Graduate medical education in the United States

1. The annual surveys of residency programs on which this report is based have had a response rate higher than 90% for the past five years. 2. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. 3. The number of GY-1 positions has not changed significantly over the past three years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased in 1985 but increased in 1986 and in 1987. This increase is due mainly to the number of residents on duty in the new internal medicine and pediatric subspecialty programs. 4. The number of new-entry (GY-1) residents decreased in 1985, 1986, and 1987. 5. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. 6. The number and percentage of women in residency programs continue to increase, as they have for the past several years. 7. The percentage of foreign medical graduate residents decreased slightly to 15.6% in 1987. 8. The number of black non-Hispanic residents increased in 1987, although the percentage of black residents remained about the same. 9. The number of graduates of osteopathic medical schools in ACGME programs has increased 59% since 1985. 10. The number of institutions involved in graduate medical education has not changed significantly over the past three years, although the number of institutions that are not hospitals has increased since 1983. Ninety percent of all types of institutions have some type of affiliation with a US medical school.     

Graduate medical education in the United States

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the past 5 years. The count of available residency positions is a fluid entity and seems to be dependent on many factors, including funding and the number of qualified candidates seen by program directors. The number of GY-1 positions has not changed significantly during the past 3 years. The number of reported unfilled positions, including GY-1 unfilled positions, has increased each year since 1985. The total number of residents on duty decreased slightly in 1988. This decrease may be due to a lower response rate. The number of new entry residents (GY-1) has been decreasing since 1985. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs have remained steady. The percentage of FMG residents decreased slightly to 15.3% in 1988. The number of black non-Hispanic residents decreased in 1988, and the percentage of all residents who are black decreased slightly. The number of graduates of osteopathic medical schools in ACGME programs has increased 39% since 1986. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years, although the number of institutions that are not hospitals has increased since 1983. Ninety-five percent of all types of institutions have some type of affiliation with a US medical school.     

Graduate medical education in the United States

The annual surveys of residency programs on which this report is based have had a higher than 90% response rate for the 5 years previous to 1989. Because of a change to the new electronic data collection system in 1989, the response rate decreased to 78.3%. To adjust for the lower response rate, a regression model computed from data from previous years was developed that permitted projected estimates for 1989 data. These numbers are included in several key tables. The number of GY-1 positions seems to have decreased for 1990, although this may be an artifact of the response rate. Reported unfilled positions, including GY-1 unfilled positions, have increased each year since 1985. The number of new-entry residents (GY-1) seems to be leveling out after decreasing since 1985. Because of the lower response rate, it is difficult to determine the trend in the total number of residents on duty. While the observed number of residents is lower than in 1988, statistical projections indicate an increase of 5% over the 1988 count. Thirty-nine percent of residents were training in family practice, internal medicine, or pediatrics. The number and percent of women in residency programs has remained relatively stable despite a steady increase in the number of women graduating from US medical schools. The percentage of FMG residents has continued to decrease. The percentage of black non-Hispanic residents remains steady. The number of graduates of osteopathic medical schools in ACGME programs has increased 17% since 1987. The number of institutions involved in graduate medical education has not changed significantly during the past 3 years.     

Graduate medical education

The annual surveys of residency programs on which this statistical report is based have had a higher than 95% response for the past four years. The number of accredited programs increased in 1984 and again in 1985, primarily as a result of the accreditation of additional subspecialty programs. Discussions about the sources and methods of financing graduate medical education may have an impact on the number and the size of programs in the near future. The count of available residency positions is a fluid entity and seems to be dependent on many factors, one of which appears to be the number of qualified candidates seen by program directors. The number of PGY-1 positions has not changed significantly over the past three years. The number of reported unfilled positions, including PGY-1 unfilled positions, has been declining since 1983. The special survey of PGY-1 programs conducted for the past three years reveals that about 10% of programs withdrew positions between October and July. However, another group of programs (some of which are new) added to the number of positions offered. The primary reason cited for withdrawing positions has changed. In 1983, the reason was cited as "financial" by 32% of program directors. In 1985, despite the national discussions about financing medical education, a financial reason was cited by only 16% of program directors. Reasons related to candidates, ie, "absence of suitable candidate" and giving the position to an "applicant at the PGY-2 or higher level," were cited by 49% of program directors in 1983 and by 67% in 1985. The total number of residents on duty (exclusive of newly accredited subspecialties) increased in 1983 and 1984 but decreased in 1985. Decreases were noted in family practice, internal medicine, pathology, and surgery. The number of new entry residents (PGY-1) decreased in 1983 (when the number of US graduates had decreased), increased in 1984, and decreased again in 1985. Forty-two percent of residents were training in family practice, internal medicine, or pediatrics. This statistic has not changed significantly over the past three years. (ABSTRACT TRUNCATED AT 400 WORDS)     

