An intradepartmental teaching effort at a medical university.

Over a period of four years, 693 third-year medical students were offered the opportunity to receive half of their required internal medicine clerkship clinical experience by rotating on a well-established family medicine inpatient service in a university hospital. This learning experience was designed and evaluated by the physician and behavioral science faculty of the department of family medicine. The family medicine inpatient experience provided the student with a greater number of individual patient encounters and a greater variety of clinical problems than an internal medicine experience. Scores on an internal medicine national board test showed no statistical difference between those students who completed a traditional internal medicine clerkship and those receiving a portion of their internal medicine experience by rotating on a family medicine inpatient service. The success of this student experience was a significant factor in the eventual acquisition of curriculum time for a third-year required family medicine clerkship.

Abnormal liver-spleen scan associated with hyperviscosity syndrome.

A patient with hyperviscosity syndrome was noted to have an abnormal liver radionuclide scan. Ultrasound and normalization of the liver scan after plasmapheresis confirmed the non-neoplastic nature of the patchy labeling defects. This case suggests a new cause for labeling abnormalities on liver radionuclide scans in patients with a syndrome where liver biopsies would be unusually hazardous. Possible mechanisms for this scintigraphic pattern in the hyperviscosity syndrome are briefly discussed.