physical examination) as a prerequisite to postgraduate medical education (residency) provides some additional, relevant data to those who select ECFMG-certified residents.     

Training internal medicine residents to screen for domestic violence

Internal medicine residency programs will need to train residents about domestic violence to comply with the Residency Review Commission standards. To assess the effectiveness of an educational intervention intended to increase screening of patients for domestic violence by internal medicine resident physicians and identify characteristics associated with increased screening, we used a quasi-experimental, pretest/posttest trial. This was conducted in an internal medicine residency program and its affiliated primary care clinic with categorical internal medicine and combined medicine/pediatrics resident physicians. Exit interview surveys of patients were conducted at baseline and following the educational program. Patients were questioned about demographics and if they were asked about domestic violence during the current visit. Physicians were questioned about demographics and attitudes and beliefs related to domestic violence. Prior to the intervention, only 0.8% (1 of 122) of patients reported being asked about domestic violence. After the intervention, the percentage asked rose to 17% (20 of 116). The odds ratio (OR) for being asked about domestic violence after training was 25.2 (6.1-104). Patients who were younger than 50 years were more likely to be asked (OR 2.5, 1.5-4.6). Caucasian physicians were more likely to ask (OR 2.8, 1.1-7.6). Patients reporting they were taught breast self-examination at that day's visit were also more likely to be screened (OR 2.9, 1.1-7.9). We found evidence that moderately intense training and focusing on results can increase resident physician screening rates for domestic violence. To do so effectively, we recommend a training session similar to this one and continued monitoring of outcome in the clinical setting.     

Rural Health Leaders Pipeline, 1990–2005: Case Study of a Second-Generation Rural Medical Education Program

ABSTRACT

A pipeline model has been suggested to increase the rural physician supply. This study is an institutional case report used to describe the context, development, and in-house evaluation of the University of Alabama Rural Health Leaders Pipeline, 1990–2005. This program was developed at a University of Alabama School of Medicine branch campus to target rural students at multiple levels, elementary schools through residency, and includes a minority focus. Requirements to enter the medical program include living 8 years in rural Alabama, meeting admission requirements, and affinity for rural lifestyles. Twenty-six percent of 316 high school participants, all 40 students in the minority-focused college program, and 3% of 90 medical program students were African American. The program includes (1) puppet shows in elementary schools depicting different health professions, (2) Rural Health Scholars Program for 11th-grade students, (3) Minority Rural Health Pipeline Program for college students, (4) Rural Medical Scholars Program, a 5-year track of study in rural community health and medicine, and (5) assured admission to family medicine residency. Outcomes studied in this case report included medical school performance, graduation rate, selection of family medicine specialty, and rural practice location. Medical scholars were anticipated to experience academic difficulty, select family medicine specialty, and locate in rural practice more often than peers. Compared to peers, medical scholars showed lower scores on preclinical courses and USMLE steps 1 and 2, reflective of their lower MCAT and GPA scores, but had (1) similar graduation rates (95% vs peers 84%), (2) higher family medicine selection rate (47% vs Huntsville 27% vs Tuscaloosa 12% vs Birmingham 4% [OR compared to Birmingham 22.7, 95% CI 10.5–49.4]), and (3) higher rural practice rate (67% vs peers 14% vs national group 9%) in the first RMSP classes. Based on these important outcomes being better than or equal to the traditional student cohorts, the institution concluded that the Rural Health Leaders Pipeline demonstrates successful use of the rural pipeline model.     

The influence of personality type on decision making in the physical therapy admission process

The purpose of this study was to identify the personality types of physical therapy (PT) interviewers and applicants, using the Personality Styles (PS) assessment tool, and to determine whether an interview team's personality type influences the rating score given. The PS was validated in a study of 298 students who completed the Myers-Briggs Type Indicator (MBTI) Form G and a PS assessment. By chi-square analysis the PS model appears to be a valid representation of the MBTI (chi 2 = 86.62, p < 0.00001). Subjects for the interview portion of the study were 282 student applicants, 19 faculty, and 47 clinicians from two PT programs. A randomly assigned faculty/clinician team interviewed each applicant. Two one-way ANOVAs were performed with interview score as the dependent variable and 1) applicant personality type in relation to faculty/clinician team (same, different from both, like one) and 2) applicant personality type as the independent variables. Internal consistency of the interview rating form was alpha = 0.89. Mean interview score was 33.97/42 (SD 4.59). Interview scores were not significantly different between applicants who interviewed with clinician/faculty teams that were "like" compared with "not like" the applicants (F0.864; p = 0.423), but were significantly different between applicants with different PS personality types (F3.159; p = 0.026). Although personality type of the interview team did not impact the score given, thereby refuting the presence of interviewer bias, the rating scores did vary according to personality type of the applicant, suggesting a possible stereotyping bias in the criteria used to rate applicants.     

Nursing opinions on collaborating with residents in new and legacy OB/GYN programs

Collaboration among physicians and nurses is vital and has shown to lead to better patient care and improve outcomes. Our study surveyed two groups of Labor and Delivery nurses in two regionally similar community hospitals in midwestern United States: one group from a new Obstetrics and Gynecology (OB/GYN) residency program (n = 49) and another from an established (legacy) OB/GYN residency program (n = 49). The survey asked nurses from the hospital with new and legacy residency program about preparedness for working with residents, perceptions of nurse-resident-patient relationships, collaboration and opinions about how resident physicians impact patient safety. Most nurses from the legacy residency program showed positive perceptions of collaboration with the residency and institutional support. In the new OB/GYN residency program, nurses were generally neutral and showed skepticism about collaboration with OB/GYN resident physicians and institutional support. Nurses from both hospitals felt similarly in their comfort escalating issues to administration and in their satisfaction with interprofessional collaboration within Labor and Delivery units. Providing nurses with opportunities to learn about the role of new medical residents in their patient care setting as well as intentional collaboration between nursing and residency program administration might result in more effective collaboration between physician residents and nursing staff.