Letters from 2005 through 2015 to determine whether they entered GME training in the United States, with particular assessment of minority graduates.
RESEARCH LETTER
Placement of US Medical School Graduates Into Graduate Medical Education, 2005 Through 2015 Medical school enrollment has increased in the United States during the past decade1; however, growth in graduate medical education (GME) positions has been slower, raising concerns about whether graduates will be able to obtain the GME necessary to qualify to practice medicine.2 Particular concerns have been raised about graduates from minority groups traditionally underrepresented in medicine.3 We evaluated graduates of all US MD-granting medical schools
Methods | We reviewed the Association of American Medical Colleges Student Record System4 to identify all graduates. At graduation (between July 1 and June 30 of an academic year), each medical school’s registrar populates this system with the initial GME program for each graduate. A graduate was considered unplaced if he or she was not designated as starting GME on July 1 after graduation by the registrar. The American Institute for Research granted a waiver of informed consent from study participants.
Table 1. US Medical School Graduates Unplaced in Graduate Medical Education (GME) No. (%)a Total No. of Academic Year (July1-June 30) Graduates Whiteb Blackb Unplaced in GME Upon Medical School Graduation 2004-2005
15 762
Hispanicb
197 (2.0)
47 (4.5)d d
American Indian/ Other or Alaskan Native Unknownb
Asianb
35 (3.7)d
85 (2.7)e
39 (12.4)d
7 (6.0)
d
Totalb
11 (6.5)e
421 (2.7)
2005-2006
15 927
184 (1.9)
38 (3.6)
27 (2.6)
88 (2.9)
6 (7.3)
50 (5.6)
16 (8.6)d
409 (2.6)
2006-2007
16 140
216 (2.2)
53 (5.3)d
35 (3.3)e
74 (2.5)
2 (6.3)
59 (5.8)d
26 (12.1)d
465 (2.9)
2007-2008
16 168
205 (2.1)
48 (4.7)d
70 (6.2)d
80 (2.6)
1 (1.7)
76 (9.8)d
18 (8.3)d
498 (3.1)
2008-2009
16 467
221 (2.2)
55 (5.6)d
77 (6.5)d
98 (3.1)d
3 (6.4)
88 (11.0)d
27 (11.3)d
569 (3.5)
2009-2010
16 835
191 (1.9)
57 (5.3)d
71 (5.9)d
100 (3.2)d
4 (5.1)
81 (10.0)d
26 (9.6)d
530 (3.1)
2010-2011
17 362
181 (1.7)
55 (5.2)d
74 (5.7)d
66 (1.9)
4 (4.7)
70 (9.2)d
24 (8.2)d
474 (2.7)
2011-2012
17 344
154 (1.5)
63 (5.7)d
69 (5.6)d
72 (2.1)e
3 (3.4)
65 (6.7)d
35 (12.9)d
461 (2.7)
2012-2013
18 154
201 (1.9)
83 (7.9)d
95 (6.8)d
90 (2.5)e
6 (7.9)
71 (6.2)d
31 (12.1)d
577 (3.2)
2013-2014
18 073
189 (1.8)
81 (7.3)d
104 (7.2)d
87 (2.4)
1 (1.4)
79 (6.7)d
32 (11.3)d
573 (3.2)
2014-2015
18 705
200 (1.8)
86 (7.8)d
92 (6.2)d
107 (2.9)d
2 (3.4)
72 (5.7)d
30 (12.7)d
589 (3.1)
186 937
2139 (1.9)
666 (5.7)d
749 (5.6)d
947 (2.6)d
39 (4.9)d
750 (7.6)d
276 (10.5)d
5566 (3.0)
3 (2.6)f
6 (1.9)f
Total
d
Non–US Citizenc
Unplaced in GME as of September 2015 2004-2005 2005-2006 2006-2007
15 762
42 (0.4)f
8 (0.8)f
8 (0.9)f
13 (0.4)f
15 927
f
f
f
f
16 140
44 (0.5)
f
54 (0.5)
f
10 (1.0)
f
5 (0.5)
f
11 (0.4)
4 (0.4)
f
1 (3.1)
9 (0.9)
106 (0.7)f
d,f
7 (0.7)
