Bibliometric Analysis of International Medical Graduates and Professorship Promotion in Neurosurgery

BACKGROUND

International medical graduates (IMGs) comprise ∼25% of physicians in the United States. Differences in promotion rates from assistant to associate to full professorship based on medical school location have been understudied. We aim to stratify odds of professional advancement by 3 categories: IMG with U.S. residency, IMG with international residency, and U.S. medical with U.S. residency training.

METHODS

We created and queried a database after exclusions of 1334 neurosurgeons including multiple demographic factors: academic productivity and promotion rates. Stratified logistic regression modeled odds of promotion including the variables: decades out of training, Scopus h-index, gender, and training location. Odds ratios (ORs) and 95% confidence intervals (CIs) for each variable were calculated.

RESULTS

Significant predictors of increased associate versus assistant professorship included decades out of training (OR = 2.519 [95% CI: 2.07-3.093], P < 0.0001) and Scopus h-index (OR = 1.085 [95% CI: 1.064-1.108], P < 0.0001) while international medical school with U.S. residency (OR = 0.471 [95% CI: 0.231-0.914], P = 0.0352) was associated with decreased promotion. Significant predictors of associate versus full professorship were decades out of training (OR = 2.781 [95% CI: 2.268-3.444], P < 0.0001) and Scopus h-index (OR = 1.064 [95% CI: 1.049-1.080], P < 0.0001). Attending medical school or residency internationally was not associated with odds of full professorship.

CONCLUSIONS

Time out of residency and Scopus h-index were associated with higher academic rank regardless of career level. Attending medical school internationally with U.S. residency was associated with lower odds of associate professorship promotion over 10 years. There was no relationship between IMG and full professorship promotion. IMGs who attended residency internationally did not have lower promotion rates. These findings suggest it may be harder for IMGs to earn promotion from assistant to associate professor in neurosurgery.

The clinical elective course and its effects on medical students and graduates of Jordanian medical schools

BACKGROUND

The elective course is part of the 6th-year medical school curriculum in Jordan. Students choose the specialty in which they wish to spend 8 weeks and choose their location even if it is outside their university's affiliated hospitals. In this study, we try to understand student choices regarding the country of elective, chosen specialty, type of placement (observership/clerkship), and elective general value from participants' perspectives.

METHODS

This paper used a cross-sectional study. The survey was distributed through social media platforms (mainly Facebook and WhatsApp) targeting 6th-year medical students and doctors who graduated from one of the 5 Jordanian medical schools (the University of Jordan, Jordan University of Science and Technology, Mutah University, Yarmouk University, and Hashemite University).

RESULTS

The majority of participants had an international elective (69.6%), mainly in the USA, followed by the UK. Internal medicine was the primary field of interest for 14.8%, followed by general surgery. Of these, 241 (62.6%) actively participated in work at their chosen hospitals as they had a clerkship/hands-on experience. In contrast, 142 (36.9%) were observers. The majority indicated that the elective is worth the time, money, and effort. Moreover, they had adequate supervision throughout the course and could achieve their preset objectives.

CONCLUSIONS

The elective course gives a unique experience to our students. General satisfaction is an indicator of the success of the course in actively exposing medical students to clinical practice.

Academic Productivity of United States Neurosurgeons Trained Abroad

BACKGROUND

Previous research in neurosurgery has examined academic productivity for U.S. medical graduates and residents. However, associations between scholarly output and international medical education, residency training, and fellowship training are scarcely documented.

METHODS

We identified 1671 U.S. academic neurosurgeons in 2020 using publicly available data along with their countries of medical school, residency, and fellowship training. Using Scopus, h-index, number of publications, and number of times publications were cited were compiled. Demographic, subspeciality, and academic productivity variables were compared between training locations using univariate analysis and multivariable linear regression.

RESULTS

Of the current neurosurgery faculty workforce, 16% completed at least 1 component of their training abroad. Canada was the most represented international country in the cohort. Academic productivity for neurosurgeons with international medical school and/or international residency did not significantly differ from that of neurosurgeons trained in the United States. Neurosurgeons with ≥1 U.S. fellowships or ≥1 international fellowships did not have higher academic productivity than neurosurgeons without a fellowship. However, dual fellowship training in both domestic and international programs was associated with higher mean h-index (β = 6.00, 95% confidence interval 1.01 to 10.98, P = 0.02), higher citations (β = 2092.0, 95% confidence interval 460.1 to 3724.0, P = 0.01), and a trend toward higher publications (β = 36.82, 95% confidence interval -0.21 to 73.85, P = 0.051).

CONCLUSIONS

Neurosurgeon scholarly output was not significantly affected by international training in medical school or residency. Dual fellowship training in both a domestic and an international program was associated with higher academic productivity.

Disruption to Surgical Training during Covid-19 in the United States, United Kingdom, Canada, and Australasia: A Rapid Review of Impact and Mitigation Efforts

OBJECTIVE

To synthesise the current evidence of pandemic-related impact on surgical training internationally and describe strategies that have been put in place to mitigate disruption.

DESIGN

Rapid scoping review of publically available published web-literature.

SETTING

Five large English speaking countries; United States (US), United Kingdom (UK), Canada, Australia and New Zealand (NZ).

RESULTS

Recruitment and selection to residency programmes in the US, Australia and NZ has been largely unaffected. Canada has implemented video-conferencing in lieu of face-to-face interviews. The UK has relied upon trainee self-assessment for selection. Widespread postponement and cancellation of surgical board examinations was seen across the studied countries. Resident assessment-in-training and certification procedures have been heavily modified. Most didactics have moved online, with some courses and conferences cancelled where this has not been possible. None of the studied countries had a central mandate on resident operating privileges during Covid-19.

CONCLUSIONS

The collective response by international surgical training bodies to the dual challenges of safeguarding residents whilst minimising disruption to training has been agile and resident centred. The pandemic has exposed weaknesses in existing training systems and has highlighted opportunity for future improvement.

First nationwide survey on the experience of Indian cardiac surgeons about international fellowship programmes

Objective

The correct path after finishing residency in cardiac surgery (CS) has been unclear to most of the young cardiac surgeons. Pursuing a fellowship abroad is by far the most preferred option for many residents after residency. We report the results of the first nationwide survey on the experience of Indian cardiac surgeons who have pursued a fellowship abroad.

Methods

A 10-question Web-based survey was distributed in March, 2018, to all cardiac surgeons in India who have done at least 1 year of fellowship or registrarship in CS abroad. A reminder was sent after 1 month. All responses were verified for genuineness and entirety. A significant 55 responses qualified for survey analysis.

Results

Fifty-five surgeons with a mean experience of 8.1 years after residency and at least 1 year of international training responded to the survey. Australia and New Zealand were the most common countries opted for post-residency training and a majority did a 2-year international fellowship. Most of them were fairly satisfied with protocol learning (4.1/5), research work (3.3/5) and financial support (3.7/5) but not with the surgical hands-on experience (2.9/5). The greatest challenge after the fellowship was to establish an independent practice and get patient referrals. Forty per cent of the surgeons felt that Indian post-residency training could be comparable to international fellowships if the centre is chosen wisely. A few (16%) of them even believed that Indian post-residency training is better than international fellowships.

Conclusions

International fellowships have their own merits and demerits and are to be chosen wisely. In the present situation, Indian post-residency training for basic surgical work is comparable to that of overseas. However, international exposure is recommended for learning advances in cardiac surgical subspecialities like minimally invasive cardiac surgery (MICS), robotic CS, aortic and endovascular techniques and heart failure surgeries.