Complete survey response data are presented in Additional file 1
. Representatives of 76 medical schools (59%) responded to the survey. Of these, 73 respondents (96%) reported that their medical schools had VMS programs. (These 73 individuals' survey responses comprise the data set for this study. Therefore, unless otherwise indicated, all forthcoming percentages are based on a denominator of 73.) Notably, there were no significant differences between responding schools and nonresponding schools regarding the percentage that had their VMS program listed in the AAMC's "Extramural Electives Compendium" Web site (P
= .51), 2007 medical student enrollments (P
= .37), or 2007 US News & World Report
= .14). For the comparison of the 2007 US News & World Report
rankings, a sample size calculation revealed that the numbers of responders and nonresponders provided 80% power to detect an effect size of 0.5, which normally is a small difference. Following is a summary of the survey findings organized by specific themes.
Organizational aspects of VMS programs
Sixty-one (84%) respondents provided the name of their VMS programs (12 [16%] respondents left the survey item blank). Almost all the reported program names included the terms "visiting," "student," and "program," whereas the terms "elective," "externship," "exchange," and "off-campus" were uncommon. Sixty-one respondents (84%) reported that a single individual or office coordinated all VMS electives and clerkships at their institutions. The most common reason cited for having a VMS program was "recruitment for residency programs" (90%); other reasons are listed in Table .
Reasons cited by US and Puerto Rico allopathic medical schools for having visiting medical student elective and clerkship programs (n = 73)a.
Across the respondents' medical schools, the median number of visiting medical students during academic year 2005-2006 was 96 (range, 0 1,400). During the same year, the median number of medical students enrolled at the respondents' schools was 550 (range, 60-1,168).
Medical schools advertise their VMS programs by using a Web site (71%), word of mouth (49%), other means such as a booth at the American Medical Student Association annual meeting (10%), and direct mailing and advertisements in medical journals (4% each). Of these, using a Web site and word of mouth were cited as the most effective means of advertisement.
Applying for VMS electives and clerkships
Fifty-nine respondents (81%) reported that applicants were required to use a paper application form, which was mailed to the school, whereas only 6 (8%) required online applications. Five respondents (7%) reported other means, including downloading and printing an application from the school's Web site, which was then mailed to the school. Three (4%) respondents left the survey item blank.
Eligibility requirements for VMS electives and clerkships
The survey respondents were asked to describe the eligibility requirements for a potential visiting student to participate in electives or clerkships at their institutions. None of the respondents reported allowing first- or second-year medical students, 7 respondents (10%) reported allowing third-year medical students, and 71 respondents (97%) reported allowing fourth-year medical students (2 respondents left the item blank). Sixty-two respondents (85%) reported that osteopathic school students were allowed to do visiting electives or clerkships at their institutions.
The survey respondents also reported a number of additional eligibility requirements, the most common being documentation of immunizations (92%) and previous clinical experience (85%) (Table ). Of the 62 programs that required clinical experience, 51 (82%) required 33 weeks or more.
Eligibility requirements for visiting medical student elective and clerkship programs at US and Puerto Rico allopathic medical schools (n = 73)a.
International visiting medical students
Of the 73 survey respondents, 42 (58%) reported that international visiting medical students were allowed to do electives or clerkships at their schools. Of these 42 respondents, 38 (90%) reported that international visiting students must be fluent in English to be eligible for electives or clerkships at their schools and 19 (45%) reported that successful completion of the Test of English as a Foreign Language (TOEFL) was required.
Notably, of the 42 respondents who reported that international visiting medical students were allowed to do electives or clerkships at their schools, 27 (64%) reported that international students comprised 25% or less of the total visiting medical students at their schools, whereas 10 (24%) reported they comprised 26% to 50%, and 1 (2%) reported they comprised 51% or more. Respondents reported hosting international visiting medical students from every region of the world during the 5 years preceding the survey, as follows: Europe, 36 (86%); Canada, 26 (62%); Asia, 21 (50%); Australia and New Zealand, 16 (38%); Africa, 16 (38%); South America, 15 (36%); and Central America, 12 (29%).
