Albuja-Cruz Maria, Travis Claire, Benge Michael, Caufield Barbara, Nehler Mark
Department of Surgery, University of Colorado Denver, Denver, Colorado.
Department of Surgery, University of Colorado Denver, Denver, Colorado.
J Surg Educ. 2018 Mar-Apr;75(2):294-298. doi: 10.1016/j.jsurg.2017.08.008. Epub 2017 Sep 5.
The majority of surgery programs roster non-designated preliminary (NDP) residents. We and others have reported on the success of NDP resident mentoring with regard to categorical position placement. Lacking is a focus on the candidates themselves and differences based on initial career of choice.
NDP residents' files since the institution of SOAP were reviewed for demographics, initial career choice, financial burden, region of medical school of origin, application and interview history, and pre-screen interview candidate score (high score of 22 - data includes USMLE scores, major clerkship grades, and AOA) used for categorical recruitment.
From 2012-16 79 NDP residents have been recruited at UCDenver (82% via SOAP). Median age was 28 years, majority were single (73%), and male (82%). Thirty percent belonged to an under-represented minority group. Mean debt was $156,000 but 20% owe over $250,000. 90% attended US medical schools with 65% from the NRMP "South" region. 86% were recruited as fourth year students. NDPs were categorized as failing to match in general surgery (38%), surgical subspecialties (47%), or other (15%). NDPs applied to median of 68 programs (range 7-200) and granted a median of 8 interviews (range 0-24). NDPs had a mean pre-screening interview score of 13 out of 22 and only 9% would have met the standard threshold to obtain a categorical surgery interview. There were no differences in pre-screening scores in the three groups. 95% NDPs (excluding present year) successfully completed their R1 year (three resigned - one obtained a general surgery spot mid-year and two after matching in non-general surgery fields). 68% NDPs placed in categorical positions after the R1 year. The placement was better for the surgical subspecialty group compared to the other two.
The bias is that due to a more competitive applicant pool recruiting NDPs from surgical subspecialties would be optimal. However, those unmatched surgical subspecialty candidates are no better academically than the unmatched general surgery group, often have career interests that do not always align with scheduled rotations, and may not feel compelled to complete the year if they match. They place minimally better when accounting for those unmatched general surgery NDP R1s continuing as NDP R2s. Ultimately the success in a non-designated preliminary R1 surgery program is alignment of clinical educational opportunities with the needs of the trainee.
大多数外科住院医师培训项目都会招录非指定的初级住院医师（NDP）。我们及其他研究者已报道了NDP住院医师在分类职位安置方面的指导成效。但目前缺乏对这些候选人自身以及基于其最初职业选择差异的关注。
回顾自实行住院医师招录与匹配计划（SOAP）以来NDP住院医师的档案，内容包括人口统计学信息、最初职业选择、经济负担、医学院校所在地区、申请及面试记录，以及用于分类招录的预筛选面试候选人分数（满分22分，数据包括美国医师执照考试成绩、主要临床实习成绩和美国骨科医师协会会员资格）。
2012年至2016年期间，科罗拉多大学丹佛分校共招录了79名NDP住院医师（82%通过SOAP招录）。中位年龄为28岁，大多数人单身（73%），男性占82%。30%属于代表性不足的少数群体。平均债务为15.6万美元，但20%的人负债超过25万美元。90%毕业于美国医学院校，其中65%来自住院医师招录与匹配计划（NRMP）的“南部”地区。86%是在四年级时被招录的。NDP住院医师被分类为未匹配到普通外科（38%）、外科亚专科（47%）或其他科室（15%）。NDP住院医师平均申请了68个项目（范围为7 - 200个），平均获得8次面试机会（范围为0 - 24次）。NDP住院医师的预筛选面试平均分数为22分中的13分，只有9%的人达到了获得分类外科面试的标准门槛。三组的预筛选分数没有差异。95%的NDP住院医师（不包括当年）成功完成了第一年住院医师培训（三人辞职，一人年中获得普通外科职位，两人在非普通外科领域匹配后辞职）。68%的NDP住院医师在第一年住院医师培训后获得了分类职位。与其他两组相比，外科亚专科组的职位安置情况更好。
有一种偏见认为，由于申请者竞争更加激烈，从外科亚专科招录NDP住院医师是最佳选择。然而，那些未匹配到外科亚专科的候选人在学业上并不比未匹配到普通外科的候选人更好，他们的职业兴趣往往与预定轮转不一致，如果他们匹配成功，可能没有动力完成这一年的培训。如果将那些未匹配到普通外科的NDP住院医师继续作为第二年NDP住院医师考虑，他们的安置情况只是略好一些。最终，非指定初级第一年外科住院医师培训项目的成功在于临床教育机会与受训者需求的匹配。
