Effecting Change Based on What Program Directors Think—Author ...

Letter to the Editor Effecting Change Based on What Program Directors Think—Author Response From: Anna Rozenshtein, MD, MPH, Darel E. Heitkamp, MD, Tan Lucien H. Mohammed, MD, Joyce S. Sclamberg, MD, Angelisa M. Paladin, MD, Stacy E. Smith, MD, Jeremy B. Nguyen, MD, Mark Robbin, MD From the Department of Radiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595 (A.R.); Department of Radiology, Indiana University, Indianapolis, Indiana (D.E.H.); Department of Radiology, University of Florida – College of Medicine, Gainesville, Florida (T.L.H.M.); Department of Diagnostic Radiology, Rush University Medical Center, Chicago, Illinois (J.S.S.); Department of Radiology, University of Washington, Seattle, Washington (A.M.P.); Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts (S.E.S.); Department of Radiology, Tulane University School of Medicine, New Orleans, Louisiana (J.B.N.); Department of Radiology, Emory University, Atlanta, Georgia (M.R.). Regarding the international medical graduates (IMG) applying to radiology, our survey results are in line with the National Resident Matching Program (NRMP) data (1), which show that US medical school graduates have an overall match rate almost double that of IMG applicants. At the same time, the recent literature (2–8) does not offer a clear justification for such pronounced preference on the basis of clinical or academic performance. Dr. Pfeifer offers his personal experience in support of IMG radiology trainees and states that the literature quoted in our article cannot be easily extrapolated to radiology. As a spoiler alert, the recently concluded 2016 Spring Association of Program Directors in Radiology survey shows

(9) that among program directors, who have experience training IMG residents, 78% thought that IMGs performed as well as US medical doctors (MD) at the end of training. We agree with Dr. Pfeifer that more research is needed to understand the differences in performance, if any, among different trainee cohorts and the barriers to recruitment and training of IMG residents. As to the present American Board of Radiology (ABR) examinations, in spite of the program directors’ preference for oral certifying examination (10), the majority felt that their graduating trainees knew as much as before. We have no data to support Dr. Pfeifer’s view that the oral ABR examination must be brought back. On behalf of my coauthors, I would like to thank Dr. Pfeifer for suggesting future survey topics. His appreciation of the Committee efforts is gratefully acknowledged. REFERENCES 1. http://www.nrmp.org/match-data/main-residency-match-data/. Accessed March 22, 2016. 2. Boulet JR, Swanson DB, Cooper RA, et al. A comparison of the characteristics and examination performances of U.S. and non-U.S. citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995–2004. Acad Med 2006; 81(10 suppl):S116–S119. 3. Benson JA, Meskauskas JA, Grosso LJ. Performance of U.S. citizen foreign medical graduates on certifying examinations in internal medicine. Am J Med 1981; 71:270–273. 4. Shea JA, Norcini JJ, Day SC, et al. Performance of U. S. citizen Caribbean medical school graduates on the American Board of Internal Medicine certifying examinations, 1984–1987. Teach Learn Med 1989; 1:10–15. 5. Norcini JJ, Anderson MB, McKinley DW. The medical education of United States citizens who train abroad. Surgery 2006; 140:338–346. 6. Norcini JJ, Boulet JR, Dauphinee WD, et al. Evaluation of quality of care provided by graduates of international medical schools. Health Aff 2010; 29:1461–1468. 7. Garibaldi RA, Subhiyah R, Moore ME, et al. The In-Training Examination in Internal Medicine: an analysis of resident performance over time. Ann Intern Med 2002; 137:505–510. 8. Gozu A, Kern DE, Wright SM. Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs. Acad Med 2009; 84:385–390. 9. Annual Survey Committee of the APDR. Personal communications. Results of the Spring 2016 membership survey. Manuscript in preparation. 2016. 10. Rozenshtein A, Heitkamp DE, Muhammad TH, et al. “What program directors think” III: results of the 2014/2015 annual surveys of the Association of Program Directors in Radiology (APDR). Acad Radiol 2016; 861–869. http://dx.doi.org/10.1016/j.acra.2016.07.017

1615