An "education for life" requirement to promote lifelong learning in an internal medicine residency program.

Background: Lifelong learning is an integral component of practice-based learning and improvement. Physicians need to be lifelong learners to provide timely, efficient, and state-of-the-art patient care in an environment where knowledge, technology, and social requirements are rapidly changing.

Objectives: To assess graduates' self-reported perception of the usefulness of a residency program requirement to submit a narrative report describing their planned educational modalities for their future continued medical learning ("Education for Life" requirement), and to compare the modalities residents intended to use with their reported educational activities.

Discrimination against international medical graduates in the United States residency program selection process.

Background: Available evidence suggests that international medical graduates have improved the availability of U.S. health care while maintaining academic standards.

A departmental experience in promoting oral and poster presentations.

Background: Residency programs must demonstrate resident and faculty involvement in scholarly activity. One acceptable method is delivering presentations at scientific meetings.

Description: A prospective database and retrospective search of all prior presentations.

Let medicine lead the way beyond the registration of clinical trials: registering hypotheses.

There has been much recent interest in improving the quality and reporting of clinical research. Major journals now require clinical trialists to register studies a priori and follow specific reporting guidelines. While best developed for randomized, controlled trials, guidelines for other study types are being developed.

Simplifying the diagnosis and management of pulseless electrical activity in adults: a qualitative review.

Objective: The algorithms provided for advanced cardiac life support by the American Heart Association and the European Resuscitation Council Guidelines for Resuscitation for the diagnosis and treatment of pulseless electrical activity (PEA) correctly stress the importance of searching for potentially treatable causes, and suggest contributing factors that should be considered. This study sought evidence to support the factors that they mention in the algorithms.

Data Source: Human and animal studies in MEDLINE.

Residency applicants misinterpret their United States Medical Licensing Exam Scores.

Proper interpretation of the results of the United States Medical Licensing Exam (USMLE) is important for program directors, residents, and faculty who advise applicants about applying for residency positions. We suspected that applicants often misinterpreted their performance in relationship to others who took the same examination. In 2005, 54 consecutive applicants to the University of Tennessee, College of Medicine internal medicine residency program were asked to complete a brief survey about their performance on Parts 1 and 2 of the USMLE exam.

The reporting of statistics in medical educational studies: an observational study.

Background: There is confusion in the medical literature as to whether statistics should be reported in survey studies that query an entire population, as is often done in educational studies. Our objective was to determine how often statistical tests have been reported in such articles in two prominent journals that publish these types of studies.

Methods: For this observational study, we used electronic searching to identify all survey studies published in Academic Medicine and the Journal of General Internal Medicine in which an entire population was studied.

The simultaneous occurrence of deep vein thrombosis and pulmonary and arterial embolization.

Introduction: A 45-year-old female presented with 8 hours of right lower extremity pain and dyspnea. She was tachycardic and her right lower extremity was dusky, cold, and pulseless.

Discussion: Computerized tomography of the venous and arterial systems revealed massive pulmonary embolism and right lower extremity arterial and left lower extremity venous thromboses.

Internal medicine residents do not accurately assess their medical knowledge.

Background: Medical knowledge is essential for appropriate patient care; however, the accuracy of internal medicine (IM) residents' assessment of their medical knowledge is unknown.

Methods: IM residents predicted their overall percentile performance 1 week (on average) before and after taking the in-training exam (ITE), an objective and well accepted method to assess medical knowledge to study resident assessment accuracy. Ordinary least squares regression was used to study the association between the absolute accuracy of their predictions of their percentile performance on the ITE examination and their actual percentile performance.

A 5-year experience with influenza prevention and containment in a program of all-inclusive care for elderly adults.

Background: Influenza causes mortality and morbidity in the frail elderly population. Influenza prevention and mitigation models need to be developed for this population.

Methods: An observational study at a Program for All-Inclusive Care for the Elderly (PACE) during years 1999-2004.

Public perceptions of alcohol use by physicians.

Objectives: The objective of this study was to assess public perceptions of alcohol use by physicians on duty.

Methods: A random telephone survey of 408 adults in one Tennessee county was used.

Results: Only 1% of the respondents reported that they suspected that a physician with whom they were in professional contact during the last year had used alcohol.

The presence of hypotheses in the medical literature.

Background: Although hypotheses are believed to be crucial to the scientific method, they are not always reported in clinical studies. We hypothesized that the presence of a hypothesis in the medical literature would be associated with study type.

Methods: All articles published in four major medical journals in the first half of 2002 were reviewed and abstracted (n = 332).

Outcomes up to 5 years after severe, acute respiratory failure.

Study Objective: To use an existing database from a large cohort study with follow-up as long as 5.5 years to assess the extended prognosis of patients who survived their hospitalizations for severe acute respiratory failure (ARF).

Design, Setting, And Patients: Secondary analysis of an inception cohort of 1,722 patients with ARF requiring mechanical ventilation from five major medical centers who were entered into the prospective Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.

Determinants of prescribing meperidine compared to morphine in hospitalized patients.

Morphine is a preferred narcotic since meperidine forms toxic metabolites. Determinants of meperidine use have been poorly described. The objective of this study is to explore factors associated with the ordering of meperidine versus morphine.

Evaluation of a labeling system to indicate the presence of an advance directive in a hospital medical record.

Objective: To investigate the accuracy of one hospital's system to indicate whether an advance directive exists within a patient's medical record.

Design: Medical record review while patients were hospitalized.

Setting: Internal medicine residency program within a tertiary care hospital.

A novel use for the word "trend" in the clinical trial literature.

Background: A new meaning of the word "trend" is appearing in reports of clinical trials.

Methods: Abstracts of all clinical trials in PubMed with English abstracts that contained the word "trend" for each decade from 1971 to 2001 were reviewed.

Results: "Trend" was used 36 times in 1981, 170 times in 1991, to 375 times in 2001, most often to refer to a judgment about statistical significance.

Temporal trends over ten years in formal inpatient gastroenterology consultations at an inner city hospital.

Goals: Inpatient consultation is an important, but poorly understood, component of medical subspecialty practices. In a time when all services strive for cost-effective and efficient treatments, little is known about the epidemiology of inpatient subspecialty consultation. This study is designed to describe the nature and trends of formal inpatient gastroenterology consultations during the past decade.