Timing of Surgery and Internal Medicine Clerkships and Surgery Shelf Examination Scores.

BACKGROUND: Many medical students believe that third-year clerkship rotation sequence affects their success. We hypothesized that students who completed the internal medicine clerkship before the surgery clerkship received higher surgery shelf examination scores compared with the students who did not. MATERIALS AND METHODS: Deidentified academic data including preclinical data and National Board of Medical Examiners shelf examination scores for surgery for all third-year medical students at a single institution from 2012 to 2017 were analyzed. Students who did not complete all six core clerkships during the standard third-year time frame were excluded. Data were analyzed using 2-tailed t-tests and Z-scores. RESULTS: Four hundred and twenty four students were included in the study. Average undergraduate grade point average, Medical College Admission Test scores, and United States Medical Licensing Examination Step 1 scores showed no significant differences between groups. In aggregate, average shelf examination scores of students who completed the internal medicine clerkship before the surgery clerkship were significantly higher than those of students who did not. When the average shelf examination scores for the two groups were analyzed by individual rotation slot, no significant difference was found between the two groups. CONCLUSIONS: Initially, it appeared that students who completed the internal medicine clerkship before the surgery clerkship scored higher on their surgery shelf examinations. When the data were analyzed by individual rotation slot, we found no difference between the students who had already completed the internal medicine clerkship and those who had not. Experience over the year rather than completion of the internal medicine rotation was associated with higher surgery shelf examination scores.

Nonrheumatoid Inflammatory Arthroses of the Hand and Wrist.

Various inflammatory and autoimmune conditions affecting joints of the hand and wrist can present with symptoms similar to those of rheumatoid arthritis. The most common of these nonrheumatoid arthroses are psoriatic arthritis, systemic lupus erythematosus, and systemic sclerosis. Management of these and several other conditions is typically medical in nature and continues to evolve with the development of biologically targeted medications. Surgical treatment is not frequently used but can be efficacious for severe cases to alleviate symptoms and correct deformities.