Are USMLE Scores Valid Measures for Chief Resident Selection?

ABSTRACT Background The US Medical Licensing Examination (USMLE) Step 1 and Step 2 scores are often used to inform a variety of secondary medical career decisions, such as residency selection, despite the lack of validity evidence supporting their use in these contexts. Objective We compared USMLE scores between non–chief residents (non-CRs) and chief residents (CRs), selected based on performance during training, at a US academic medical center that sponsors a variety of graduate medical education programs. Methods This was a retrospective cohort study of residents' USMLE Step 1 and Step 2 Clinical Knowledge (CK) scores from 2015 to 2020. The authors used archived data to compare USMLE Step 1 and Step 2 CK scores between non-CR residents in each of the eligible programs and their CRs during the 6-year study period. Results Thirteen programs enrolled a total of 1334 non-CRs and 211 CRs over the study period. There were no significant differences overall between non-CRs and CRs average USMLE Step 1 (239.81 ± 14.35 versus 240.86 ± 14.31; P = .32) or Step 2 scores (251.06 ± 13.80 versus 252.51 ± 14.21; P = .16). Conclusions There was no link between USMLE Step 1 and Step 2 CK scores and CR selection across multiple clinical specialties over a 6-year period. Reliance on USMLE Step 1 and 2 scores to predict success in residency as measured by CR selection is not recommended.

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Characteristics of Postgraduate Physician Assistant Residency/fellowship Programs: A National Survey

10.21203/rs.3.rs-136568/v1 ◽

2021 ◽

Author(s):

Vasco Kidd ◽

Sarah Vanderlinden ◽

Roderick Hooker

Keyword(s):

Physician Assistant ◽

Medical Center ◽

Academic Medical Center ◽

Postgraduate Education ◽

Physician Assistants ◽

Teaching Hospitals ◽

Assigned Reading ◽

Academic Medical ◽

Wide Range ◽

The Us

Abstract Introduction: The development of postgraduate programs for physician assistants (PAs) began in 1973 and by 2020 there were approximately 100 programs spread across a broad range of medical and surgical disciplines. An assessment of these programs was undertaken. Method: A non-experimental, descriptive research study was designed to obtain information on the characteristics of PA postgraduate education programs in the US. The source of information was from surveyed members of the Association of Postgraduate Physician Assistant Programs. Questions were drawn from consensus discussions. Programs that were operational in 2020 were eligible to participate. Results: Seventy-two programs were invited to the survey and 34 replied. They are geographically distributed across the US in 13 states. The respondents represent a wide range of medicine: surgery, emergency medicine, critical care, orthopaedics, hospitalist, psychiatry, oncology, primary care, pediatrics, and cardiology. Most programs are associated with an academic medical center. The curriculum includes bedside teaching, lectures, mentorship, assigned reading, procedures, simulation, and conferences. The PA fellow serves as house officer alongside physician residents and fellows. An average program length is 12 months and awards a certificate. Stipends for PA fellows are $50,000-80,000 (2020 dollars) and benefits include paid time off, health and liability insurance. About half of the programs bill for the services rendered by the PA. Over 90% of graduates are employed within two months of fellowship completion. Conclusion: A trend is underway in American medicine to include PAs in postgraduate education. PA fellowships occur across a broad spectrum of medical and surgical areas, as well as diverse institutions and organizations overseeing the programs. Most are in academic medical centers or teaching hospitals. This study expands information on PA fellowships and their operation.

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Patterns of Consultation and Treatment of Patients with Hepatocellular Carcinoma Presenting to a Large Academic Medical Center in the US

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-013-2253-y ◽

2013 ◽

Vol 17 (9) ◽

pp. 1600-1608 ◽

Cited By ~ 8

Author(s):

Sylvie Stacy ◽

Omar Hyder ◽

David Cosgrove ◽

Joseph M. Herman ◽

Ihab Kamel ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

The Us

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Objective Resident Characteristics Associated with Performance on the Ophthalmic Knowledge Assessment Program Examination

Journal of Academic Ophthalmology ◽

10.1055/s-0040-1722311 ◽

2021 ◽

Vol 13 (01) ◽

pp. e40-e45

Author(s):

Michael J. Fliotsos ◽

Sidra Zafar ◽

Shazia Dharssi ◽

Divya Srikumaran ◽

Jessica Chow ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Residency Training Program ◽

