Knowing Your Applicants J. Christian Barrett M.D. Division of Hematology, Oncology and Palliative care

Road Map  Approach to Recruitment  US Allopathic Graduates  Osteopathic Graduates  International Graduates

Critical Appraisal  Appraise your program goals and vision  What type of applicant are you trying to attract?  What are the barriers to attracting the applicants you desire?

Factors Influencing Applicants  Geography/Location  Reputation  Institutional  Program  Board pass rates—first time takers  Resident’s happiness  Current resident quality  Post-graduation placement

Establishing a Strategy  Recruitment cannot just happen  Actively develop a recruitment strategy  Highlighting strengths  Mitigating weaknesses  Hard to truly measure impact

Selecting Your Residents  You CANNOT control who comes to your program  You CAN control who you will not take

Screening the Applicants  Task varies by program size and volume  Establish recruitment targets  Number of slots  Number of applicants per slot  How willing are you to not fill?

Interviewing  Interview fatigue  What information are you getting/giving?  Are you able to

360-Evaluation  How are using your resources in your selection process?  Valuable sources of information  Know your culture and your applicants  Aligning feedback with your goals

GME Collision Point  US society physician shortage and GME funding debated – 50% cuts vs. 15,000 resident slot expansion  How to count other providers in calculations?  Do more doctors improve care, increase care, increase health care costs, etc?  What type of doctors are we going to fall short?  Linking to performance measures of quality  The fiscal cliff?

GME Applicant Collision Point  Medical School Openings and Expansions (MD and DO)  2015 is point where US medical students exceed the number of existing GME slots  1 st year students 2015 = 26,403  1 st year GME positions ~ 23,000  6,000 slots per year typically filled by IMG

GME Applicant Collision Point  AMSA position supports federal funding to ensure only that there is a sufficient number of positions for US medical graduates  What impact does that have on you applicant pool?

US Allopathic Graduates  The Application  Interpreting the MSPE, Transcripts, and LOR  Lake Wobegon School of Medicine  Make sure you are looking at the histograms and any qualifying comment definitions  Are comments in total or “selected”/”representative”  Extension/Remediation  Board Scores  AOA

Predictors of “Success”  USMLE Board scores  University of Michigan Radiology Program experience  ITE and Radiology Board Performance  Correlated with…  Honors in preclinical courses (Anatomy, Biochem, Pathology, Pharmacology, and Physiology)  Honors in clerkships (Medicine, Pediatrics, and Surgery)  Boards Scores  Did not correlate with…  MSPE or LOR superlatives  Honors in clerkships (OB-Gyn and Radiology)  Medical school prestige (based on US News & World Reports rankings)  Students who excelled were excelled as residents regardless of medical school prestige  None of the factors correlated with rotational performance evaluations Boyse et al. Academic Radiology 2002;9(4):

Social Media  Survey with 12,000 program director respondents in 22 specialties accredited by ACGME  196 (16.3%) visit internet sites for additional information  74 (38.1%) has ranked an applicant lower as result of information found

Board Scores  Score Migration  Changes being considered

Board Scores STEP IStep IICOMLEX ICOMLEX II Minimum passing Median Score First Time Pass MD 94%97% First Time Pass IMG 73%82% First Time Pass DO 89%93%

Perceptions and the IMG  Factors consistently shown to influence  Program reputation  Geographic location  Perceived current resident happiness  Perceived quality of current residents  Study set up to examine influence of the number of IMGs

Perceptions and the IMG  Medical student survey – 1994  Part 1  Rank five hypothetical programs 1-5  Score each program based on desirability  Part 2  Rate importance of 25 factors in influencing their actual match ranking list on scale 1-6  Part 3  Rank 12 factors 1-12 in order of importance to their actual selection process

