Yu, Yue

BACKGROUND: Recent years have seen considerable growth and significant changes in the anesthesiology residency application process. Although the National Residency Match Program provides data on attributes of successfully matching applicants, it does not provide detailed characteristics of applicants’ research portfolio. This single-program retrospective analysis aims to characterize granular aspects of applicant research experiences to determine whether research involvement is linked to higher odds of matching. METHODS: Applications from interviewed United States allopathic (US-MD) and osteopathic (US-DO) applicants at a single anesthesiology residency program were analyzed for research experience. The primary outcome assessed was the association of any research experience with odds of ranked-to-match and the association of specific types of research experience with ranked-to-match. Secondary outcomes included the association of medical degree type (US-MD vs US-DO) or affiliation of medical school with an anesthesiology residency program to the number of research experiences, and the association of research experiences with the United States Medical Licensing Examination (USMLE) Step 1 score type (Pass/Fail vs Scored). RESULTS: Applicants with at least one research experience were more likely to be ranked-to-match than applicants without research experience (odds ratio [OR]: 2.16, 95% confidence interval [CI], [1.55–3.02], P < .001). Similar odds were demonstrated for applicants with at least one peer-reviewed publication compared to no peer-reviewed publications (OR: 2.25, 95% CI, [1.79–2.82], P < .001), and at least one anesthesiology-related research experience compared to no anesthesiology-related research experience (OR: 1.76, 95% CI, [1.36–2.26], P < .001. Applicants from US-MD schools were more likely to have research experience than those from US-DO schools ( P < .001); applicants from a medical school affiliated with an anesthesiology residency were more likely to have research experience than applicants from unaffiliated medical schools ( P < .001); and applicants with Pass/Fail USMLE Step 1 examinations were more likely than their Scored counterparts to report at least one research experience ( P < .001). CONCLUSIONS: Applicant research is associated with greater odds of being ranked-to-match in anesthesiology residency. Applicants from US-MD schools and schools affiliated with anesthesiology residency programs have significantly greater rates of reporting at least one research experience. There is a trend toward a higher incidence of reporting at least one research experience with the change of USMLE Step 1 policy toward a Pass/Fail examination.

Background Peripheral nerve stimulation (PNS) is an emerging neuromodulation therapy for chronic pain, yet its use in clinical practice varies significantly. Although temporary PNS is widely incorporated, either as a screening trial or a treatment itself, the evidence supporting the use of temporary PNS prior to permanent implantation is limited. We aimed to compare pain relief, opioid consumption, and adverse events between an approach implementing temporary PNS before permanent implantation (temporary-to-permanent (TTP)) vs proceeding directly to permanent PNS implantation (direct-to-permanent (DTP)). Methods A multicenter retrospective study was undertaken at seven major academic institutions from January 1, 2014, to January 1, 2024. Adult patients who underwent permanent PNS implantation for the treatment of chronic pain conditions were included and were divided into TTP or DTP cohorts based on their clinical approach. The dual primary outcomes were pain relief and opioid consumption (in oral morphine equivalents) at 6 months compared with baseline before any PNS therapy. Multivariable Tobit regression analysis was performed to identify predictors of pain relief at 6 months using a stepwise approach. Results A total of 130 patients were analyzed (54 in TTP approach, 76 in DTP approach). Patient-reported percentage pain relief was 56.7%±27.9% at 6 months compared with baseline (before PNS implantation) in the TTP cohort, and 45.1%±33.6% in the DTP cohort. The estimated mean percentage pain relief at 6 months was similar in the TTP and DTP cohorts (between-group difference 15.24%; 95% CI −0.32 to 30.80, p=0.052), with consistent findings after sensitivity analysis with multiple imputation. Opioid consumption declined similarly in the TTP (−3.1±9.9 mg) and DTP (−2.1±8.1 mg) cohorts at 6 months with no statistical difference between cohorts (mean between-group difference: −1.00, 95% CI −4.57 to 2.57, p=0.580), and with consistent findings after sensitivity analysis. Device explantation rates and adverse event profiles were comparable between cohorts. Conclusion Although temporary PNS is widely performed prior to permanent PNS implantation, there was no evidence that the TTP approach is associated with superior analgesic outcomes compared with the DTP approach. Further, patients in both approaches achieved clinically meaningful pain relief at 6 months compared with baseline status prior to PNS therapy.