Journal of Academic Ophthalmology
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Sex Disparities in Productivity among Oculoplastic Surgeons
No full textAbstract
Purpose The aim of the study is to investigate sex differences in academic rank, publication productivity, and National Institute of Health (NIH) funding among oculoplastic surgeons and whether there is an association between American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) membership and scholarly output.
Methods Sex, residency graduation year, and academic rank were obtained from institutional websites of 113 U.S. ophthalmology programs. H-indices and m-quotients were obtained from the Scopus database. NIH funding information was obtained from the NIH Research Portfolio Online Reporting Tool.
Results Of the 272 surgeons, 74 (30.2%) were females. When adjusted for career duration, differences in female to male proportions were only significant at the rank of assistant professor (assistant: 74.3 vs. 48.5%, p = 0.047; associate: 18.9 vs. 24.6%, p = 0.243; full professor: 13.0 vs. 37.2%, p = 0.114). Women had a shorter career duration than men [10.0 (interquartile range or IQR 12.0) vs. 21.0 (IQR 20.0) years; p \u3c 0.001] and a lower h-index [4.0 (IQR 5.0) vs. 7.0 (IQR 10.0); p \u3c 0.001], but similar m-quotients [0.4 (IQR 0.4) vs. 0.4 (IQR 0.4); p = 0.9890]. Among ASOPRS members, females had a lower h-index than males [5.0 (IQR 6.0) vs. 9.0 (IQR 10.0); p \u3c 0.001] due to career length differences. No difference in productivity between sexes was found among non-ASOPRS members. ASOPRS members from both sexes had higher scholarly output than their non-ASOPRS counterparts. Just 2.7% (2/74) of females compared with 5.3% (9/171) of males received NIH funding (p = 0.681).
Conclusion Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output
The Impact of the COVID-19 Pandemic on Ophthalmology Resident Perceptions of Clinical Experience, Surgical Training, and Personal Life
No full textAbstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has affected multiple areas of health care, including residency training programs. Elucidating the effect of the COVID-19 pandemic on resident clinical experience, surgical training, and wellness is essential to identify areas in which programs can provide additional educational and personal resources to trainees. This study aims to evaluate the experiences of ophthalmology residents during the pandemic.
Design The design is a cross-sectional, nonvalidated survey study. The survey was administered online with data collection from August 22 to August 31, 2020.
Participants Applicants to the Bascom Palmer Eye Institute ophthalmology residency program during the 2016 to 2019 application cycles were invited to complete the survey to encompass trainees currently in ophthalmology residency during the COVID-19 pandemic. Applicants who were not training at an ophthalmology residency program during the pandemic were excluded.
Methods This study involved eliciting feedback from ophthalmology residents on the perceived impact of COVID-19 on their residency experiences through survey questions.
Main Outcome Measures Perceived didactic, clinical, surgical, and overall experiences of residents during the COVID-19 pandemic, effect on cataract and noncataract surgical case volume, and perceived effects on resident personal life.
Results Responses were obtained from 357 (22.8%) individuals, 193 of which met inclusion criteria (59.1% male, 54.9% aged 30–34). Most participants reported overall worsening of their ophthalmology training experience due to COVID-19 (75.1%), with worsening of clinical training reported by 72.5% of participants and worsening of surgical training reported by 89.1% of participants. There were no significant differences in the perception of the impact of COVID-19 on overall training experience, clinical training experience, or surgical training experience among geographic regions (p = 0.43, p = 0.23, p = 0.27, respectively). A higher percentage of post-graduate year 3 (PGY3) and PGY4 trainees reported worsened clinical (p = 0.003) or surgical (p = 0.03) experience compared with PGY2 trainees. Participants also reported impact on personal life including time spent away from family (52.9%), worsened friendships with co-residents (29.5%), forced changes in living situation (15.0%), and increased expenses (13.5%).