Prevalence of Burnout in residents of obstetrics and gynecology: A systematic review and meta-analysis

Background: Burnout is currently a major concern among physicians due to their high level of stress at work. There are several reports on various levels of burnout in residency programs due to several predisposing factors. The aim of this systematic review was to estimate a more precise prevalence of burnout among residents of obstetrics and gynecology. Methods: PubMed, Science Direct and Scopus were searched to identify peer-reviewed Englishlanguage studies published from January 1974 to 2005 reporting burnout among residents of obstetrics and gynecology. The key words used in the search were as follows: Residents, gynecology and obstetrics, professional burnout, depersonalization, distress, anxiety, or emotional exhaustion. Relevant additional articles were identified from the lists of the retrieved articles. Results: We identified 12 studies which met our criteria. A total of 2509 participants were included in this meta-analysis. The overall prevalence rate of burnout on all the three subscales was 44% (95% CI: 30 - 57) in this group of residents. Conclusion: This meta-analysis revealed a high prevalence of burnout syndrome in residents during obstetrics and gynecology residency program. Therefore, it is recommended to consider and address this important issue to develop solutions and interventions which could improve the work condition of the medical residents.     

Trends in medical knowledge as assessed by the certifying examination in internal medicine

The past decade has seen less competition for medical school positions accompanied by the declining interest of medical students in internal medicine. At the same time, the number of first postgraduate-year positions in internal medicine residencies has increased, as has the number of first-year residents who take those positions. The purpose of this study was to examine trends in the medical knowledge of internal medicine residents during the past 6 years. Comparison of performance on the items common to pairs of the certifying examinations of the American Board of Internal Medicine from 1983 to 1988 revealed that the scores of candidates in the reference group have declined, but not dramatically. This trend has occurred among candidates from the top residency programs as well as all other residency programs, and it is present in candidates of all levels of overall clinical competence. Continuing declines in this area could ultimately affect patient care.     

中国台湾地区妇产科住院医师培训体系研究与思考

本文介绍中国台湾地区妇产科住院医师培训的历史发展、培训内容、考查机制、管理制度等方面。借鉴中国台湾地区妇产科住院医师规范化培训体系的经验与理念,结合大陆地区妇产科住院医师培训制度的现状与不足,针对大陆妇产科住院医师规范化培训提出建设性建议,以获得更为高效、满意的培训效果,为大陆地区培养优秀的妇产科专科医生提供思路。     

Effect of history of psychological counseling on selection of applicants for residencies

The stress of medical education and its consequences are widely recognized and acknowledged. However, many students may be reluctant to seek help for stress-related problems because they are concerned over the ramifications such a decision may have on their career opportunities. The purpose of the present study was to determine the extent to which an applicant's history of having received psychological counseling for stress-related problems influenced residency program directors' perceptions of such applicants seeking admission to residency programs. Five hundred twenty-three residency directors in six medical specialties (pediatrics, internal medicine, family medicine, psychiatry, obstetrics and gynecology, and surgery) rated a hypothetical residency applicant. The student's gender and history of psychological counseling were manipulated, but their basic qualifications remained constant. The directors rated the likelihood that they would invite the student for an interview and accept the applicant for the residency. Analysis of variance showed that the directors in pediatrics, family medicine, and psychiatry viewed the hypothetical applicant more favorably overall than directors in internal medicine, obstetrics and gynecology, and surgery. The program directors rated female applicants more favorably than their male counterparts and had a strong bias against inviting for an interview or accepting into their programs students who had a history of psychological counseling. Implications of these findings are discussed.     

Predictors of the performance of foreign medical graduates on the 1982 certifying examination in internal medicine

This study describes a cohort of foreign medical school graduates (FMGs) who first sat for the American Board of Internal Medicine's (ABIM) 1982 certifying examination, compares their performance with that of US medical school graduates, describes differences between US citizen FMGs and alien FMGs, and examines which background factors predict success on the ABIM examination. Data for this study were derived by combining information retained by the Educational Commission for Foreign Medical Graduates with ABIM data. Most FMGs who took the 1982 ABIM certifying examination for the first time were educated in and citizens of Asia, but a sizable minority were US citizens educated in Europe. Scores and program directors' ratings were lower for FMGs than US medical school graduates, and they attended different types of training programs. United States citizen FMGs were very similar to alien FMGs. Foreign medical school graduates who did well on the ABIM examination had done well on the Educational Commission for Foreign Medical Graduates examination and were rated highly by their residency program director.     

