Andriole Dorothy A, Klingensmith Mary E, Schechtman Kenneth B
Washington University School of Medicine, St. Louis, Missouri, USA.
Curr Surg. 2005 Jul-Aug;62(4):423-8. doi: 10.1016/j.cursur.2005.01.001.
Although 1996 to 2002 was a period of declining interest in general surgery (GS) among U.S. medical students (USS), most categorical general surgery (C-GS) training positions offered in the National Residency Matching Program (NRMP) continued to fill. We measured the impact of the decreasing U.S. student applicant volume on C-GS match outcomes and GS resident workforce composition over this time period.
Match outcomes were analyzed for 7 applicant categories. Subsequent GS resident workforce compositions were analyzed for proportions of U.S. allopathic medical school graduates (USG), osteopathic medical graduates (OMG), Canadian MG (CMG), foreign MG (FMG), female physicians, and African-American physicians. Mantel-Haenzel chi-square tests measured trends in match percentages, C-GS positions filled, and GS workforce composition. All p-values are 2-sided.
Increasing match percentages for USS applicants (p < 0.0001) and USG (p = 0.001), with a decreasing percentage of C-GS positions filled by these applicants (p < 0.0001), were from declining applicant volumes. Increasing match percentage for non-U.S. allopathic medical applicants reflected increases in both applicant volumes and matched applicants, with an increasing percentage of C-GS positions filled by these applicants (p < 0.0001). The subsequent resident workforce included increasing proportions of FMGs and OMGs (each p < 0.001); proportions of USG MDs and CMGs decreased (p < 0.0001 and p < 0.02, respectively). Concurrently, there were increasing numbers and proportions of female physicians (p < 0.0001) and African-American physicians (p < 0.0001) in the general surgery resident workforce.
Declining interest among U.S. students in GS has resulted in a workforce comprised of residents from a broad range of educational backgrounds, but also it has provided an opportunity for progress toward achievement of a GS resident physician workforce more equitably representative of the racial and gender composition of our society at large.
尽管1996年至2002年期间美国医学生（USS）对普通外科（GS）的兴趣呈下降趋势，但美国国家住院医师匹配计划（NRMP）提供的大多数普通外科分类培训职位（C-GS）仍能招满。我们在此期间测量了美国学生申请人数量减少对C-GS匹配结果和GS住院医师劳动力构成的影响。
分析了7类申请人的匹配结果。随后分析了GS住院医师劳动力构成中美国opathic医学院毕业生（USG）、整骨医学院毕业生（OMG）、加拿大医学院毕业生（CMG）、外国医学院毕业生（FMG）、女医生和非裔美国医生的比例。Mantel-Haenzel卡方检验测量了匹配百分比、C-GS职位填补率和GS劳动力构成的趋势。所有p值均为双侧。
USS申请人（p < 0.0001）和USG（p = 0.001）的匹配百分比增加，而这些申请人填补的C-GS职位百分比下降（p < 0.0001），原因是申请人数量减少。非美国opathic医学申请人的匹配百分比增加反映了申请人数量和匹配申请人数量的增加，这些申请人填补的C-GS职位百分比也增加（p < 0.0001）。随后的住院医师劳动力中FMG和OMG的比例增加（均为p < 0.001）；USG医学博士和CMG的比例下降（分别为p < 0.0001和p < 0.02）。与此同时，普通外科住院医师劳动力中女医生（p < 0.0001）和非裔美国医生（p < 0.0001）的数量和比例都在增加。
美国学生对GS的兴趣下降导致了一支由广泛教育背景的住院医师组成的劳动力队伍，但同时也为朝着更公平地代表我们整个社会的种族和性别构成的GS住院医师劳动力队伍的目标取得进展提供了机会。
