Yes, it’s true:

The reason a physician in graduate medical education training is called a “resident” is because back in the day, they *literally* lived in the hospital.

(a short thread)
One text recommended two medical and two surgical residents per 100 beds, a number which would “prove sufficient for all purposes.”

(If you’re wondering why the residents lived on the upper floors, it’s because “in case of fire, they, being in good health, could easily escape.”) Screenshot of an 1859 textbook describing how to build a hos
But that’s not all.

A century ago, residency had no fixed time endpoint - training could last any amount of time.

Most programs also had a ‘pyramid’ structure, in which many interns competed for fewer resident positions at each level and ultimately just one chief resident spot.
Once you were chief, you stayed until a suitable faculty position became available.

For example:

Dr. Kenneth Blackfan - one of the most accomplished pediatricians of the era - served as a chief resident for 11 YEARS before becoming faculty.

en.wikipedia.org/wiki/Kenneth_B…
(For anyone interested, last year I wrote a little bit about how we ended up with our residency training system.)

thesheriffofsodium.com/2019/12/22/why…

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More from @jbcarmody

19 Jun
Yes, I do have some thoughts on the pathways through which IMGs can bypass USMLE Step 2 CS and receive ECFMG certification.

(thread)
The messaging from the ECFMG has been that IMGs who complete

a) English proficiency test

-and-

b) one of these five pathways

will be equivalent to IMGs who pass Step 2 CS.
That’s an interesting assertion.

Because although 95% of US MDs pass Step 2 CS on their first attempt, only around 75-82% of IMGs do.

How, then, can the ECFMG be so confident that the applicants they certify would have passed USMLE Step 2 CS if they’d had the chance?
Read 16 tweets
5 Jun
Back when I was an intern, I was chatting with the grandmother of one of my patients.

Her granddaughter was about to begin 9th grade, and she recalled how excited she’d been to start high school herself - but the school was closed.

I was puzzled. I didn’t know what she meant.
She was talking about Massive Resistance.

After Brown v. Board of Education, Virginia’s governor had an idea to avoid desegregating the state’s schools.

The federal government can’t force you to integrate the public schools... if there are no public schools to integrate.
So rather than letting white and black children attend school together, many Virginia schools shut down completely.

Most white children attended private schools. Many black children got no education at all.

My patient’s grandmother missed out on high school because of this.
Read 13 tweets
8 May
Well, it’s (all but) official:

The AAMC has recommended that residency programs offer only virtual interviews for the upcoming season.

Who wins, and who loses? Let’s find out!

(thread)
WINNER: Homegrown applicants.

Every year, many students choose to stay at the same institution for residency. Many PDs will be eager to snap up these “known quantities” from an otherwise more uncertain applicant pool.

LOSER: DOs and IMGs, who may not have a “home” program.
WINNER: Student travel budgets.

Previously, many applicants spent upwards of five figures traveling to in-person interviews. You gotta try *really* hard to spend that kind of money sitting in your living room doing Zoom and WebEx interviews.
Read 11 tweets
3 Mar
Well, another residency application season is in the books.

And in 2019, the average residency applicant (all comers) submitted 92 residency applications.

Yes.

NINETY-TWO.

And each year, this number creeps higher and higher.

We need to talk about this.

(thread)
First:

Can we please stop defending application inflation by saying that applicants *HAVE* to apply to so many programs because the number of residency programs isn’t growing at the same rate as applicants?

It’s not true.
Statistically-speaking, there’s never been a better time IN THE PAST 50 YEARS for a graduating U.S. medical student to get a PGY-1 position.

But don’t take my word for it - let’s get it straight from @TheNRMP.

mk0nrmp3oyqui6wqfm.kinstacdn.com/wp-content/upl…
Read 9 tweets
14 Feb
Since the announcement that Step 1 will go pass/fail, there’s been a growing false narrative that USMLE scores allowed IMGs to compete on a level playing field with U.S. MDs for competitive residencies.

Here is the uncomfortable truth - and what to do about it.

(thread)
Even with a scored USMLE Step 1, DOs and IMGs were not “beating out” U.S. MDs for competitive residency positions or specialties.

Does this look like a level playing field?
Almost all IMGs match in specialties in which there are not enough U.S. MD graduates to fill the available positions. The number of IMGs who match in competitive fields (like surgical subspecialties) is vanishingly small.
Read 11 tweets
5 Jan
The @NBMEnow has a task force to study whether high-stakes exams like the USMLE contribute to student burnout.

It sounds to me like their inclination is just to blame students for their lack of resiliency.
Am I misunderstanding something here?

Here’s the link to the interview so you can listen to the whole thing for yourself.

missinglogic.com/podcast
It’s striking to me how the interviewee poignantly shares his own story of burnout from his internship - which occurred “before duty hours were truly implemented” - but seems largely oblivious to the fact that *systems* contribute to student burnout today.
Read 11 tweets

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