의예과 교육과정과 입학 요건과 의과대학 퍼포먼스와 레지던트 취업의 관계(Acad Med, 2016)
The Association Between Premedical Curricular and Admission Requirements and Medical School Performance and Residency Placement: A Study of Two Admission Routes
Paul George, MD, MHPE, Yoon Soo Park, PhD, Julianne Ip, MD, Philip A. Gruppuso, MD, and Eli Y. Adashi, MD, MS
의예과 커리큘럼 요소는 진행중인 논쟁의 주제입니다. 한편으로는 의예과 교육 커리큘럼을 표준화하여 과학적 역량에 대한 투자를 늘리자는 의견이 있습니다. 이 전망은 최근 보고서에서 가장 잘 표현되어 있습니다. 반면에, 의예과 교육 커리큘럼을 다각화하여 보다 자유로운 교육에 찬성하는 강력한 주장이 제기되고있다. 이 견해는 최근의 의학 대학 입학 시험 (MCAT)의 개정에서 가장 분명하게 드러났는데, "MCAT"는 "행동의 심리적, 사회적 및 생물학적 토대"에 중점을두고 있습니다.
The curricular elements of undergraduate premedical education are the subject of an ongoing debate.1–3
On the one hand, a case is being made for greater investment in scientific competencies with an eye toward standardizing the undergraduate premedical curriculum. This outlook is most eloquently articulated in a recent report.1
On the other hand, compelling arguments are being put forth in favor of more liberal education with an eye toward diversifying the undergraduate premedical curriculum.4,5 This view is most apparent in the recent revision of the Medical College Admission Test (MCAT), which seeks to increase the emphasis on the “psychological, social, and biological foundations of behavior”
1985 년 워렌 알퍼트 브라운 대학 (AMS) 의과 대학은 교양 의학 교육 (PLME)에서이 프로그램을 시작했습니다. 처음부터 이 8년제 학사 학위 / MD 프로그램 (미국에 있는 40여개 프로그램 중 하나)은 학생들에게 교육 및 사회 과학 및 행동 관점을 교육 프로그램에 통합하여 광범위한 교양 교육을 제공하고자했습니다
In 1985, the Warren Alpert Medical School of Brown University (AMS) launched the Program in Liberal Medical Education (PLME). From the outset, this eight-year baccalaureate/MD program (1 of approximately 40 in the United States7) sought to provide students with a broad and liberal education, integrating asocial science and behavioral perspective into the educational program
이 사명을 준수하면서 PLME는 참가자들이 인문, 사회 과학 또는 자연 과학에 대한 다양한 이해 관계를 자유롭게 추구하도록 장려했습니다.
PLME 학생들은 고등학교에서의 성적을 근거로 브라운 대학에 입학하고 학사 학위 요건을 성공적으로 이수하고 AMS에 임시 입학을 허가합니다.
PLME 학생은 AMS에 입학하기 위해 전통적인 학부 학점 평균 점수 (GPA)는 고려되지 않습니다. 또한 MCAT 점수도 입학 면접도 필요하지 않습니다.
PLME 학생의 학부 과정 요구 사항은 기존의 사전 진료 경로 (TPM) 학생의 부분과 부분적으로 겹치지만 PLME 학생은 이러한 과목에서 AP를 통해 생물학 과정 1 개, 수학 1 개 과정 및 물리 과정 1 개에 해당하는 크레딧을받을 수 있습니다 . PLME 학생들은 3 가지 핵심 생물학 과정 각각에 대해 A 또는 B 등급을 받아야합니다. 물리학 및 화학과 같은 다른 학부 과학 과정은 합격 점수 만 필요하며 합격 / 불합격으로 응시할 수 있습니다.
PLME는 모든 AMS matriculants의 약 50 %를 차지합니다.
In keeping with this mission, the PLME has encouraged entrants to freely pursue their varied interests in the humanities, social sciences, or natural sciences.8 PLME students are admitted to Brown University on the basis of their performance in high school and are granted provisional admission to the AMS subject to the successful completion of the undergraduate degree requirements. When admitting PLME students to the AMS, traditional undergraduate grade point average (GPA) is not considered. Moreover, neither an MCAT score nor an admissions interview is required. While the undergraduate course requirements for PLME students partially overlap with those of students in the traditional premedical route (TPM), PLME students may receive competency credits equivalent to one biology course, one mathematics course, and one physics course by attaining advanced placement in these subjects. PLME students must attain a grade of A or B for each of three core biology courses; other undergraduate science courses (such as physics and chemistry) require a passing grade only and may be taken on a pass/fail basis. The PLME accounts for approximately 50% of all AMS matriculants.
