The Physician Experience Teaching an Integrated Curriculum to First-Year Medical Students.

Introduction The authors review a model of early medical student education that leverages the strengths of physician educators in curriculum development and small-group instruction in the first year of medical school. Objective The objective of this study was to understand the experience of practicing physicians who helped to design, implement, and deliver the first-year curriculum at a new medical school. Methods Survey data were collected for all first-year physician instructors and first-year medical students at the new Kaiser Permanente Bernard J. Tyson School of Medicine during the inaugural 2020-2021 academic year. Physician involvement in curriculum design and implementation, time required for teaching preparation, ratings of collaboration with basic scientists, and confidence and satisfaction of the clinician educators with first-year medical student education, as well as student satisfaction with physician educators, were all explored. Results Despite extensive time commitment from the physician educators and some reported variability in confidence ratings for course content, physicians rated their experience teaching first-year medical students at the new medical school highly. They rated their collaboration with basic scientists highly as well. Medical students rated their physician educators highly across multiple assessment domains. Conclusion The successful combination of basic scientists with physician educators in first-year medical education may provide a road map for other medical schools seeking to further integrate clinical sciences into basic science education.

Immunohistochemistry of p16 in nevi of pregnancy and nevoid melanomas.

BACKGROUND: Hormonal changes in pregnancy are known to alter melanocytic lesions, with some nevi noted to have increased mitotic figures and increased Ki-67 proliferation index. Additionally, cytomorphologic changes have also been noted, referred to as superficial micronodules of pregnancy. These changes may alarm the pathologist for malignancy, particularly nevoid melanoma. Immunohistochemistry for p16 has been recently utilized to distinguish benign nevi from melanoma. We assessed the use of p16 immunohistochemistry for distinguishing melanocytic nevi of pregnant patients from nevoid melanomas. METHODS: Fourteen nevomelanocytic lesions were obtained from pregnant or postpartum patients along with 20 nevoid melanomas for comparison. Immunohistochemistry with p16 was performed on each melanocytic lesion. The percentage of nuclear p16 staining of dermal melanocytes was grouped on a scale of <5%, 5% to 25%, >25% to 50%, and >50%. RESULTS: The majority of nevi from pregnant patients (81%) showed staining of >5% for p16. In contrast, the majority of nevoid melanomas (65%) had staining of <5% for p16. CONCLUSION: The application of p16 as a potential immunohistochemistry diagnostic marker to distinguish nevi from pregnant patients vs nevoid melanomas may be useful.

A case of lichen planus following Tdap vaccination.

Lichen planus (LP) is an inflammatory dermatosis of unknown etiology that is primarily associated with liver disease. Recently, there have been several reports of LP developing after administration of the hepatitis B, influenza and combined MMR-DTaP-IPV vaccines. Here we report the first case of LP developing on the lower extremities of an otherwise healthy adult male after administration of the Tdap vaccine. We present this case to draw awareness to this observation in light of recently updated Tdap vaccination recommendations.

Development of thyroid storm after surgical resection of a thyrotropin-secreting pituitary adenoma.

OBJECTIVE: To describe a patient with a thyrotropin-secreting pituitary adenoma in whom postoperative thyroid storm developed. METHODS: We present a case report with details of the initial presentation, laboratory evaluation, surgical and pathologic findings, and subsequent course in a patient with a thyrotropin (thyroid-stimulating hormone or TSH)-secreting adenoma and postoperative thyroid storm. RESULTS: An 18-year-old male patient presented with severe headaches and was found to have a large suprasellar tumor and a mildly elevated level of TSH. Thyroid storm developed immediately after surgical resection of the pituitary mass. Results of laboratory evaluation undertaken preoperatively became available after the patient had undergone the surgical procedure and revealed thyroid hormone levels 2 to 3 times the upper limit of normal. Propylthiouracil and beta-adrenergic blocking agents controlled the postoperative thyrotoxicosis and were subsequently discontinued as his TSH and thyroid hormone levels normalized. CONCLUSION: This case demonstrates the rare case of a TSH-secreting adenoma in a young patient, which was complicated by the development of postoperative thyroid storm. In addition, this case emphasizes the importance of preoperative pituitary hormonal evaluation and treatment of hormonal abnormalities in all patients presenting with sellar or suprasellar tumors.