Program report cards: evaluation across multiple residency programs at one institution.

The designated institution official (DIO) is responsible for monitoring all residency programs within an institution. Although program-evaluation tools have been developed for residency program directors to use, there are currently no such published evaluation tools for DIOs. This manuscript describes the development and implementation of a standardized, dimensional program report card for the more than 60 residency and fellowship programs at our institution.

Primary hyperparathyroidism with a low-normal, atypical serum parathyroid hormone as shown by discordant immunoassay curves.

Context: In patients with primary hyperparathyroidism (PHP), one expects to find a serum PTH in the high or high-normal range. The presence of a low-normal PTH in PHP can be difficult to explain.

Objective: Our objective was to investigate the cause of a low-normal serum PTH in a patient with PHP.

Personal observations on the cultural evolution in academic surgery.

Background: The changing environment in academic medical centers has had a major effect on the recruitment and the demographic characteristics of leadership positions in academic surgery. Categorization of "cultures" from the business model has been extrapolated into the academic surgical model.

Methods: The types of cultures in organizations according to Cameron and Quinnn at a school of management can be classified into four: clan culture, adhocracy culture, hierarchy, and market-driven culture.