The Lore of Admissions Policies: Contrasting Formal and Informal Understandings of the Residency Selection Process

PURPOSE: The selection process for residency positions is sometimes seen as being "opaque" and unfair by students, and can be a significant source of student stress. Yet efforts to clarify the process may not have helped reduce student stress for a number of reasons. This paper examines the nature of the knowledge that students possess and describes the implications for future efforts at addressing this knowledge. METHODS: The current study assessed the perceptions of three groups (selection committee members, faculty advisors, and students) at a single institution using two evaluation methods (ranking of a context-free list of variables, and an assessment of the legitimacy of 20 "common language" opinion statements comparing the variables). RESULTS: For the context-free ranking of variables, ICC's were moderately high for all three groups (0.479-0.584) and the disattenuated correlations were very high (0.872 to 0.946). By contrast, when more contextually relevant opinion statements were evaluated, the ICC's were much more variable (less than 0 to 0.279), the correlations (where calculable) were lower (0.449 to 0.547), and inconsistencies of opinion regarding particular variables became apparent. CONCLUSIONS: To properly understand the true nature of the opinions that are being held by the various groups it is necessary to use statements that reflect the vernacular of the "rumour mills" that are the common source of student information.     

Spondylometaphyseal dysplasia, corner fracture type: a heritable condition associated with coxa vara

The authors present the radiographic features of a previously incompletely delineated bone dysplasia, which they call spondylometaphyseal dysplasia, corner fracture type. This is a dominant heritable condition associated with short stature and developmental coxa vara. The progressive hip deformity usually causes significant disability requiring surgical correction. Developmental coxa vara, simulated corner fractures of long tubular bones, and vertebral body abnormalities result in a diagnostic constellation. Knowledge of these distinctive radiologic features allows accurate diagnosis, which in turn should lead to appropriate genetic counseling and possibly to earlier, more efficacious surgical treatment of the coxa vara.     

A comparison of polymerase chain reaction and an infectivity assay for human immunodeficiency virus type 1 titration during virus inactivation of blood components

Three examples of human plasma-derived concentrates, intermediate- purity factors VIII and IX, and fibrinogen were spiked with tissue culture-grown human immunodeficiency virus type 1 (HIV-1) strain RF. All examples were freeze-dried and heated at 80 degrees C for 72 hours by using validated production process models. HIV-1 infectivity was measured by a syncytial infectivity assay in C8166 cells and then compared with levels determined by nested HIV polymerase chain reaction (PCR). The infectivity assay demonstrated a reduction index of at least 4.5 log10, while PCR showed an average 1.7 log10. Large amounts of HIV- 1 RNA (10(5)) were still detectable by PCR in samples in which infectivity assays failed to detect any HIV-1. These data suggest that HIV-1 PCR levels do not parallel HIV-1 infectivity levels during virus- inactivation procedures involved in coagulation factor concentrate production. PCR was able to detect the RNA associated with inactivated HIV-1 particles in the factor concentrates, which allows the conclusion that PCR is not a useful test with which to monitor virus-inactivation procedures such as heating at 80 degrees C for 72 hours. This judgment contrasts with the more definite and sensitive role of PCR in diagnosing HIV-1 infection in patients in whom a positive HIV-1 PCR result correlates with active HIV-1 infection and with PCR's usefulness in monitoring virus removal.     

MASSIVE LOWER GASTROINTESTINAL HAEMORRHAGE SECONDARY TO METASTATIC SQUAMOUS CELL CARCINOMA OF THE LUNG

SUMMARY Clinically significant symptoms due to gastrointestinal metastases from primary lung cancers is rare. A case of life-threatening lower gastrointestinal haemorrhage secondary to metastatic squamous cell carcinoma of the lung is reported. Previous reports of such metastases are reviewed, with reference to management and prognosis. After resection of colonic metastases from squamous cell lung cancer, survival is similar to that for primary disease. It is suggested that patients with known or suspected squamous cell lung cancer presenting with lower gastrointestinal symptoms be managed as aggressively as those with no previous history of disease.     