Conclusion The COVID-19 pandemic has substantially impacted clinical and surgical experience of ophthalmology residents, who also report personal stressors due to the pandemic. Identifying alterations in the ophthalmology residency experience is essential to provide additional resources to support ophthalmology trainees professionally and personally during this time
Factors Influencing Choice of Medical Specialty among Ophthalmology and Non-Ophthalmology Residency Applicants
No full textAbstract
Objective The study aimed to investigate factors influencing choice of specialty among ophthalmology and non-ophthalmology residency applicants.
Patients and Methods Anonymous, web-based surveys were distributed through REDCap to the 2019 to 2020 residency applicants to the Penn State Department of Ophthalmology and, as a control group, Penn State medical students applying to non-ophthalmology residencies for the 2019 to 2020 cycle. The primary outcome was factors that influenced specialty choice among ophthalmology versus non-ophthalmology applicants. Secondary outcomes include hours of exposure to applicants\u27 selected specialty in the medical school preclinical curriculum, and proportion of ophthalmology versus non-ophthalmology applicants who decided on, or developed a strong interest in, their specialty prior to clinical rotations.
Results Surveys were completed by 203/441 (46.0%) ophthalmology and 85/139 (61.1%) non-ophthalmology applicants. Fewer than 20 hours of exposure to an applicant\u27s selected specialty were provided in the medical school preclinical curriculum for 86.7% of ophthalmology and 42.4% of non-ophthalmology applicants (p \u3c 0.001). Ophthalmology applicants decided on, or developed a strong interest in, their selected specialty before clinical rotations at a similar rate to non-ophthalmology applicants (60.6 vs. 58.8%, respectively). Factors influencing specialty choice cited most commonly by ophthalmology applicants include professional satisfaction (94.1%), performing surgeries/procedures (92.6%), personal fit with specialty (91.1%), work-life balance (91.1%), and ability to see patients in a clinic setting (90.6%), compared to personal fit with specialty (95.3%)%, clinical rotation in selected specialty (95.3%), professional satisfaction (91.8%), intellectual stimulation (89.4%), and subinternship or away rotation (89.4%) among non-ophthalmology applicants.
Conclusion Professional satisfaction and personal fit with specialty were among the most commonly cited factors influencing specialty choice for both groups. Other factors cited most frequently by ophthalmology applicants include performing surgeries/procedures, work-life balance, and ability to see patients in a clinic setting. Despite limited ophthalmology exposure in medical school preclinical curricula, ophthalmology applicants decided on, or developed a strong interest in, their selected specialty before clinical rotations at a rate similar to non-ophthalmology applicants
Myers-Briggs Type Indicator Personality Types of Ophthalmology Residents
No full textAbstract
Objective This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection.
Study Design After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis.
Setting This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute.
Participants A total of 66 current residents and recent graduates of five residency programs were involved in this study.
Main Outcomes and Measures This study evaluated four-letter personality type from each participant.
Results Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) (p = 0.049), thinking (T) than feeling (F) (p = 0.027), and judging (J) than perceiving (P) (p = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level.
Conclusion Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one\u27s training
Comparison between Medical Student Educators and Program Directors in 2010 and 2019
No full textAbstract
Objective Over the last decade, prominence of the Directors of Medical Student Education in Ophthalmology (DMSEs) within the Association of University Professors of Ophthalmology (AUPO) has increased. With increased recognition of this important leadership position, an examination of the trending demographic differences between DMSEs and the Ophthalmology Program Directors (PDs) may be helpful, especially in regard to the potential for academic promotion from each track.
Design Present study is a database study.
Methods The AUPO directory was used to ascertain the DMSE and the PD members between 2010 and 2019. The demographic profile for each member was determined using publicly available resources. Chi-square analysis of the data was performed.
Main Outcome Measures Number of DMSE and PD AUPO from 2010 to 2019 in AUPO Directory, sex, geographic location, and graduation year were measured through this study.
Results There has been a steady increase in the number of DMSEs from 2010 to 2019, whereas the number of PDs have remained stable. The number of DMSEs have increased in all regions of the United States. The year of ophthalmology residency graduation was similar in the DMSE and PD cohorts in 2010 and 2019. The number of women have increased in the DMSEs in 2019 compared with 2010; the number of women who were PDs in 2019 were similar to 2010. Finally, more PDs in 2010 became Chairs in 2019, whereas no DMSEs in 2010 became Chair in 2019.
