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METHODS
Data sources
The American Medical Association (AMA)
Medical Education Research and Information Database was the main
source of data for this study.3
This database is fed and updated by the AMA's annual Graduate
Medical Education survey sent to all Accreditation Council for
Graduate Medical Education (ACGME) accredited residency programs
for information on each program and each resident. Since 1994,
the ACS has collaborated with the AMA on the resident-specific
portion of the GME survey. The AMA agreed to provide the ACS
with resident data in return for ACS efforts to increase the
response rate of all surgical programs. By telephone, mail-in,
or fax-in surveys, AMA resident files for the 1994-95 and 1995-96
academic years were updated by the ACS to include data from all
programs that did not respond to the original AMA surveys.
The postgraduate year (PGY) status of a resident in the AMA
files was frequently verified with information from the ACS Resident
Masterfile, which contains tracking data about individual residents
from 1982 to the present. Created from a combination of annual
surveys of ACGME-accredited surgical programs and data obtained
from specialty boards, the Surgical
Resident Masterfile represents the most comprehensive and complete
source of surgical resident data in the United States.
Selecting surgical residents beginning a residency program
For 1994-95 and 1995-96, surgical residents were considered
beginners in a residency program in general surgery, orthopaedic
surgery, otolaryngology, urology, and neurological surgery if
they were not identified in any surgical program in preceding
years. Residents who were identified in a specialty program after
one or more years in general surgery were arbitrarily assigned
to the specialty. For example, a resident was considered to have
begun a residency program in neurological surgery in the 1994-95
academic year if he or she was a resident in general surgery
in 1994-95 and continued in neurological surgery in 1995-96.
Because of this redistribution of designated preliminary residents
into their respective postpreliminary specialties, the remaining
residents in general surgery are either categorical general surgery
residents or undesignated preliminary residents.
Residents in plastic surgery and ophthalmology have a variety
of prerequisite GME options, and there is no GME prerequisite
for residents entering obstetrics and gynecology. Hence, residents
entering programs in these specialties were considered beginners
in a particular academic year if they were not identified in
any program in those specialties in the preceding years.
Selecting the 1995 and 1996 graduates
We included all residents graduating within a calendar year
in the cohort of graduates of that year.
Analysis
Corrected data in the AMA 1994-95 and 1995-96 resident files
were analyzed to derive counts of 1995 and 1996 graduates in
the 8 core and 5 advanced surgical residencies. Counts of beginning
and graduating residents in the core and advanced surgical residencies
were also obtained. Data were analyzed by gender, ethnic background,
citizenship status, age, and the type of medical school attended.
Chi-square tests of independence were used for comparing proportions;
t-tests were used for continuous measures. The Statistical
Package for the Social Sciences (SPSS) software (SPSS Inc, Chicago,
IL) was used for all computations.
Introduction
| Methods | Results
| Discussion
| References
JACS
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