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Computerised application process for medical postgraduate study
CORRESPONDENCE
Computerised application process for medical postgraduate study Sir—Postgraduate medical education in the USA and the internet have merged to form a dominating application process for fourth-year medical students and young physicians, in a new creation: the Electronic Residency Application Service (ERAS). This year, ERAS charged US$45 as an application fee, $60 for up to ten programmes, $6 each for programmes 11–20, $12 each for programmes 21–30, and $25 each for programmes 31 and above. In the past, the only fee an applicant had to pay was postage. Since ERAS can filter applicants, despite paying up to $25 per application, a candidate’s records might not even be viewed. Since each application after programme 30 costs $25, some US medical students and many international medical graduates in the USA are now paying more than $1000 simply to apply to residencies. I do pro bono work helping international graduates. This year I guided two European physicians who spent thousands of dollars, but each received only one interview in places where they had contacts but to which they were not matched. Most programme directors did not read their material. Some may have chosen the option of considering only US and Canadian citizens. In my own highly competitive specialty, dermatology, one of my students this year applied to 91 dermatology programmes as well as to several internal-medicine internships. In past years he would have received about 30 interview requests. With ERAS, however, he was filtered out in most programmes, since he had narrowly missed election to the medical honour society and other applicable scores. He was invited to only seven interviews, mostly from top residencies that are not participating in ERAS. Another of my students needed only an internship. But the programme he wanted could hire him only through ERAS, so he had to pay ERAS$105 for his one application. Is it moral to charge applicants? Is it honourable to increase fees with increasing number of programmes? Is it ethical for programme directors to sign a contract so that they must refuse paper applications? Although probably unintentional, these ERAS policies result in an anti-immigrant bias, since such applicants need to apply to many
THE LANCET • Vol 358 • August 18, 2001
programmes, as well as a financial burden for all medical students. ERAS is owned by the Association of American Medical Colleges (AAMC). The AAMC, which might otherwise be paying to obtain this graduate medical education data, has instead developed a lucrative endeavour. But do applicants and programme directors need it? Perhaps programme directors who wish to use a computer-based system could allow paper applications as well? I favour no application fee and paper application, which I believe better facilitates each person being assessed as an individual. Robert A Schwartz New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
Why are public-health policies ill made in Japan? Sir—After a long-term battle, Japanese patients with Hansen’s disease (leprosy) won the lawsuit against the government on May 11, 2001. The patients were victims of the worst form of stigmatisation and social discrimination. The Japanese government established the quarantine policy in 1907. Since then, people with the disease had been forced to be incarcerated in remote leprosariums. Access to the outside world was completely cut off. Patients were, on admission, compelled to even change their name to break off the relationship to their families. Under these circumstances, many killed themselves or died trying to escape. Furthermore, men who wished to marry had to undergo vasectomies and women were forced to have abortions. What makes the government unable to circumvent accusation is that, in 1953, the Japanese Diet passed the Leprosy Prevention Law, which reinforced the isolation policy, whereas, around the time and the following years, dapsone became available, and studies showed that the disease is not contagious. In 1996, 44 years after WHO’s calls for phasing out the isolation policies, the Japanese government abolished the law. Who had been responsible for such terrible negligence? Should only politicians be censured? What sort of leadership are the academics or researchers expected to have in this country in relation to the public-health policies? In principle, the people at the forefront should take a strong stance to put forward a suggestion to policy makers based on the scientific evidence. However, there has been no
sign of this in Japan, as is evident for leprosy. In my view, Japanese investigators in clinical research seem to receive little credence from the public and the bureaucrats. A notable doctor in the field of AIDS, a member of the AIDS Research Committee organised by the Department of Health, was accused of neglecting to stop the use of nonsterilised blood transfusion to treat haemophilic patients who were consequently exposed to the risk of AIDS (in effect, about 2000 are reported to have been infected) even after he was aware of such a risk. However, through court hearings, irresponsibility of the “bureaucrat, academic, and drug industry” alliance has come to light. There is a welcome phenomenon, however, that the new Japanese prime minister, Jun-ichirou Koizumi, strongly advocating the need of revolution with the term “structural changes without sanctuary”, is receiving support from more than 80% of the nation’s people. However, one politician’s influence is limited and the areas that need to be reformed are many. Certainly, the process of making a decision on the public-health-related issues needs to be greatly reformed, and the academics and the authorities, who should recognise that they are in a powerful position to affect the policies to be made, have to take responsibility for, and take a decisive stance on the provision of the optimum physical and mental wellbeing for the nation’s people. Nori Takei Department of Psychiatry and Neurology and Stanley Foundation Research Centre, Japan, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan (e-mail: [email protected])
Implication in posttransfusion infection Sir—In 1990, a white individual acquired hepatits B virus (HBV) and developed acute hepatitis B; infection and recovery were confirmed serologically. 5 years later, in 1995, in accordance with the guidelines for donor selection in use at the time, this individual donated blood for transfusion. This blood and that from one other donor were given perioperatively to a patient who subsequently developed hepatitis B 3 months later. The infection in the recipient triggered a post-transfusion hepatitis enquiry. The two involved donors were identified and samples were drawn for investigation. The presence in the serum of anti-HBc in
589