Knowledge Assessment ◽

Pass Rates ◽

Additional Degree ◽

Assessment Program ◽

Usmle Step 1 ◽

Usmle Step ◽

Percentile Scores

Abstract Background To determine objective resident characteristics that correlate with Ophthalmic Knowledge Assessment Program (OKAP) performance, as well as to correlate OKAP performance with Accreditation Council for Graduate Medical Education (ACGME) milestone assessments, written qualifying examination (WQE) scores, and oral board pass rates. Methods Review of administrative records at an ACGME-accredited ophthalmology residency training program at an urban, tertiary academic medical center. Results The study included data from a total of 50 resident physicians who completed training from 2012 to 2018. Mean (standard deviation) OKAP percentile performance was 60.90 (27.51), 60.46 (28.12), and 60.55 (27.43) for Years 1, 2, and 3 examinations, respectively. There were no statistically significant differences based on sex, marital status, having children, MD/PhD degree, other additional degree, number of publications, number of first author publications, or grades on medical school medicine and surgery rotations. OKAP percentile scores were significantly associated with United States Medical Licensing Examination (USMLE) Step 1 scores (linear regression coefficient 0.88 [0.54–1.18], p = 0.008). Finally, continuous OKAP scores were significantly correlated with WQE (r s = 0.292, p = 0.049) and oral board (r s = 0.49, p = 0.001) scores. Conclusion Higher OKAP performance is correlated with passage of both WQE and oral board examinations during the first attempt. USMLE Step 1 score is the preresidency academic factor with the strongest association with success on the OKAP examination. Programs can utilize this information to identify those who may benefit from additional OKAP, WQE, and oral board preparation assistance.

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177. Implementation of Pharmacist-Driven Penicillin Allergy Evaluation and Testing with a Focus on Bypassing Penicillin Skin Testing at an Academic Medical Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.221 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S95-S96

Author(s):

YoungYoon Ham ◽

Shyam Joshi ◽

Ellie Sukerman ◽

Kendall J Tucker ◽

Diana Yu ◽

...

Keyword(s):

Medical Center ◽

Skin Testing ◽

Academic Medical Center ◽

Penicillin Allergy ◽

Patient Interview ◽

Academic Medical ◽

Number Of Patients ◽

The Us ◽

Graded Challenge ◽

Negative Health Outcomes

Abstract Background Penicillin allergies are reported by approximately 10% of the US population; however, studies reveal that >90% of those patients can tolerate penicillins. Penicillin allergies are associated with negative health outcomes, both clinical and financial, due to reduced efficacy and increased adverse effects of alternative antibiotics. Patient interview, penicillin skin testing (PST) and/or an oral graded challenge can be used to evaluate penicillin allergies. Different facilities use various algorithms for testing. The objective of this project was to determine whether a pharmacist-driven penicillin allergy evaluation and testing protocol which largely bypasses PST could safely de-label patients. Methods Adult patients (≥18 years) admitted with a penicillin allergy were evaluated for eligibility between September 2019 and June 2020. Pregnant patients, critically-ill patients, and patients receiving test-invalidating medication were excluded. Patients were evaluated and tested using institutional protocols, which allowed for the majority of patients to be challenged without PST. Allergies were removed with standardized documentation, and patients were given a pamphlet and counseled to discourage relabeling. Data collected included but were not limited to, the number of patients challenged and de-labeled, number of patients who were relabeled, and number of patients whose change in allergy status resulted in change of therapy. Results Forty-eight patients were interviewed and evaluated. One patient was evaluated by PST and oral graded challenge while 27 patients underwent an oral graded challenge only. Twenty patients were de-labeled as a result of patient interview. One patient failed oral challenge with minor itching that did not require any treatment, while 27 patients passed. Forty-seven allergies were removed or modified. Two patients who were de-labeled were relabeled with no record of a new reaction. Of de-labeled patients, 50% received a penicillin following removal of the allergy. Conclusion Penicillin allergies can be evaluated and removed using a pharmacy-driven algorithm that prioritizes direct challenges when appropriate. Risks of a reaction are low, and removal leads to change in treatment in a significant portion of patients. Disclosures All Authors: No reported disclosures

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Complementary and Integrative Medicine at Mayo Clinic

The American Journal of Chinese Medicine ◽

10.1142/s0192415x15500858 ◽

2015 ◽

Vol 43 (08) ◽

pp. 1503-1513 ◽

Cited By ~ 15

Author(s):

Ran Pang ◽

Shihan Wang ◽

Lin Tian ◽

Mark C. Lee ◽

Alexander Do ◽

...

