不匹配的住院医师职位录取：毕业后医学教育中提前匹配的可能程度及影响

Out-of-Match Residency Offers: The Possible Extent and Implications of Prematching in Graduate Medical Education.

作者信息

Wetz Robert V, Seelig Charles B, Khoueiry Georges, Weiserbs Kera F

出版信息

J Grad Med Educ. 2010 Sep;2(3):327-33. doi: 10.4300/JGME-D-09-00053.1.

DOI:10.4300/JGME-D-09-00053.1

PMID:21976077

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2951768/

Abstract

BACKGROUND

When the data from the National Resident Matching Program (NRMP) are used to analyze trends in medical students' career preferences, positions offered outside the match are omitted. The purpose of the study was to evaluate the extent and nature of out-of-match residency offers.

METHODS

We obtained total resident complements and postgraduate year-1 positions offered in 7 specialties in 2007 and compared these with the 2007 NRMP match data. We compared the percentage of positions offered outside the match to "success" in matching United States medical doctors (USMDs) and to the availability of fellowship positions, using the Spearman rank order test (SROT).

RESULTS

A total of 18 030 postgraduate year-1 positions were offered in 9 specialty areas. Of 15 205 positions offered in the match, 54% were taken by USMDs. The percentage of outside-the-match offers was found to vary by specialty, from 7% in obstetrics-gynecology to 23% in internal medicine, and was inversely correlated with the specialty's "success" in matching USMDs (SROT = -0.87). The 3 nonprocedural primary care specialties (internal medicine, family medicine, and pediatrics) accounted for 10 091 (46.2%) of the 21 845 total positions offered in the match, with 4401 (43.6%) offered almost entirely to non-USMDs. Another 2467 positions were offered outside the match, resulting in 6868 positions offered to non-USMDs (55% of all primary care positions). In internal medicine, the percentage of outside-the-match offers was significantly and inversely associated with the availability of intrainstitutional fellowship programs (P < .0001). Prematching of independent applicants was significantly higher in primary care than in procedural-lifestyle programs (P < .0001).

CONCLUSION

The NRMP's match data do not account for positions filled outside the match, a finding that appears to be significant. In 2007, 1 in 5 positions in primary care was offered outside the match.

摘要

背景

当利用国家住院医师匹配计划（NRMP）的数据来分析医学生职业偏好的趋势时，匹配之外提供的职位被忽略了。本研究的目的是评估匹配之外住院医师职位提供的程度和性质。

方法

我们获取了2007年7个专业提供的住院医师总数和第一年住院医师职位，并将其与2007年NRMP匹配数据进行比较。我们使用斯皮尔曼等级相关检验（SROT），比较了匹配之外提供的职位百分比与美国医学博士（USMD）匹配“成功”率以及专科住院医师职位的可获得性。

结果

9个专业领域共提供了18030个第一年住院医师职位。在匹配中提供的15205个职位中，54%被USMD占据。发现匹配之外提供职位的百分比因专业而异，从妇产科的7%到内科的23%，并且与该专业在匹配USMD方面的“成功”率呈负相关（SROT = -0.87）。3个非程序性初级保健专业（内科、家庭医学和儿科）在匹配中提供的21845个职位中占10091个（46.2%），其中4401个（43.6%）几乎全部提供给了非USMD。另外有2467个职位在匹配之外提供，导致共有6868个职位提供给了非USMD（占所有初级保健职位的55%）。在内科，匹配之外提供职位的百分比与机构内住院医师培训项目的可获得性显著负相关（P < 0.0001）。独立申请人的预匹配在初级保健专业中显著高于程序性 - 生活方式类专业（P < 0.0001）。