16 (1.4)
16 (0.5)
0
10 (4.6)
107 (0.7)f
55 (0.5)f
13 (1.3)e,f
23 (1.9)d,f
16 (0.5)f
1 (2.1)
23 (2.9)d,f
15 (6.3)d,f
146 (0.9)f
2009-2010
16 835
52 (0.5)f
13 (1.2)e,f
20 (1.7)d,f
18 (0.6)f
2 (2.5)
19 (2.3)d,f
20 (7.4)d,g
144 (0.9)f
2010-2011
17 362
75 (0.7)f
16 (1.5)e,f
28 (2.2)d,f
14 (0.4)e,f
2 (2.3)
26 (3.4)d,f
18 (6.2)d,g
179 (1.0)f
2011-2012
17 344
69 (0.7)f
21 (1.9)d,f
34 (2.7)d,f
21 (0.6)f
1 (1.1)
29 (3.0)d,f
26 (9.6)d,f
201 (1.2)f
18 154
f
d,f
d,f
f
d,f
d,f
252 (1.4)f
d
451 (2.5)f
d
535 (2.9)f
d,f
2293 (1.2)f
2013-2014 2014-2015 Total
18 073 18 705 186 937
143 (1.4)
f
184 (1.7)
f
854 (0.8)
69 (6.2)
d
83 (7.5)
d,f
281 (2.4)
40 (2.9)
d,f
89 (6.2)
d,f
85 (5.8)
d,f
352 (2.6)
a
Data represent the actual number of graduates unplaced in GME. The percentages do not add up to 100% because they are the percentage of graduates unplaced in GME out of all medical graduates for each group.
b
In the upper half of the Table, P < .01 for trend for black and Hispanic; in the lower half, for white, black, Hispanic, Asian, other or unknown, and total.
c
Refers to foreign citizens and those without US permanent resident status (US green card) and is not a race/ethnicity; however, but it is treated as such for completeness of the analysis. P < .05 for trend in entire column.
jama.com
39 (1.1)
f
67 (1.8)
d,f
99 (2.7)
d,f
333 (0.9)
f
16 (7.4)
49 (0.5)
d,f
d
87 (0.5)f
d,f
7 (3.7)
16 467
32 (3.0)
f
0
85 (0.5)f
e,f
16 168
f
e,f
19 (0.6)
5 (2.9)g
2008-2009
87 (0.8)
f
4 (0.4)
f
2007-2008
2012-2013
f
9 (0.9)
d,g
9 (1.2)
g
2 (2.6)
28 (2.4)
d,f
1 (1.4)
53 (4.5)
d,f
2 (3.4) e,f
15 (1.9)
54 (4.3)
d,f
260 (2.6)
24 (9.4)
29 (10.3) 28 (11.8) 198 (7.5)
d
P < .01 for 2-sample t test comparing minority proportion with white proportion.
e
P < .05 for 2-sample t test comparing minority proportion with white proportion.
f
P < .01 for paired t test for group proportion upon graduation vs 2015.
g
P < .05 for paired t test for group proportion upon graduation vs 2015.
(Reprinted) JAMA December 8, 2015 Volume 314, Number 22
Copyright 2015 American Medical Association. All rights reserved.
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2409
Letters
Table 2. Odds Ratios (ORs) for Placing Into Graduate Medical Education Upon Graduation From US Medical Schoolsa Unadjusted OR (95% CI) (n = 186 937)
Adjusted OR (95% CI) (n = 186 380)b
White
1 [Reference]
1 [Reference]
Black
0.37 (0.34-0.41)
0.63 (0.57-0.70)
Hispanic
0.58 (0.58-0.65)
0.88 (0.78-0.99)
Asian
0.76 (0.70-0.82)
0.85 (0.78-0.92)
American Indian/Alaskan 0.37 (0.26-0.51) Native
0.60 (0.43-0.84)
Other or unknown
0.27 (0.25-0.30)
0.31 (0.28-0.34)
Non–US citizen
0.20 (0.18-0.23)
0.21 (0.18-0.24)
a
The ORs were estimated with multilevel logistic regression; medical schools were the random effect (intercept only). Study years include the 2004-2005 academic year through the 2014-2015 academic year.
b
Adjusted for medical student sex and Step 1 total score at first testing.
