On the basis of sex and sleep: the influence of the estrous cycle and sex on sleep-wake behavior.

The recurrent hormonal fluctuations within reproductive cycles impact sleep-wake behavior in women and in rats and mice used in preclinical models of sleep research. Strides have been made in sleep-related clinical trials to include equal numbers of women; however, the inclusion of female rodents in neuroscience and sleep research is lacking. Female animals are commonly omitted from studies over concerns of the effect of estrus cycle hormones on measured outcomes.

Exploring metabolomic dynamics in acute stress disorder: amino acids, lipids, and carbohydrates.

Acute Stress Disorder (ASD) is a psychiatric condition that can develop shortly after trauma exposure. Although molecular studies of ASD are only beginning, groups of metabolites have been found to be significantly altered with acute stress phenotypes in various pre-clinical and clinical studies. ASD implicated metabolites include amino acids (β-hydroxybutyrate, glutamate, 5-aminovalerate, kynurenine and aspartate), ketone bodies (β-hydroxybutyrate), lipids (cortisol, palmitoylethanomide, and N-palmitoyl taurine) and carbohydrates (glucose and mannose).

Accreditation of undergraduate medical training programs: practices in nine developing countries as compared with the United States.

Context And Objectives: Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA).

Methods: Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents.

Formative assessment promotes learning in undergraduate clinical clerkships.

Introduction: Clinical clerkships, typically situated in environments lacking educational structure, form the backbone of undergraduate medical training. The imperative to develop strategies that enhance learning in this context is apparent. This study explored the impact of longitudinal bedside formative assessment on student learning in a medical clerkship.

An Investigation of the Sources of Measurement Error in the Post-Encounter Written Scores from Standardized Patient Examinations.

Purpose. Post-encounter written exercises (e.g.

The changing pool of international medical graduates seeking certification training in US graduate medical education programs.

International medical graduates (IMGs) consistently represent approximately one fourth of both the physician workforce and the graduate medical education (GME) population of the United States. To enter into accredited US GME programs, IMGs must be certified by the Educational Commission for Foreign Medical Graduates (ECFMG). Changes in the number and characteristics of those seeking certification directly affect the GME population and the future physician workforce in the United States.

Evaluating the spoken English proficiency of graduates of foreign medical schools.

Purpose: The purpose of this study was to gather additional evidence for the validity and reliability of spoken English proficiency ratings provided by trained standardized patients (SPs) in high-stakes clinical skills examination.

Method: Over 2500 candidates who took the Educational Commission for Foreign Medical Graduates' (ECFMG) Clinical Skills Assessment (CSA) were studied. The CSA consists of 10 or 11 timed clinical encounters.

The management of patient encounter time in a high-stakes assessment using standardized patients.

Objectives: The purpose of this study was to gather information regarding the appropriateness of the length of time allotted for candidates to complete the history taking and physical examination tasks in a high-stakes standardized patient (SP) assessment.

Design: Data were collected on actual time used by 1548 examinees for each of their 10 standardized patient encounters, for which a maximum of 15 minutes was allotted, but not required.

Setting: The Clinical Skills Assessment Center of the Educational Commission for Foreign Medical Graduates (ECFMG), Philadelphia, Pennsylvania, USA.

Erroneous concerns about child sexual abuse.

Aim: To assess the incidence and nature of concerns about sexual abuse, with particular reference to erroneous concerns of sexual abuse made by children.

Methods: A review of case notes of all child sexual abuse reports to the Denver Department of Social Services over 12 months. Cases were put into four groups: substantiated, not sexual abuse, inconclusive and erroneous accounts by children.

The performance of foreign medical graduates on the National Board of Medical Examiners (NBME) standardized patient examination prototype: a collaborative study of the NBME and the Educational Commission for Foreign Medical Graduates (ECFMG).

Objectives: The purpose of the study was to explore foreign medical graduates' (FMGs) performance on a clinical skills (SPX) examination. The National Board of Medical Examiners (NBME) is in the process of developing an SPX for potential use in the United States Medical Licensing Examination (USMLE). The Educational Commission for Foreign Medical Graduates (ECFMG) is developing the Clinical Skills Assessment (CSA) as an additional requirement for FMGs who wish to be certified by ECFMG.

