US graduate medical education, 1999-2000

This report examines data collected through the American Medical Association Annual Survey of Graduate Medical Education Programs for 1999-2000 and compares these data with similar data collected during the past several years. The number of resident physicians enrolled during 1999-2000 was 606 more than during the previous year; graduates of US osteopathic medical schools (USDOs) had the greatest proportional increase (5.2%). The number of physicians entering graduate medical education (GME) for the first time in 1999-2000 (n = 22,320) also increased, with the number of USDOs increasing the most, by 14.5%, followed by international medical graduates (IMGs) at 6.5%. Between academic years 1998-1999 and 1999-2000, the number of physicians with prior US GME occupying first-year positions for which prior GME was not required (GY1 positions) increased by more than 300 (12%). Compared with graduates of US allopathic and osteopathic medical schools (USMGs), IMGs were more likely to seek additional training after graduating from a program. However, this was not true of IMGs who were US citizens or who had been naturalized or had permanent residency status. For the second year in a row, the number of white graduates of US allopathic medical schools (USMDs) entering GME has declined (2.0%), while the number of Hispanic GY1 USMDs has increased by 10.5%. The number of Asian GY1 USMDs increased steadily (11.0%) but the number of blacks decreased by 7.1% from 1998-1999. Growth continues, both in numbers and in heterogeneity of physicians in training, and must be considered in the future development of policy to guide US GME. JAMA. 2000;284:1121-1126     

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 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, 1998-1999: a closer look.

Despite the ever-present risk of a critical imbalance in the physician workforce total numbers and specialty distribution, no systematic planning mechanism is in place. Furthermore, the length of training for graduate medical education (GME) precludes timely rectification of imbalances. We report GME activities collected in the American Medical Association Annual Survey of Graduate Medical Education Programs for 1998-1999, along with trends during the last 3 to 6 years. These data initially suggest that little has changed during the past several years; however, on closer examination, small but significant changes during the past 2 years may have serious consequences if continued. The total number of resident physicians, which has been constant during the last several years, decreased in 1998 by 760 from the previous year, while the number of programs continues to increase (6.1% since 1993). The number of US medical graduates entering GME programs remained stable during the last 6 years, the number of osteopathic graduates entering GME increased by 55.7%, and the number of international medical graduates (IMGs) entering GME continued to drop (down 13.2% since 1993). More IMGs tend to pursue additional training than do US graduates (in 1997, 32.9% vs 23.6%). Because IMGs are remaining in GME programs for longer periods, the total number of IMGs has not yet reflected significant change. About 62% of IMGs now entering GME training are either US citizens or permanent residents; ethnic minority residents are not decreasing in numbers as some predicted; and for the first time in the past 5 years, the primary care specialties have ceased their persistent growth. Toward the end of GME, the number of residents leaving programs before completion increased by 5.7% during the last 3 years. While some of these changes may be ascribed to reduced GME funding through the Balanced Budget Act of 1997, other factors clearly are at play. To anticipate future changes in the physician workforce, these factors should be identified to permit them to be monitored and modified as needed.     

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.     

The stability of early specialty preferences among US medical school graduates in 1983

Medical graduates in 1983 were in preclinical training when the Graduate Medical Education National Advisory Committee forecast a surplus of 70,000 physicians by 1990. Among the problems identified was the nuclear role of medical schools in affecting specialty choices. To understand this role further, the current study determined the stability and evolution of specialty preferences between the time of the Medical College Admission Test and the senior year of medical school. The study included 10,321 US medical school graduates in 1983. Eighty percent changed their specialty preference during this interval, demonstrating the substantial effects that medical schools have on specialty selection. The stability of early preferences ranged from 41% to 1%. Interest in primary care specialties declined among both men and women; interest in specialty care and supporting services increased during this five-year longitudinal study. These findings parallel shifts away from primary care among US medical school graduates in 1978 and 1983.     

Foreign medical graduates. The experience of the Australian Medical Examining Council and the Australian Medical Council, 1978-1989: implications for medical immigration and the medical workforce

From July 1978 to March 1989, 1703 foreign medical graduates who entered Australia as immigrants took the examinations of the Australian Medical Examining Council (AMEC) and its successor since 1986, the Australian Medical Council (AMC). Of these, 821 (48.2%) passed the multiple choice question examinations and, of these, 627 (76.3%) passed the clinical examinations. The overall pass rate was 36.8%. The majority of those who passed required more than one attempt to do so. Graduates of medical schools from South Africa, Canada and the United States were, in general, more successful than those from other countries by a large margin. Most candidates were graduates of medical schools in third-world countries and Eastern Europe, and although substantial numbers ultimately passed, few of them had reached the same level of competence as graduates from South Africa and North America. There are many probable reasons for their generally poor performance, the most likely being the quality of their medical education in preclinical and clinical sciences and their lack of substantial postgraduate experience. A second factor for some is their inadequate command of English. A third factor is age. Of 547 candidates who presented for the first time in 1988 and 1989, 258 (47%) were 35 or more years old. Since 1984 medical immigration has trebled and is still rising. At the present rate of growth, foreign graduates sitting the AMC examinations for the first time in 1994 will number approximately 482, which (assuming all pass) will be equivalent to 40% of doctors expected to graduate from the 10 Australian medical schools in that year. In spite of a more than adequate supply of locally qualified doctors, Australia, through easy immigration, has become a target country for foreign medical graduates. The high failure rate in the AMC examinations has led to immigrant-activated political pressure for bridging courses and other concessions. If, as a result, the majority of the immigrants were to pass the AMC examinations and so enter general practice, medical immigration will increase at an even faster rate than it has since 1984, with significant changes in the medical workforce. Some reforms which might avert this are suggested.     