Race/ethnicity was self-reported by each student on his or her medical school application. Graduates who were foreign citizens or without US permanent resident status were grouped as non–US citizens. To identify those unplaced in GME upon medical school graduation who ultimately entered GME, the GMETrack First Year On-Duty file was searched in September 2015 for the years 2004 through 2014. The GMETrack records trainees in all Accreditation Council for Graduate Medical Education accredited programs on December 31 of each year. Approximately 5% of residencies do not participate each year. 5 Therefore, we also searched for initially unplaced graduates who did not appear in GMETrack in the American Medical Association Physician Masterfile as direct patient care physicians and in the Centers for Medicare & Medicaid Services National Provider Identifier database, assuming those identified must have received GME. We determined the percentage of graduates unplaced in GME the academic year of their graduation and in 2015, overall and by race/ethnicity. We used a 2-sample t test to compare the proportion of minority vs white graduates unplaced in GME and used a paired t test to compare the proportion unplaced upon graduation vs unplaced as of 2015. We used simple linear regressions to determine trendline P values for the proportions unplaced in GME during the study years. We calculated the unadjusted and adjusted odds ratios for placement into GME upon medical school graduation using multilevel logistic regression in which medical school was entered as a random effect. All P values were 2-sided; P < .05 was considered statistically significant. We used SAS version 9.3 (SAS Institute Inc) for all statistical analyses. Results | There were 186 937 graduates (48.2% female) during the study period, increasing from 15 762 in 2004-2005 to 18 705 in 2014-2015. The percentage of graduates unplaced in GME during the academic year of their graduation from medical school remained stable, ranging from 2.6% to 3.5% (P = .18 for trend) with a mean of 3.0% (Table 1). 2410
Unplaced black, Hispanic, and non–US citizen graduates increased over time. Racial/ethnic minority graduates were consistently less likely to begin GME the year they graduated than whites (Table 2). However, within 6 years after graduation, more than 99% of all graduates entered GME or were found in practice in the United States. The racial/ethnic differences seen at graduation diminished with time but remained statistically significant (Table 1). Discussion | The percentage of US MD graduates entering GME the year of graduation has remained stable during the past decade despite an increase in the number of graduates. Within 6 years after graduation, almost all graduates entered GME, and the percentage of minority graduates ultimately entering GME approached that of their white colleagues. Limitations include that we did not examine GME placement for other GME applicants, such as international medical school graduates and doctors of osteopathic medicine, and we reported only on placement into GME, not whether these graduates eventually completed GME and became practicing physicians. As the number of US MD graduates continues to increase with the creation of new medical schools and the growth of existing schools, these trends should be closely monitored. Henry M. Sondheimer, MD Imam M. Xierali, PhD Geoffrey H. Young, PhD Marc A. Nivet, EdD Author Affiliations: Association of American Medical Colleges, Washington, DC. Corresponding Author: Henry M. Sondheimer, MD, Association of American Medical Colleges, 655 K St NW, Ste 100, Washington, DC 20001 ([email protected]). Author Contributions: Dr Nivet had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: Sondheimer, Xierali. Drafting of the manuscript: Sondheimer, Xierali. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Sondheimer, Xierali. Administrative, technical, or material support: Sondheimer. Study supervision: Nivet. Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. 1. Association of American Medical Colleges. Results of the 2014 medical school enrollment survey. https://members.aamc.org/eweb/upload/Results%20of %20the%202014%20Medical%20School%20Enrollment%20Survey.pdf. Accessed May 18, 2015 2. Iglehart JK. The residency mismatch. N Engl J Med. 2013;369(4):297-299. 3. Walker KO, Moreno G, Grumbach K. The association among specialty, race, ethnicity, and practice location among California physicians in diverse specialties. J Natl Med Assoc. 2012;104(1-2):46-52. 4. Association of American Medical Colleges. Handbook for student records administrators. https://www.aamc.org/download/54660/data /studentrecordshandbook.pdf. Accessed October 12, 2015. 5. Jolly P, Lischka T, Sondheimer H. Numbers of MD and DO graduates in graduate medical education programs accredited by the Accreditation Council for Graduate Medical Education and the American Osteopathic Association. Acad Med. 2015;90(7):970-974.
JAMA December 8, 2015 Volume 314, Number 22 (Reprinted)
Copyright 2015 American Medical Association. All rights reserved.
