The Revised 2017 MSPE: Better, But Not "Outstanding".

AIM: The medical student performance evaluation (MSPE) is relied on as an objective summary evaluation by surgical program directors. In 2017, an MSPE task force released recommendations for best practice for their format and content. The purpose of this study was to analyze US medical schools' adherence to these guidelines. METHODS: MSPEs from 113 of 147 Liaison committee on Medical Education (LCME)-accredited medical schools were analyzed for measurable attributes such as word counts, transparent clerkship grading, comparative performance data, and statements of professionalism. 2017 MSPEs were compared to a baseline group of 45 MSPEs from 2016 to measure change over time. Measurable attributes were compared using the Fisher exact and Mann Whitney-U tests. A p value < 0.05 was deemed statistically significant. RESULTS: We analyzed 113 MSPEs from 2017. The median page count decreased by one from the prior year, with a narrower range of variation. 96% of schools reported a discreet grade in surgery. We observed substantial compliance with the recommendation for a statement of professionalism, noteworthy characteristics, and comparative clerkship data. More schools were observed to report school-wide rankings. There were significant variations in the graphical depiction of student achievement. CONCLUSIONS: In response to the 2017 task force guidelines, MSPEs have become more standardized and transparent with regard to medical student evaluation. There is increased (but not ubiquitous) adherence with the recommendation for three noteworthy characteristics and statements of professionalism. Of particular importance to surgical program directors, 95.6% of 2017 MSPEs report a grade in the surgical clerkship and 85.8% include school-wide comparative clerkship performance data. Still, only 69.9% currently report school-wide summative performance data.

Procalcitonin elevation suggests a septic source.

Procalcitonin is used as a marker for sepsis but there is little known about the correlation of the procalcitonin elevation with the causative organism in sepsis. All patients aged 18 to 80 years who were admitted to the surgery service from June 2010 to May 2012 and who had a procalcitonin drawn were evaluated. Culture data were reviewed to determine the causative organism. Infections analyzed included pneumonia, urinary tract infection (UTI), bloodstream infection, and Clostridium difficile. Other parameters assessed included reason for admission, body mass index, pressor use, antibiotic duration, and disposition. Two hundred thirty-two patient records were reviewed. Patients without a known infection/source of sepsis had a mean procalcitonin of 3.95. Those with pneumonia had a procalcitonin of 20.59 (P = 0.03). Those with a UTI had a mean procalcitonin of 66.84 (P = 0.0005). Patients with a bloodstream infection had a mean procalcitonin of 33.30 (P = 0.003). Those with C. difficile had a procalcitonin of 47.20 (P = 0.004). When broken down by causative organisms, those with Gram-positive sepsis had a procalcitonin of 23.10 (P = 0.02) compared with those with Gram-negative sepsis at 32.75 (P = 0.02). Those with fungal infections had a procalcitonin of 42.90 (P = 0.001). These data suggest that procalcitonin elevation can help guide treatment by indicating likely causative organism and infection type. These data may provide a good marker for initiation of antifungal therapy.