BackgroundMedian indebtedness at graduation is now more than $170,000 for graduates of US Medical Schools. Debate still exists as to whether higher debt levels influence students to choose high paying non-primary care specialties. Notably, no previous research on the topic has taken into account cost of attendance when constructing a debt model, nor has any research examined the non-career major life decisions that medical students face.MethodsMedical students were surveyed using an anonymous electronic instrument developed for this study. The survey was delivered through a link included in a study email and students were recruited from school wide listservs and through snowball sampling (students were encouraged to share a link to the survey with other medical students). No incentives were offered for survey completion.ResultsResponses were recorded from 102 US Allopathic medical schools (n=3,032), with 22 institutions (11 public, 11 private) meeting inclusion criteria of 10% student body response proportion (n=1,846). Students with higher debt relative to their peers at their home institution reported higher frequencies of feeling callous towards others, were more likely to choose a specialty with a higher average annual income, were less likely to plan to practice in underserved locations, and were less likely to choose primary care specialties. Students with higher aggregate amounts of medical student loan debt were more likely to report high levels of stress from their educational debt, to delay getting married and to report disagreement that they would choose to become a physician again, if given the opportunity to revisit that choice. Increases in both aggregate and relative debt were associated with delaying having children, delaying buying a house, concerns about managing and paying back educational debt, and worrying that educational debt will influence one's specialty choice.ConclusionsMedical student debt and particularly debt relative to peers at the same institution appears to influence the way that students approach major life choices like when to start a family, when to buy a home, and what specialty to choose. Future research should take into account cost of attendance when looking for the impact of medical student debt on major life choices.

One-half of patients with muscle-invasive bladder cancer who underwent treatment were diagnosed with a psychiatric disorder, which resulted in worse survival outcomes compared with patients who did not have a posttreatment psychiatric diagnosis. This information can be used to inform interventions to educate patients with muscle-invasive bladder cancer regarding the impact of different treatments on mental health. Cancer 2018. © 2018 American Cancer Society.

Introduction Identification of successful general surgical residents remains a challenging endeavor for program directors (PD) with a national attrition of approximately 20% per year. The Big 5 Personality traits and the Grit Scale have been extensively studied in many industries and certain traits are associated with professional or academic success. However, their utility in surgery resident selection is unknown. Methods We performed a retrospective review of all categorical surgery residents (n=34) at the University of Texas Medical Branch from 2015–2017. Current residents were classified into low performing (n=12) or non-low performing (n=22) based on residency performance and standardized test scores. Groups were assessed for differences in both conventional metrics used for selection and Big 5 and Grit Scores using bivariate analysis and Pearson’s correlation coefficient. Personality testing was administered to recent resident applicants (N=81). Applicants were ranked using conventional application information. We then examined the applicants’ personalities and their rank position with personality characteristics of non-low performing residents to determine if there was any correlation. Results The Big 5 personality test identified significantly higher extroversion, conscientiousness, and emotional stability scores in those residents classified as non-low performers. There was no significant difference in conventional metrics or in grit scores between non-low performers and low performers. Our final rank does not correlate well with personality traits of non-low performers. Conclusions The Big 5 test may prove to be a useful adjunct to the traditional residency application in identifying applicants who may become successful in general surgery residency.

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