南京医科大学七年制临床医学专业人才培养效果评价

通过对毕业生及其培养或用人单位的问卷调查,本文分析了南京医科大学七年制临床医学专业人才培养的成效,以及江苏省医疗卫生事业发展对高层次医学人才的需求.结果 显示,临床实践能力和科研创新能力是医疗卫生事业发展所需要的高层次医学人才的重要能力;在三级甲等医院工作,具有硕士/博士学位、在专业技术岗位的被调查者更加看重医学生的科研创新能力;而在"1年通识教育、4年医学专业教育(含1年临床课程及见习、1年临床通科实习)、2年二级学科轮转"模式下培养的七年制临床医学专业毕业生的临床实践能力较强,但是科研创新能力不足,且学业负担偏重.因此,应当加强对七年制临床医学专业学生科研创新能力的培养和临床实践能力的通科训练.     

Educational programs in US medical schools, 1998-1999.

To describe the current status of medical education programs in the United States and to trace trends in medical education over this century, we used data from the 1998-1999 Liaison Committee on Medical Education Annual Medical School Questionnaire, which had a 100% response rate, and data from other sources. In 1998-1999, total full-time faculty members numbered 98202, a 1.5% increase from 1997-1998. The number of applicants to medical school declined for the second consecutive year, from 43020 in 1997 to 41004 in 1998, but the academic qualifications of entering students remained steady. The number of applicants from underrepresented minority groups decreased 1.3% from 1997 to 1998, compared with an 11.1% decrease between 1996 and 1997. Women constituted 43.4% of applicants in 1998, slightly more than the 42.5% in 1997. The total number of required hours in the first and second years of the curriculum and the number of scheduled hours per week have declined over the past 15 years, while the average lengths of clinical clerkships remained about the same. The number of schools requiring students to pass Steps 1 and 2 of the United States Medical Licensing Examination continued to increase in 1998-1999, with 50% of schools requiring passing both examinations, compared with 46% in 1997-1998.     

南京医科大学七年制临床医学专业人才培养效果评价

通过对毕业生及其培养或用人单位的问卷调查,本文分析了南京医科大学七年制临床医学专业人才培养的成效,以及江苏省医疗卫生事业发展对高层次医学人才的需求.结果 显示,临床实践能力和科研创新能力是医疗卫生事业发展所需要的高层次医学人才的重要能力;在三级甲等医院工作,具有硕士/博士学位、在专业技术岗位的被调查者更加看重医学生的科研创新能力;而在"1年通识教育、4年医学专业教育(含1年临床课程及见习、1年临床通科实习)、2年二级学科轮转"模式下培养的七年制临床医学专业毕业生的临床实践能力较强,但是科研创新能力不足,且学业负担偏重.因此,应当加强对七年制临床医学专业学生科研创新能力的培养和临床实践能力的通科训练.

Abstract：

An evaluation of 7-year medical education program in Nanjing Medical University was performed via questionnaire survey to the graduates and the staff of hospitals in which the graduates work,and the demand for advanced quality of medical graduates in the field of medical health care in Jiangsu Province is further analyzed. The results showed that the capacity for clinical practice and the capacity for research and innovation are the most important, which can meet the demands of health service development for high-level medical talents. The staff working in advanced hospitals, possessing master or doctor degree,or working as medical experts put more emphasis on the ability of the graduates to do innovative scientific research. Through the completed procedure of the 7-year program includes college general education for 1 year, medical education for 4 years ( containing senior clinical clerkship for 1 year and internship for 1 year) and alternation for medical and surgery subspecialties for 2 years, the graduates showed higher ability to do clinical practice, but not showed the growth of capacity for research and innovation. The most staff investigated proposed an enhancement in training for the capacity for innovative research and general clinical practice.     

医学英语专业毕业生去向的比较分析

医学英语专业是医学院校为顺应医学事业发展而设立的交叉学科专业,毕业生就业状况对探索专业教育发展及人才培养具有重要意义.本文通过分析某高校2007～2012届医学英语专业本科毕业生的就业数据,探讨医学英语专业毕业生的就业特点及存在的问题,同时对毕业生的就业工作及职业生涯指导提出建议,并对医学英语专业定位进行了思考.     

