International Medical Graduates in the Pediatric Workforce in the United States

Through the analysis of health workforce databases, in this study, we summarize the supply, distribution and characteristics of international medical graduates in the US pediatric workforce. BACKGROUND AND OBJECTIVES: To describe the supply, distribution, and characteristics of international medical graduates (IMGs) in pediatrics who provide patient care in the United States. METHODS: Cross-sectional study, combining data from the 2019 Physician Masterfile of the American Medical Association and the Educational Commission for Foreign Medical Graduates database. RESULTS: In total, 92 806 pediatric physicians were identified, comprising 9.4% of the entire US physician workforce. Over half are general pediatricians. IMGs account for 23.2% of all general pediatricians and pediatric subspecialists. Of all IMGs in pediatrics, 22.1% or 4775 are US citizens who obtained their medical degree outside the United States or Canada, and 15.4% (3246) attended medical school in the Caribbean. Fifteen non-US medical schools account for 29.9% of IMGs currently in active practice in pediatrics in the United States. IMGs are less likely to work in group practice or hospital-based practice and are more likely to be employed in solo practice (compared with US medical school graduates). CONCLUSIONS: With this study, we provide an overview of the pediatric workforce, quantifying the contribution of IMGs. Many IMGs are US citizens who attend medical school abroad and return to the United States for postgraduate training. Several factors, including the number of residency training positions, could affect future numbers of IMGs entering the United States. Longitudinal studies are needed to better understand the implications that workforce composition and distribution may have for the care of pediatric patients

A comparison of physician emigration from Africa to the United States of America between 2005 and 2015

BACKGROUND: Migration of health professionals has been a cause for global concern, in particular migration from African countries with a high disease burden and already fragile health systems. An estimated one fifth of African-born physicians are working in high-income countries. Lack of good data makes it difficult to determine what constitutes "African" physicians, as most studies do not distinguish between their country of citizenship and country of training. Thus, the real extent of migration from African countries to the United States (US) remains unclear. This paper quantifies where African migrant physicians come from, where they were educated, and how these trends have changed over time. METHODS: We combined data from the Educational Commission for Foreign Medical Graduates with the 2005 and 2015 American Medical Association Physician Masterfiles. Using a repeated cross-sectional study design, we reviewed the available data, including medical school attended, country of medical school, and citizenship when entering medical school. RESULTS: The outflow of African-educated physicians to the US has increased over the past 10 years, from 10 684 in 2005 to 13 584 in 2015 (27.1% increase). This represents 5.9% of all international medical graduates in the US workforce in 2015. The number of African-educated physicians who graduated from medical schools in sub-Saharan countries was 2014 in 2005 and 8150 in 2015 (304.6% increase). We found four distinct categorizations of African-trained physicians migrating to the US: (1) citizens from an African country who attended medical school in their own country (86.2%, n = 11,697); (2) citizens from an African country who attended medical school in another African country (2.3%, n = 317); (3) US citizens who attended medical school in an African country (4.0%, n = 537); (4) citizens from a country outside Africa, and other than the United States, who attended medical school in an African country (7.5%, n = 1013). Overall, six schools in Africa provided half of all African-educated physicians. CONCLUSIONS: The number of African-educated physicians in the US has increased over the past 10 years. We have distinguished four migration patterns, based on citizenship and country of medical school. The majority of African graduates come to the US from relatively few countries, and from a limited number of medical schools. A proportion are not citizens of the country where they attended medical school, highlighting the internationalization of medical education

Three dimensional graphics station for computer integrated manufacturing research

Issued as Final report, Project no. E-25-69

Canadians studying medicine abroad and their journey to secure postgraduate training in Canada or the United States

Background: From national and international workforce perspectives, Canadians studying medicine abroad (CSAs) are a growing provider group. Some were born in Canada whereas others immigrated as children. They study medicine in various countries, often attempting both American and Canadian medical licensure pathways. Methods: Using data from the Educational Commission for Foreign Medical Graduates (ECFMG) and the Medical Council of Canada (MCC), we looked at CSAs who attempted to secure residency positions in both Canada and the United States. We detailed the CSAs’ countries of birth and medical education. We tracked these individuals through their postgraduate education programs to enumerate their success rate and categorize the geographic locations of their training. Results: The majority of CSAs study medicine in one of 10 countries. The remainder are disbursed across 88 other countries. Most CSAs were born in Canada (62%). Approximately 1/3 of CSA from the 2004-2016 cohort had no record of entering a residency program in Canada or the United States (U.S.). Recently graduated CSAs were most likely to secure residency training in Ontario and New York. Conclusion: Many CSAs attempt to secure residency training in both Canada and the U.S. Quantifying success rates may be helpful for Canadians thinking about studying medicine abroad. Understanding the educational pathways of CSAs will be useful for physician labour workforce planning