Infiltrative lamina propria invasion pattern as an independent predictor for cancer‐specific and overall survival of instillation treatment‐naïve stage T1 high‐grade urothelial bladder cancer

Objectives

To investigate established prognostic factors and relatively new histopathological tumor characteristics including metric substage and lamina propria invasion patterns in a large series of T1 high‐grade non‐muscle‐invasive bladder cancer.

Methods

Between 1989 and 2012, 322 patients with initial stage T1 high‐grade bladder cancer underwent transurethral resection, followed by re‐transurethral resection and a conservative approach with follow‐up regime alone or instillation treatment. Transurethral resection specimens were reassessed by two experienced urological pathologists for tumor grade according to the World Health Organization 1973 classification, metric T1 substage, lamina propria invasion pattern and associated carcinoma in situ. The median follow‐up period was 42 months (interquartile range 25–72 months). In addition to Kaplan–Meier analyses, uni‐ and multivariable Cox regression analyses were used to compare progression‐free survival, cancer‐specific survival and overall survival for the studied parameters comparing two subcohorts.

Results

While in patients after instillation treatment no examined feature was shown as an independent predictor for prognosis, there were predictive histopathological features in multivariable Cox regression analyses in instillation treatment‐naïve patients: associated carcinoma in situ (hazard ratio 2.278, 95% confidence interval 1.119–4.634, P = 0.023) and World Health Organization 1973 grade 3 (hazard ratio 2.950, 95% confidence interval 1.021–8.536, P = 0.046) for worse progression‐free survival, infiltrative lamina propria tumor pattern for worse cancer‐specific survival (hazard ratio 2.369, 95% confidence interval 1.034–5.429, P = 0.042) and overall survival (hazard ratio 1.049, 95% confidence interval 1.024–1.075, P = 0.001).

Conclusions

The results of the present T1 high‐grade bladder cancer series suggest that lamina propria invasion pattern is a promising parameter to predict the prognosis of T1 high‐grade bladder cancer in an instillation treatment‐naïve subcohort. Prospective multicenter evaluations are warranted. The need for instillation treatment in T1 high‐grade bladder cancer is clearly demanded.     

Predictive Validity of the Global Assessment Form Used in a Final-year Undergraduate Rotation in Emergency Medicine

OBJECTIVES: To determine whether the predictive validity of Global Assessment Form (GAF) knowledge subdomain marks exceeds that of the overall GAF marks with respect to written examination marks for an undergraduate rotation in emergency medicine, and to determine the interdependence between subdomain marks on the GAF. METHODS: Final-year clinical clerks completing a four-week rotation through the emergency departments of a university teaching center were evaluated using both a ten-subdomain GAF for clinical performance and an independent written examination. The GAF and examination marks were prospectively obtained for clinical clerks over a two-year period. Pearson correlations were calculated between examination marks and both the GAF knowledge subdomain and the GAF overall mark. Olkin's Z score was calculated to determine the significance of the difference between correlations. Interdependencies between subdomains of the GAF were calculated using an alpha coefficient and inter-item correlations. RESULTS: Data sets were reviewed for 347 clinical clerks. Nine sets of data were excluded (incomplete evaluations); 338 sets were analyzed. Means for overall clinical mark and examination mark were 80.11% (SD = 4.375) and 81 (SD = 7.66). Among subdomains, knowledge had the highest correlation with the examination mark (0.19). Overall clinical marks had lower correlation with the examination marks (0.169); the difference was not significant (Olkin's Z = 0.40). The correlation of the examination marks with the average marks of all subdomains excluding knowledge was even lower (0.12). The tenitem alpha for the GAF was 0.92. CONCLUSIONS: Clinical GAF assessments of knowledge, as measured by written examination, do not appear to be any more predictive than overall clinical impression. There is substantial consistency between subdomain scores, suggesting that assessors are not effectively discriminating between them when assigning marks.