CK Scores Research Articles

Soluble IL-2 Receptor in Dermatomyositis: Its Associations with Skin Ulcers and Disease Activity.

Objective To investigate the role of soluble interleukin-2R (sIL-2R) in idiopathic inflammatory myopathies (IIM). Methods Serum sIL-2R levels were measured in 74 dermatomyositis (DM), 16 immune-mediated necrotizing myopathy (IMNM), 24 rheumatoid arthritis (RA), 20 systemic lupus erythematosus (SLE), and 20 healthy controls (HCs) by chemiluminescent immunometric assay. Clinical features and laboratory data were collected from electronic medical record. Disease activity was evaluated by using physician global disease activity and myositis disease activity assessment visual analog scale (MYOACT) on admission. 20 DM patients were followed. Serum sIL-2R levels were analyzed and compared with clinical features, laboratory data, and measures of disease activity. Results Serum sIL-2R levels were significantly higher in DM patients than in IMNM patients and HCs (648.8 ± 433.1 U/ml vs. 352.3 ± 126.0 U/ml and 648.8 ± 433.1 U/ml vs. 285.8 ± 101.9 U/ml, respectively; all P < 0.001), while there was no significant difference between IMNM and HCs. There were also no significant differences of sIL-2R levels in DM, SLE, and RA. Importantly, serum sIL-2R levels were significantly higher in treatment-naïve or active DM patients than those that are not (1100.9 ± 550.4 U/ml vs. 615.6 ± 330.4 U/ml, P = 0.006; 808.8 ± 421.6 U/ml vs. 339.8 ± 103.4 U/ml, P < 0.001). DM patients with skin ulcers had significantly higher sIL-2R levels than those without (889.3 ± 509.9 U/ml vs. 640.0 ± 368.7 U/ml, P = 0.023). Cross-sectional analysis in DM showed that sIL-2R levels positively correlated with CK, ESR, CRP, ferritin, physician VAS, and MYOACT scores (rho = 0.278, rho = 0.474, rho = 0.469, rho = 0.454, r = 0.646, and r = 0.600, respectively; all P < 0.05), negatively correlated with T cell counts and MMT8 scores (r = −0.380, P = 0.002; rho = −0.394, P = 0.001). Follow-up study showed that changes in sIL-2R levels after treatment correlated with changes in physician VAS and MYOACT scores (r = 0.823 and r = 0.695, respectively; all P < 0.01). Conclusion Serum sIL-2R levels were elevated in DM but not in IMNM. Serum sIL-2R could act as a disease activity marker and be associated with ulcerative skin lesions in DM.

The Change of USMLE Step 1 to Pass/Fail: Perspectives of the Surgery Program Director

ObjectiveThis study sought to evaluate the perspectives of surgical program directors regarding the change of USMLE Step 1 to pass/fail grading.DesignValidated electronic survey.SettingVanderbilt University Medical Center Department of Plastic Surgery.ParticipantsProgram directors of all ACMGE-accredited General Surgery, Integrated Vascular Surgery, Integrated Thoracic Surgery, and Integrated Plastic Surgery residency programs.ResultsThe overall response rate was 55.5%. Most PDs (78.1%) disagreed with the scoring change. Only 19.6% believe this change will improve medical student well-being. For 63.5% of PDs, medical school pedigree will become more important, and 52.7% believe it will place international medical graduates at a disadvantage. Only 6.2% believe Step 2 CK should also be pass/fail, while 88.7% will increase the weight of Step 2 CK and 88.4% will now require Step 2 CK score submission with the electronic residency application service.ConclusionsWhile well-intentioned, changing USMLE Step 1 to pass/fail may have unintended consequences and may disadvantage certain groups of applicants. The emphasis on Step 1, and resulting test-taking apprehension, will likely shift to Step 2 CK. Proponents of equitable evaluation should direct their efforts toward increasing, not decreasing, the number of objective measures available for student assessment.