Internists' and surgeons' attitudes toward guns and firearm injury prevention.

Background: The high rates of death, injury, and long-term disability related to firearms in the United States have led to growing concern in the health care community. Medical organizations and journals are devoting increasing attention to firearm violence as a public health problem; however, few reports discuss physician attitudes toward guns and prevention of firearm-related injury.

Objective: To determine internists' and surgeons' attitudes toward guns and firearm injury prevention.

Lessons learned from six years of international administrations of the ECFMG's SP-based clinical skills assessment.

Purpose: The Educational Commission on Foreign Medical Graduates (ECFMG) conducted international clinical skills assessments (CSAs) to evaluate the readiness of foreign medical graduates to enter U.S. residency programs, to validate national medical examinations in other countries, and to introduce other countries to new methods of evaluating medical students.

A national survey to define a new core curriculum to prepare physicians for managed care practice.

All levels of medical education will require modification to address the challenges in health care practice brought about by managed care. Because preparation for practice in a managed care environment has received insufficient attention, and because the need for change is so great, in 1995 the authors sought information from a variety of sources to serve as a basis for identifying the core curricular components and the staging of these components in the medical education process. This research effort consisted of a survey of 125 U.

Retraining physicians for primary care. A study of physician perspectives and program development.

Objective: To determine the number and kinds of programs that medical schools and managed care organizations offer or plan to offer to retrain physician specialists to practice primary care medicine and to discover physicians' attitudes toward such retraining.

Design: A survey was mailed in 1994 to all 126 medical schools and the 19 largest US managed care organizations to collect detailed information about existing and potential retraining programs. Physicians' attitudes toward retraining were elicited from participants in 3 geographically diverse focus groups.

Graduates of foreign medical schools: progression to certification by the Educational Commission for Foreign Medical Graduates.

The application process leading to certification by the Education Commission for Foreign Medical Graduates (ECFMG) was studied using the group of 9,491 graduates of foreign medical schools who initiated their applications in 1988. Using the ECFMG's database, these applicants' countries of citizenship, examination histories, certification status, and exchange visitor status were determined for a period of seven years and 9 months, ending in September 1995. Within that time, 45% of these applicants became ECFMG-certified, and 26% of that group entered residency programs accredited by the Accreditation Council for Graduate Medical Education.

Nancy E. Gary, MD: providing HCFA with a new perspective on the 'hassle factor':. Interview by Janice C. Simmons.

As senior medical adviser to Health Care Financing Administration head, Gail Wilensky, Dr. Gary provides the agency with a physician's view on issues and has become a liaison with the medical community--with an open ear to the regulatory hassles that beset practicing physicians.

Changes in admissions, lengths of stay, and discharge diagnoses at a major university-affiliated teaching hospital: implications for medical education.

The implications for medical education of a declining average length of stay (ALOS) and changes in numbers of hospital admissions have been the subject of considerable discussion. The changing hospital reimbursement schedules and the rise of managed-care systems have altered patterns of hospital use and consequently posed new problems for the education of medical students and residents. Between 1980 and 1986 in one university-affiliated hospital, the ALOS for patients with any of the most frequent discharge diagnoses for either of those years had declined 34% since 1980, despite a 59% increase in the number of patients with those diagnoses.

Clinical identification and comparative prognosis of high-risk patients with Haemophilus influenzae meningitis.

One hundred ninety-five consecutive children with Haemophilus influenzae meningitis were retrospectively reviewed to identify those patients at high risk of death or severe sequelae using a previously described clinical scoring system. One hundred sixty-nine children (86.7%) had prognostic scores less than or equal to 4.

Factors influencing breast-feeding among adolescents.

During a 15-month study period, 244 adolescent mothers under 18 years of age were surveyed, of whom 53% elected to breast-feed. A subset of 60 primiparous breast-feeding adolescents were studied regarding the influence of several factors on the duration of breast-feeding. An attitude questionnaire was administered in the hospital within 48 hours of delivery.