Conclusion There are a growing number of DMSEs, overall, with an increasing proportion of women in the 2019 DMSE group compared with 2010. In contrast, the overall number of PDs have remained stable, as has the proportion of female PDs in 2019 compared with 2010. DMSEs, compared with PDs, are less likely to become Chairs. The increased opportunity for academic leadership with the growing DMSE group may help change leadership patterns overall in academic ophthalmology
Ophthalmology Residency Virtual Interviews in the Setting of the COVID-19 Pandemic: Perspectives of Applicants, Selection Committee Members, and Current Residents
No full textAbstract
Background In the setting of the COVID-19 pandemic, residency programs implemented videoconferencing “virtual” interviews for the 2020 to 2021 match cycle. There is limited published information on virtual ophthalmology residency interviews.
Objective The study aimed (1) to assess applicant, selection committee member, and resident opinions of technical quality, communication quality, and ability to assess applicant or program “fit” during virtual interviews; (2) to determine which interview format—in-person or virtual—each party would prefer in the future; and (3) to survey which residency resources applicants found helpful.
Design Surveys were sent to applicants, selection committee members, and residents to assess the above objectives for the 2020 to 2021 match cycle virtual interviews at the Moran Eye Center, University of Utah.
Setting This study was conducted in a single residency program interview season from 2020 to 2021.
Participants Forty applicants, eight committee members, and seven residents who participated in the virtual interview process were surveyed.
Intervention or Exposure Prior to interviews, various avenues were implemented to connect with applicants. A videoconferencing software was utilized for interviews. Applicants and selection committee members met in one-on-one or small group interviews. Residents communicated with applicants in a large group setting between interviews.
Main Outcome and Measure The study aims to survey the participants as stated in the objectives. There was no planned outcome for this quality improvement study.
Results Survey response rate was 98.2% (54/55). All parties rated the technical components as good or very good. Applicants and selection committee members rated communication as overall good or very good, although residents thought communication was very poor. A total of 92.3% applicants, 75% selection committee members, and 0% residents were reported that they were able to appropriately assess fit of the program with the applicant. However, 46.3% respondents preferred in-person interviews in the future. Popular applicant resources were resident-produced videos (82.1%), conversations with residents (46.2%), and a gift bag (43.6%).
Conclusion and Relevance Overall, the technical components of the interview were successful. Small, structured group interactions led to better communication and assessment of fit. There were variable opinions regarding future interview format preference between in-person, virtual, or choice. Amid the COVID-19 pandemic, connecting with applicants via various means can optimize the match process
Comparing Eyesi Virtual Reality Simulator and Traditional Teaching Methods for Direct Ophthalmoscopy: Students\u27 Perspectives at Indiana University School of Medicine
No full textAbstract
Background The fundus examination is an essential part of any ophthalmologic evaluation. However, medical students and primary care physicians often lack confidence with direct ophthalmoscopy. Virtual reality simulators are being employed in medical education to teach this technically challenging examination.
Objective To compare medical student ratings of the Eyesi Direct Ophthalmoscope Simulator and traditional small group teaching methods for learning direct ophthalmoscopy skills.
Methods All medical students at Indiana University School of Medicine traditionally learn direct ophthalmoscopy in their first 2 years during a small group session led by a physician instructor. Students who later enrolled in ophthalmology clinical electives during 2019 and 2020 were invited to additionally complete the Eyesi Direct Ophthalmoscope Simulator virtual reality curriculum. A voluntary, anonymous survey was sent between June and August 2020 to students who had completed both the traditional and Eyesi simulator sessions. Students were asked to rate their confidence in performing direct ophthalmoscopy following each session, and to indicate which teaching method was superior and why. Chi-square analysis was used to compare categorical variables.
Results Students\u27 confidence ratings for performing direct ophthalmoscopy were significantly higher following completion of the Eyesi simulator session compared with the traditional small group session (p \u3c 0.001). Four-fifths of respondents felt that the Eyesi simulator was superior to the traditional small group for learning the skills of direct ophthalmoscopy, while one-fifth felt that the two sessions were equally effective (p \u3c 0.001). None of the students responded that the small group session was the superior teaching method.