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season

COVID-19 and the Radiology Match: A Residency Program's Survival Guide to the Virtual Interview Season

Do USMLE steps, and ITE score predict the American Board of Internal Medicine Certifying Exam results?

BackgroundTo evaluate if United States Medical Licensing Examination (USMLE) Step 1, USMLE Step 2 CK, USMLE Step 3, and residency third-year in-service training exam (ITE) scores predict the results of American Board of Internal Medicine Certifying Exam (ABIM-CE).MethodsWe performed a retrospective review of USMLE Step 1, USMLE Step 2 CK, USMLE Step 3, third-year residency ITE scores and ABIM-CE results of IM residents at our residency program from 2004 through 2017. Statistical analysis was perfrormed using Pearson correlation coefficient, and logistic regression to assess the relationship between USMLE Step 1, USMLE Step 2CK, USMLE Step 3, 3rd year ITE scores and ABIM-CE results. We used Multivariate logistic regression to predict pass or fail results in ABIM-CE based on USMLE and third-year ITE test scores controlling for other covariates.ResultsAmong 114 Internal Medicine MD residents included in the study, 92% (n = 105) passed the ABIM-CE. The OR of passing ABIM-CE was 2.70 (95% CI = 1.38–5.29), 2.31 (95% CI = 1.33–4.01), and 1.63 (95% CI = 0.81–3.29) with a ten-point increase in USMLE Step 1, USMLE Step 2 CK and USMLE Step 3 scores respectively. The OR of ABIM-CE passing chance was 2.96 (95% CI = 0.95–9.20), with a ten-point increase in the average score of the above three exams. A 5 % increase in ITE percentage raised the likelihood of passing ABIM-CE (OR 2.92, 95% CI 1.15–7.38). All residents who failed ABIM-CE had Step 1 scores < 220. Among 31 residents with Step 2 CK score < 220, 20% (n = 6) failed ABIM. Similarly, 9% of residents with USMLE Step 3 score < 220 failed ABIM-CE; all residents who failed had scored < 220. The probability curve predicted that the chance of passing ABIM- CE was around 80% with USMLE scores greater than 200 and increased to almost 100% with USMLE scores of 250 or more.ConclusionUSMLE Step 1, USMLE Step 2 CK, and third-year ITE scores can predict the chances of passing ABIM-CE. The third-year ITE score has a higher preditive value compared to USMLE Step 1 and USMLE Step 2 scores. USMLE Step 1 scores more predictive of ABIM-CE results compared to USMLE Step 2CK scores. Thus, residency programs can identify internal medicine residents at risk of failing ABIM-CE and formulate interventions at an early stage during residency training. Measures such as enrolling them in question banks or board review courses can be helpful in improving their chances of passing ABIM-CE.

Investigating the Relationship Between a Clinical Science Composite Score and USMLE Step 2 Clinical Knowledge and Step 3 Performance.

Previous research has found a moderate relationship between performance on individual clinical science subject examinations and USMLE performance. Given the widespread use of the clinical science subject examinations and the need for measures of clinical knowledge that help predict performance on Steps 2 CK and 3 and performance in residency training, this study explores the use of composite scores based on clinical science subject examinations to predict clinical knowledge outcome measures. The data set included students who took all of the five most widely used clinical science subject examinations (medicine, obstetrics and gynecology, pediatrics, psychiatry, and surgery) between January 1, 2013, and December 31, 2017 (N= 65,516). Composite scores were calculated based on average equated percent correct scores across various combinations of clinical science subject examinations. Stepwise linear regression analyses were performed with composite score and Step 1 score as predictor variables and Step 2 CK score or Step 3 score as the dependent variable. In all cases, the proportion of variance explained (R 2 ) by the composite score (0.62-0.65 for Step 2 CK score and 0.45-0.48 for Step 3 score) was greater than R 2 for Step 1 by itself (0.52 for Step 2 CK score and 0.37 for Step 3 score). Logistic regression analyses found that higher composite scores were associated with a greater probability of passing Steps 2 CK and 3. Composite scores can be used alone or in conjunction with Step 1 to identify students at risk of failing Step 2 CK and/or Step 3 to facilitate remediation.

