Guidelines for Evaluating the Educational Performance of Medical School Faculty: Priming a National Conversation

Background: The academic community needs a sound framework for the promotion and advancement of educators. The Group on Educational Affairs of the Association of American Medical Colleges organized a consensus conference that affirmed the use of five domains for documenting the quantity and quality of scholarly engagement in educational activities: teaching, curriculum, advising/mentoring, educational leadership/administration, and learner assessment. Summary: In this article, we offer detailed guidelines to evaluate these five domains of educator performance and the essential elements of scholarly activity. The guidelines are adapted from our developmental educator portfolio template and educator portfolio analysis tool, previously published in MedEdPORTAL. A short tool for educator performance evaluation that summarizes items in the guidelines is proposed for discussion. Conclusions: Our goal in this article is to itemize criteria for systematic faculty evaluation that can be applied in any institutional setting to assist promotion decision makers in their task of evaluating medical school faculty.     

Recurrent papilloedema and early onset optic atrophy in Beh?et's syndrome.

Two patients with Behçet''s syndrome and intracranial hypertension are reported. One developed a recurrence of papilloedema while receiving treatment but eventually made a full recovery, whereas the other developed optic atrophy within three months of onset despite treatment.     

MDCT of the central airways: comparison with bronchoscopy in the evaluation of complications of endotracheal and tracheostomy tubes

OBJECTIVE: To evaluate the accuracy of multidetector row computed tomography (MDCT) compared with bronchoscopy in the assessment of airway complications related to endotracheal and tracheostomy tubes. MATERIALS AND METHODS: A review was performed of all consecutive patients undergoing computed tomography (CT) and bronchoscopy for symptomatic complications of endotracheal or tracheostomy tubes during an 18-month period. MDCT imaging was performed according to a standard protocol and interpreted by an experienced thoracic radiologist before bronchoscopy. After bronchoscopy by an experienced interventional pulmonologist, CT and bronchoscopic findings were reviewed jointly, and the accuracy of CT was determined using bronchoscopy as the "gold standard." RESULTS: The study population was comprised of 32 patients (range: 26 to 88 y, mean 55.6) with a total of 47 airway complications: tracheal stenosis (n=25), tracheomalacia (n=8), tracheal granulation tissue (n=8), tracheal cartilage fracture (n=4), tracheal perforation (n=1), and tracheostomy tube disruption (n=1). CT accurately diagnosed 42 of 47 airway complications (sensitivity 89.4%, specificity 95.2%, positive predictive value 85.7%, negative predictive value 96.5%). False negative findings at CT occurred in 5 (11.1%) of 47 cases. Contributing technical factors were identified in 3 (60.0%) of 5 false-negative cases, including the presence of tracheostomy tube during imaging and patient inability to complete the CT protocol. CONCLUSIONS: MDCT of the central airways is highly accurate for detecting symptomatic airway complications of endotracheal and tracheostomy tubes, particularly when technical limitations to the performance of CT are minimized.     

Fractal analysis of mammographic parenchymal patterns in breast cancer risk assessment