Survey of combined residency programs in internal medicine and pediatrics on curricula

Combined residency programs in internal medicine and pediatrics began to emerge during the past decade. Combined programs provide four years of training that leads to board eligibility in both disciplines. To learn more about the curricula of these programs, the authors sent a questionnaire to the directors of the 81 known combined programs. Sixty-eight such programs were active as of July 1986. Of these, 54 had been active in the 1985-86 academic year and had a total enrollment of 390 residents, an average of 7.2 residents per program. Fourteen new programs were activated in July 1986 and enrolled 46 residents, with an average of 3.3 residents per program. Virtually all the programs emphasized training in primary care and included the use of outpatient clinics where residents often work with nonphysician health-care providers. Many programs provided instruction in the use of community resources, preceptorships, and outpatient-oriented conferences and emphasized data-gathering skills. Areas that need to be addressed by program directors and the accrediting organizations are discussed by the authors.     

北京大学医学部内科总住院医师培训现状分析

总住院医师培训是由住院医师成长为主治医师的重要阶段,总住院医师承担着医疗、教学和管理职责。随着内科专业化的不断增强、专科医师规范化培训的逐步开展,内科总住院医师培训受到一定的影响。本文通过调研北京大学医学部在培内科总住院医师和临床指导教师,了解了内科总住院医师的培训现状,发现了存在的问题,并提出了改进建议。     

Introductory course in biomedical ethics in the obstetrics-gynecology residency

Teaching biomedical ethics to physicians at the postgraduate level is difficult because of the time constraints in residency training programs. The author here describes the information used in a brief lecture that introduces a biomedical ethics curriculum in an obstetrics and gynecology residency.     

The characteristics of training in ambulatory medicine in U.S. residencies

To determine the characteristics of training in ambulatory internal medicine, all internal medicine residency programs in the United States were surveyed in 1981-82. Thirty-eight percent of 477 hospitals responded. Quantitative information was sought regarding the specific features of the ambulatory residency programs, formal teaching conferences, supervision of residents, and evaluation of residents in ambulatory care. According to the responses, the training of the small cadre of primary care residents does emphasize ambulatory medical experience, supervised by an increasing number of faculty members in general medicine. Formal post-clinic conferences, analogous to inpatient attending rounds, are held substantially more often in hospitals with primary care programs than in hospitals without primary care programs. Formal ambulatory teaching conferences stress both traditional topics important in internal medicine and psychosocial issues. However, the authors could detect little effect of these activities in primary care programs on the training of traditional internal medicine residents even within the same hospital.     

男性医学生在妇产科实习中存在问题的调查研究

目的探讨男性医学生在妇产科实习中面临的问题及其根源,并提出改善的意见与建议。方法对本校临床医学(七年制)和临床医学(五年制)共104名在妇产科实习的男性医学生进行了自编问卷调查,问题包括男生对在妇产科实习的态度、在妇产科实习的效果以及遇到的问题等。调查数据采用SPSS 13.0软件进行统计整理。结果认为妇产科实习很重要的人占83.65%;问诊及体检时遭遇过患者拒绝的人为99人,占95.19%;认为能按照教学大纲圆满完成任务的仅有29人,占27.88%;所有男生均认为在妇产科实习期间最大的问题就是实践机会太少,原因是多方面的。结论男生在妇产科实习时所遇问题的主要原因包括社会、患者、男生自身、带教教师等多方面因素。为解决这些问题,医学院校必须从加强社会宣传、提高教师教学意识、增强男生自身认识和综合素质、加强男生与患者之间的沟通交流。     

Two combined residency programs in internal medicine and pediatrics

Combined residency training in internal medicine and pediatrics is becoming a popular postgraduate program among graduating medical students. The number of such programs has increased rapidly but with little interchange of ideas and without the benefit of a national data base. In this paper, the authors review the experience of two combined programs. Initially established because of the desire to provide broad-based training in primary care, the programs now offer a curriculum that prepares residents for primary care or education in the subspecialties. The difficulty for residents of achieving competence in two disciplines is compounded by a lack of faculty role models. The two programs offer special advantages to the residents and the departments involved. The career outcomes of program graduates have varied from primary care or subspecialty practice in one or both disciplines to faculty positions in teaching institutions. Whether the program remains successful will depend on the ability of its graduates to offer special talents to academic and clinical practice settings and on the availability of funding.     