AMS는 또한 학생들의 GPA, MCAT 점수 및 입학 면접에 신중한 고려가있는 TPM을 통해 비슷한 수의 학생들을 입학시킵니다. 그러나 일단 AMS에 있으면 모든 학생들은 동일한 의학 교육 프로그램을 받게됩니다.
The AMS also matriculates a similar number of students via the TPM wherein careful consideration is given to students’ GPA, MCAT score, and admissions interview. However, once they are at the AMS, all students are subject to the same medical education program.
방법
Method
The cohorts studied included all of the PLME (n = 295) and TPM (n = 215) students who graduated from the AMS between 2010 and 2015. We obtained demographic (race/ethnicity, SAT scores, GPA, MCAT score data, etc.) and outcome data (see below) for all students through the AMS Oasis system, which serves as the official medical school registration system. Underrepresented in medicine (URM) status refers to students who identified themselves as black or Hispanic. As of the time of publication, residency placement records were not yet available for students in the class of 2015.
성과 변수
Outcome variables
Our outcome variables included
the average of the year 1 and year 2 examination scores,
United States Medical Licensing Examination (USMLE) Step 1 score,
USMLE Step 2 Clinical Knowledge (CK) score,
average of the six core clerkship examination (shelf examination) scores,
core clerkship honors grades,
doctoring honors grades,
induction into the Alpha Omega Alpha Honor Medical Society or the Gold Humanism Honor Society,
professionalism ratings,
participation in a scholarly concentration (SC) program,
publication metrics, and
residency placement.
We did not include undergraduate GPA and MCAT scores in our analysis because these data were not available for the PLME cohort. (Brown University does not calculate a GPA for any of its students and PLME students do not take the MCAT.) The USMLE Step 2 CK data do not include the class of 2015, for which data were unavailable. The six core clerkships at the AMS are medicine, surgery, pediatrics, obstetrics– gynecology, psychiatry–clinical neuroscience, and family medicine.
통계 분석
Statistical analysis
SPSS version 20 (IBM, Armonk, New York) was used for data analysis. We employed unadjusted tests of averages and proportions (independent t tests and chi-square tests) to compare variables associated with students admitted to the AMS via the PLME or TPM routes. We then performed multiple logistic regression analyses for dichotomous outcome measures and multiple linear regression analyses for continuous outcome measures. Both the logistic and linear regressions controlled for age, URM status, and the number of undergraduate premedical science courses completed.
결과
Results
PLME students constituted 57.8% (n = 295) and TPM students constituted 42.2% (n = 215) of the AMS classes of 2010–2015 (n = 510).
평균 SAT 점수
The average SAT scores attained by the PLME cohort were 716/800 (for the verbal section) and 728/800 (for the mathematical section).
평균 의대(AMS) 진학 비율
The average rate at which PLME students matriculated to the AMS was 88% (range: 83%–98% for individual classes); the majority of PLME students who did not matriculate to the AMS matriculated to other medical schools.
다양성
The PLME student cohort was more racially and ethnically diverse, as measured by URM status (n = 72 [24.4%] for PLME students versus n = 31 [14.4%] for TPM students; P < .01), and
과학 전공
less likely to major in a science discipline (n = 138 [46.8%] for PLME students versus n = 140 [65.1%] for TPM students; P < .001) than the TPM student cohort.
의예과 수강 과목 수
Moreover, there was a statistically significant difference in the number of undergraduate premedical science courses completed by the two student cohorts (Figure 1).
입학 전형과 의과대학 퍼포먼스
Relationship between admission route and medical school performance
평균점수
The average scores attained in standardized multiple-choice examinations revealed marginal, but statistically significant, differences between the PLME and TPM student cohorts (Figure 2).
Honor grade 숫자
Students in the TPM cohort received more honors grades in the six core clerkships than their PLME counterparts (average = 2.8 [standard deviation (SD) = 1.87] versus average = 1.9 [SD = 1.75]; P < .001). These results did not differ in linear regression models after controlling for age, URM status, and the number of undergraduate premedical science courses completed.
AOA Honor
The Alpha Omega Alpha Honor Medical Society inducted a higher proportion of TPM students than PLME students (Table 1).
