The Perception of Surgery Program Directors of Residency Applicants From Longitudinal Integrated Curriculum Medical Schools: A Survey of the Association of Program Directors in Surgery Members.

Research statement This study explores whether longitudinal integrated clerkship (LIC) students are competitive general surgery applicants and if they are perceived as adequately prepared for general surgery residency compared to traditional block rotation (BR) students. Background/relevance of the study There is increasing interest in LIC models of clinical education versus BR models. LIC students have been shown to perform similarly on examinations to BR students. However, while LICs seem well suited for students pursuing primary care specialties, little is known about how this approach impacts clinical education for surgery. Design and methods An electronic survey was prepared and approved by the Association of Program Directors in Surgery (APDS) and our university's institutional review board (IRB). Ten multiple-choice questions were administered along with an option for narrative comments. Surveys were sent over a one-month period to members of APDS Listserv. Returned emails were de-identified, and the results were tabulated. Results From 43 responses, the majority identified as program directors (PDs) (65%) and reported being somewhat familiar or very familiar with LICs (90%). When asked about the statement "LIC students are prepared for surgical residency," 22% "disagreed" or "strongly disagreed." When asked "How would you rank a LIC prospective applicant in comparison to a BR student?" 35% responded that they would rank the LIC student lower or not at all. Of the respondents, 47% reported that they have current residents who were LIC students. Most of these residents (65%) are graded as "average" for current performance. Conclusions The results suggest that medical students who are trained using LICs may be disadvantaged when applying to general surgery residencies. Interpretation is limited by the small number of respondents, and it only reflects the opinions of active APDS Listserv members. Further study is needed to confirm these findings and elucidate the basis of perceived deficiencies in LICs. Students from these schools should be advised to obtain additional surgery experience.

Optimizing antibody panels for efficient and cost-effective flow cytometric diagnosis of acute leukemia.

BACKGROUND: Differentiating acute myeloid leukemia (AML) from acute lymphoblastic leukemia (ALL) determines effective patient management and often depends on flow cytometry. Antibodies used in flow cytometry are costly, and the expenses are not always reimbursed. Having observed that AML and ALL have distinct patterns in the CD45/SSC panel, we set to analyze more leukemia cases and establish an algorithm for the efficient diagnosis of acute leukemia. METHODS: We retrospectively analyzed 127 consecutive cases of acute leukemia within the last 2 years and correlated the blast distribution patterns in the CD45/SSC panel, with the morphology and the detailed immunophenotype. RESULTS: Our results show that all the acute leukemias can be initially triaged into AML, ALL, and Indeterminate provisional groups based on the blast distribution patterns in the CD45/SSC panel and morphology. Each group was then further analyzed with tailored AML, ALL, and Indeterminate flow panels. Using this approach, we have efficiently and correctly diagnosed almost all the acute leukemias. Our analysis also determined the minimal numbers of immunological markers needed for the lineage assignment of acute leukemia. CONCLUSION: The algorithmic approach with tailored subsequent antibody selection could maintain diagnostic accuracy while significantly reducing reagent use, labor, and time. With a shrinking reimbursement for flow cytometric studies, an increase in laboratory efficiency without compromising diagnostic accuracy or turnaround time will contribute to preserving revenue and optimizing clinical service.

Large B-cell lymphoma with an unusual infiltrating pattern: report of two cases.

Large B-cell lymphoma presents with the most varied infiltrating patterns and morphologies. Here we report two cases of unusual large B-cell lymphoma in two old female patients. Both lymphomas show: 1) scattered and clustered large B-cells infiltrating the periphery of polyclonal lymphoid nodules; 2) large B-cells with an immunoblastic morphology; 3) large B-cell infiltration associated with vascular proliferation; 4) coexisting lymphoid nodules with hyaline vascular proliferation. The first case took an aggressive clinical course with transformation into acute leukemia, and imparted a short patient survival, whereas the second case responded to chemotherapy, experienced a local recurrence and long survival for >7 years. To our knowledge, these are the first reported cases of large B-cell lymphomas with a paranodular infiltrating pattern, immunoblastic morphology, and associated vascular proliferation.