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RESEARCH LETTER
Placement of US Medical School Graduates Into Graduate Medical Education, 2005 Through 2015 Medical school enrollment has increased in the United States during the past decade1; however, growth in graduate medical education (GME) positions has been slower, raising concerns about whether graduates will be able to obtain the GME necessary to qualify to practice medicine.2 Particular concerns have been raised about graduates from minority groups traditionally underrepresented in medicine.3 We evaluated graduates of all US MD-granting medical schools
Methods | We reviewed the Association of American Medical Colleges Student Record System4 to identify all graduates. At graduation (between July 1 and June 30 of an academic year), each medical school’s registrar populates this system with the initial GME program for each graduate. A graduate was considered unplaced if he or she was not designated as starting GME on July 1 after graduation by the registrar. The American Institute for Research granted a waiver of informed consent from study participants.
Table 1. US Medical School Graduates Unplaced in Graduate Medical Education (GME) No. (%)a Total No. of Academic Year (July1-June 30) Graduates Whiteb Blackb Unplaced in GME Upon Medical School Graduation 2004-2005
15 762
Hispanicb
197 (2.0)
47 (4.5)d d
American Indian/ Other or Alaskan Native Unknownb
Asianb
35 (3.7)d
85 (2.7)e
39 (12.4)d
7 (6.0)
d
Totalb
11 (6.5)e
421 (2.7)
2005-2006
15 927
184 (1.9)
38 (3.6)
27 (2.6)
88 (2.9)
6 (7.3)
50 (5.6)
16 (8.6)d
409 (2.6)
2006-2007
16 140
216 (2.2)
53 (5.3)d
35 (3.3)e
74 (2.5)
2 (6.3)
59 (5.8)d
26 (12.1)d
465 (2.9)
2007-2008
16 168
205 (2.1)
48 (4.7)d
70 (6.2)d
80 (2.6)
1 (1.7)
76 (9.8)d
18 (8.3)d
498 (3.1)
2008-2009
16 467
221 (2.2)
55 (5.6)d
77 (6.5)d
98 (3.1)d
3 (6.4)
88 (11.0)d
27 (11.3)d
569 (3.5)
2009-2010
16 835
191 (1.9)
57 (5.3)d
71 (5.9)d
100 (3.2)d
4 (5.1)
81 (10.0)d
26 (9.6)d
530 (3.1)
2010-2011
17 362
181 (1.7)
55 (5.2)d
74 (5.7)d
66 (1.9)
4 (4.7)
70 (9.2)d
24 (8.2)d
474 (2.7)
2011-2012
17 344
154 (1.5)
63 (5.7)d
69 (5.6)d
72 (2.1)e
3 (3.4)
65 (6.7)d
35 (12.9)d
461 (2.7)
2012-2013
18 154
201 (1.9)
83 (7.9)d
95 (6.8)d
90 (2.5)e
6 (7.9)
71 (6.2)d
31 (12.1)d
577 (3.2)
2013-2014
18 073
189 (1.8)
81 (7.3)d
104 (7.2)d
87 (2.4)
1 (1.4)
79 (6.7)d
32 (11.3)d
573 (3.2)
2014-2015
18 705
200 (1.8)
86 (7.8)d
92 (6.2)d
107 (2.9)d
2 (3.4)
72 (5.7)d
30 (12.7)d
589 (3.1)
186 937
2139 (1.9)
666 (5.7)d
749 (5.6)d
947 (2.6)d
39 (4.9)d
750 (7.6)d
276 (10.5)d
5566 (3.0)
3 (2.6)f
6 (1.9)f
Total
d
Non–US Citizenc
Unplaced in GME as of September 2015 2004-2005 2005-2006 2006-2007
15 762
42 (0.4)f
8 (0.8)f
8 (0.9)f
13 (0.4)f
15 927
f
f
f
f
16 140
44 (0.5)
f
54 (0.5)
f
10 (1.0)
f
5 (0.5)
f
11 (0.4)
4 (0.4)
f
1 (3.1)
9 (0.9)
106 (0.7)f
d,f
7 (0.7)
16 (1.4)
16 (0.5)
0
10 (4.6)
107 (0.7)f
55 (0.5)f
