Fischer, Philip R.

Abstract Purpose Medical school applicants engage in informal preference signaling by submitting letters of intent (which include a commitment to accept an admission offer) and letters of interest (which include no such commitment). Commitments are unenforceable and are based on an honor system. Applicants submit letters to medical schools before receiving financial aid offers, potentially disadvantaging low socioeconomic status (SES) applicants. This study describes postinterview communication patterns and analyzes associations among applicant demographics, letter submission rates, and admissions outcomes. It tests the hypothesis that low SES is negatively associated with letter of intent submission. Method The authors collected postinterview communications from all interviewees at the Mayo Clinic Alix School of Medicine during 3 admissions cycles (2021-2023). Authors developed and validated codebook definitions for the 2 letter types. SES was defined using the Association of American Medical Colleges education-occupation indicator. Letter submission rates were compared using mixed-effects logistic regression. Results Of 1,313 applicants, 1,109 submitted 1 letter or more. The sample included 257 (19.6%) low-SES and 1,056 (80.4%) non–low-SES applicants. Coders showed excellent interrater reliability (Gwet AC1 range, 0.89-0.995). Low-SES applicants submitted letters of intent with similar frequency to higher-SES applicants (33.9% [87/257] vs 33.5% [354/1,056]; odds ratio, 1.02; 95% CI, 0.76-1.37; P = .88) and submitted letters of interest at similar frequency (55.6% [143/257] vs 59.5% [628/1,056]; odds ratio, 0.86; 95% CI, 0.65-1.13; P = .27). Among 116 applicants who wrote letters of intent and were offered admission, 20 (17.2%) declined the admission offer. Conclusions There was no difference in letter of intent submission based on SES, and letter of intent submission was positively associated with matriculation. Among letter of intent writers who were offered admission, 1 in 6 declined. Undergraduate medical education may wish to consider a formalized preference signaling system to promote an honest and transparent application process.

Abstract Purpose: Adolescents with chronic orthostatic intolerance (COI) experience symptoms related to impaired tolerance of upright posture. Postural Orthostatic Tachycardia Syndrome (POTS) is a specific type of COI, marked by an excessive increase in heart rate (≥40 bpm or an absolute HR >120 bpm) when standing. This study compares Functional Disability Inventory (FDI) scores between adolescents with COI with and without excessive postural tachycardia (POTS subtype). Methods: Patients ≤19 years referred to our POTS program (Aug 2024–Mar 2025) with orthostatic symptoms for>3 months were included. Based on active stand HR, patients were categorized as POTS (HR ≥40 bpm) or COI without excessive postural tachycardia (HR <40 bpm). FDI scores were collected. Chi-square tests assessed group differences. A two-sample t-test compared FDI severity. Linear regression evaluated the association between HR change and FDI score. Results: All data were normally distributed, allowing the use of parametric analyses. Of the 92 patients (46 per group), 78% were female. The mean age was 16.0 ± 1.48 years in the COI group and 16.3 ± 1.7 years in the POTS group, with no significant sex differences between groups. The COI group had a higher mean FDI score than the POTS group, but this difference was not statistically significant. The distribution of FDI severity (mild, moderate, severe) was similar between groups. Linear regression showed a non-significant trend of a 1 bpm increase in heart rate associated with a 0.1055-point decrease in FDI score Conclusion: Functional disability was similar between the COI and POTS groups.

Introduction Subjectively experienced cognitive difficulties are common in youth with postural orthostatic tachycardia syndrome. The pathophysiological and psychological contributions of these cognitive impairments remain unclear. Method Participants were 96 adolescents and young adults diagnosed with postural orthostatic tachycardia syndrome and admitted to an intensive pain treatment program. Participants completed cognitive assessment and measures of postural orthostatic tachycardia syndrome symptoms, pain intensity, pain catastrophizing, anxiety, depression, and functional disability. Results Self-reported autonomic symptom intensity, but not severity of heart rate change, was associated with cognitive performance. Symptoms of depression were associated with decreases in most measures of cognitive functioning. Pain intensity, pain catastrophizing, and depression but not cognitive scores and physiological measures, were significant predictors of disability. Conclusion Depression appears to be a significant contributor to the cognitive difficulties in youth with postural orthostatic tachycardia syndrome. These findings highlight the importance of assessing and treating affective symptoms in this population along with medical and lifestyle approaches to treating postural orthostatic tachycardia syndrome symptoms.