RATIONALE AND OBJECTIVES: To evaluate fractal-based computerized image analyses of mammographic parenchymal patterns in the task of differentiating between women at high risk and women at low risk for developing breast cancer. MATERIALS AND METHODS: The fractal-based texture analyses are based on a box-counting method and a Minkowski dimension, and were performed within the parenchymal regions of normal mammograms. Four approaches were evaluated: 1) a conventional box-counting method, 2) a modified box-counting technique using linear discriminant analysis (LDA), 3) a global Minkowski dimension, and 4) a modified Minkowski technique using LDA. These fractal based texture features were extracted from regions of interest to assess the mammographic parenchymal patterns of the images. Receiver operating characteristic analysis was used to evaluate the performance of these features in the task of differentiating between the two groups of women. RESULTS: Receiver operating characteristic analysis yielded an A(z) value of 0.74 based on the conventional box-counting technique and an A(z) value of 0.84 based on the global Minkowski dimension in the task of distinguishing between the two groups. By using LDA to assess the characteristics of mammograms, A(z) values of 0.90 and 0.93 were obtained in differentiating the two groups, for the modified box-counting and Minkowski techniques, respectively. Statistically significant improvement was achieved (P < .05) with the new techniques compared to the conventional fractal analysis methods. A simulation study, which used the slope and intercept extracted from the least square fit of the experimental data with the LDA approaches, yielded A(z) values similar to those obtained with the conventional approaches in the task of differentiating between the two groups. CONCLUSIONS: The proposed LDA approach improved significantly the separation between the two groups based on experimental data. Because this approach was used as a linear classifier rather than as a regression function, it combined the fractal analysis with the knowledge of the high- and low-risk patterns, and thus better characterized the multifractal nature of the parenchymal patterns. We believe that the proposed analyses based on the LDA technique to characterize mammographic parenchymal patterns may potentially yield radiographic markers for assessing breast cancer risk.     

Omentum transposition surgery for patients with Alzheimer's disease: a case series

OBJECTIVE: To examine effect of omentum transposition surgery (OT) in Alzheimer's disease (AD). METHODS: Within-subjects design, also known as repeated-measures design, was used. OT was performed on six biopsy-confirmed AD patients (three to the left and right hemispheres each). Follow-up was conducted over 16-50 months. Outcome measures included the sum of the sub-scores of the clinical dementia rating scale (CDRSS), dementia severity rating scale (DSRS), mini-mental status exam (MMSE) and neuropsychiatric inventory (NPI), all normalized to 0-1.0. Outcomes were compared to baseline values and to expected decline with and without cholinesterase inhibitors therapy (ChEI). RESULTS: Compared to baseline and to expected decline with ChEI, CDRSS scores were 22 and 39% less impaired at means of 14 and 25 months post-OT, and DSRS scores were 12 and 22% less impaired at means of 14 and 19 months post-OT (p<0.0001). Compared to baseline and expected course with and without ChEI, the MMSE scores of the left hemisphere OT patients were not significantly different for 11, 17 and 22 months respectively (p>0.49), while those of the right hemisphere OT patients more rapidly declined. The two patients with significant pre-operative behavioral problems markedly improved; NPI severity scores decreased by 23 (16%) and 78 (54%) points and were sustained for 22 and 42 months. DISCUSSION: OT yielded cognitive, functional or behavioral improvement for up to 3.5 years in these AD patients. Compared to randomized ChEI clinical trials, OT was 34 times more likely to produce clinically significant improvement. Basic research to identify the mechanisms underlying the therapeutic effect of omentum is warranted.     

Silent ischaemia in diabetic men with autonomic neuropathy.

Autonomic neuropathy is associated with an increased incidence of silent myocardial infarction and sudden death. The purpose of this study was to investigate the prevalence of silent myocardial ischaemia in diabetic patients with autonomic neuropathy and without. Five standard autonomic function tests were performed on 41 men with diabetes: postural change in blood pressure, postural change in heart rate, heart rate response to deep breathing, heart rate response to Valsalva's manoeuvre, and blood pressure response to sustained handgrip. There were 17 patients with autonomic neuropathy (group A) and 24 with normal autonomic function (group B). All patients underwent 24 hour ambulatory electrocardiographic monitoring to detect silent ischaemia. There was no significant difference in risk factors for coronary artery disease or history of angina pectoris between these groups. The prevalence of silent ischaemia was 64.7% in group A (95% confidence interval (95% CI) 38.33 to 85.79%) and 4.1% in group B (95% CI 0.11 to 21.12%). This represents a relative risk of 42.2 (95% CI 4.5 to 39.4, p less than 0.001). These results are consistent with the concept that autonomic neuropathy may prevent the development of anginal pain and thus obscure the presence of ischaemic heart disease. Twenty four hour ambulatory electrocardiographic monitoring may identify a subgroup of diabetic patients with autonomic neuropathy who have myocardial ischaemia and to whom treatment may be offered.