Everett George D, Maharam Edward, Yi Fanchao
From the Internal Medicine Department and the Research Institute, AdventHealth Orlando, Orlando, Florida.
South Med J. 2021 Oct;114(10):657-661. doi: 10.14423/SMJ.0000000000001301.
Prospective first-year house staff and residency program leaders spend substantial time, effort, and expense preparing a rank order list for the National Resident Matching Program (NRMP). Previous studies have mostly shown minimal or no relation between rank order and subsequent resident performance, raising questions about the value of this process. Furthermore, no previous studies have been done with Internal Medicine residencies. As such, the purpose of this study was to compare NRMP rank order to multiple objective outcomes of an Internal Medicine residency.
A retrospective cohort of Internal Medicine residents from five consecutive graduating classes, trained between July 1, 2013 and July 31, 2020, were evaluated for five objective outcomes: Accreditation Council for Graduate Medical Education (ACGME) milestones, faculty rankings of quality, National In-Training Examination scores, chief resident attainment, and fellowship attainment. Outcomes were analyzed in relation to eight potential predictors: NRMP rank, medical school type and grades, immigration status, added qualifications, sex, age and US Medical Licensing Examination (USMLE) scores, using univariate and multivariate analyses.
From a cohort of 61 residents, 56 were eligible. All eligible residents' data were included, for a participation rate of 100% (56 of 56). There were no statistically significant univariate or multivariate predictors for the endpoint of fellowship attainment. Higher USMLE scores were predictive of chief resident status in univariate analysis only. NRMP rank was significantly correlated with ACGME milestones in the univariate analysis. The multivariate analysis revealed that higher USMLE score was statistically significantly predictive of more favorable milestones, faculty ranking, and National In-Training Examination score.
Higher USMLE score was statistically significantly associated with multiple favorable objective residency outcomes in an Internal Medicine residency. A better NRMP rank was correlated with favorable ACGME milestones in univariate analysis, but USMLE score emerged as the strongest predictor in multivariate analysis.
即将进入住院医师培训第一年的住院医师和住院医师培训项目负责人花费大量时间、精力和费用来准备国家住院医师匹配计划（NRMP）的排名顺序表。先前的研究大多表明排名顺序与住院医师随后的表现之间关系甚微或没有关系，这引发了对这一过程价值的质疑。此外，以前没有针对内科住院医师培训进行过研究。因此，本研究的目的是将NRMP排名顺序与内科住院医师培训的多个客观结果进行比较。
对2013年7月1日至2020年7月31日期间接受培训的连续五届毕业班级的内科住院医师进行回顾性队列研究，评估五个客观结果：研究生医学教育认证委员会（ACGME）的里程碑、教师质量排名、全国住院医师培训考试成绩、担任总住院医师情况以及获得专科培训资格情况。使用单变量和多变量分析，分析了与八个潜在预测因素相关的结果：NRMP排名、医学院类型和成绩、移民身份、附加资格、性别、年龄和美国医师执照考试（USMLE）成绩。
在61名住院医师队列中，56名符合条件。纳入了所有符合条件住院医师的数据，参与率为100%（56/56）。对于获得专科培训资格这一终点，没有统计学上显著的单变量或多变量预测因素。仅在单变量分析中，较高的USMLE成绩可预测担任总住院医师的情况。在单变量分析中，NRMP排名与ACGME里程碑显著相关。多变量分析显示，较高的USMLE成绩在统计学上显著预测了更有利的里程碑、教师排名和全国住院医师培训考试成绩。
在一项内科住院医师培训中，较高的USMLE成绩在统计学上与多个有利的客观住院医师培训结果显著相关。在单变量分析中，更好的NRMP排名与有利的ACGME里程碑相关，但在多变量分析中，USMLE成绩成为最强的预测因素。