의예과 과학과목 수강과 관계
We hypothesized that the number of undergraduate premedical science courses completed by PLME students would contribute significantly to their medical school performance. In particular, we anticipated a strong relationship between the number of undergraduate premedical science courses completed and the average year 1 examination score. In fact, the association, though statistically significant, was weak (r2 = 0.023; P = .02) (Figure 3).
TPM 코호트도 동일
These same relationships were examined for the TPM cohort; in no case was a significant correlation noted.
입학전형과 레지던트 placement와의 관계
Relationship between admission route and residency placement
일차의료 전공: PLME
We used several metrics to assess residency placement for the classes of 2010–2014 (PLME [n = 190] and TPM [n = 132] students). A somewhat greater proportion of PLME students than TPM students entered primary care disciplines (family medicine, internal medicine, pediatrics, or medicine/pediatrics) (109/190 [57.4%] versus 62/132 [47.0%]; P = .07), although this difference was not statistically significant.
경쟁이 심한 전공의 프로그램: 차이 X
We carried out an additional analysis to assess the two cohorts’ placement rates with competitive residency training programs affiliated with leading medical schools. No statistically significant difference in placement was noted between the two cohorts.
학부 과학과목 이수와 레지던트와의 관계: 약하지만 유의함
Finally, we carried out an analysis to determine the correlation between the number of undergraduate premedical science courses completed and residency placement. We found a weak but statistically significant association between the number of undergraduate premedical science courses completed and residency placement as indicated by the average USMLE Step 1 score required by individual medical disciplines (r2 = 0.023; P = .05) (Figure 3).
고찰
Discussion
설립 초기부터 PLME는 학부 및 의학 교육을 연결하는 동시에 AMS에서 인종 및 민족적 다양성을 증가시키는 것을 목표로 삼았습니다. PLME는 많은 의예과 요건을 유지하지만 AMS에 입학하려면 MCAT 점수가 필요하지 않습니다. 또한 PLME 학생들은 여러 가지 전통적인 의예과 과정을 마쳤지 만 GPA 계산을 배제하는 합격 / 불합격 기준으로 수행합니다.
From its inception, the PLME has aimed to bridge undergraduate and medical education and at the same time increase racial and ethnic diversity at the AMS. While the PLME maintains a number of premedical science requirements, an MCAT score has not been required for admission to the AMS. Additionally, though PLME students complete multiple traditional premedical science courses, they often do so on a pass–fail basis, which precludes the calculation of a GPA.
몇몇 학문은 combined 학사 학위 / MD 프로그램에 등록한 학생의 성과를 조사했습니다. 최근의 7개 학부/MD 학위 프로그램에 대한 한 연구에서 TPM학생들이 얻은 점수와 비교했을 때, 의과 대학 성적 또는 면허 시험 점수에서 뚜렷한 차이를 발견하지 못했습니다.
Few studies have examined the performance of students enrolled in combined baccalaureate/MD programs. One recent study of seven combined baccalaureate/MD programs observed no apparent difference in the medical school grades or licensing examination scores the baccalaureate/ MD students obtained relative to the scores obtained by students who had taken the TPM.13
PLME는 GPA, MCAT 점수, 입학 면접 요건, AMS에 입학한 학생들의 높은 비율 등과 같이 특히 중요한 몇 가지 측면에서 다른 결합 된 학사 학위 / MD 프로그램과 다릅니다.
the PLME differs from other combined baccalaureate/ MD programs in several important aspects, most notably in waiving the GPA, MCAT score, and admissions interview requirements and in the large percentage of students admitted to the AMS through this route.
TPM 학생들은 PLME에 비해 표준화 된 다중 선택 시험에서 평균 점수가 통계적으로 유의하게 높았다. 이러한 차이는 PLME 학생들이 달성 한 우수한 SAT 점수를 고려할 때 시험 수행 능력의 고유 한 차이로 인한 것은 아닐 것이다.
TPM의 엄격함은 표준화 된 객관식 시험 패러다임에서 탁월한 능력을 발휘하는 데 필요한 필수 시험 수험 기술뿐만 아니라, 광범위한 지식 기반의 습득을 촉진하였을 것이다.
또한 표준화 된 객관식 시험에서 열악한 성적을 보이는 TPM 학생들은 MCAT 점수를 기준으로 했을 때 선발되지 못했을 것이다.
Prominent among our findings was that TPM students achieved marginally, but statistically significantly, higher average scores in standardized multiple-choice examinations relative to their PLME counterparts. It is unlikely that this difference can be attributed to an inherent difference in test-taking ability given the excellent SAT scores achieved by PLME students.