Conclusion The Eyesi Direct Ophthalmoscope Simulator was rated highly among medical students and offers distinct learning advantages that could not be replicated in a traditional small group environment, such as providing numerous examples of pathological findings and allowing unlimited examination time without concern for patient\u27s inconvenience or light exposure. The Eyesi simulator is a promising tool for teaching direct ophthalmoscopy to medical students. Ultimately, familiarity with the fundus examination will enable future physicians across specialties to better evaluate and appropriately refer patients with ocular fundus pathology
Utilizing a Professionalism Mentor to Address Sexual Harassment in Academic Ophthalmology
No full textAbstract
Objective This study assesses a new departmental role—a professionalism mentor—who receives sexual harassment reporting, liaisons with campus resources, and organizes educational sessions.
Study Design Multicenter randomized controlled survey study.
Methods Academic ophthalmology departments in the United States were randomized to a professionalism mentor group (n = 9) and a control group (n = 7). Among both pre- and postsurveys, 605 faculty and trainee responses were received and 546 were complete. The intervention group was assigned a professionalism mentor with educational session for a 6- to 10-month period. Sexual harassment and reporting rate change over time were compared between the two groups.
Results Among 546 anonymous responses, 16% experienced workplace sexual harassment during the prior 10 months. Location in the South or Midwest was a risk factor (p \u3c 0.001). Victims were mostly women (76%), including residents/fellows (46%) and academic attendings (49%); perpetrators included patients (35%) and academic attendings (35%). Departments with and without a professionalism mentor had stable harassment from pre- to postsurvey (p = 0.95 comparing change). The professionalism mentor group had an increase in reporting to an authority from pre- to postsurvey (7–23%), whereas the control group had a decrease (27–12%; p = 0.07 comparing change). Most faculty and trainees in the interventional arm of this study recommended instituting a professionalism mentor with educational session (66% presurvey and 68% postsurvey), compared with educational session alone (25% presurvey and 23% postsurvey), or neither (9% presurvey and 9% postsurvey). Residency program directors in the professionalism mentor group even more strongly supported instituting both a professionalism mentor and educational program (100% presurvey and 100% postsurvey) as opposed to educational program alone (0% presurvey and 0% postsurvey) or neither (0% presurvey and 0% postsurvey).
Conclusion This study identified a high sexual harassment rate in academic ophthalmology departments over a brief period. The presence of a professionalism mentor was viewed favorably and may lead to increased reporting
Understanding the Lack of Under-represented Racial and Ethnic Minorities in Ophthalmology
No full textTo adequately address the racial and ethnic disparities in eye care for our increasingly diverse society there needs to be a significant increase in physicians from under-represented minority groups (URMs) who pursue careers in ophthalmology. Studies have shown that patient–physician racial congruence tends to improve patient satisfaction and medical compliance.[1] However, there are significant racial and ethnic disparities that exist within medicine as a whole and, more specifically, within the field of ophthalmology.[2] One way to address this gap is to diversify the physician workforce by increasing the number of physicians from URMs.[2] URM is defined by membership in certain ethnic and racial minority groups (i.e., Black, Hispanic, American-Indian, Alaskan Native, Native Hawaiian, and Pacific Islander). These ethnic/racial minority groups have been deemed underrepresented in medicine (URiM).[3] According to recent United States (U.S.) Census data, URM groups comprise 30.7% of the American population.[3] However, a study published in 2016 based on information from the U.S. Census, Association of American Medical Colleges (AAMC), and the American Medical Association (AMA), found that only 6% of practicing ophthalmologists were from URM minority groups (3.3% Hispanic, 2.5% Black, and 0.2% Native American).[3] Fairless et al reviewed the medical school faculty demographic data from the 2019 American Association of Medical Colleges Faculty Roster and discovered that ophthalmology has the third lowest proportion of URM faculty within all clinical departments at U.S. medical schools.[4] Similarly, URiM trainees comprise only 7.7% of ophthalmology residents across the country, a figure that has been essentially stagnant, despite widespread efforts to increase URM matriculants in medical schools.[3] A recent call to action highlighted the significant need to increase the number of URiMs within ophthalmology training programs, academic institutions, and private practices.