Medical School Research Research Articles

Organizational Culture in an Academic Health Center

Implementing cultural change and aligning organizational cultures could enhance innovation, quality, safety, and job satisfaction. The authors conducted this mixed-methods study to assess academic physician-scientists' perceptions of the current and preferred future organizational culture at a university medical school and its partner health system. In October 2010, the authors surveyed academic physicians and scientists jointly employed by the University of Oxford and its local, major partner health system. The survey included the U.S. Veterans Affairs Administration's 14-item Competing Values Framework instrument and two extra items prompting respondents to identify their substantive employer and to provide any additional open-ended comments. Of 436 academic physicians and scientists, 170 (39%) responded. Of these, 69 (41%) provided open-ended comments. Dominant hierarchical culture, moderate rational and team cultures, and underdeveloped entrepreneurial culture characterized the health system culture profile. The university profile was more balanced, with strong rational and entrepreneurial cultures, and moderate-to-strong hierarchical and team cultures. The preferred future culture (within five years) would emphasize team and entrepreneurial cultures and-to a lesser degree-rational culture, and would deemphasize hierarchical culture. Whereas the university and the health system currently have distinct organizational cultures, academic physicians and scientists would prefer the same type of culture across the two organizations so that both could more successfully pursue the shared mission of academic medicine. Further research should explore strengthening the validity and reliability of the organizational culture instrument for academic medicine and building an evidence base of effective culture change strategies and interventions.

Inhibitory effects of methotrexate on spontaneous motility and Cajal-like type of tubal interstitial cells in rabbit oviduct

To study the adverse biomechanical effects of methotrexate (MTX) on spontaneous tubal motility and on a widely distributed Cajal-like type of tubal interstitial cells (t-ICC) in rabbits. In our previous study, MTX was confirmed to cause acute endosalpingitis, and ultrastructural and steroid receptor damage in rat's endosalpinx in a dose-dependent manner. Differences in spontaneous tubal contractions and cellular distribution of t-ICC in isthmus were evaluated in response to MTX. Medical school research laboratory. Twenty nonpregnant female New Zealand albino rabbits in estrus stage were divided equally into four groups. Rabbits received IM MTX (1, 5, 10 mg/kg body weight) and controls received physiological saline. On day 7, in vitro motility studies measuring spontaneous tubal contractions were performed, and cellular distribution of t-ICC was determined by immunohistochemistry. Methotrexate produced a concentration-dependent inhibition of spontaneous isthmus contractions (frequency in 5, 10 mg/kg groups, and amplitude in 1, 5, 10 mg/kg MTX groups). It decreased significantly compared with the control group. Meanwhile, MTX at 5, 10 mg/kg decreased the population of c-kit immunoreactive t-ICC significantly. The decreased t-ICC may contribute to the diminished tubal smooth muscle contractility caused by MTX as observed. Tubal interstitial cells might be new potential targets for a variety of dysfunctional tubal motility diseases.

Repowering the ovary

Massachusetts General Hospital and Harvard Medical School researchers have devised a way to generate viable oocytes from human germline stem cells. The findings have been licensed by OvaScience, which plans to use the oocyte precursor cells to develop several platforms for restoring fertility in vitro and in vivo.

2HG on the brain (tumor)

Harvard Medical School researchers have shown that noninvasive detection of a key metabolite in the brain can diagnose IDH1-mutant tumors. Agios plans to use the method for the preclinical development of its glioma therapies.

Phospholipase C-ζ-induced Ca2+ oscillations cause coincident cytoplasmic movements in human oocytes that failed to fertilize after intracytoplasmic sperm injection

ObjectiveTo evaluate the imaging of cytoplasmic movements in human oocytes as a potential method to monitor the pattern of Ca2+ oscillations during activation.DesignTest of a laboratory technique.SettingUniversity medical school research laboratory.Patient(s)Donated unfertilized human oocytes from intracytoplasmic sperm injection (ICSI) cycles.Intervention(s)Microinjection of oocytes with phospholipase C (PLC) zeta (ζ) cRNA and a Ca2+-sensitive fluorescent dye.Main Outcome Measure(s)Simultaneous detection of oocyte cytoplasmic movements using particle image velocimetry (PIV) and of Ca2+ oscillations using a Ca2+-sensitive fluorescent dye.Result(s)Microinjection of PLCζ cRNA into human oocytes that had failed to fertilize after ICSI resulted in the appearance of prolonged Ca2+ oscillations. Each transient Ca2+ concentration change was accompanied by a small coordinated movement of the cytoplasm that could be detected using PIV analysis.Conclusion(s)The occurrence and frequency of cytoplasmic Ca2+ oscillations, a critical parameter in activating human zygotes, can be monitored by PIV analysis of cytoplasmic movements. This simple method provides a novel, noninvasive approach to determine in real time the occurrence and frequency of Ca2+ oscillations in human zygotes.