Prematriculation Healthcare Employment Predicts Success in Clerkship Environment.

The average age of the matriculating medical student is increasing as more students take time between college and medical school. Increasing numbers of students are employed in the healthcare field during these gap years. Studies have explored the relationship between matriculation age and medical school performance with conflicting findings. The impact of prior healthcare employment (PHE) on future clerkship performance has not been explored. We hypothesize that medical school performance metrics would be higher for students with PHE than their peers. A retrospective review of four medical school classes at a single institution was conducted. Each student's admission application was examined to identify students with at least 6months paid employment in a clinical healthcare position (i.e., pre-matriculation direct patient interaction, PHE cohort). Multiple medical school performance metrics were obtained for each student. Of the 434 included students, 49 were PHE (11.29%) and percent of students with PHE trended up over time. MCAT scores, USMLE Step 1, and Step 2 CK scores were not different for PHE and non-PHE medical students. PHE students had significantly higher NBME subject exams, clinical clerkship scores, and cumulative year 3 performance. Students who matriculate to medical school with prior healthcare employment outperform their peers in the clinical environment, possibly due to acquisition of knowledge or skills from their prior employment. These findings support students seeking paid healthcare experiences prior to medical school and have implications for pre-medicine advising, admissions, and medical school curricula.

Student academic performance factors affecting matching into first-choice residency and competitive specialties

BackgroundAlthough specific specialties and residency programs have investigated student performance factors affecting matching, there is a paucity of information from medical schools. Furthermore, factors contributing to matching into first-choice residency have not been examined. This study aimed to identify academic performance factors affecting matching into first-choice residency and highly competitive specialties.MethodsThe authors conducted a study of 1726 graduates from their institution from 2010 to 2017 and assessed pre−/post-admission academic variables associated with matching into first choice and highly competitive specialties.Results53.9% of graduates matched into their first choice. This was associated with passing COMLEX Level 2 CE (p = 0.01), PE (p = 0.02) on first attempt, and higher COMLEX Level 2 CE and USMLE 2 CK scores (p < 0.001 and 0.002; 14.1 and 3.9-point difference in mean scores respectively). Pre-clinical GPA (p = 0.002) and highest MCAT score (p = 0.02) were associated, however differences in means were < 1 point for both. Factors associated with matching into first choice included: MCAT (OR 0.95, 95% CI = (0.92, 0.98)), Level 2 CE score (OR = 1.01, 95% CI = (1.01, 1.02)) and passing Level 2 PE (OR = 3.68, 95% CI = (1.2, 11.28)). 12% of graduates matched into high- and 63% into low-competitiveness specialties. Matching into highly competitive specialties was associated with passing COMLEX Level 1 (p < 0.001), Level 2 CE (p < 0.001), USMLE Step 1 (p < 0.001) and Step 2 CK (p = 0.03) on first attempt. Mean scores of students matching into high- versus low-competitiveness specialties differed as follows: COMLEX Level 1 62.7 points, Level 2 CE 50.5 points, USMLE Step 1 13.6 points, Step 2 CK 7 points (all p < 0.001), as did pre-clinical GPA (2.4 points, p < 0.001). Level 1 score was the strongest predictor for matching into highly competitive specialties (OR = 1.04, 95% CI = (1.02, 1.05)).ConclusionsLicensing exam performance is important for matching into first-choice residency and into highly competitive specialties. Differences in exam scores were more pronounced for matching into highly competitive specialties than into first choice, with a larger difference in mean scores between students matching into specialties of high versus low competitiveness, than between students matching into their first- versus non first-choice residency. These results may help faculty prepare students and inform curriculum design to improve matching.

Uncovering the Relation between CK and PCK: An Investigation of Preservice Elementary Mathematics Teachers’ Algebra Teaching Knowledge

This article discuss the algebra teaching knowledge of preservice elementary mathematics teachers in the context of CK and PCK as well as the relationship between them. The study was conducted with 101 preservice teachers sampled from a state university in Turkey. Rasch analysis was used to interpret the data. The results revealed that preservice teachers performed at mid-level for both CK and PCK tests. It was also found that there was significant correlation between the CK and PCK test scores. Weaknesses of the preservice teachers in terms of knowledge of the learner component of PCK, in comparison with presentation of content, were identified.

