Information within residency monthly evaluation forms at two institutions.

Periodic review of resident performance is an important aspect of residency training. Amongst allopathic residency programs, it is expected that the performance of resident physicians which can be grouped based on the ACGME core competencies, be assessed so as to allow for effective feedback and continuous improvement. Review of monthly evaluation forms for residents in the core ACGME programs at Marshall University and the University of Toledo demonstrated a wide spread in the number of Likert questions that faculty were asked to complete. This number ranged from a low of 7 in Surgery to a high of 65 in Psychiatry (both Marshall Programs). Correlation and network analysis were performed on these data. High degrees of correlations were noted between answers to questions (controlled for each resident) on these forms at both institutions. In other words, although evaluation scores varied tremendously amongst the different residents in all the programs studied, scores addressing different competencies tended to be very similar for the same resident, especially in some of the programs which were studied. Network analysis suggested that there were clusters of questions that produced essentially the same answer for a given resident, and these clusters were bigger in some of the different residency program assessment forms. This seemed to be more the rule in the residency programs with large numbers of Likert questions. The authors suggest that reducing the number of monthly questions used to address the core competencies in some programs may be possible without substantial loss of information.

Commentary: criminal background checks for entering medical students: history, current issues, and future considerations.

In this commentary, the authors aim to contextualize the history and rationale for what has become the Association of American Medical Colleges-facilitated criminal background check process for entering medical students. As the process was being considered, many issues with a standardized process were identified. There were concerns that demographic or socioeconomic factors might unfairly burden certain applicants or discourage them from applying to medical school. On the other hand, a unified, national program would minimize cost and enhance quality assurance. The authors discuss these issues. Lessons learned in the first three years of the program are also addressed, including some unexpected and favorable consequences such as the identification of accepted applicants with at-risk behaviors (e.g., substance abuse), who would have otherwise gone undetected. Several challenges remain, including the fact that the criminal background check process creates an enhanced role for prehealth advisors and encourages undergraduate institutions to establish standards and processes relating to professionalism. While this is, no doubt, an evolving program which needs continued oversight and ongoing reevaluation, the authors support the continued advancement of the criminal background check process for entering medical students.

Impact of preadmission variables on USMLE step 1 and step 2 performance.

PURPOSE: To examine the predictive ability of preadmission variables on United States Medical Licensing Examinations (USMLE) step 1 and step 2 performance, incorporating the use of a neural network model. METHOD: Preadmission data were collected on matriculants from 1998 to 2004. Linear regression analysis was first used to identify predictors of performance on step 1 and step 2. A generalized regression neural network (GRNN) as well as a feed forward neural network (FFNN) was then developed in an effort to more accurately predict step 1 and step 2 scores from these preadmission data. RESULTS: Statistically significant predictors for step 1 and step 2 included science grade point average (SGPA), the biologic science (BS) section of the Medical College Admissions Test (MCAT), college selectivity, race, and age of the applicant. Neural networks were found to predict a significant portion of the variance, and the FFNN demonstrated some superiority over that obtained with linear regression models as well as the GRNN. CONCLUSIONS: The results have implications that could impact the selection of applicants to medical school and the neural networks that we developed could be used in a prospective manner.

Review of compartment syndrome due to group A streptococcal infection.

PURPOSE: To present a case of nontraumatic compartment syndrome secondary to group A streptococcal infection and review the literature regarding this unusual clinical entity. METHODS: Case reports of compartment syndrome due to group A streptococci in the English language literature were identified through a computer-generated search using MEDLINE 1950-2007. Reviews of the cited literature in pertinent articles were also undertaken to find additional cases. Cases with evidence of chronic infection or trauma were excluded; cases were included for analysis if enough demographic information was available to allow identification of individual patients. RESULTS: Thirteen cases, including the current case of group A streptococcus, were identified. The average age was 34 years (range 2-76). The majority of patients (77%) were previously healthy with no significant medical history or evidence of immunosuppression. All patients presented with either fever, or hypotension, or white blood cells >10,000 cells/mm and 77% presented with at least 2 of these signs. All patients received prompt surgical intervention and antibiotic therapy with gram-positive activity. The mortality rate was 15%. CONCLUSIONS: Nontraumatic acute compartment syndrome presenting with fever, or hypotension, or leukocytosis may be associated with infection such as group A streptococcus. Prompt surgical and antibiotic therapy was associated with a relatively low mortality rate. A high clinical index of suspicion should occur for the possibility of infection with an organism such as group A streptococcus in patients presenting with acute extremity pain and tense compartments without trauma and with signs of a systemic inflammatory response.

The use of professionalism scenarios in the medical school interview process: faculty and interviewee perceptions.