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Computerised application process for medical postgraduate study Sir—Postgraduate medical education in the USA and the internet have merged to form a dominating application process for fourth-year medical students and young physicians, in a new creation: the Electronic Residency Application Service (ERAS). This year, ERAS charged US$45 as an application fee, $60 for up to ten programmes, $6 each for programmes 11–20, $12 each for programmes 21–30, and $25 each for programmes 31 and above. In the past, the only fee an applicant had to pay was postage. Since ERAS can filter applicants, despite paying up to $25 per application, a candidate’s records might not even be viewed. Since each application after programme 30 costs $25, some US medical students and many international medical graduates in the USA are now paying more than $1000 simply to apply to residencies. I do pro bono work helping international graduates. This year I guided two European physicians who spent thousands of dollars, but each received only one interview in places where they had contacts but to which they were not matched. Most programme directors did not read their material. Some may have chosen the option of considering only US and Canadian citizens. In my own highly competitive specialty, dermatology, one of my students this year applied to 91 dermatology programmes as well as to several internal-medicine internships. In past years he would have received about 30 interview requests. With ERAS, however, he was filtered out in most programmes, since he had narrowly missed election to the medical honour society and other applicable scores. He was invited to only seven interviews, mostly from top residencies that are not participating in ERAS. Another of my students needed only an internship. But the programme he wanted could hire him only through ERAS, so he had to pay ERAS$105 for his one application. Is it moral to charge applicants? Is it honourable to increase fees with increasing number of programmes? Is it ethical for programme directors to sign a contract so that they must refuse paper applications? Although probably unintentional, these ERAS policies result in an anti-immigrant bias, since such applicants need to apply to many
THE LANCET • Vol 358 • August 18, 2001
programmes, as well as a financial burden for all medical students. ERAS is owned by the Association of American Medical Colleges (AAMC). The AAMC, which might otherwise be paying to obtain this graduate medical education data, has instead developed a lucrative endeavour. But do applicants and programme directors need it? Perhaps programme directors who wish to use a computer-based system could allow paper applications as well? I favour no application fee and paper application, which I believe better facilitates each person being assessed as an individual. Robert A Schwartz New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103, USA
Why are public-health policies ill made in Japan? Sir—After a long-term battle, Japanese patients with Hansen’s disease (leprosy) won the lawsuit against the government on May 11, 2001. The patients were victims of the worst form of stigmatisation and social discrimination. The Japanese government established the quarantine policy in 1907. Since then, people with the disease had been forced to be incarcerated in remote leprosariums. Access to the outside world was completely cut off. Patients were, on admission, compelled to even change their name to break off the relationship to their families. Under these circumstances, many killed themselves or died trying to escape. Furthermore, men who wished to marry had to undergo vasectomies and women were forced to have abortions. What makes the government unable to circumvent accusation is that, in 1953, the Japanese Diet passed the Leprosy Prevention Law, which reinforced the isolation policy, whereas, around the time and the following years, dapsone became available, and studies showed that the disease is not contagious. In 1996, 44 years after WHO’s calls for phasing out the isolation policies, the Japanese government abolished the law. Who had been responsible for such terrible negligence? Should only politicians be censured? What sort of leadership are the academics or researchers expected to have in this country in relation to the public-health policies? In principle, the people at the forefront should take a strong stance to put forward a suggestion to policy makers based on the scientific evidence. However, there has been no
sign of this in Japan, as is evident for leprosy. In my view, Japanese investigators in clinical research seem to receive little credence from the public and the bureaucrats. A notable doctor in the field of AIDS, a member of the AIDS Research Committee organised by the Department of Health, was accused of neglecting to stop the use of nonsterilised blood transfusion to treat haemophilic patients who were consequently exposed to the risk of AIDS (in effect, about 2000 are reported to have been infected) even after he was aware of such a risk. However, through court hearings, irresponsibility of the “bureaucrat, academic, and drug industry” alliance has come to light. There is a welcome phenomenon, however, that the new Japanese prime minister, Jun-ichirou Koizumi, strongly advocating the need of revolution with the term “structural changes without sanctuary”, is receiving support from more than 80% of the nation’s people. However, one politician’s influence is limited and the areas that need to be reformed are many. Certainly, the process of making a decision on the public-health-related issues needs to be greatly reformed, and the academics and the authorities, who should recognise that they are in a powerful position to affect the policies to be made, have to take responsibility for, and take a decisive stance on the provision of the optimum physical and mental wellbeing for the nation’s people. Nori Takei Department of Psychiatry and Neurology and Stanley Foundation Research Centre, Japan, Hamamatsu University School of Medicine, Hamamatsu, 431-3192, Japan (e-mail: [email protected])
Implication in posttransfusion infection Sir—In 1990, a white individual acquired hepatits B virus (HBV) and developed acute hepatitis B; infection and recovery were confirmed serologically. 5 years later, in 1995, in accordance with the guidelines for donor selection in use at the time, this individual donated blood for transfusion. This blood and that from one other donor were given perioperatively to a patient who subsequently developed hepatitis B 3 months later. The infection in the recipient triggered a post-transfusion hepatitis enquiry. The two involved donors were identified and samples were drawn for investigation. The presence in the serum of anti-HBc in
589
For personal use. Only reproduce with permission from The Lancet Publishing Group.