Factors Associated With Surgery Clerkship Performance and Subsequent USMLE Step Scores

We conducted an in-depth empirical investigation to achieve a better understanding of the surgery clerkship from multiple perspectives, including the influence of clerkship sequence on performance, the relationship between self-logged work hours and performance, as well as the association between surgery clerkship performance with subsequent USMLE Step exams' scores. The study cohort consisted of medical students graduating between 2015 and 2018 (n = 687). The primary measures of interest were clerkship sequence (internal medicine clerkship before or after surgery clerkship), self-logged work hours during surgery clerkship, surgery NBME subject exam score, surgery clerkship overall grade, and Step 1, Step 2 CK, and Step 3 exam scores. We reported the descriptive statistics and conducted correlation analysis, stepwise linear regression analysis, and variable selection analysis of logistic regression to answer the research questions. Students who completed internal medicine clerkship prior to surgery clerkship had better performance on surgery subject exam. The subject exam score explained an additional 28% of the variance of the Step 2 CK score, and the clerkship overall score accounted for an additional 24% of the variance after the MCAT scores and undergraduate GPA were controlled. Our finding suggests that the clerkship sequence does matter when it comes to performance on the surgery NBME subject exam. Performance on the surgery subject exam is predictive of subsequent performance on future USMLE Step exams.

Increasing the number of integrated vascular surgery residency positions is important to address the impending shortage of vascular surgeons in the United States

ObjectiveThe demand for vascular surgeons is expected to far exceed the current supply. In an attempt to decrease the training duration and to address the impending shortage, integrated vascular surgery residencies were approved and have expanded nationally. Meanwhile, vascular fellowships have continued to matriculate approximately 120 trainees annually. We sought to evaluate the supply and demand for integrated vascular residency positions as well as changes in the quality of applicants. MethodsWe conducted a retrospective review of national data compiled by the Association of American Medical Colleges and the National Resident Matching Program regarding integrated vascular surgery residency programs (2008-2015) and fellowships (2007-2016). Variables reviewed included the total number of applicants, sex, U.S. vs international medical school enrollment, applications per program, and applicants per position. In addition, we conducted a retrospective review of applicants to the University of Massachusetts Medical School integrated vascular surgery residency program from 2008 to 2015 to examine these variables and United States Medical Licensing Examination Step 1 and Step 2 CK scores over time. ResultsThe number of vascular surgery integrated residency positions increased from 4 in 2008 to 56 in 2015. Concurrently, the number of integrated residency applicants grew from 112 in 2008 to 434 in 2015. This increase has been predominantly driven by a 575% increase in U.S. graduate applicants and a 170% increase in women applicants. The percentage of international medical graduates has decreased by 17% during the study period. The total number of applicants per residency position increased from 5.9 to 7.8. Meanwhile, the number of vascular surgery fellowship positions remained stable with an applicant to position ratio near 1:1. At the University of Massachusetts Medical School, the mean United States Medical Licensing Examination Step 1 (226 to 235) and Step 2 CK (237 to 243) scores among integrated residency applicants have improved annually and typically exceed the national average among U.S. applicants who have matched in their preferred specialty. ConclusionsSince the approval of a primary certificate in vascular surgery and the subsequent rollout of integrated vascular residency programs, the number of residency programs and the quality of residency applicants have continued to increase. Demand from medical school applicants vastly outweighs the current supply of training positions by eightfold. In contrast, demand from fellowship applicants matches the supply of fellowship positions. The matriculation of additional trainees must be met with continued expansion of the integrated vascular surgery residency pathway to manage future public health needs.

