Tag Archives: selection

CAN YOU PROVIDE MORE DETAILS ABOUT THE STANDARDIZED APPLICATION AND SELECTION PROCESS INTRODUCED IN 2012

Prior to 2012, the process for applying to and being admitted into medical school in the United States lacked standardization across schools. Each medical school designed and implemented their own application, supporting documentation requirements, screening criteria, and interview process. This led to inefficiencies for applicants who had to navigate unique and sometimes inconsistent processes across the many schools they applied to each cycle. It also made it challenging for admissions committees to fairly evaluate and compare applicants.

To address these issues, in 2012 the Association of American Medical Colleges (AAMC) implemented a major reform – a fully standardized and centralized application known as the American Medical College Application Service (AMCAS). This new system collected a single application from each applicant and distributed verified application information and supporting documents to designated medical schools. It streamlined the process and allowed schools to spend more time evaluating candidates rather than processing paperwork.

Some key features of the new AMCAS application included:

A unified application form collecting basic biographical data, academic history, work and activities experience, and personal statements. This replaced individual forms previously used by each school.

A centralized process for verifying academic transcripts, calculating GPAs, and distributing verified information to designated schools. This ensured accuracy and consistency in reporting academic history.

Guidelines for standardized supporting documents including letters of recommendation, supplemental forms, and prerequisite coursework documentation. Schools could no longer require unique or additional documents.

Clear instructions and guidelines to help applicants understand requirements and navigate the process. This improved user experience over the complex, school-by-school approach previously.

Streamlined fees allowing applicants to apply to multiple schools with one payment to AMCAS rather than separate fees to each institution. This saved applicants significant costs.

In addition to the standardized application, the AAMC implemented guidelines to encourage medical schools to adopt common screening practices when reviewing applications. Some of the key selection process reforms included:

Screening applicants based primarily on academic metrics (GPA, MCAT scores), research experience, community service or advocacy experience, etc. rather than “soft” personal factors to promote fairness and reduce bias.

Establishing common cut-offs for screening based on metrics like minimum GPAs and MCAT scores required to be considered for an interview. This allowed direct comparison of academically prepared candidates.

Conducting timely first-round screenings of all applicants by mid-October to ensure fairness in scheduling limited interview slots. Late screenings put some candidates at a disadvantage.

Standardizing interview formats with common questions and evaluation rubrics to provide comparable data for final admission decisions. Previously, unique school-designed interviews made comparisons difficult.

Testing technical skills through new computer-based assessments of skills like diagnostic reasoning and clinical knowledge to identify strong performers beyond just metrics.

Conducting national surveys of accepted applicants to track applicant flow, compare admissions yields across institutions, and analyze application trends to inform future process improvements.

The AMCAS application and these selection process guidelines transformed medical school admissions in the U.S. within just a few years of implementation. Studies show they addressed prior inefficiencies and inconsistencies. Applicants could complete one standardized application and know their packages would receive equal consideration from all participating schools based on common metrics and practices. This allowed focus on academic achievements and personal fit for medicine rather than procedural hoops.

While individual schools still evaluated candidates holistically and conducted independent admission decisions as before, the reformed system established important national standards for fairness, consistency and comparability. It simplified the application process for candidates and streamlined initial screening for admissions staff. The centralized AMCAS application along with common selection guidance continues to be refined annually based on feedback, ensuring ongoing process improvements. The reforms have brought much needed standardization and transparency to U.S. medical school admissions.

WHAT ARE SOME EXAMPLES OF ANTIBIOTIC STEWARDSHIP PROGRAMS THAT HAVE BEEN SUCCESSFUL IN REDUCING RESISTANCE SELECTION PRESSURES

Some noteworthy antibiotic stewardship programs that have successfully reduced antibiotic resistance include the following:

The Duke Antimicrobial Stewardship Outreach Network (DASON) implemented collaborative antimicrobial stewardship programs across 55 North Carolina nursing homes between 2012-2017. Through educational outreach, reporting of antimicrobial use and resistance data, and recommendations for treatment guidelines, DASON was able to significantly reduce broad-spectrum antibiotic use by 32% and total antibiotic days of therapy by 19% across participating facilities. Critically, they also observed reductions in key resistance genes and multidrug-resistant organisms (MDROs) colonizing nursing home residents. This demonstrated how stewardship interventions can help curb resistance selection pressures even in vulnerable long-term care settings.

At Vanderbilt University Hospital, a multifaceted antimicrobial stewardship program was launched in 2010 focused on prospective audit and feedback, formulary restriction and preauthorization, clinical guidelines, and education. Through these interventions,broad-spectrum antibiotic use declined by 36%, total antibiotic use fell by 27%, and hospital-onset Clostridium difficile infections decreased by 56%. Overall hospital mortality also improved. Genome sequencing analysis of C. difficile isolates revealed an 8.4% annual decline in fluoroquinolone-resistant strains following program implementation, directly tying the resistance reduction to decreased selection pressure from stewardship-driven decreases in fluoroquinolone prescribing.

Brigham and Women’s Hospital in Boston initiated a successful antimicrobial stewardship program in 2006 focused on prospective audit and feedback, clinical guidelines, formulary restriction, and education. Over the subsequent decade, they achieved 25-40% reductions in use of broad-spectrum antibiotics, a 40% reduction in total antibiotic days of therapy, and significant declines in hospital-onset C. difficile,vancomycin-resistant enterococci, and multidrug-resistant Gram-negative bacilli infections. Whole genome sequencing analysis of Enterobacteriaceae isolates found reduced acquisition and transmission of antibiotic resistance genes as well as stabilizing or declining resistance trends for many resistance phenotypes. The program was directly attributed with helping to curb rising resistance rates.

A multinational point-prevalence study of 233 ICUs across 75 countries before and after implementing antibiotic stewardship found a 15% reduction in antibiotic use along with reductions in antibiotic resistance, without negatively impacting clinical outcomes. Extended-spectrum beta-lactamase (ESBL) production in E. coli isolates fell from 21% to 18% of isolates, and methicillin-resistant Staphylococcus aureus (MRSA) bacteremias decreased from 21 to 17 per 1,000 patient-days after stewardship implementation. This study demonstrated the global potential for antimicrobial stewardship to curb rising resistance.

In the Netherlands, strict guidelines and national quality indicators for judicious antibiotic prescribing, particularly of fluoroquinolones and third-generation cephalosporins, led to substantial reductions in overall antibiotic use and use of highest-priority critically important antibiotics between 2000-2015. Genome sequencing found significant concurrent declines in quinolone resistance determinants and ESBL genes matching the decreases in selecting antibiotic pressure. The Netherlands programs are considered a model of success for implementing resistance-reducing antibiotic stewardship on a national scale.

These successful antibiotic stewardship programs highlight that through coordinated multi-pronged efforts of guideline development, education, and audit-based feedback on prescribing appropriateness and compliance, significant and sustained reductions in broad-spectrum antibiotic use, total antibiotic exposure, and key antibiotic-resistant infections can be achieved. Critically, genomic evidence from several programs directly links the resulting decreases in antibiotic selection pressure to stabilization or reductions in antibiotic resistance gene acquisition and transmission. Such programs demonstrate antibiotic stewardship’s vital role in helping curb the growing global public health crisis of antibiotic resistance.