Academic and professional career outcomes of medical school graduates who failed USMLE Step 1 on the first attempt.

This study sought to determine the academic and professional outcomes of medical school graduates who failed the United States Licensing Examination Step 1 on the first attempt. This retrospective cohort study was based on pooled data from 2,003 graduates of six Midwestern medical schools in the classes of 1997-2002. Demographic, academic, and career characteristics of graduates who failed Step 1 on the first attempt were compared to graduates who initially passed.

Variables associated with full-time faculty appointment among contemporary U.S. Medical school graduates: implications for academic medicine workforce diversity.

Purpose: The authors sought to identify variables independently associated with full-time faculty appointment among recent medical graduates.

Method: With institutional review board approval, the authors developed a database of individualized records for six midwestern medical schools' 1997-2002 graduates. Using multivariate logistic regression, they identified variables independently associated with full-time faculty appointment from among demographic, medical-school-related, and career-intention variables.

Core clerkship directors: their current resources and the rewards of the role.

Purpose: To conduct a national multidisciplinary investigation assessing core clinical clerkships and their directors, variances in resources from national guidelines, and the impact of the clerkship director role on faculty members' academic productivity, advancement, and satisfaction.

Method: A multidisciplinary working group of the Alliance for Clinical Education (ACE), representing all seven core clinical disciplines, created and distributed a survey to clerkship directors at 125 U.S.

Resources and rewards for clerkship directors: how surgery compares.

Background: Clerkship directors (CDs) are key educators and active clinicians. In 2003, the Alliance for Clinical Education published standards for CD resources and responsibilities, but how reality compares is unknown.

Methods: Representatives from each core clinical disciplines' CD organizations created an electronic survey that CDs received in 2006-2007.

Are students learning what faculty are intending to teach?

Background: Lectures are common in surgical clerkships, although faculty members rarely are trained in this skill. Previous authors have addressed the impact of lecture format, length, etc. on post-test performance, but little work has addressed students' free recall of information.

Extra-intestinal manifestations of Crohn's disease.

Extra-intestinal manifestations occur in at least 25% of Crohn's disease patients. Some extra-intestinal manifestations, such as erythema nodusum and peripheral arthropathy, will wax and wane in keeping with bowel inflammation. The more severe cutaneous ulcerations, uveitis, and axial arthropathy may precede bowel disease or persist after it subsides.

Which U.S. medical graduates plan to become specialty-board certified? Analysis of the 1997-2004 national association of American Medical Colleges Graduation Questionnaire database.

Background: Predictors of U.S. allopathic medical-school graduates' board-certification plans have not been characterized.

The resident view of professionalism behavior frequency in outstanding and "not outstanding" faculty.

Background: Professionalism assessment has become necessary for all postgraduate training programs because it is now required for accreditation. To validate the novel items we generated to assess professionalism, we tested whether residents' ratings of faculty they judged as outstanding in professionalism would be distinguishable from those they judged as not outstanding.

Methods: Educators from core clinical disciplines generated 20 items assessing professionalism behaviors on a 7-point frequency scale anchored by "always" and "never.

Temporarily impaired surgeons and calling for help.

Surgeons who are ill must sometimes make their own judgments about their fitness to operate. The profession might consider more explicitly how surgeons make such judgments.

Intracerebroventricular calcitonin prevents stress-induced gastric dysfunction.

Background: Restraint stress produces gastric hypercontractility and acidity leading to stress ulceration. Intracerebroventricular (ICV) salmon calcitonin (sCT) decreases restraint injury and acidity, but its effects on restraint-induced hypercontractility are unknown.

Methods: Using stereotactic guidance, ICV catheters were placed into the lateral ventricle of adult male rats and calibrated gastric strain gauge transducers were implanted 5 days prior to restraint stress.

Mechanisms of impaired gallbladder contractile response in chronic acalculous cholecystitis.

The mechanisms involved in the impaired gallbladder contractile response in chronic acalculous cholecystitis are unknown. To determine the mechanisms that may lead to impaired gallbladder emptying in chronic acalculous cholecystitis, gallbladder specimens removed during hepatic resection (controls) and after cholecystectomy for chronic acalculous cholecystitis were attached to force transducers and placed in tissue baths with oxygenated Krebs solution. Electrical field stimulation (EFS) (1 to 10 Hz, 0.

Lipopolysaccharide temporarily impairs sphincter of Oddi motility.