Perceptions and the IMG  702 students from 18 medical schools  Part 1  Rank five hypothetical programs 1-5  Randomly assigned characteristics  Salary and benefits, geography, program size, etc  1/3 of students received information regarding the number of IMG in each program  1/3 of students received information regarding the reputation of each program  1/3 of students received no information regarding IMGs or reputation

Perceptions and the IMG Ranking Program (%IMG) Without IMG With IMG Rank Change Without IMG With IMG Rating Change B(90%) D(44%) C(35%) E(26%) A(3%) A and D University-based programs BDCEA Board pass rates (85%/100%/5%/70%/50%)

International Graduates: Are They All the Same?  Quality variation  Teaching quality of institution  Quality of the clinical training  Graduation Dates  US medical experience of equivalent  Observership vs. clinical experience  Will this requirement evolve?  Board scores—Timing of examination

Developing a List  Personal Experience  Reputation  Colleagues  Intra-institutional Peers  Specialty society/PD peers  Contacts at the school

QS World University Rankings  Ireland  Trinity College Dublin  University of Glasgow  Royal College of Surgeons  Singapore  National University of Singapore (NUS)  Japan  University of Tokyo  Australia  University of Melbourne  University of Sydney  University of Queensland  Germany  Ruprecht-Karls-Univeritat Heidelburg  Korea  Seoul National University  New Zealand  University of Otago  The University of Auckland

My Personal Experience  Middle East  American University of Beirut  Weill-Cornell-Qatar  Peru  National University of San Marcos  Cayetano Heridia University

Medical Schools in India  All India Institute of Medical Sciences, New Delhi  Christian Medical College, Vellore  Armed Forces Medical College, Pune  JIPMER, Pondicherry  Maulana Azad Medical College, Delhi  University College of Medical Science and Research Centre, New Delhi  Kasturba Medical College, Manipal  Grant Medical College, Mumbai  Seth GS Medical College, Mumbai  Lady Hardinge Medical College, New Delhi  Royal College of Medical Science and Research Centre, New Delhi  St. John’s Medical College, Bangalore  Madras Medical College, Chennai  Osmania Medical College, Hyperabad  Bangalore Medical College, Bangalore  BJ Medical School (MJMC), Ahmedabad

Indian Grading Scales  As with the US, hard to compare  Look at  Minimum passing score  Numbers can appear low (%)  Distinction/First Class score (A equivalent)  Second Class ~ same as B+

Americans Abroad  Poland  Univ. of Warsaw  Jagiellonian university medical college  6 year program offered to HS graduates

Americans Abroad  Caribbean  Saint George’s University  American University of the Caribbean  48 schools excluding Cuba  23 (48%) founded since 2000  32 “offshore”  21 (66%) founded since 2000

Fifth Pathway  4 years Intl. school  1 year US clinical work without degree  Step III eligible  Issued through December 31, 2009  Last accepted December 31, 2016  Afterwards, must seek ECFMG certification

Partnerships— One Size Does Not Fit All?  Duke-National University Singapore  Inaugural class June 2007  July 2011  Dubai and Harvard  University of Queensland SOM and Oschner Health System  Weill Cornell-Qatar  Inaugural class June 2002  July 2008

Accreditation  Commission on Higher Education of the Middle States Association of Colleges and Schools  Council on Higher Education for Public Health (CEPH)  First outside of North America  Commission for Collegiate Nursing Education  Joint Commission International  AOA Honor Society

Aculturalization  Are you able and ready to handle IMG aculturalization?  Is aculturalization a two-way street?

ACGME-I  Why?  Improve physician training/education as means to improve health care delivery standards  Diminishing opportunities potentially looming  Size limitations prohibitive to set up own GME accreditation systems with rigorous peer review as in USA  Physician retention in countries

ACGME-I  Currently 3 accredited programs (Singapore)  National Healthcare Group Program  National University Health System Program  Singapore Health Services Pte Ltd Program  Contracts Signed  Qatar  UAE  Oman (negotiations ongoing)

Making your Match List  Check NRMP first to be certain no prior match violations