关于妇产科学科研型学位研究生学历住院医师规范化培训的思考

目的 比较妇产科学科研型学位与临床型学位研究生及其他学历的住院医师在临床专业能力、自主学习能力及人际沟通能力方面的差异,进一步完善妇产科学住院医师规范化培训制度.方法 对在北京大学人民医院妇产科参加第一阶段规范化培训的不同学历层次和类别的24名住院医师进行综合评分,包括临床专业能力、自主学习能力及人际沟通能力三个方面,并对得分情况进行逐项分析.结果 ①第二年住院医师中,科研型学位研究生学历住院医师的专业知识、临床思维、自主学习能力、人际沟通能力得分及总分均低于其他住院医师（P＜0.05）.②第三年住院医师中,科研型学位研究生学历住院医师的临床思维、自主学习能力、人际沟通能力得分及总分均低于其他住院医师（P＜0.05）.结论 科研型学位研究生学历住院医师在临床专业能力、自主学习能力及人际沟通能力方面均弱于临床型学位研究生及其他学历的住院医师.     

US graduate medical education, 2002-2003

Sarah E. Brotherton, PhD; Paul H. Rockey, MD, MPH; Sylvia I. Etzel

JAMA. 2003;290:1197-1202.

Context  By selecting a specialty to train in, physicians entering graduate medical education (GME) training provide advance information about the future physician workforce.

Objective  To determine trends in the residency choices of medical school graduates entering GME training.

Design, Setting, and Participants  The American Medical Association and Association of American Medical Colleges jointly surveyed active programs as well as combined programs in academic year 2002-2003 about active, transferred, and graduated residents. In 2002 the survey was sent to 8064 program directors; 84.2% of them confirmed the status of all active residents and 82.6% completed the program survey.

Main Outcome Measures  In addition to overall trends, the specialty choices of graduates of osteopathic schools (DOs) and international medical graduates (IMGs). Also, where native US citizen resident physicians attended medical school if not in the United States, with a focus on Hispanic ethnicity and Spanish-language facility.

Results  The census counted 98 258 resident physicians in GME programs in academic year 2002-2003, similar to 5 years ago and reversing a decline over the past few years. There were 23 443 residents in graduate year 1 (GY1) positions, for which prior GME training is not required, a slight increase from 2001-2002. The proportion of GY1 residents without prior GME increased slightly compared with 2001-2002 (92.3% to 93.3%). In 1996-1997, 624 DOs were GY1 residents without prior GME (2.9%); their numbers increased to 1312 (6.0%) in 2002-2003. The number of IMGs in GY1 positions without prior GME also increased over this period, from 5033 (23.5%) to 5623 (25.7%). Over the past 6 years the number of IMG and DO GY1 residents without prior GME in specialties such as general surgery, obstetrics and gynecology, and emergency medicine has increased disproportionately faster than the overall rate. Hispanic native US citizens are more likely to be IMGs than non-Hispanic native US citizens (9.6% vs 5.0%). One third of Hispanic native US citizen IMGs received their medical education in Spanish vs less than 3% of non-Hispanic native US citizen IMGs.

Conclusions  Nearly 25% of physicians in US allopathic training programs in 2002-2003 were IMGs, and the percentage of DOs continues to increase. The number of residents conversant in Spanish could serve a need for a large US minority population.

     