The aim of our study was to determine the effect of lipopolysaccharide (LPS) on sphincter of Oddi (SO) motility. Opossums received saline, Escherichia coli LPS (1.0 mg/kg), or E.

Weaving women's health across clinical clerkships.

Clerkship directors have an opportunity to develop consensus on learning objectives for women's health issues and to develop curricula that cross disciplinary boundaries. A collaborative interdisciplinary approach assures proper sequencing of knowledge and skill acquisition, conserves educational resources, and reflects the values of connectedness and patient-centeredness that are central to women's health. The informal networks and the institutional structures that bring clerkship directors together for discussion of a variety of educational issues promote such collaboration.

Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters.

Background And Aims: Total parenteral nutrition (TPN) is typically delivered through catheters inserted into the superior vena cava (SVC) via a subclavian or internal jugular vein approach. A peripherally-inserted central venous catheter (PICC), utilizing a cephalic or basilic venous approach, may provide a safe alternative to the standard catheter approach and, because non-physician providers can insert the PICC, may introduce a potential cost-savings to health care institutions. We sought to determine if PICC lines are safer and more cost-effective than the standard central venous catheter approach for hospitalized patients who require TPN.

Effect of endotoxin on opossum gallbladder motility: a model of acalculous cholecystitis.

Objective: To determine whether endotoxin causes histologic changes in the gallbladder consistent with acalculous cholecystitis, and to determine the effects of endotoxin on gallbladder motility.

Summary Background Data: Acute acalculous cholecystitis is frequently seen in critically ill, septic patients, after prolonged fasting and gallbladder stasis. The pathogenesis of acalculous cholecystitis is unknown; however, previous studies have suggested that ischemia may play a role.

Are gastric, jejunal, or both forms of enteral feeding gastroprotective during stress?

Background: Clinical data suggest enteral nutrition prevents stress ulceration and intragastric nutrients prevent restraint-induced gastric injury. The purpose of these studies was to determine if jejunal nutrients can protect without gastric contact and to determine if gastric pH, motility, or mucosal perfusion is affected.

Methods: In Experiment 1, 27 rats were restrained for 2 h at room temperature followed by 2 h in cold (4 degrees C), with intragastric (IG) or intrajejunal (IJ) 2 ml/h infusions of saline or 25% glucose.

The cup is half full.

Background: The clinical outcomes following feeding tube procedures are infrequently studied because most patients have other incurable conditions.

Methods: Multiple electronic databases were used to track clinical outcomes following all gastrostomies and jejunostomies performed at a single institution from October 1, 1992, through December 31, 1995. Preoperative risk factors and postoperative morbidity were available for all 104 cases; long-term status was available for all but 2 of 104.

Gastric emptying of liquids and postprandial pancreatobiliary secretion are temporarily impaired during endotoxemia.

The aims of our study were to determine mechanisms by which pancreatobiliary secretion is altered during endotoxemia. Dogs underwent placement of duodenal perfusion and aspiration catheters and antral manometry catheters. Gastric emptying of liquids, antral motility, output of bile acids and amylase, and serum levels of enteric hormones were determined after ingestion of a 360-kcal mixed-nutrient liquid meal.

The role of antioxidant enzymes in the control of opossum gallbladder motility.

Background: Superoxide rapidly oxidizes nitric oxide (NO) to form peroxynitrite, thus terminating the biological activity of NO. The aims of our study were to determine if superoxide alters the motor function of the gallbladder and to localize the antioxidant enzymes in the gallbladder.

Materials And Methods: Immunostaining and immunoblots were performed and enzyme activities were measured in the gallbladder.

Effects of endotoxin on regulation of intestinal smooth muscle nitric oxide synthase and intestinal transit.

Background: The disrupted intestinal transit during endotoxemia may be mediated by nitric oxide (NO). We hypothesized that the isoforms of nitric oxide synthase (NOS) are up-regulated in intestinal smooth muscle during endotoxemia and that the scavenging of NO will normalize transit.

Methods: Rats were given Escherichia coli lipopolysaccharide (LPS) 10 mg/kg intravenously and were killed 4 hours later.

Changes in intestinal transit and absorption during endotoxemia are dose dependent.

Background: Septic patients are often intolerant of enteral feedings due to a combination of motility disturbances and impaired absorptive function. Our laboratory has previously demonstrated that endotoxemia results in rapid intestinal transit and decreased jejunal absorption of water, electrolytes, and glucose. We hypothesized that the changes in jejunal transit and absorption during endotoxemia may be dependent on the dose of endotoxin.