Abstract No. 465 Making a case for more IR residency positions: comparing qualifications of medical students applying to IR/DR residencies to NRMP DR match data

To compare measurable qualifications of medical students applying to diagnostic radiology (DR) and interventional radiology/diagnostic radiology (IR) programs in order to promote and support creation of new IR residency positions. NRMP DR match outcome data (2016) and survey data from medical students applying for the upcoming match were used to compare measurable qualifications of medical students applying to IR residencies with those who match into DR residencies. DR data was based on NRMP data from 652 US allopathic seniors who matched in 2016. A total of 32 medical students completed the survey. Out of the students surveyed, 100% are planning on pursuing careers in IR. The majority of the student respondents were in their match application year (75%) and applying to both IR and DR residencies (100%). Students planned to rank IR programs ahead of DR programs (100%). No students intend to apply to only IR programs or DR programs without early specialization in IR (ESIR). Medical students pursuing IR residencies had better average Step 1 and Step 2 CK scores when compared to those who matched in DR (249 vs. 240 and 251 vs. 247, respectively). The percentage of students who had achieved AOA status was also higher among those applying to IR (31%) when compared to DR (18.4%). There were more research experiences and scholarly activity per applicant in the IR group (3.9 and 5.7) when compared to those who matched in DR (3.1 and 4.9). Both groups had similar work and volunteer experiences. Interestingly, there were more students matched into DR with Ph.D. or graduate degrees (5% and 15.4%) when compared to those applying to IR (3.1% and 9.4%). Medical students pursuing careers in IR perform better than their DR counterparts in several key measurable qualifications. DR residencies should favour starting an IR residency and existing IR residencies should consider expansion in order pursue these high caliber students as they appear driven to seek institutions that will satisfy their ability to train in IR.

Early experience with a combined surgical and obstetrics/gynecology clerkship: We do get along

BackgroundIn 2012, the Ohio State University College of Medicine (OSUCOM) implemented a new undergraduate medical curriculum. We compare outcomes of a third year traditional clerkship format to a combined Surgery and Obstetrics/Gynecology ‘ring’. MethodsPerformance outcomes of 4 consecutive classes were compared between pre- (2014, 2015) and post-curricular revision (2016, 2017). ResultsThree hundred ninety-one students consented use of their educational data for research. We examined medical knowledge (NBME scores, USMLE Step 1 and Step 2 CK scores) and student satisfaction between pre- and post-curricular revision. Results demonstrated no statistically significant difference in the Obstetrics/Gynecology NBME shelf examination. Surgery NBME and USMLE Step 2 scores were increased and statistically significant but satisfaction of both disciplines was higher pre-curricular revision. ConclusionMedical knowledge outcomes in this combined ’ring’ were similar to or higher than performance in previous years'. Future analyses are needed to assess the impact of OSUCOM curricular revision.

US Medical Licensing Examination Step 2 Clinical Knowledge Score in Dermatology Resident Selection

This survey analysis assesses the use of USMLE Step 2 CK scores in resident selection in US dermatology residency programs.

Development, implementation and assessment of a concussion education programme for high school student-athletes

ABSTRACTAlthough experts have noted that adolescent athletes should be educated about concussions to improve their safety, there is no agreement on the most effective strategy to disseminate concussion education. The purpose of this study was to develop, implement and assess a concussion education programme. More precisely, four interactive oral presentations were delivered to high school student-athletes (N = 35, Mage = 15.94, SD = 0.34) in a large urban centre. Participants completed a questionnaire at three time-points during the season to measure changes in their knowledge (CK) and attitudes (CA) of concussions, and focus group interviews were conducted following the concussion education programme. Questionnaire data revealed participants’ post-intervention CK scores were higher than their pre-intervention scores. During the focus groups, the student-athletes said they acquired CK about the role of protective equipment and symptom variability, and in terms of CA, they intended to avoid dangerous in-game collisions in the future. Our study was the first to create and deliver a concussion education intervention across multiple time-points, and to use mixed-methods in its assessment. These findings may be of interest to researchers, practitioners and stakeholders in sport who are invested in making the sport environment safer through concussion education and awareness.

