Page 5 - Kansas Journal of Medicine, Volume 10 Issue 3
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KANSAS JOURNAL of M E D I C I N E                                         tremely high values, up to 90 days. Students may have under-re-
                                                                          ported time due to regulations about absences from fourth year
STUDENT EXPENSES IN RESIDENCY TRAINING                                    courses. Time lost from education is of major concern. In addi-
continued.                                                                tion to absences, we cannot estimate the negative educational
                                                                          impact of students distracted from their studies by concerns
November was the most common month with an aver-                          about the match process. Student narrative comments described
age 4.2 interviews per student. Students reported an aver-                significant stress over obtaining and completing interviews, es-
age 13 days’ notice for interviews (range 1 - 60 days). All               pecially those involving frequent schedule changes. Students re-
students perceived pressure to respond quickly to inter-                  ported that receiving interview invitations in distant cities with
view invitations: 36% responded within ten minutesxxand                   only one to two days’ notice was not uncommon, especially late
72% within the hour. Only 5% waited more than 24 hours.                   in the interviewing period. Many students experienced constant
                                                                          vigilance and a sense of urgency in decisions about interviewing.
    A MANOVA to determine the effect of gender, campus location,
and primary care application on five dependent variables related to          Primary care students received interview invitations from
interview time and scheduling (i.e., days interviewing, number of         about 60% of applications. Those applying to non-primary
cancelled and rescheduled interviews, prior notice, and respond-          care averaged invitations from 37% of applications despite ap-
ing to interview invitations within ten minutes) found no significant     plying to significantly more programs. Both groups of stu-
difference for gender (Wilks’s Λ = .91, F(5,105) = 2.03, p = .08, η2 =    dents failed to complete interviews for about one third of in-
.09) or for primary care (Wilks’s Λ = .91, F(5,105) = 2.2, p = .06, η2 =  vitations. Further research is indicated into the reasons for
.09). A significant difference was found between regional and main        declining or cancelling interviews, but 63% of xour students
campuses (Wilks’s Λ = .87, F(5,105) = 29, p = .01, η2 = .13; Table 2).    reported limited interviewing because of financial concerns.

    The ANOVA found significantly more days devoted to inter-                The study has several limitations, including being con-
viewing for the main campus (F(1,109) = 12.7, p = .001, η2 = .10)         ducted in a single institution, self-reported costs, possible re-
and a significantly higher proportion of students responding within       call bias, and the definition of primary care that includes stu-
ten minutes of interview invitation (F(1,109) = 4.63, p = .03, η2 =       dents intending to subspecialize. Similarly, grouping surgical
.04). No significant campus differences were found for the num-           specialties masks differences among different specialties. We
ber of cancelled interviews (F(1,109) = 1.09, p = .29, η2 = .01), re-     were unable to include measures of student “competitive-
scheduled interviews, (F(1,109) = .55, p = .46, η2 = .01), or length      ness” in our analysis without compromising anonymity. Appli-
of notice for each interview (F(1,109) = 1.14, p = .29, η2 = .01).        cation of our findings to other schools must be individualized.

DISCUSSION                                                                   To the extent that our findings are generalizable to other institu-
    This study provided a detailed picture of the residency interview-    tions, they provide financial data to the debate over the escalating
                                                                          number of NRMP applications per student. This trend raises costs
ing experience of a large class of students at a tri-campus, Midwest-     and strains resources for students and programs despite a sustained
ern state medical school. The high response rate reflects student         match rate for U.S. allopathic graduates of around 94%.1,5,16-21 Our re-
leadership and interest in the topic. The key findings are confirma-      port also draws attention to the days lost from education in the fourth
tion of the major impact of primary care specialty choice, the mod-       year of medical school at a time when national curricular innovations
est differences for regional campus students, and the absence of sig-     increasingly emphasize the crucial role of the final year in achieving
nificant gender differences. Average expenses for non-primary care        competencies and transitioning to the residency stage of education.
applicants were over 60% higher than those of primary care appli-
cants. When adjusted for specialty choice, regional campus students          Further studies are indicated in the role of cost and oth-
did not report higher costs despite the distance of regional campuses     er factors in the failure to complete interviews after invi-
from major cities. The absence of gender differences may reflect the      tation, and into the extent and significance of program fi-
similarity in specialty choice by KUSM male and female students           nancial contributions to student interviewing expenses.
(e.g., 17% of women and 19% of men applied to surgical specialties).
    Similar to other studies,2,7-14 our students spent an average            Trisha Melhado participated in study design and
$3,500 but the range was $20 to $12,000 and 22% of all students
(and 35% of primary care applicants) spent less than $1,000. Stu-         a 2015 pilot project. This study received $2,500
dents added expenses to existing debt, often using multiple funding       from the KUSM-W Dean’s Level I Grant Award.
sources. The topic of program financial support merits further study
as programs compete for the best applicants; for example, national-                                                                             53
ly in 2016, Internal Medicine program directors reported receiving
an average of 2,619 applicants and interviewing 201 applicants.15

    The time spent interviewing has been reported in one previ-
ous study.11 This study estimated a median of 20 days for appli-
cants to urology programs in 2006. Time was a limiting factor
in interviewing for 58% of students. A few students reported ex-
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