Exploring Perspectives from Internal Medicine Clerkship Directors in the USA on Effective Narrative Evaluation: Results from the CDIM National Survey.

Purpose: Clinical performance evaluations play a critical role in determining medical school clerkship grades. This study aimed to provide clarification from clerkship directors in internal medicine on what constitutes an effective and informative narrative description of student performance.

Methods: In September 2016, the Clerkship Directors in Internal Medicine (CDIM) electronically administered its annual, voluntary, and confidential cross-sectional survey of its US membership.

Beyond standard checklist assessment: Question sequence may impact student performance.

Introduction: Clinical encounters are often assessed using a checklist. However, without direct faculty observation, the timing and sequence of questions are not captured. We theorized that the sequence of questions can be captured and measured using coherence scores that may distinguish between low and high performing candidates.

Protecting the culture of a patient-centered medical home.

Objective: This study describes and categorizes the cultural frictions and conflicts within a successfully implemented Internal Medicine Patient-Centered Medical Home (PCMH) clinic at the National Naval Medical Center, and provides lessons learned for combating these concerns.

Methods: A semistructured interview protocol was developed, focusing on unique tenets of the PCMH, benefits of the model, and perceived obstacles to practicing medicine within this delivery system. The interviews included questions regarding efforts to foster team cohesion and impediments within the PCMH, as well as unique influences of the larger organization and the patient population, and lingering concerns about threats to the PCMH's viability.

Association between interest group participation and choice of residency.

Background And Objectives: While medical student interest groups (IGs, also known as student clubs) are widely offered, their actual use and effectiveness to affect students' specialty choice (eg, increase selection of family medicine) are poorly understood. We performed this study to describe student participation in IGs, association with specialty selection, and perceived benefit of participation.

Methods: An electronic, cross-sectional, quantitative survey of all fourth-year US medical students in 2009 with a Department of Defense service obligation was conducted.

Cardiopulmonary bypass and renal cell carcinoma with level IV tumour thrombus: can deep hypothermic circulatory arrest limit perioperative mortality?

Objective: • To review experience with nephrectomy/thrombectomy for a renal cell carcimoma (RCC) with a level IV tumour thrombus and to evaluate the benefit of deep hypothermic circulatory arrest (DHCA) with cardiopulmonary bypass (CPBP).

Patients And Methods: • A multi-institutional retrospective database was created to assess the outcomes of surgery for RCC and associated level IV tumour thrombus from 1983 to 2007. Patients were identified based on radiographic records/operative findings.

Cytoreductive nephrectomy for kidney cancer with sarcomatoid histology--is up-front resection indicated and, if not, is it avoidable?

Purpose: Cytoreductive nephrectomy has a survival advantage in select patients. Patients with sarcomatoid features are known to have poor outcomes. We reviewed the role of surgery in this population to see if these patients could be identified preoperatively.

Brain metastasis from renal cell carcinoma: presentation, recurrence, and survival.

Background: Patients with renal cell carcinoma brain metastases (RCCBM) are frequently excluded from trials and to the authors' knowledge no guidelines currently exist regarding central nervous system (CNS) surveillance or treatment. The objective of the current study was to assist in the creation of treatment guidelines.

Methods: Patients undergoing evaluation for RCCBM from 1989 to 2006 were identified.

The staging of renal cell carcinoma.

Purpose Of Review: Accurate staging of renal cell carcinoma is essential for patient care. The current staging system provides a common language to describe extent of disease, stratifies surveillance requirements, provides prognostic information, and selects patients for adjuvant clinical trials. We describe the current tumor, nodes, metastasis system, existing problems and controversies, and introduce integrated staging systems such as the University of California, Los Angeles Integrated Staging System and the Stage, Size, Grade, and Necrosis scoring algorithm.

Performance status and cytoreductive nephrectomy: redefining management in patients with poor performance.

Background: An Eastern Cooperative Oncology Group performance status (ECOG PS) of 2/3 can quantify cancer patients' well being and may be used to select patients for treatment. The objective of the current study was to investigate the outcomes of cytoreductive nephrectomy (CN) for patients who have an impaired performance status (ECOG PS 2/3).

Methods: Patients who underwent CN for renal cell carcinoma (RCC) between 1989 and 2006 were identified.

An internal medicine interest group research program can improve scholarly productivity of medical students and foster mentoring relationships with internists.

Background: Shortages in primary care careers such as internal medicine are projected in the future. Conducting research is an explicit requirement for graduate medical education and interest in research is growing in undergraduate medical education.

Purpose: We hypothesized that a medical student research initiative could increase student research productivity and foster mentoring relationships with internists.

Neoadjuvant targeted therapy and advanced kidney cancer: observations and implications for a new treatment paradigm.

Objective: To evaluate our early experience with neoadjuvant therapy (sunitinib or sorafenib) in advanced renal cell carcinoma (RCC), to explore the effect on both tumour biology and potential for downstaging advanced tumours, as systemic therapy for RCC has historically resulted in little if any primary tumour response, but recent experience with targeted therapy suggests otherwise.

Patients And Methods: The preliminary experience with neoadjuvant therapy for the surgical management of RCC was reviewed at two large referral centres. Several unique patients were identified who had a novel response to systemic therapy that altered the surgical strategy.