Is VEGF a marker of severity of scrub typhus infection?

Vascular endothelial growth factor (VEGF) and its receptors have been reported as severity markers of septicemia. Scrub typhus (ST) results in multi-organ dysfunction but the role of VEGF has not been evaluated. We report VEGF and its receptors in ST and its correlation with severity, outcome and laboratory findings. Thirty patients with ST diagnosed by solid phase immune chromatographic assay and Weil-Felix tests were included. Their clinical details, Glasgow Coma Scale (GCS), SOFA and modified Rankin Scale (mRS) scores and laboratory findings were noted. VEGF, VEGFR1 and VEGFR2 were done by ELISA at admission and repeated at 1 month. Outcome was defined at 1 month. Serum VEGF and VEGF-R1 levels were significantly higher and VEGFR2 was significantly lower in the ST patients compared to the controls. These levels significantly improved at 1 month. VEGF level correlated with SOFA score (p = 0.05) and SGPT (p = 0.04). VEGFR1 correlated with hemoglobin (p = 0.04), platelet count (p = 0.03), serum CK (p = 0.001), weakness (p = 0.04) and mRS score (p = 0.04). VEGFR2 did not correlate with any clinical or laboratory parameters. All the patients recovered with doxycycline. Serum VEGF and VEGFR1 levels increased in ST and suggest disease severity but do not predict outcome.

The Correlation of COMLEX and USMLE Scores Among Osteopathic Applicants to Obstetrics and Gynecology Residency?

OBJECTIVE: To determine whether there is a correlation between COMLEX and USMLE scores for osteopathic students applying to the obstetrics and gynecology residency program at Reading Hospital. METHODS: Participant selection included osteopathic applicants to the Reading Health System's obstetrics and gynecology residency from 2010 to 2014, including both those students who took only the COMLEX and those who took both the COMLEX and the USMLE. After institutional review board approval, these data were abstracted from ERAS applications and de-identified for analysis. RESULTS: Eighty-two students took both COMLEX level 1 and USMLE step 1, with mean (standard deviation [SD]) scores of 528.5 (58.4) and 207.5 (14.4), respectively. Seventy-two students took both COMLEX level 2 CE and USMLE step 2 CK, with mean (SD) scores of 543.1 (83.9) and 222.7 (19.2), respectively. USMLE step 1 scores are positively correlated to COMLEX level 1 scores by Spearman correlation (r=0.74, P<.0001). This gives a predictive equation of USMLE step 1 score=108.89+0.1866×COMLEX level 1 score. USMLE step 2 scores are positively correlated to COMLEX level 2 scores by Spearman correlation (r=0.70, P<.0001). This gives a predictive equation of USMLE step 2 CK score=134.1+0.1631×COMLEX level 2 CE score. CONCLUSION: These results may suggest that both steps of USMLE scores are strongly correlated with both levels of COMLEX scores. Further research is indicated at other programs to gauge whether these results may be generalizable to a larger group than just the applicants to Reading Hospital.

Determining Predictors of Success on the American Board of Anesthesiology Written Certification Exam

Introduction The purpose of this research was to determine what, if any, relationship existed between in-training exams (ITE) given during the categorical years of anesthesiology residency training and first attempt performance on Part One of the American Board of Anesthesiology (ABA) certification examination (CE). Additionally, several variables available to residency program directors, to include gender, medical degree, medical school, and United States Medical Licensing Examination (USMLE) Step 1 and Step 2 CK scores, were analyzed to determine if a predictive relationship existed between any variable(s) and the Part One CE. Current research in anesthesiology only looked at PGY-II ITE scores, while other specialties have found relationships in later years of training not yet studied in anesthesiology.

