Heather L. Hageman

The changing paradigm of contemporary U.S. allopathic medical school graduates' career paths: analysis of the 1997-2004 national AAMC Graduation Questionnaire database.

Purpose During the last 15 years, the proportion of U.S. allopathic medical graduates planning to pursue alternative careers (other than full-time clinical practice) has been increasing. The authors sought to identify factors associated with contemporary medical graduates’ career-setting plans. Method The authors obtained anonymous data from the 108,408 U.S. allopathic medical graduates who completed the 1997–2004 national Association of American Medical Colleges Graduation Questionnaire (GQ). Using multinomial logistic regression, responses to eight GQ items regarding graduates’ demographics, medical school characteristics, and specialty choice were tested in association with three career-setting plans (full-time university faculty; other, including government agencies, non-university-based research, or medical or health care administration; or undecided) compared with full-time (nonacademic) clinical practice. Results The sample included 94,101 (86.8% of 108,408) GQ respondents with complete data. From 1997 to 2004, the proportions of graduates planning full-time clinical practice careers decreased from 51.3% to 46.5%; the proportions selecting primary care and obstetrics–gynecology specialties also decreased. Graduates reporting Hispanic race/ethnicity or no response to race/ethnicity, lower debt, dual advanced degrees at graduation, and psychiatric-specialty choice were consistently more likely to plan to pursue alternative careers. Graduates selecting an obstetrics–gynecology specialty/ subspecialty were consistently less likely to plan to pursue alternative careers. Being female, Asian/Pacific Islander, Black or Native American/Alaskan, and selecting non-primary-care specialties were variably associated with alternative career plans. Conclusions As the medical student population becomes more demographically diverse, as graduates increasingly select non-primary-care specialties, and as dual-degree-program graduates and alternative career opportunities for physicians expand, the proportion of U.S. graduates planning full-time clinical practice careers likely will continue to decline.

What predicts USMLE Step 3 performance

Background Academic and other student-specific variables associated with United States Medical Licensing Examination (USMLE) Step 3 performance have not been fully defined. Method We analyzed Step 3 scores in association with medical school academic-performance measures, gender, residency specialty, and first postgraduate year (PGY-l) of training program-director performance evaluations. Results There were significant first-order associations between Step 3 scores and each of USMLE Step 1 and Step 2 scores, third-year clerkships’ grade point average (GPA), Alpha Omega Alpha election, Medical Scientist Training Program graduation, broad-based specialty residency training, and PGY-l performance evaluation score. In a multiple linear regression model accounting for over 50% of the total variance in Step 3 scores, Step 2 scores, broad-based-specialty residency training, and GPA independently predicted Step 3 scores. Conclusions Individualized Step 3 scores provide medical schools with additional means to externally validate their educational programs and to enhance the scope of outcomes assessments for their graduates.

Attrition During Graduate Medical Education: Medical School Perspective

OBJECTIVE To identify predictors of attrition during graduate medical education (GME) in a single medical school cohort of contemporary US medical school graduates. DESIGN Retrospective cohort study. SETTING Single medical institution. PARTICIPANTS Recent US allopathic medical school graduates. MAIN OUTCOME MEASURE Attrition from initial GME program. RESULTS Forty-seven of 795 graduates (6%) did not complete the GME in their initial specialty of choice. At bivariate analysis, attrition was associated with election to the Alpha Omega Alpha Honor Medical Society, being an MD-PhD degree holder, and specialty choice (all P < .05). Attrition was not associated with graduation year (P = .91), sex (P = .67), or age (P = .12). In a multivariate logistic regression model, MD-PhD degree holder (odds ratio, 3.43; 95% confidence interval, 1.27-9.26; P = .02), election to Alpha Omega Alpha (2.19; 1.04-4.66; P = .04), choice of general surgery for GME (5.32; 1.98-14.27; P < .001), and choice of 5-year surgical specialty including those surgical specialties with a GME training requirement of 5 years or longer (2.74; 1.16-6.44; P = .02) each independently predicted greater likelihood of attrition. CONCLUSION Academically highly qualified graduates and graduates who chose training in general surgery or in a 5-year surgical specialty were at increased risk of attrition during GME.

Which U.S. medical graduates plan to become specialty-board certified? Analysis of the 1997-2004 national association of American Medical Colleges Graduation Questionnaire database.

Background Predictors of U.S. allopathic medical-school graduates’ board-certification plans have not been characterized. Method Using multivariable logistic regression, graduates’ responses to 11 questions on the 1997–2004 Association of American Medical Colleges Graduation Questionnaire were analyzed to identify independent predictors of plans for specialty-board certification. Results The proportion of 108,408 graduates planning specialty-board certification decreased from 97.3% in 1997 to 88.4% in 2004. Among 101,805 (93.9%) graduates with complete data, graduates who were Hispanic, rated their clinical clerkships, quality of medical education, and confidence in clinical skills more highly, had any debt, and planned “University-faculty” careers were more likely to plan becoming board certified. Females, Asians/Pacific Islanders, and graduates who planned to practice in underserved areas, planned “other” nonclinical-practice careers, and graduated with MD/other (non-PhD) degrees were less likely to plan becoming board certified. Conclusion Specialty-board certification does not appear to be among the professional goals for a growing proportion of U.S. medical graduates.