US graduate medical education, 2003-2004

Context  Information about recent graduates of medical schools and the characteristics of physicians training in graduate medical education (GME) portends the size and composition of the US physician workforce of the near future. Objectives  To examine trends in training programs and career choices of graduating male and female residents and to monitor trends in the size of the entire residency population. Design, Setting, and Participants  The American Medical Association and Association of American Medical Colleges jointly surveyed residency programs during the academic year 2003-2004 about active, transferred, and graduated residents, as well as about program characteristics. The 8192 programs confirmed the status of 94.6% of residents. Nearly 86% of program directors (n = 7040) completed the accompanying program survey. Main Outcome Measures  Overall trends during the last 6 years in the number and characteristics of residents and programs, as well as the specialty of male and female graduating residents. Results  There were 99 964 active residents during the 2003-2004 academic year, the highest ever recorded by the National GME Census. The number of residents (n = 22 444) entering US graduate medical education programs for the first time is also the highest on record. In 1999, 28 773 physicians completed training, 10 546 (36.7%) of whom were women. In 2003, there were 29 745 graduates, 11 681 (39.3%) of whom were women, representing a 10.8% increase. The number of obstetrics/gynecology male graduates decreased 31.3%, while female graduates increased 18.2%. Other specialties that lost men and gained women were dermatology, family medicine, internal medicine, ophthalmology, pathology, psychiatry, and general surgery. The proportion of graduates who pursued additional training increased; percentages were 27.2% in 1999, 29.6% in 2001, and 32.1% in 2003. In 2000, 35.7% of programs provided opportunities to develop cultural competence; the percentage in 2003 was 50.7%. The percentage of programs with complementary/alternative medicine curriculum has held steady at 24%. Conclusions  The number of physicians in GME is at its highest, and nearly one third of physicians completing training in one program continue on in another. The choices of female residents parallel those of male residents in many respects, but there are important differences.      

National survey of internal medicine residency program directors regarding problem residents

CONTEXT: Internal medicine residency training is demanding and residents can experience a wide variety of professional and personal difficulties. A problem resident is defined by the American Board of Internal Medicine as "a trainee who demonstrates a significant enough problem that requires intervention by someone of authority." Data are sparse regarding identification and management of such residents. OBJECTIVE: To gain more understanding of the prevalence, identification, management, and prevention of problem residents within US internal medicine residency programs. DESIGN, SETTING, AND PARTICIPANTS: Mailed survey of all 404 internal medicine residency program directors in the United States in October 1999, of whom 298 (74%) responded. MAIN OUTCOME MEASURES: Prevalence of problem residents; type of problems encountered; factors associated with identification and management of problem residents. RESULTS: The mean point prevalence of problem residents during academic year 1998-1999 was 6.9% (SD, 5.7%; range, 0%-39%), and 94% of programs had problem residents. The most frequently reported difficulties of problem residents were insufficient medical knowledge (48%), poor clinical judgment (44%), and inefficient use of time (44%). Stressors and depression were the most frequently identified underlying problems (42% and 24%, respectively). The most frequent processes by which problem residents were discovered included direct observation (82%) and critical incidents (59%). Chief residents and attending physicians most frequently identified problem residents (84% and 76%, respectively); problem residents rarely identified themselves (2%). Many program directors believed that residents who are from an underrepresented minority, are international medical graduates, or are older than 35 years are at increased risk of being identified as a problem resident (P<.05). Program directors believed that frequent feedback sessions (65%) and an assigned mentor for structured supervision (53%) were the most helpful interventions. CONCLUSION: Nearly all internal medicine residency programs in this sample had problem residents, whose presenting characteristics and underlying issues were diverse and complex. JAMA. 2000;284:1099-1104     

妇产科住院医师规范化培训实施效果分析

目的探讨妇产科住院医师规范化培训实施效果。方法以我院参加2016至2018年妇产科住院医师规范化培训的40名学员为调查对象,通过对其培训前后的敬业精神、责任感、沟通技巧、文书书写、病史采集、体格检查、诊断与鉴别能力、药物使用、临床技能、计算机运用等行为的评分情况,以及培训前后的理论与技能考试成绩进行搜集、整理和对比;以此分析妇产科住院医师规范化培训实施的效果。数据比较采用SPSS 22.0进行Z检验及t检验。结果学员培训前后行为变化评分:敬业精神[(4.775±0.366)vs.(7.475±0.362)]、责任感[(4.800±0.333)vs.(7.850±0.366)]、沟通技巧[(4.575±0.382)vs.(7.550±0.339)]、文书书写[(4.833±0.376)vs.(7.762±0.343)]、病史采集[(4.762±0.314)vs.(7.738±0.316)]、体格检查[(4.434±0.347)vs.(7.565±0.317)]、诊断与鉴别能力[(4.239±0.274)vs.(7.348±0.314)]、药物使用[(4.370±0.261)vs.(8.022±0.246)]、临床技能[(4.370±0.330)vs.(8.217±0.265)]、计算机运用[(4.652±0.260)vs.(8.630±0.289)],差异有统计学意义(P<0.05);学员培训前后理论考试成绩[(70.95±1.165)vs.(89.675±1.164)]、技能考试成绩[(67.575±0.947)vs.(88.15±0.877)],差异有统计学意义(P<0.05)。结论妇产科住院医师规范化培训可以加强学员对临床技能的掌握,提高学员临床思维能力。