Duration of VMS electives and clerkships
Sixty-three respondents (86%) reported that the length of a single elective or clerkship at their schools for a visiting student was 4 to 5 weeks. At 29 schools responding (40%), the minimum amount of time that a visiting student must spend doing a clerkship or elective at the school was less than 4 weeks, whereas at 39 schools (53%), the minimum amount of time was 4 to 5 weeks. At 35 schools (49%), the maximum amount of time was 6 to 8 weeks, whereas 34 schools (47%) listed a maximum time of 7 to 8 weeks (5 respondents [7%] listed "no limit"). Despite these varying time requirements and allowances, at 60 schools (82%), the average amount of time a visiting student actually spent at the host institution was 4 to 5 weeks.
Elective and clerkship prioritization and choices
Seventy survey respondents (96%) reported that, for a given elective or clerkship, medical students at their own institutions were given priority over visiting students. Nevertheless, 57 respondents (78%) reported that visiting students were allowed to do electives and clerkships in all departments and divisions at their institutions. Sixty-six respondents (90%) listed the 3 most popular electives and clerkships for visiting medical students at their institutions (7 [10%] respondents left the survey item blank). In descending order, the most popular rotations were in general and subspecialty internal medicine, orthopedic surgery, emergency medicine, general and subspecialty pediatrics, and obstetrics and gynecology; other specialties were listed only occasionally.
Reported reasons medical students do visiting electives and clerkships
The survey respondents were asked to rank reasons visiting medical students choose to do electives or clerkships at their institutions. Among various choices, "desire to do a residency at our institution" (47%) and "reputation of our institution" (22%) were ranked first most often (Table ). Notably, only 1 respondent (1%) reported that visiting students were guaranteed an interview for a future residency program position at their institution.
Top reason cited by survey respondents why visiting medical students do clerkships or electives at US and Puerto Rico allopathic medical schools with visiting medical student programs (n = 73)a.
Evaluation of visiting medical students
Of the 73 survey respondents, 57 (78%) reported that visiting students were not evaluated any differently than their own medical students. Sixty-six (90%) reported that grades were part of the evaluation of visiting students; the following grading systems were reported: 24 (36%) reported an "honors, high pass, pass, marginal pass, fail" system; 14 (21%) reported a "pass/fail" system; 8 (12%) reported letter grades (A, B, C, etc); and 20 (30%) reported "other" (various grading systems depending on the elective or clerkship).
Thirty-eight respondents (52%) reported that they completed evaluation forms provided by the students' home medical schools, 23 (32%) that they completed their own evaluation forms and forms provided by the students' home schools, 4 (5%) that they completed only their own evaluation forms, 3 (4%) reported "other," and 5 (7%) did not respond to the survey question (left the item blank). Fifty respondents (68%) reported that the specific elective or clerkship director completed evaluation forms for visiting students, whereas 3 (4%) reported that the VMS program coordinator at their schools completed the forms; 17 (23%) reported "other." These "other" individuals, according to free-text entries, included "preceptor," "attending physician," and "residents." Three (4%) respondents did not respond to the survey question.
Forty-six respondents (63%) reported that the visiting student's home medical school received the evaluation. Fourteen respondents (19%) reported the visiting student and the student's home medical school received the evaluation, 6 (8%) reported only the visiting student received the evaluation, and 3 respondents (4%) reported "other." Three respondents (4%) reported that records on visiting students were kept for less than 1 year, 26 (36%) reported 1 to 3 years, 14 (19%) reported 4 to 7 years, 2 (3%) reported more than 7 years, and 22 (30%) reported "indefinitely."
Challenges related to having and maintaining a VMS program
All the survey respondents reported challenges related to having and maintaining a VMS program. The most commonly cited challenges were insufficient overall slots to meet the demand (36%), insufficient slots to meet the demand for a specific specialty (26%), and widely variable eligibility criteria among departments and divisions (14%) (Table ).
Top challenge cited by survey respondents related to having and maintaining a visiting medical student program at US and Puerto Rico allopathic medical schools (n = 73)a.
Success of former visiting medical students in securing a residency position
The survey respondents were asked to report the number of their new first-year residents who were former visiting medical students at their institutions. Across the respondents' medical schools, the median number of new first-year resident physicians during academic year 2006-2007 who were former visiting medical students at the respondents' schools was 6 (range, 0-76).