We read with profound interest the article by Ganesh Kumar et al1 highlighting trainee perspectives regarding the use of a United States Medical Licensing Examination (USMLE) pass/fail score in place of the traditional 3-digit numerical scoring system for resident selection in graduate medical education (GME) residency programs. The authors surveyed a diverse cohort of residents, fellows, and medical students, inclusive of US allopathic (MD) students, US osteopathic (DO) students, and international medical graduates (IMGs) in 2020. A total of 11 633 trainees (7254 residents/fellows and 4379 medical students), 14% of which were underrepresented in medicine (UiM), responded to the survey and provided insights on this controversial subject. The authors emphasized in their discussion that, although 35% of the respondents supported the proposed USMLE Step 1 pass/fail scoring system, 44% of the survey respondents disliked this system. US allopathic medical students and UiM trainees were the most supportive of a USMLE Step 1 pass/fail scoring system. In contrast, many non-UiM, DO, and IMG respondents felt that they would be at a disadvantage. Regarding the secondary outcome measure that a USMLE Step 1 pass/fail scoring system will reduce socioeconomic disparities in resident selection, it was fascinating to read that UiM medical students primarily supported this hypothesis. We applaud the Vanderbilt University investigators for performing this study, which provides GME leaders with vital data as we transition to a USMLE Step 1 pass/fail scoring system.In the United States, GME is at a crucial crossroads regarding resident selection. Historically, USMLE Step 1 scores have served as a benchmark for screening resident candidates, especially in highly competitive programs. Although USMLE scores may reflect some degree of inherent knowledge, the preparation required to excel on the examination may also depend on socioeconomic factors. Medical students often take multiple preparation courses, such as the PASS Program and Kaplan, to improve their content knowledge and test-taking skills for the USMLE examinations. Many of these are high cost, and in an era of rising medical school tuition costs, access may be limited to students with adequate financial resources. Students from socioeconomically disadvantaged backgrounds may have lower USMLE Step 1 scores because of reduced resources. For this and other reasons, the decision to move to a USMLE Step 1 pass/fail scoring system was made. However, as found by Ganesh Kumar et al,1 trainees who responded to this survey had varied perspectives—a significant subset of these respondents, particularly DO and IMG trainees, were skeptical of this transformation. As a result, we caution GME leaders to be thoughtful with this new binary USMLE Step 1 pass/fail scoring system, because it may introduce additional implicit biases against DO and IMG applicants. It may be helpful to remove credentials that could encourage implicit bias, such as the MD, DO, or IMG designation when reviewing an applicant.The critical question now becomes: How will residency admission committees identify top-level applicants in the era of a USMLE Step 1 pass/fail scoring system? We believe that using a meritocratic, holistic approach to residency admission, inclusive of letters of recommendation, the binary USMLE Step 1 pass/fail score, medical school transcripts, trainee experiences, personal attributes, interview performance, and barriers encountered during their education and training, can identify the best and brightest medical students for residency programs.2 Hopefully, this holistic approach to resident selection will eliminate ingrained socioeconomic disparities that may hinder UiM students from joining competitive residency programs.
Background: Graduate medical education (GME) orientation/onboarding is conventionally an in-person activity, but the COVID-19 pandemic prompted virtual approaches to learner onboarding. However, online GME onboarding strategies have not been disseminated in the literature. Objective: To determine the usefulness of an online curriculum for GME learner orientation at a large sponsoring institution using an electronic survey. The primary outcome was to discover the usefulness of our online curriculum for GME onboarding, and secondary outcomes included identifying barriers to implementation and weaknesses associated with online GME orientation. Methods: We created an online GME orientation curriculum to onboard incoming learners (from June 1 to August 31, 2020) and electronically surveyed our learners to determine the usefulness of this novel approach. We conducted orientation sessions and electronically recorded questionnaire responses using CarmenCanvas, our institutional learning management system. Linear regression analysis was performed to identify factors predicting satisfaction with virtual GME orientation using IBM SPSS Statistics, Version 26.0 (Armonk, NY, USA). Results: Of 353 trainees, 272 completed the survey for a 77% response rate. 97% of respondents reported that the curriculum supported performance of learner duties. 79% of trainees perceived the overall quality as "very good" or "good", 91% responded that the curriculum provided "effective learning", 94% reported "accessing the course content easily", 92% reported "easily navigating the curriculum", 91% described the curriculum as "well-organized", and 87% reported that the lectures "supported their learning". Conclusion: Online delivery of a comprehensive GME orientation curriculum is useful and facilitates learner education, training, and integration into a large GME institution in the COVID-19 era. Keywords: online graduate medical education orientation, graduate medical education orientation curriculum, COVID-19, resident and fellow onboarding, sponsoring institution, Accreditation Council for Graduate Medical Education
To examine the effect of the revision of the US national AIDS case definition in September 1987, we compared demographic and clinical information for AIDS patients diagnosed and reported to the San Francisco Department of Public Health between 1 September 1987 and 31 October 1989. Of the 3167 patients diagnosed and reported during the study period, 584 (18%) met the revised case definition only, increasing AIDS case reporting in San Francisco by 23%. One hundred and thirty-four of these 584 patients (23%) subsequently developed diagnoses meeting the old definition. After adjusting for this proportion, the revised case definition increased reporting by 17%. The mean time between initial diagnosis with a disease meeting the revised definition and subsequent development of a disease meeting the old definition was 18.5 months. Patients who met the revised case definition only were slightly older and more likely to be Black, female, and intravenous drug users (IVDUs) than those meeting the old case definition. The majority of patients who met the revised case definition only had initial diagnoses of HIV wasting syndrome (26%), HIV encephalopathy (21%), and presumptive Pneumocystis carinii pneumonia (19%). The revised AIDS case definition has significantly increased the reporting of severe morbidity associated with HIV infection, particularly among IVDUs.
Abstract Background: Graduate medical education (GME) orientation is traditionally an in-person endeavor. The COVID-19 pandemic has prompted virtual approaches to trainee onboarding to reduce viral transmission; however, virtual orientation has not been well-described in GME. This study assesses the effectiveness of virtual orientation of GME trainees using data from an electronic survey. Objectives: We aimed to determine the usefulness of virtual instruction on demand for GME trainee onboarding at a large sponsoring institution. Methods: We conducted a retrospective analysis of de-identified electronic survey responses by residents and fellows who underwent GME orientation at our institution from June to August 2020. The primary outcome was to determine the effectiveness of virtual GME orientation for onboarding, and secondary outcomes included identifying barriers to implementation and weaknesses associated with virtual GME orientation. We conducted orientation sessions for the incoming residents and fellows using CarmenCanvas, our institutional learning management system (LMS). Results: 272 of 337 incoming trainees completed the virtual GME orientation survey. 97% of respondents reported that the contents of the orientation modules would help them perform their duties. 79% of trainees rated the overall quality as very good or good, 91% responded that virtual orientation provided effective learning, 94% reported accessing the course content easily, 92% reported easy navigation of the modules, 91% described it as well-organized, and 87% said that the modules supported their learning. Conclusions: Virtual instruction on demand is a safe, effective, and practical approach to resident and fellow onboarding into a GME sponsoring institution in the COVID-19 pandemic era.