[2] Here, we explore potential explanations for the low numbers of URMs in ophthalmology, in an effort to provide insights to improve the diversity of the ophthalmology workforce. One proposed explanation for a lack of ophthalmologists in training programs, and ultimately practicing ophthalmologists, stems from a lack of role models and mentors within the field of ophthalmology. Studies have consistently demonstrated that role models have the capacity to significantly influence the specialty, or subspecialty, that their mentees ultimately choose.[2] According to a published report on science, technology, engineering, and mathematics (STEM) program at University of North Carolina at Chapel Hill (UNC-CH), URM students view “advisors,” as those who they sought out for advice but with whom they remained more distant and less involved.[5] However, the URM students view “mentors” as those who help students not only in academics and research, but also who inspire them through their shared personal, such as ethnic or gender, identity.[5] Given that URMs comprise only 6% of practicing ophthalmologists, it would be much less likely for a URM mentee to be exposed to a URM ophthalmologist at their medical schools and within their communities to serve as a potential race-concordant mentor.[3] [6] Concurrently, the proportion of URMs among ophthalmology faculty has decreased over the past decade (from 6.2 to 5.7%; p = 0 0.01).[2] [3] The lack of both early exposure and adequate mentorship within the field may further decrease one\u27s chance of choosing to pursue and successfully matching into an ophthalmology residency, which are notoriously competitive. More opportunities to expose URM medical students to ophthalmology at an earlier stage of their training are needed. This can be partially achieved by involvement of cross-cultural, or race-discordant mentors.[6] Limited data exists about the benefit of race-concordant versus race-discordant mentoring relationships. Recognizing the importance of this problem, there have been many programs developed within the field of ophthalmology to help to increase the early exposure and all mentorship for URM medical students. The Minority Ophthalmology Mentoring program, a newer initiative established in partnership with the American Academy of Ophthalmology and the Association of University Professors of Ophthalmology, aims to increase URM medical students\u27 exposure to the field of ophthalmology.[7] The impact of this program needs to be evaluated over time to determine its ability to effect change. Another explanation for the paucity of URMs in ophthalmology is due to the limited number of URMs in medicine, as a whole, which translates into an even smaller percentage opting to pursue a career in ophthalmology.[8] In 2019, only approximately 13% of physicians were from URM groups, whereas 31% of the U.S. population identify with one or more URM groups.[3] According to the American Medical Association, there were 38,376 applicants for 35,185 total positions into U.S. residency positions.[9] However, in the same year, only 512 U.S. allopathic medical school seniors out of 38,376 (1.3%) applied for an ophthalmology residency.[9] [10] In 2021, only 74% of the medical students who applied, matched into one of the 499 available ophthalmology residency spots, confirming the competitive nature of securing a spot within an ophthalmology residency program.[10] Ophthalmology is not prominently included within the medical school curriculum during the first and second years and, at most schools, is not a required rotation during third year clerkships. As a result, early exposure, even by a chance encounter, during high school, college or early on during medical school can become hugely important to pique one\u27s interest in the field. The problem is compounded by the fact that there is a higher probability of Black males attending under-performing schools that lack comprehensive premedical resources, making it more difficult for students to successfully apply to medical school.[11] The AAMC reported an alarming 35-year decline in Black males pursuing careers in medicine.[11] Over the same time course, the Black population has experienced poorer health outcomes compared with their White counterparts in the United States.[12] One way to address this is to have early initiatives starting in high school or college to expose students to medical careers earlier during their schooling. Additionally, giving more support to Historically Black Colleges and Universities (HBCU) could become very valuable, as HBCUs have graduated more Black doctors over the past 10 years than the top 10 predominantly White schools, combined.[13] Lastly, the financial cost of pursuing a medical career can be a significant deterrent to URM students and this impact may be more dramatic for Black Americans, given the higher proportions of unemployment rates within the community.[14] [15] According to a qualitative study on Black high school students in a Milwaukee Public High School, it was identified that financial constraints contribute to significant barriers to pursuing medical careers.