Challenges of providing timely feedback to Residents: Faculty perspectives

Objective To explore faculty\u27s perceptions of challenges in providing verbal feedback to the Residents and suggest ways to overcome the barriers. Methods As part of a larger study on feedback assessment, five focus group discussions were conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, during faculty development workshops held from January to June 2010. Qualitative grounded theory was used to explore faculty perceptions of challenges in providing verbal feedback to the Residents. Results Of the 54 faculty members, 49(91%) participated. Four themes that emerged were \u27time constraint\u27 indicating high patient load; \u27faculty related issues\u27 indicating faculty\u27s apprehension about its own evaluation by Residents; \u27educational issues\u27 indicating that the importance of feedback was not emphasised; and \u27system and logistic issues\u27 indicating that the assessment form used for assessing Residents was ambiguous. Conclusion Work load of the faculty and the expectations with respect to patient care responsibilities may have an impact on the quality, timing, content and delivery of the feedback provided to the Residents

Mechanisms of cell entry by human papillomaviruses: an overview

As the primary etiological agents of cervical cancer, human papillomaviruses (HPVs) must deliver their genetic material into the nucleus of the target cell. The viral capsid has evolved to fulfil various roles that are critical to establish viral infection. The particle interacts with the cell surface via interaction of the major capsid protein, L1, with heparan sulfate proteoglycans. Moreover, accumulating evidence suggests the involvement of a secondary receptor and a possible role for the minor capsid protein, L2, in cell surface interactions

Transmission of mitochondrial DNA following assisted reproduction and nuclear transfer

Review of the articleMitochondria are the organelles responsible for producing the majority of a cell's ATP and also play an essential role in gamete maturation and embryo development. ATP production within the mitochondria is dependent on proteins encoded by both the nuclear and the mitochondrial genomes, therefore co-ordination between the two genomes is vital for cell survival. To assist with this co-ordination, cells normally contain only one type of mitochondrial DNA (mtDNA) termed homoplasmy. Occasionally, however, two or more types of mtDNA are present termed heteroplasmy. This can result from a combination of mutant and wild-type mtDNA molecules or from a combination of wild-type mtDNA variants. As heteroplasmy can result in mitochondrial disease, various mechanisms exist in the natural fertilization process to ensure the maternal-only transmission of mtDNA and the maintenance of homoplasmy in future generations. However, there is now an increasing use of invasive oocyte reconstruction protocols, which tend to bypass mechanisms for the maintenance of homoplasmy, potentially resulting in the transmission of either form of mtDNA heteroplasmy. Indeed, heteroplasmy caused by combinations of wild-type variants has been reported following cytoplasmic transfer (CT) in the human and following nuclear transfer (NT) in various animal species. Other techniques, such as germinal vesicle transfer and pronuclei transfer, have been proposed as methods of preventing transmission of mitochondrial diseases to future generations. However, resulting embryos and offspring may contain mtDNA heteroplasmy, which itself could result in mitochondrial disease. It is therefore essential that uniparental transmission of mtDNA is ensured before these techniques are used therapeutically

Project-based, collaborative, algorithmic robotics for high school students: Programming self-driving race cars at MIT

We describe the pedagogy behind the MIT Beaver Works Summer Institute Robotics Program, a new high-school STEM program in robotics. The program utilizes state-of-the-art sensors and embedded computers for mobile robotics. These components are carried on an exciting 1/10-scale race-car platform. The program has three salient, distinguishing features: (i) it focuses on robotics software systems: the students design and build robotics software towards real-world applications, without being distracted by hardware issues; (ii) it champions project-based learning: the students learn through weekly project assignments and a final course challenge; (iii) the learning is implemented in a collaborative fashion: the students learn the basics of collaboration and technical communication in lectures, and they work in teams to design and implement their software systems. The program was offered as a four-week residential program at MIT in the summer of 2016. In this paper, we provide the details of this new program, its teaching objectives, and its results. We also briefly discuss future directions and opportunities

The consequences of nuclear transfer for mammalian foetal development and offspring survival : a mitochondrial DNA perspective

Review of the articleThe introduction of nuclear transfer (NT) and other technologies that involve embryo reconstruction require us to reinvestigate patterns of mitochondrial DNA (mtDNA) transmission, transcription and replication. MtDNA is a 16.6 kb genome located within each mitochondrion. The number of mitochondria and mtDNA copies per organelle is specific to each cell type. MtDNA is normally transmitted through the oocyte to the offspring. However, reconstructed oocytes often transmit both recipient oocyte mtDNA and mtDNA associated with the donor nucleus. We argue that the transmission of two populations of mtDNA may have implications for offspring survival as only one allele might be actively transcribed. This could result in the offspring phenotypically exhibiting mtDNA depletion-type syndromes. A similar occurrence could arise when nucleo-cytoplasmic interactions fail to regulate mtDNA transcription and replication, especially as the initiation of mtDNA replication post-implantation is a key developmental event. Furthermore, failure of the donor somatic nucleus to be reprogrammed could result in the early initiation of replication and the loss of cellular mtDNA specificity. We suggest investigations should be conducted to enhance our understanding of nucleo-cytoplasmic interactions in order to improve NT efficiency