Differences in residency performances and specialty choices between graduates of three- and four-year curricula.

This study identified differences in the specialty choices and residency program directors' performance ratings of residents graduated from two different curricula of the same medical school. One curriculum was three years long, and compressed two years of the basic sciences into one year of study. The other was a four-year program devoting two years each to the basic and clinical science, but with elements unifying the two areas. Using an 18-item form, the program directors rated the performance of 42-96% of the residents who had graduated in the classes of 1982, 1984, 1985, and 1986. (1982 was the only class of the three-year curriculum that was studied.) Graduates of the three-year program showed less strength in background medical knowledge and in their experience of using research data; their greatest strengths seemed to be in the sorts of skills that normally would be acquired during the course of residency experiences. Graduates of the four-year curriculum seemed more able to integrate background medical knowledge and effective care of patients. Their weaknesses appeared to be in those skills that would be developed during the course of the residency experience. The only marked differences between the two groups in terms of residency specialty choice were in surgery and medicine.

Rhabdomyolysis in a case of free-base cocaine ("crack") overdose.

This is the case of a 27-year-old black man who was admitted to Loyola University Medical Center after a one-time experience of smoking free-base ("crack") cocaine. Clinical manifestations of the resulting cocaine intoxication were rhabdomyolysis, acute renal failure, and transient liver failure. This patient came to our attention because of the striking alterations in his blood-chemistry values, which indicated acute tissue damage, and his remarkable recovery within 96 h. We discuss the dramatic changes in the laboratory findings and the clinical course of this patient.

Comparison of graduates of regular curriculum and unified basic-science-clinical curriculum.

The purpose of the study reported here was to identify differences between graduates who were in different curricula at Loyola University of Chicago Stritch School of Medicine. The physicians who had been in the special track, which combined the basic and clinical sciences throughout the program, chose specialties in family practice and psychiatry more than the regular track students and more often were salaried. One-third of those in the special curriculum felt the greatest strength of their medical school training was the preparation for independent learning, and a majority viewed a practice in which there were uncertainties in diagnosis as desirable. The traditional program graduate preferred to deal with cases in which important decisions had to be made rapidly and the effects of treatment could be immediately addressed. The two groups disagreed as to who should have major control of health care, on issues of peer review in the office, and on the emphasis physicians should give preventive care.