[16] The Guardian reports that half of Black college students graduate with more than $25,000 in student loan debt.[17] According to a report by educationdata.org, in the United States, 40% of Black graduates have student loan debt from graduate school compared with 22% of White college graduates.[18] The 2018 U.S. census data reports that Native Americans, Blacks, and Hispanics have the highest poverty rates at 25.4, 20.8, and 17.6%, respectively, compared with 10.1% of their White counterparts, which contribute to the racial and ethnic disparities seen within medicine given aforementioned barriers.[19] There are likely cultural differences that contribute to and help to understand educational disparities.[20] In one study, Latino youths were less likely to picture themselves attending college but instead saw themselves starting a family, which may lead to a lower socioeconomic status.[21] For Black students, there were also reported negative social pressures and risks of being accused of “acting White” for one\u27s educational achievements, which could act to deter a student from being successful in school.[21] Programs such as the Robert Wood Johnson Foundation have been successful in supporting minority students in going to medical schools and increasing diversity in the health professions.[22] There needs to be more financial support such as longitudinal scholarships, travel grants, and housing stipends to support URMs with interests in medicine and provide them with earlier exposure to the field of ophthalmology. While there are many potential root causes to this problem, there are potential ways to help increase the number of URMs within the field of ophthalmology. Early exposure, such as outreach in diversity and inclusion college programs may increase awareness to ophthalmology among URM college students. There are already limited ophthalmology programs; similarly, medical students\u27 exposure to ophthalmology is becoming more limited in most medical schools, and the number of medical schools requiring a formal ophthalmology rotation has declined over the years.[23] Perhaps, ophthalmology academic departments could team-up with ophthalmology special interest groups within the medical schools to present lectures and case presentations to first and second year medical students to help pique the students\u27 interests in the field.[23] Meanwhile, it is important to recruit non-URM ophthalmology faculty to mentor URM students to help improve diversity in ophthalmology.[6] According to a systemic review, mentorship of URM students can be effective even if the mentor is not from the same background.[24] We hope that this article is the first step, of many, to explore reasons why there is a lack of URM trainees in ophthalmology with the goal to have medical doctors and ophthalmologists more accurately reflect the diversity that exists within the population of the United States to be able to achieve the best health outcomes. Additionally, we hope that our suggestions may help to improve both the number of URMs in ophthalmology training programs as well as those practicing as ophthalmologists in the United States
Objective Resident Characteristics Associated with Performance on the Ophthalmic Knowledge Assessment Program Examination
No full textAbstract
Background To determine objective resident characteristics that correlate with Ophthalmic Knowledge Assessment Program (OKAP) performance, as well as to correlate OKAP performance with Accreditation Council for Graduate Medical Education (ACGME) milestone assessments, written qualifying examination (WQE) scores, and oral board pass rates.
Methods Review of administrative records at an ACGME-accredited ophthalmology residency training program at an urban, tertiary academic medical center.
Results The study included data from a total of 50 resident physicians who completed training from 2012 to 2018. Mean (standard deviation) OKAP percentile performance was 60.90 (27.51), 60.46 (28.12), and 60.55 (27.43) for Years 1, 2, and 3 examinations, respectively. There were no statistically significant differences based on sex, marital status, having children, MD/PhD degree, other additional degree, number of publications, number of first author publications, or grades on medical school medicine and surgery rotations. OKAP percentile scores were significantly associated with United States Medical Licensing Examination (USMLE) Step 1 scores (linear regression coefficient 0.88 [0.54–1.18], p = 0.008). Finally, continuous OKAP scores were significantly correlated with WQE (r s = 0.292, p = 0.049) and oral board (r s = 0.49, p = 0.001) scores.
Conclusion Higher OKAP performance is correlated with passage of both WQE and oral board examinations during the first attempt. USMLE Step 1 score is the preresidency academic factor with the strongest association with success on the OKAP examination. Programs can utilize this information to identify those who may benefit from additional OKAP, WQE, and oral board preparation assistance