13 (1.3)e,f
23 (1.9)d,f
16 (0.5)f
1 (2.1)
23 (2.9)d,f
15 (6.3)d,f
146 (0.9)f
2009-2010
16 835
52 (0.5)f
13 (1.2)e,f
20 (1.7)d,f
18 (0.6)f
2 (2.5)
19 (2.3)d,f
20 (7.4)d,g
144 (0.9)f
2010-2011
17 362
75 (0.7)f
16 (1.5)e,f
28 (2.2)d,f
14 (0.4)e,f
2 (2.3)
26 (3.4)d,f
18 (6.2)d,g
179 (1.0)f
2011-2012
17 344
69 (0.7)f
21 (1.9)d,f
34 (2.7)d,f
21 (0.6)f
1 (1.1)
29 (3.0)d,f
26 (9.6)d,f
201 (1.2)f
18 154
f
d,f
d,f
f
d,f
d,f
252 (1.4)f
d
451 (2.5)f
d
535 (2.9)f
d,f
2293 (1.2)f
2013-2014 2014-2015 Total
18 073 18 705 186 937
143 (1.4)
f
184 (1.7)
f
854 (0.8)
69 (6.2)
d
83 (7.5)
d,f
281 (2.4)
40 (2.9)
d,f
89 (6.2)
d,f
85 (5.8)
d,f
352 (2.6)
a
Data represent the actual number of graduates unplaced in GME. The percentages do not add up to 100% because they are the percentage of graduates unplaced in GME out of all medical graduates for each group.
b
In the upper half of the Table, P < .01 for trend for black and Hispanic; in the lower half, for white, black, Hispanic, Asian, other or unknown, and total.
c
Refers to foreign citizens and those without US permanent resident status (US green card) and is not a race/ethnicity; however, but it is treated as such for completeness of the analysis. P < .05 for trend in entire column.
jama.com
39 (1.1)
f
67 (1.8)
d,f
99 (2.7)
d,f
333 (0.9)
f
16 (7.4)
49 (0.5)
d,f
d
87 (0.5)f
d,f
7 (3.7)
16 467
32 (3.0)
f
0
85 (0.5)f
e,f
16 168
f
e,f
19 (0.6)
5 (2.9)g
2008-2009
87 (0.8)
f
4 (0.4)
f
2007-2008
2012-2013
f
9 (0.9)
d,g
9 (1.2)
g
2 (2.6)
28 (2.4)
d,f
1 (1.4)
53 (4.5)
d,f
2 (3.4) e,f
15 (1.9)
54 (4.3)
d,f
260 (2.6)
24 (9.4)
29 (10.3) 28 (11.8) 198 (7.5)
d
P < .01 for 2-sample t test comparing minority proportion with white proportion.
e
P < .05 for 2-sample t test comparing minority proportion with white proportion.
f
P < .01 for paired t test for group proportion upon graduation vs 2015.
g
P < .05 for paired t test for group proportion upon graduation vs 2015.
(Reprinted) JAMA December 8, 2015 Volume 314, Number 22
Copyright 2015 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a Central Michigan University User on 12/08/2015
2409
Letters
Table 2. Odds Ratios (ORs) for Placing Into Graduate Medical Education Upon Graduation From US Medical Schoolsa Unadjusted OR (95% CI) (n = 186 937)
Adjusted OR (95% CI) (n = 186 380)b
White
1 [Reference]
1 [Reference]
Black
0.37 (0.34-0.41)
0.63 (0.57-0.70)
Hispanic
0.58 (0.58-0.65)
0.88 (0.78-0.99)
Asian
0.76 (0.70-0.82)
0.85 (0.78-0.92)
American Indian/Alaskan 0.37 (0.26-0.51) Native
0.60 (0.43-0.84)
Other or unknown
0.27 (0.25-0.30)
0.31 (0.28-0.34)
Non–US citizen
0.20 (0.18-0.23)
0.21 (0.18-0.24)
a
The ORs were estimated with multilevel logistic regression; medical schools were the random effect (intercept only). Study years include the 2004-2005 academic year through the 2014-2015 academic year.
b
Adjusted for medical student sex and Step 1 total score at first testing.
