Changes in the Visiting Medical Student Clerkship Program at Mayo Clinic–Reply–I

We appreciate Dr Bubb's feedback. It is true that we expected an increase in the percentage of our international visiting medical students (VMSs) who apply for residency positions at our institution as a result of our VMS program's new requirements that international medical students successfully complete the US Medical Licensing Examination (USMLE) Step 1 and Test of English as a Foreign Language (TOEFL) before being considered for our VMS program. Also, as we stated in the article, a corollary reason for the new requirements was our desire to reduce “the number of elective and clerkship slots taken by VMSs who did not intend to apply for [Mayo] residency program positions” in order to make these slots available to VMSs who did.1 Like other VMS programs,2 residency recruitment is a major objective of ours. Indeed, before the new requirements, we observed that only a minority of our international VMSs applied for a Mayo residency position (82/464 [18%]). Dr Bubb states that, after the new requirements were implemented, the percentage of international VMSs who applied for Mayo Clinic residency positions “nominally decreased” (34/205 [17%]). However, this change was not statistically significant (P=.80). Dr Bubb further states that we “neglect the fact that before implementation, international students were more likely to be appointed than US students (39% vs 31%).” However, this change also was not statistically significant (P=.16). Because of the new requirements, we expected that the absolute numbers of international VMSs applying for and participating in our VMS program as well as applying for, and being appointed to, our residency programs would correspondingly decrease. We agree that our new requirements discourage international medical students who have not taken the USMLE Step 1 and TOEFL from applying to our VMS program. As a result, it is possible that some international medical students who would be competitive for our residency programs will not visit our campus or participate in our VMS program. Notably, during 2009, 75 international VMSs participated in our VMS program, of which 32 (43%) applied for Mayo residency program positions and 11 (34%) were appointed to Mayo residency program positions. We are encouraged by these statistics that argue against Dr Bubb's concern that the new requirements adversely affect the culture of our VMS program and that international VMSs “concluded that the environment was not optimal for their educational needs.” Nevertheless, the effects of the USMLE Step 1 and TOEFL requirements deserve ongoing monitoring. Overall, we remain steadfast in our desire to attract the best and brightest international VMSs to participate in the Mayo VMS Program and recruit these students to our residency programs.