A Baccalaureate–MD Program for Students From Medically Underserved Communities: 15-Year Outcomes

The Premedical Honors College (PHC) is an eight-year, BS-MD program created in 1994 by Baylor College of Medicine (BCM) and The University of Texas-Pan American (UT-PA) to increase the number of physicians addressing the health care needs of underserved populations in Texas. The PHC targets South Texas, a 13-county, medically underserved area with a population that is 82% Hispanic. To date, the PHC has had 159 matriculants and 71 graduates, of whom 60 (84.5%) have matriculated into medical school. These results are significant considering that in 1996, only four students from all five South Texas colleges (combined enrollment of 30000 students) were accepted to medical school. An outcomes study comparing PHC matriculants with students of similar academic ability, ethnicity, and interest in medicine revealed that the odds of medical school matriculation were seven times higher for PHC students than for non-PHC students. The PHC's initial success has been acknowledged by the Texas legislature, which recently passed a bill to promote the PHC's replication. In addition, the number of PHC students-of whom 95% are Mexican American-who matriculate into medical school annually is significant nationally. In 2001, only 386 U.S. medical school matriculants (2.3% of all matriculants) were Mexican American; 17 of these students (4.4%) were PHC graduates. If current trends continue, the PHC could significantly expand the number of physicians serving minority and medically underserved populations in Texas and the nation. Also, the PHC provides an opportunity for research on programs designed to create pathways from high school to medical school.

In Memoriam: Herbert L. Fred, MD (1929–2018)

A healthy lifestyle is fundamental for the prevention and treatment of cardiovascular disease and other noncommunicable diseases (NCDs). Investment in primary prevention, including modification of health risk behaviors, could result in a 4-fold improvement in health outcomes compared with secondary prevention based on pharmacological treatment. The American Heart Association (AHA) emphasized the importance of lifestyle in its 2020 goals for cardiovascular health promotion and disease reduction. In addition to defining “cardiovascular health” based on criteria for blood pressure and biochemical markers (lipids and glycemia), the AHA Strategic Planning Committee further identified lifestyle characteristics of central importance: nutrition, physical activity, smoking, and maintenance of a healthy body weight.1 The World Health Organization estimated that ≈80% of NCDs could be prevented if 4 key lifestyle practices were followed: a healthy diet, being physically active, avoidance of tobacco, and alcohol intake in moderation.2 To support healthy lifestyle initiatives, major changes are necessary at the societal level to improve population health. Numerous strategies might help to create a culture that promotes and facilitates healthy behaviors, including creating laws and regulations, mounting large-scale public awareness and education campaigns, implementing local community programs, and providing individual counseling.3 Physicians are uniquely positioned to encourage individuals to adopt healthy lifestyle behaviors: Approximately 80% of Americans visit their primary care physician at least once a year. Physicians directly communicate with their patients during clinical encounters across numerous settings, and research indicates that patients highly value recommendations provided by their physicians.4,5 However, data further indicate that lifestyle counseling does not routinely occur in physicians’ offices, thereby representing a lost opportunity. Physicians report that they perform lifestyle counseling during ≈34% of clinic visits.4 Patients, in turn, report an even lower frequency of physician lifestyle counseling. For example, obese patients reported receiving physical activity and …

Mentor Program Reaches Out to Minority Psychiatrists

The authors describe how Baylor College of Medicine (BCM), with three other Texas medical schools, "adopted" virtually all the 620 medical students and 526 house officers of Tulane University School of Medicine and continued their education for eight months after most of New Orleans, including Tulane, was flooded on August 29, 2005, after Hurricane Katrina. Soon after, BCM's president asked all senior staff to take whatever actions were necessary to sustain Tulane, and on September 7, leaders from BCM and three other Texas medical schools met to plan the relocation of Tulane's students and programs. The authors explain how problems were overcome (e.g., locating the scattered Tulane students and staff, finding them lodging, obtaining their records, and providing financial aid and counseling), and how high-quality educational experiences were maintained for both Tulane's and BCM's students and residents while assisting Tulane's faculty in numerous ways, helping Tulane plan the enrollment of its following year's students, and undergoing Liaison Committee for Medical Education and Accreditation Council on Graduate Medical Education site visits to BCM. After the BCM-Tulane experience, BCM developed a disaster-management plan (available online) that could help other schools as they plan for disasters. The authors also offer lessons learned in the areas of communication, cooperation, curriculum, collaboration, contact with accrediting bodies, and compassion. They close by stating that when BCM faculty are asked "how could you take Tulane's medical school in?" their response is, "how could we not?" They continue: "In medical education, a frequent discussion is how to teach humanism and professionalism; we teach it best by modeling it."

Medical Student Education in Ophthalmology: Crisis and Opportunity

Faculty Development for Medical Educators: Current Barriers and Future Directions

IntroductionWhile many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts.MethodsAn 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels.ResultsStudents demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups.DiscussionAn intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

The authors present an overview of the educational programs, infrastructure to support them, and the assessment strategies of 128 medical schools in the United States and Canada, based on reports submitted by those schools and published in this supplement to Academic Medicine. The authors explore many important changes that have occurred since the publication of the Flexner Report in 1910 as well as the progress that is evident since a similar collection of medical school reports was published in September 2000, also as a supplement to Academic Medicine. Drawing on the reports, the authors summarize, among other topics, the advances that have taken place in the support for faculty, the funding of medical student education, changes in pedagogy and assessment, and the expansion of medical education to distributed models and regional campuses.The authors observe that the reports from the 128 schools illustrate that medical student education has undergone and continues to undergo substantive change, has advanced markedly since the reforms stimulated by the Flexner Report, and has continued to evolve during the past decade. The reports illustrate the strength of support for the educational programs, even in a time of financial constraints, and the increasing recognition of the scholarly contributions of faculty through teaching. The authors provide examples of the changes in pedagogy and new topics in the required curriculum in the past decade and describe selected highlights of the 128 educational programs.

Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a relatively newly recognized disease. A clinical profile of patients with this condition was first published in 1982.1 In that report, it was observed that the majority of patients were male. Patients presented with ventricular tachycardia of left bundle-branch block morphology. An enlarged right ventricle due to fibrofatty infiltration of the right ventricular free wall and a familial association were noted. It was considered to be a rare disease of unknown cause. Since then, it has been diagnosed with increasing frequency and has been reported to account for 3% to 5% of unexplained sudden cardiac death under the age of 65 years.2,3 Evidence of the disease is found in 30% to 50% of family members who are studied by noninvasive tests, including ECG, echocardiography, and signal-averaged ECG.4,5 It has been suggested that MRI may also be used for diagnostic purposes, but this remains controversial.6,7 Six genetic loci have been reported to be associated with ARVD/C, and 3 genes have been identified: ryanodine receptor (RyR2),8 plakoglobin (JUP),9and desmoplakin (DSM).10 There is autosomal dominant transmission with all the genetic forms except Naxos disease8 and Carvahal syndrome,11 both of which have autosomal recessive transmission. These 2 autosomal recessive disorders are variants of ARVD/C that are associated with skin and hair abnormalities. The cardiac presentation in Carvahal syndrome is that of a left ventricular cardiomyopathy and arrhythmias. With the recognition that ARVD/C is frequently familial and can cause arrhythmic death, the clinical challenge is how to definitively identify individuals with ARVD/C who have mild or minimal structural abnormalities of the right ventricle. Definite identification of minimal structural abnormalities of the right ventricle can be difficult because of the irregular shape and asymmetrical contractile pattern …

Sleep Disorders in Neurorehabilitation

INTRODUCTION Ethics has become a recognized component of health professions education over the past three decades.1 The Medical Professionalism Project launched by the European Federation of Internal Medicine, the American College of Physicians, and the American Board of Internal Medicine in 1999 placed medical ethics at the center of a charter of behaviors and attitudes for all physicians.2 In 2003, the Liaison Committee on Medical Education3 identified the teaching of medical ethics as a core curriculum component of modern medical education. In their recent review of ethics education in medical schools, Eckles and colleagues1 concluded that “deep shortcomings exist in all areas of the literature in the theoretical work done on the overall goals of medical ethics education; in the empirical studies that attempt to examine outcomes for students; and in the studies evaluating the effectiveness of various teaching methods.” The emergence of basic ethics education for nonphysician providers of medical care has evolved in a somewhat similar manner. In 1990, standards governing the accreditation of physician assistant (PA) programs recommended that programs “assist students develop basic intellectual and ethical principles essential for gaining and maintaining the confidence of the patient, the trust of professional associates, and the support of the community.”4 The importance of medical professionalism was introduced with the revised 1997 standards stating that “students should be taught the importance of biomedical ethics and professional responsibility in relation to their role as health care providers.” Medical Carl Fasser, PA, is director of the PA program at the Baylor College of Medicine (BCM); Amy McGuire, JD, MD, is assistant professor at the BCM Center for Ethics and Health Policy; Katherine Erdman, MPAS, PA-C, is assistant director; Dana Nadalo, MHS, PA-C is an instructor and coordinator of quality assurance; Shellie Scott, MPAS, PA-C is academic faculty; and Vicki Waters, MS, PA-C, is assistant director for experiential learning at the Baylor College of Medicine PA Program, Houston, Texas.

Achieving Diversity in Academic Internal Medicine: Recommendations for Leaders

Response to letter to the editor on "More than good seed: cultivating investigators from underrepresented minority backgrounds in physiatric research".

The Association of Obesity With Episodic and Chronic Migraine Randolph W. Evans MD, Randolph W. Evans MD From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).Search for more papers by this authorMichelle A. Williams ScD, Michelle A. Williams ScD From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).Search for more papers by this authorAlan M. Rapoport MD, Alan M. Rapoport MD From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).Search for more papers by this authorB. Lee Peterlin DO, Corresponding Author B. Lee Peterlin DO From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).B. L. Peterlin, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA.Search for more papers by this author Randolph W. Evans MD, Randolph W. Evans MD From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).Search for more papers by this authorMichelle A. Williams ScD, Michelle A. Williams ScD From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).Search for more papers by this authorAlan M. Rapoport MD, Alan M. Rapoport MD From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).Search for more papers by this authorB. Lee Peterlin DO, Corresponding Author B. Lee Peterlin DO From the Baylor College of Medicine, Houston, TX, USA (R.W. Evans); Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA (M.A. Williams); Department of Neurology, UCLA, Los Angeles, CA, USA (A.M. Rapoport); Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA (B.L. Peterlin).B. L. Peterlin, Johns Hopkins University School of Medicine, 4940 Eastern Avenue, Baltimore, MD 21224, USA.Search for more papers by this author First published: 08 March 2012 https://doi.org/10.1111/j.1526-4610.2012.02114.xCitations: 26 Conflict of Interest: The authors report no conflict of interest. Case histories submitted by: Randolph W. Evans, MD and B. Lee Peterlin, DO. Expert opinion by: Michelle A. Williams, ScD, Professor and Chair of Epidemiology, Harvard School of Public Health, Boston, MA, USA Alan M. Rapoport, MD, Clinical Professor of Neurology, UCLA, Los Angeles, CA, USA B. Lee Peterlin, DO, Assistant Professor of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume52, Issue4April 2012Pages 663-671 RelatedInformation