医学研究生就业形势分析与就业力提升策略研究

近年来,随着研究生招生规模的不断扩大,研究生就业难的问题已经引起社会各界的广泛关注。一度就业情况良好的医学研究生群体,就业压力逐年增加,就业矛盾日益凸显。本研究结合近五年重庆医科大学研究生就业情况的调查,在分析医学院研究生就业形势的基础上,立足医学研究生培养特点,探索通过六种途径提升医学研究生的就业力,从而促进医学研究生更好就业。     

US graduate medical education, 2000-2001

Sarah E. Brotherton, PhD; Frank A. Simon, MD; Sylvia I. Etzel

JAMA. 2001;286:1056-1060.

For the last three quarters of a century, the American Medical Association's national collection of graduate medical education (GME) data has evolved in its scope and methods. This year's GME survey involved new technology. The National GME Census for 2000-2001, jointly administered by the American Medical Association and the Association of American Medical Colleges, was part of an Internet-based product called GME Track. Because of technical problems, data collection was less complete than in previous years. Similar to the 1999-2000 survey, we observed an increase in the number of subspecialty programs, with 79 more than last year (2.1% increase), and a decrease in the number of specialty programs, with 40 (0.9%) fewer. Parallel to this continuing trend was a decrease in the number of graduates of US medical schools who were matched into primary care residencies, particularly family practice programs (20% decrease compared with 1996-1997). The number of graduates of osteopathic medical schools training in allopathic programs continued to rise, increasing 7.9% from last year. Numbers of Hispanic and Asian graduates from US allopathic medical schools (USMDs) in graduate year 1 (GY1) positions increased numerically to 887 and 2356, respectively, and proportionally by 7.2% and 17.3%, respectively. Although the number of white USMDs in GY1 positions increased, their proportion decreased slightly among those with known race or ethnicity from 72.2% to 71.7%, and the number of black USMD GY1 residents, numbering 859, declined from the previous year. Although we observed an overall decline in the average number of on-duty hours expected of residents in their first year in a program (from 55 in 1996-1997 to 54 in 2000-2001; P<.001), the average number of hours reported by the majority of programs that typically report the most on-duty hours did not decrease. The issues of resident work hours and the diversity and specialty distribution of the physician workforce continue to foster debate.

     

The development of medical education on alcohol- and drug-related problems at the University of Toronto.

Medical education on alcohol- and drug-related problems at the University of Toronto covers undergraduate, residency and graduate programs, a result of collaboration since 1959 between the university and the Addiction Research Foundation of Ontario. An undergraduate core curriculum, developed in the early 1970s, is offered in year 2; it has been supplemented by electives, selectives and comprehensive clinics. The undergraduate program is rated highly by students; since 1978, 3024 have completed the core program. Residency training started in 1974 and is available through electives lasting from 1 to 12 months in internal medicine, psychiatry, and family and community medicine. To date, 370 residents have completed one of these electives; 129 have completed graduate programs in which their theses concerned alcohol- and drug-related topics, and there have been an additional 13 research and postdoctoral fellows. Despite the progress, there is still a need to improve and expand the undergraduate and residency programs and to develop an effective program of continuing medical education. The goals should be to ensure that, as far as possible, all medical graduates from the University of Toronto have the knowledge, attitudes, skills and behaviours needed to contribute effectively to the prevention and treatment of alcohol- and drug-related problems in their chosen field of practice and to avoid problems from their personal use of alcohol and other drugs.     

Factors used by program directors to select residents

A national, stratified random sample of 405 graduate medical education program directors was surveyed on the way they selected their residents. The results from the 237 respondents reaffirm earlier studies which found that the interview was the most important selection variable. The results indicate that the recent increase in competition for residency positions has increased the importance of academic variables. For example, 86 percent of the respondents stated that they would not rank a candidate who had not passed the National Board of Medical Examiners Part I examination. Because 86 percent also stated that they give preference in ranking students to those who have done well in an elective at their hospitals, the senior year of medical school may be used as a "residency chase" rather than for the general professional education of the physician.     

上海县医疗服务费用

医疗服务费用包括门诊医药费用和住院医药费用。本文根据对上海县1980年至1990年各级医疗机构医疗服务和莘庄医院住院病例调查,反映上海县1980年以来医疗费用变化趋势和现状,分析上海县居民门诊和住院医疗服务的利用及费用的水平与变动,为有效控制医药费用过速增长、合理组织医疗服务提供参考。     

Relationship between past academic performance and results of specialty in-training examinations

In this study, the authors review the records of 63 graduates of Northwestern University Medical School who were residents in its graduate medical education programs of anesthesia and orthopedic surgery. They examine the relationship among college grades, medical school performance, and the results of assessment by annual, nationwide, medical specialty in-training examinations. For the anesthesia group, the best predictors of in-training examination performance were the Medical College Admission Test (MCAT) Verbal Ability score, the college grade-point average for nonscience subjects, and the MCAT Science, General Information, and Quantitative Ability scores. For the orthopedic group, the best predictors were the MCAT Verbal Ability score, the college grade-point average in nonscience subjects, the MCAT Science score, and the National Board of Medical Examiners Part I and Part II examination scores. The previous academic records for the 63 residents contained little to presage results in the in-training examination. The correlation obtained between nonscience college subjects and the in-training examination results was negative.     

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.