It is plausible that the rigors of the TPM promote the acquisition of a broad knowledge base, as well as the requisite test-taking skills that are needed to excel in the standardized multiple-choice examination paradigm.
It is also plausible that in the TPM students who perform poorly on standardized multiple-choice examinations are being deselected on the basis of their MCAT score.
프로페셔널리즘 등급은 두 학생 코호트에서 비슷한 것으로 나타났습니다. 학생들의 학술 성취도는 peer-reviewed publication rate 과 impact factor of the journal에 의해 측정하였으며, 두 코호트에서 비슷하게 나타났습니다.
Professionalism ratings proved comparable for the two student cohorts. The scholarly accomplishments of students, as measured by the peer-reviewed publication rate and impact factor of the journal they were published in, proved similar for the two cohorts.
우리는 특정 의료 분야에서 레지던트 배치에 필요한 평균 USMLE 1 단계 점수를 사용하여 특정 전공과목의 레지던트 배치에 대한 학생 transition readiness의 간접적인 지표로 사용하기로 결정했습니다. 이와 관련하여 PLME 학생과 TPM 학생들은 비슷한 것으로 나타났습니다.
we elected to rely on residency placement as an indirect indicator of the readiness of students for this transition, using the average USMLE Step 1 score required for residency placement in a specific medical discipline. In this regard, PLME students and their TPM counterparts proved comparable.
이러한 결과에 대한 우리의 폭 넓은 해석은 PLME 학생들이 TPM 학생 코호트와 관련된 레지던트 배치와 관련하여 별다른 단점이 없다는 것입니다. 우리는 또한 AMS 졸업생이 전공 한 의예과 과학과목의 수는 의대에서의 성공 또는 경쟁력있는 레지던트 배치의 성공에 대한 강력한 예측 인자는 아니라고 결론 내리고 있습니다.
Our broad interpretation of these results is that PLME students are at no distinct disadvantage with regard to residency placement relative to the TPM student cohort. We also conclude that the number of undergraduate premedical science courses AMS graduates complete is not a strong predictor of success in medical school or of achieving competitive residency placement.
결론
Conclusions
의대 퍼포먼스, 레지던트 배치, 의예과 커리큘럼, 입학 요건 사이의 연관이 약합니다.
Our findings suggest that the association between medical school performance and residency placement and undergraduate premedical curricular and admission requirements is weak.
7 Association of American Medical Colleges. What are the combined baccalaureate/M.D. programs in each state featured in the Island.Medical School Admission Requirements website? https://www.aamc.org/students/ applying/requirements/msar/gethelp/188498/ whatarethecombinedbaccalaureatemd programsineachstatefeaturedinm.html. Accessed October 29, 2013.
The Association Between Premedical Curricular and Admission Requirements and MedicalSchool Performance and Residency Placement: A Study of Two Admission Routes.
Author information
- 1
- P. George is associate professor of family medicine and associate professor of medical science, Warren Alpert Medical School of Brown University, Providence, Rhode Island. Y. Soo Park is assistant professor of medical education, University of Illinois College of Medicine, Chicago, Illinois. J. Ip is clinical associate professor of family medicine and associate dean of medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island. P.A. Gruppuso is professor of pediatrics, Warren Alpert Medical School of Brown University, Providence, Rhode Island. E.Y. Adashi is professor of medical science and former dean of medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
Abstract
PURPOSE:
METHOD:
RESULTS:
CONCLUSIONS:
- PMID:
- 26422591
- PMCID:
- PMC4767648
- [Available on 2017-03-01]
- DOI:
- 10.1097/ACM.0000000000000922
'Articles (Medical Education) > 입학, 선발(Admission and Selection)' 카테고리의 다른 글
| 의과대학 입학시험: 부모가 의사인 학생이 이득? (BMC Med Educ, 2015) (0) | 2017.10.23 |
|---|---|
| 선발의 우주론: 교수 쿠키통의 교훈(Med Educ, 2016) (0) | 2017.10.20 |
| 의과대학 입학의 도덕성(Adv Health Sci Educ Theory Pract. 2004) (0) | 2017.09.14 |
| 사회과학과 인문과학(SSH)을 전공한 학생이 의과대학 입학과정에서 소외되는가? Review and Contextualization (Acad Med, 2014) (0) | 2017.08.02 |
| 이공학계열 출신 학생과 비이공학계열출신 학생 혼합의 효과 탐색(Medical Education, 2014) (0) | 2017.08.02 |