PURPOSE: The purpose of this study was to determine the impact of professionalism scenarios on the medical school admissions process from applicant and faculty perspectives. Specifically, do completing professionalism scenarios as part of the medical school interview process have an impact on both the interviewee's and the faculty's perception of the process and outcome? METHOD: Ninety-one faculty interviewed 199 applicants from January 2007 through April 2007 at The University of Toledo College of Medicine. All applicants were asked one standard professionalism scenario in each of their two interviews. A total of six scenarios were used for the entire interviewing season in rotation every two months. A survey was administered by an admissions office staff member to both the interviewed applicants as well as faculty who conducted interviews about how these scenarios impacted their interview experience. RESULTS: Asking applicants to respond to professionalism scenarios during the interview was described as having a positive influence on their interview experience. This was also associated with leaving an impression on the applicant about what our institution values in its students and contributed an element of personal reflection about what will be expected of them in the medical profession. Applicants more often reported that asking questions about professionalism was an important aspect of the interview than did faculty. Overall, there was an association between the interviewer's perception of the applicant's response and the interviewer's assessment of professionalism. CONCLUSIONS: Professionalism scenarios can be a worthwhile tool for use in the admissions process. The interview process should encourage participation from faculty who value this as an important component in the evaluation of an applicant. Determinants of faculty perception of the role of assessing professionalism in the interview process should be investigated in future research.

Anesthetic considerations of the herbal, kava.

The herbal remedy, kava, is reviewed, with special focus on the anesthetic management of the perioperative patient. Consumption of kava has potential cardiovascular consequences that could manifest in the perioperative period. Kava may act through inhibition of sodium and calcium channels to cause direct decreases in systemic vascular resistance and blood pressure. Kava inhibits cyclooxygenase to potentially cause a decrease in renal blood flow and to interfere with platelet aggregation. Kava may also cause adverse neurologic effects because of benzodiazepine and antidepressant activities on noradrenergic and/or serotoninergic pathways that may potentiate benzodiazepine and induction anesthetic potency and cause excessive perioperative sedation. Patients often do not disclose their use of herbal substances, and drug interaction can occur without being suspected as the cause for a change in patient homeostasis. A role for patient education about the potential adverse consequences of kava use in the perioperative period is suggested.

Impact of ginkgo biloba on the pharmacokinetics of digoxin.

Many medications are known to alter digoxin pharmacokinetics, including the herbal medication St. John's wort. An open-labeled, randomized, crossover trial was conducted in eight healthy human volunteers to determine if ginkgo biloba (GB) also alters the pharmacokinetics of digoxin. On two occasions separated by 2 weeks, subjects ingested digoxin, 0.5 mg. One week prior to each study phase, half of the volunteers were randomly initiated on GB therapy, 80 mg three times daily, that continued until the end of the study phase. Immediately prior to and for 36 hours following digoxin ingestion, multiple blood samples were collected for digoxin plasma concentration determination. No significant difference between treatments was observed with respect to AUC(0- infinity ) (digoxin alone: 21.0 +/- 8.6 [ng/mL] x h; digoxin + GB: 25.6 +/- 13.2 [ng/mL] x h). Additionally, no significant difference between therapies was observed with respect to C(max), T(max), or Cl(o). In six subjects, k(e) and t(1/2) were able to be determined. These parameters also did not differ significantly between treatments. In conclusion, within the context of the specific GB product used during this investigation, the concomitant use of GB and digoxin did not appear to have any significant effect on the pharmacokinetics of orally administered digoxin in healthy volunteers.

A survey of herbal product use in a dialysis population in Northwest Ohio.

OBJECTIVE: To identify herbal product use in a dialysis population. DESIGN AND SETTING: Cross-sectional survey conducted at 2 freestanding dialysis centers in Northwest Ohio. PATIENTS: Two hundred and sixteen hemodialysis and peritoneal dialysis patients who provided informed consent. INTERVENTION: All patients were surveyed by personal interview regarding use of herbal products. Patients identified as current users were asked questions about specific agents. Respondents reporting past but not current use were questioned about specific agents and reasons for discontinuation. RESULTS: Thirty-one patients reported taking herbal therapies. Twenty-six patients discontinued use before the survey. Sixteen different herbal products were reported being used in our study population. Those who reported ever using an herbal product were more likely to be employed or disabled and have higher education when compared with nonusers. CONCLUSION: Our data suggest a lower frequency of herbal product use in the dialysis population as compared with the general population and other chronically ill populations. Education and employment are factors associated with use. Many of the herbal therapies used potentially could have significant adverse effects in dialysis patients. These include effects on blood pressure, blood glucose, coagulation parameters, and electrolyte disturbances. Dialysis patients currently taking herbal products may not be reevaluating their need for continuation and may not be informing members of the nephrology care team about their use.