No abstract

International Medical Graduate (IMG) physicians applying to residency training programs in a country different from where they completed medical school, bring beneficial diversity to a training program, but also face significant challenges matching into an Accreditation Council for Graduate Medical Education (ACGME)-accredited residency program. Despite the growing number of IMG applications in Emergency Medicine (EM), there is a paucity of targeted recommendations for IMG applicants. As a result, the Council of Residency Directors (CORD) Advising Students Committee in EM (ASC-EM) created a dedicated IMG Advising Team to create a set of evidence-based advising recommendations based on longitudinal data from the National Residency Match Program (NRMP) and information collected from EM program directors and clerkship directors. IMG applicants should obtain at least two EM standardized letters of evaluation (SLOEs), review IMG matched percentages for programs-of-interest, analyze their objective scores with the previous matched cohorts, and rank at least 12 programs to maximize their chances of matching into EM.

we calculated the accessibility index by determining (a) access to timely essential surgery in two hours or less, (b) number of specialist surgical workforce, (c) surgical volume and (d) perioperative mortality rate. The accessibility index is a measure of the availability of care to the exposed population within a catchment area. Results: 5452 (97.9%) Brazilian municipalities had access to surgical care in less than two hours. Specifically, 1775 (31.9%) cities had access to surgical care in less than two hours travel time when the recommended workforce of 20 or more surgical specialist per 100,000 inhabitants was considered. Only 529 (9.5%) municipalities were served by a facility which met the minimum recommended surgical volume of 5000 procedures per 100,000 inhabitants. Finally, only 4532 (81.4%) cities had hospitals with a mortality rate of less than 5% of patients who underwent a surgical procedure. In total, 5312 (95.4%) cities were missing at least one of the four criteria defining access to quality surgical care. Conclusions: Evaluating the strength of the emergency and surgical care services within a health system is an important measure to align with the World Bank's Universal Health coverage paradigm. The set of indicators evaluated in this study highlights the need to improve the distribution of care throughout the Brazilian hospital network; the most important areas for improvement are in increase in the available health care workforce and an increase in the volume of procedures accessible across the health system.