Race/ethnicity was self-reported by each student on his or her medical school application. Graduates who were foreign citizens or without US permanent resident status were grouped as non–US citizens. To identify those unplaced in GME upon medical school graduation who ultimately entered GME, the GMETrack First Year On-Duty file was searched in September 2015 for the years 2004 through 2014. The GMETrack records trainees in all Accreditation Council for Graduate Medical Education accredited programs on December 31 of each year. Approximately 5% of residencies do not participate each year. 5 Therefore, we also searched for initially unplaced graduates who did not appear in GMETrack in the American Medical Association Physician Masterfile as direct patient care physicians and in the Centers for Medicare & Medicaid Services National Provider Identifier database, assuming those identified must have received GME. We determined the percentage of graduates unplaced in GME the academic year of their graduation and in 2015, overall and by race/ethnicity. We used a 2-sample t test to compare the proportion of minority vs white graduates unplaced in GME and used a paired t test to compare the proportion unplaced upon graduation vs unplaced as of 2015. We used simple linear regressions to determine trendline P values for the proportions unplaced in GME during the study years. We calculated the unadjusted and adjusted odds ratios for placement into GME upon medical school graduation using multilevel logistic regression in which medical school was entered as a random effect. All P values were 2-sided; P < .05 was considered statistically significant. We used SAS version 9.3 (SAS Institute Inc) for all statistical analyses. Results | There were 186 937 graduates (48.2% female) during the study period, increasing from 15 762 in 2004-2005 to 18 705 in 2014-2015. The percentage of graduates unplaced in GME during the academic year of their graduation from medical school remained stable, ranging from 2.6% to 3.5% (P = .18 for trend) with a mean of 3.0% (Table 1). 2410
Unplaced black, Hispanic, and non–US citizen graduates increased over time. Racial/ethnic minority graduates were consistently less likely to begin GME the year they graduated than whites (Table 2). However, within 6 years after graduation, more than 99% of all graduates entered GME or were found in practice in the United States. The racial/ethnic differences seen at graduation diminished with time but remained statistically significant (Table 1). Discussion | The percentage of US MD graduates entering GME the year of graduation has remained stable during the past decade despite an increase in the number of graduates. Within 6 years after graduation, almost all graduates entered GME, and the percentage of minority graduates ultimately entering GME approached that of their white colleagues. Limitations include that we did not examine GME placement for other GME applicants, such as international medical school graduates and doctors of osteopathic medicine, and we reported only on placement into GME, not whether these graduates eventually completed GME and became practicing physicians. As the number of US MD graduates continues to increase with the creation of new medical schools and the growth of existing schools, these trends should be closely monitored. Henry M. Sondheimer, MD Imam M. Xierali, PhD Geoffrey H. Young, PhD Marc A. Nivet, EdD Author Affiliations: Association of American Medical Colleges, Washington, DC. Corresponding Author: Henry M. Sondheimer, MD, Association of American Medical Colleges, 655 K St NW, Ste 100, Washington, DC 20001 ([email protected]). Author Contributions: Dr Nivet had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: All authors. Acquisition, analysis, or interpretation of data: Sondheimer, Xierali. Drafting of the manuscript: Sondheimer, Xierali. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Sondheimer, Xierali. Administrative, technical, or material support: Sondheimer. Study supervision: Nivet. Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. 1. Association of American Medical Colleges. Results of the 2014 medical school enrollment survey. https://members.aamc.org/eweb/upload/Results%20of %20the%202014%20Medical%20School%20Enrollment%20Survey.pdf. Accessed May 18, 2015 2. Iglehart JK. The residency mismatch. N Engl J Med. 2013;369(4):297-299. 3. Walker KO, Moreno G, Grumbach K. The association among specialty, race, ethnicity, and practice location among California physicians in diverse specialties. J Natl Med Assoc. 2012;104(1-2):46-52. 4. Association of American Medical Colleges. Handbook for student records administrators. https://www.aamc.org/download/54660/data /studentrecordshandbook.pdf. Accessed October 12, 2015. 5. Jolly P, Lischka T, Sondheimer H. Numbers of MD and DO graduates in graduate medical education programs accredited by the Accreditation Council for Graduate Medical Education and the American Osteopathic Association. Acad Med. 2015;90(7):970-974.
JAMA December 8, 2015 Volume 314, Number 22 (Reprinted)
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