Keyword(s):

Back Pain ◽

Stress Management ◽

Mayo Clinic ◽

Medical Center ◽

Academic Medical Center ◽

Psychological Disorders ◽

Management Training ◽

Stress Management Training ◽

Academic Medical ◽

The Us

Complementary and alternative medicine (CAM) has gained acceptance throughout the industrialized world. The present study was performed to provide information about the use of CAM at Mayo Clinic, an academic medical center in Northern Midwest of the US. We retrospectively reviewed the electronic medical records of 2680 patients visiting the CAM program at Mayo Clinic, Rochester, between 1 July 2006 and 31 March 2011. Services provided included acupuncture, massage, integrative medical consultations and executive stress management training. Data including age, gender, race, diagnosis and the number of treatment/consultation sessions were collected to describe the use of CAM in our institute over the last several years. It was found that the mean (standard deviation) age of patient was 52.6 (15.5) years. Of those, 73.1% were female and 26.9% were male. Most patients were white. The number of patients referred to CAM increased significantly from 2007 to 2010. The three most common diagnostic categories were back pain (12.9%), psychological disorders (11.8%), and joint pain (9.6%). Back pain was the most common diagnosis for patients receiving acupuncture, and fibromyalgia was the most common for patients receiving massage therapy. Psychological disorders (i.e., stress) were the major diagnosis referred to both integrative medical consults and executive stress management training. These results suggest that the diseases related to pain and psychological disorders are the main fields of CAM use. It also shows the increasing trend of the use of CAM at an academic medical center in the US.

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Omadacycline for the Treatment of Mycobacterium abscessus Disease: A Case Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa415 ◽

2020 ◽

Vol 7 (10) ◽

Cited By ~ 1

Author(s):

Jeffrey C Pearson ◽

Brandon Dionne ◽

Aaron Richterman ◽

Samuel J Vidal ◽

Zoe Weiss ◽

...

Keyword(s):

Antimicrobial Agents ◽

Medical Center ◽

Academic Medical Center ◽

Case Series ◽

Mycobacterium Abscessus ◽

Academic Medical ◽

The Us ◽

Culture Positive ◽

Definitive Role

Abstract Background Omadacycline is an aminomethylcycline antimicrobial approved by the US Food and Drug Administration in 2018 for community-acquired bacterial pneumonia and acute bacterial skin and skin structure infections. It has in vitro activity against nontuberculous mycobacteria, including Mycobacterium abscessus complex, but clinical data for this indication are lacking. Methods Omadacycline use was reviewed at an 804-bed academic medical center. Patients were included if they received omadacycline for culture-proven M abscessus disease in 2019. Results Four patients received omadacycline for the treatment of culture-positive M abscessus disease in 2019. Two patients had cutaneous disease, 1 had pulmonary disease, and 1 had osteomyelitis and bacteremia. The patients received omadacycline for a median duration of 166 days (range, 104–227) along with a combination of other antimicrobial agents. Omadacycline-containing regimens were associated with a clinical cure in 3 of 4 patients, with 1 patient improving on ongoing treatment. Omadacycline’s tolerability was acceptable for patients with M abscessus disease, with 1 patient discontinuing therapy in month 6 due to nausea. Conclusions Omadacycline is a novel oral option for the treatment of M abscessus disease, for which safe and effective options are needed. Although this case series is promising, further data are required to determine omadacycline’s definitive role in the treatment of M abscessus disease.

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A rationale and framework for seeking remote electronic or phone consent approval in endovascular stroke trials – special relevance in the COVID-19 environment and beyond

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016221 ◽

2020 ◽

Vol 12 (7) ◽

pp. 654-657 ◽

Cited By ~ 4

Author(s):

Ansaar T Rai ◽

Donald Frei

Keyword(s):

Informed Consent ◽

Medical Center ◽

Academic Medical Center ◽

Rural Geography ◽

Non Profit ◽

Academic Medical ◽

The Us ◽

Hub Network ◽

Legal Frameworks ◽

Special Relevance

BackgroundEnrollment in time-sensitive endovascular stroke trials can be challenging because of an inability to consent a debilitated patient. Often the legally authorized representative is not on site. Remote consent procedures in the US are inconsistent with the majority of sites shunning these approaches. The current pandemic with visitor restrictions highlights the need for enhancing these options.MethodsRemote electronic and phone consent procedures specifically for endovascular stroke trials from two comprehensive stroke centers (CSC) are presented. An overview of the genesis of informed consent procedures in the US is also included.ResultsThe two CSCs identified as Institution-1 and Institution-2 are large tertiary systems. Institution-1 is a non-profit university-affiliated academic medical center in rural geography. Institution-2 is an HCA hospital in an urban environment. Both serve patients through a spoke-and-hub network, have participated in multiple randomized endovascular stroke trials, and have successfully used these remote options for enrollment. A tiered approach is employed at both institutions with an emphasis on obtaining informed consent in person and resorting to alternatives methods when efforts to that are unsuccessful. A rationale for electronic and phone consent is included, followed by step-by-step illustration of the process at each institution.ConclusionTwo examples of remote electronic or phone consent procedures from institutions in different geographic environments and organization structures demonstrate that these options can be successfully used for enrollment in stroke trials. The current pandemic highlights the need to enhance these approaches while maintaining appropriate adherence to ethical and legal frameworks.

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