Knowing Your ApplicantsJ. 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 1st year students 2015 = 26,403 1st 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):437-445

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 ScoresSTEP I Step II COMLEX

ICOMLEX II

Minimum passing

188 196 400 400

Median Score

224 500 500

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 0-100 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 IMGRanking Ranking

Program (%IMG)

Without IMG

With IMG

Rank Change

Without IMG

With IMG

Rating Change

B(90%) 2.5 3.5 -1.0 72 54 -18

D(44%) 1.9 1.8 +0.1 80 79 -1

C(35%) 4.7 4.4 +0.3 30 32 +2

E(26%) 3.0 2.9 +0.1 62 64 +2

A(3%) 3.0 2.4 +0.6 61 71 +10

• 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