Cultural values at the individual level and the malleability of ways of knowing

This research tested the relationship between individuals cultural values and the malleability in their ways of knowing in two social contexts. Two hundred and ninety-two college students majoring in either business or social sciences initially received two priming conditions (two weeks apart) where they reflected on either their in-group or their out-group. Then, their adherences to ways of knowing: separate knowing (SK, being a devil’s advocate) and connected knowing (CK, being perspective taker) and cultural values: collectivist-horizontal, collectivist-vertical, individualist-horizontal and individualist-vertical were assessed. Analyses revealed a priming condition X ways of knowing X cultural values interaction. When students had their in-group in mind, their CK score was significantly higher than their SK score in all cultural categories. When students had their out-group in mind, their CK scores decreased to comparable levels of their SK score in all cultural values except horizontal-collectivist. Students with a dominant collectivist-horizontal values maintained higher CK scores compared with their SK scores in the out-group condition. Implications for perspective-taking and critical thinking are discussed.

Duration of anatomy courses and performance on the USMLE Step 1 and Step 2 Examinations: Is there a relationship?

During the past two decades, anatomy instruction has changed due to curricular reforms in medical schools. Reduction in total hours of anatomy course and cadaver dissection, as well as shifts towards an integrated curricula has raised questions whether changes have had a negative impact on the students’ knowledge of anatomy. Our purpose was to investigate the effect of changes in course hours, curriculum type, and laboratory experience on USMLE Step 1 and Step 2 CK scores. Results of 2009 AAA online survey of anatomy course directors from 54 LCME‐accredited schools were matched with USMLE scores for 6,411 examinees taking Step 1 for the first time in 2009. The USMLE scores included Step 1 total test scores, Step 1 gross anatomy sub‐scores, and Step 2 CK total test scores. Analyses of data indicate that for all three USMLE scores, examinees from schools with stand‐alone gross anatomy courses slightly outperformed examinees from schools with integrated curricula. Conversely, the number of course hours had no effect on how students performed on Step 1 or Step 2 CK. Examinees that were exposed to both dissection and prosection slightly outperformed on Step 2 examinees that had dissection only. While these relationships are statistically significant, they may not be practically meaningful and more research is needed to fully explore different aspects of anatomy curricula and retention of anatomy knowledge.

The Surgical Clerkship: A Contemporary Paradigm

Introduction: Traditional Surgical clerkships have been composed of a mixture of hospitalized patients, daily resident interaction, periodic attending rounds, and assigned texts, often augmented by lectures. Recently, academic research has challenged the underpinnings of this traditional curriculum. Moreover, traditional clerkships do not necessarily mirror today's surgical practice given its increasing short-stay and out-patient emphasis. Initiated in 2001, the allopathic Florida State University College of Medicine provided an opportunity to create a contemporary surgical curriculum, emphasizing learning rather than teaching. Methods: The eight week FSU surgical clerkship is a tutorial model. at each of our six regional campuses, students are assigned one-on-one to a carefully selected, board-certified community surgeon, responsible for daily in-patient and out-patient teaching. the academic spine for the rotation is provided by a central curriculum, containing defined objectives and competencies, administered during weekly meetings with the student by campus-specific surgical clerkship directors. Residents do not participate in student teaching, nor are lectures used. Students are free to choose from among suggested print materials or alternative learning sources. Patient contacts are entered into an electronic data collection system, capable of comparing both student and individual campus experiences. Evaluations of student performance are 360 degrees: by patients, staff, clerkship faculty, and clerkship directors. Results: to date, 456 students have graduated. No significant differences exist between campuses with respect to either the numbers or types of patients encountered. USMLE Step II CK and CS scores, or NBME Surgery Subject Examination scores (p>.05). Student satisfaction with the course is evidenced by exceptionally positive responses to the end-of-clerkship evaluations of both faculty and clerkship at each of the campuses, and by anonymous laudatory responses by graduating seniors to the AAMC GQ Survey. Overall, 23.3% of graduates have chosen some aspect of Surgery as a career. the community faculty retention rate exceeds 97%. Conclusions: 1) A quality clerkship experience in Surgery can be provided by a non-traditional community-based system, 2) the distributed campus model does not lead to inequality of learning opportunities or surgical experiences, 3) Both students and community faculty strongly support the tutorial model, 4) Student learning has been confirmed by national metrics.