Assessing the first eight years of an optional five-year medical curriculum.

Experience with the initial eight years (1980-1987) of a voluntary five-year medical degree program at the Boston University School of Medicine is examined. The program, called the Alternative Curriculum, permits medical students to "decompress" the first year of their medical school curriculum. The program was designed to be a parallel curricular pathway and not a remedial program. Some students in academic difficulty, however, have been enrolled in this program. The students' records and their responses to a questionnaire form the basis for this report. The students who entered the Alternative Curriculum before the start of classes or who, upon entering, were in good academic standing generally did well academically and were uniformly pleased with the time that was available to pursue other interests. Several of these students were subsequently permitted to decompress other curricular years, with uniform success. Of the students for whom the Alternative Curriculum was used as a remedial program, nearly half had left or been dismissed from school at the time of this report.

Eosinophilic gastroenteritis with malabsorption, extensive villous atrophy, recurrent hemorrhage and chronic pulmonary fibrosis.

A patient with diffuse eosinophilic gastroenteritis, associated with progressive chronic interstitial pulmonary fibrosis, was followed for 29 years. His major symptoms were recurrent gastrointestinal bleeding, anemia, diarrhea, malabsorption, and increasing respiratory insufficiency. Multiple jejunal biopsies revealed eosinophilic infiltration and extensive villous atrophy. Results of a lung biopsy and pulmonary function tests were consistent with chronic interstitial pulmonary fibrosis. His gastrointestinal symptoms responded to steroid therapy, but he died of progressive respiratory insufficiency. At autopsy, villous atrophy was noted to extend throughout the whole extent of the small intestine in association with multiple "pseudopolypoidal" inflammatory lesions.