The Effect Of Academic “Misrepresentation” on Residency Match Outcomes

Studies have uniformly demonstrated misrepresentation of accomplishments by applicants to residency programs; yet it is unknown whether such applicants have a competitive advantage in the MATCH. Herein we identify the factors that influence an applicant's successful selection to a competitive residency. Comparative study of 317 dermatology residency applicants during the 2007 application season. successful matching of an applicant into a U.S. dermatology residency. Factors positively associated with matching in univariate analysis included age (p=0.023); membership, Alpha Omega Alpha honors society (p=0.007); medical school research rank (p=0.013); USMLE scores (p<0.001); and number of unpublished manuscripts (p<0.001). Factors not associated with matching included the number of published manuscripts (p=0.460) and the combined impact factor of all published manuscripts (p=0.490). Multivariate analysis revealed that the USMLE Step 1 score (p=0.001), medical school research rank (p=0.040), and total number of unpublished manuscripts (p=0.046) were significantly associated matching in dermatology. Male gender trended towards but did not reach significance (p=0.054). Applicants that list multiple unpublished manuscripts have a significant competitive advantage in matching into a dermatology residency, even if these manuscripts remain unpublished.

J021024 交通事故実態調査に基づく腹部傷害メカニズムの解析

Nihon University and Nippon Medical School research the traffic accident. This study analyzed anatomical damage and the vehicle damage of the findings from medical and engineering. Abdominal injury is the largest in seatbelt user's death and serious injury rate. Generating mechanism should be solved fast. The research example which abdominal injury occurred had the feature which the sheet bearing has damaged. It case had been suffered abdominal injury seatbelt is removed from the pelvic region. Abdominal injury, it is necessary for the anatomical evaluation of AIS of bleeding increases with time, even minor injuries. To simulate the behavior obtained from the survey crew, we want to clarify the generation mechanism of abdominal injury.

Disentangling effort and performance: a renewed look at gender differences in commercializing medical school research

Recently, questions about gender gaps in science have extended to academic technology transfer. Using systematic data on US medical school faculty, we capture both behavior and performance, examining the hypothesis that women are less likely than men to commercialize their research findings. We pooled faculty invention data from ten departments in three Academic Health Centers from 1991 to 1998—a period when pat- enting had become prevalent and other researchers note that a gender gap was pronounced. Rather than focusing on patenting, we capture the first step in the commercialization process, as well as the subsequent successful licensing of faculty inventions to a company. We find no significant gender differences in the likelihood of reporting inventions or successfully commercializing them. We do find differences in the number of inventions reported, however, with women disclosing fewer inventions than their male counterparts. Our results demonstrate that gender effects are highly conditioned by employment context and resources. We attribute differences in our findings with regards to gender to the use of outcome measures that capture both behavior and performance, and the inclusion of a more extensive set of control variables.

CUASF: Fostering clinician-scientists in Canadian urology

Clinician-scientists play a pivotal role in the gap between biomedical research and clinical practice, formulating important patient-focused research questions and then translating novel findings back to the clinic. There has been increasing documentation and dialogue over the last three decades around the decline in the number of clinician-scientists as well as a shift of focus, for those still actively engaged, away from patient-based investigation.1 One can appreciate the growing concern of stagnation in an exclusively technical expertise, particularly in surgical specialties, without the constant reconstruction afforded by the development and implementation of novel clinical and basic science knowledge. Although postulated explanations for the decline of the clinician-scientist are multiple and varied, most have revolved around issues of training/mentorship, time and financial disincentives. Many of these perceived barriers seem to start early with several published reports documenting the ambivalent attitude towards the value of biomedical research in both medical school and residency training.2 However, many initiatives in Canada may have started to address this disinclination towards research endeavors by practicing physicians. Some of these include increasing early exposure to research at the medical school level, initiating medical scientist training programs, fostering research in sub-specialty fellowships and developing essential Canadian Institutes of Health Research (CIHR) and other non-for-profit clinician-scientist awards. Mirroring some optimistic reports from the United States, Lander and colleagues recently reported a study suggesting that Canadian clinician-scientists are awarded an increasing proportion of CIHR research grants and salary awards.3 Although this study paints a fairly optimistic picture, the barriers to most of our newly minted surgical-scientists are still significant with, at best, ad hoc university resources to address issues of protected time from clinical responsibilities and salary support without well-defined, coordinated national policies or programs. The Canadian Urological Association Scholarship Fund (CUASF) was established in 1973 as a means of supporting promising Canadian urologic researchers and therefore to facilitate Canadian urology research productivity. This early career award plays a vital role within our specialty, enabling young clinical-scientists get their foot in the door with respect to peer-reviewed support and financial backing at a critical point in their careers. Over the last 28 years, the CUASF has supported more than 91 academic urologists, as well as many community-based and international physicians, with a commitment to advancing biomedical research in urology. Reviewing this month’s CUAJ, it is notable there is at least one previous CUASF scholarship recipient listed as an author in every article. With an increasing impact factor (most recently 1.72), CUAJ is proud to contribute to the mission of the urological research community in Canada. As Associate Editor of CUAJ and the Chair of the CUASF, I would like to acknowledge and congratulate this year’s CUASF scholarship winners: Frederick Pouliout – Universite Laval Sero Andonian – McGill University Rodney Breau – University of Ottawa Naji Touma – Queen’s University Blayne Welk – University of Western Ontario Jennifer Mickelson – University of British Columbia

Changes in family functions in patients with secondary premature ejaculation

Amac: Bu calismada akkiz prematur ejakulasyonu (PE) olan bireylerde ailesel islevlerdeki degisikliklerin arastiril­masi amaclandi. Gerec ve yontem: Calismamizda PE grubu Mustafa Ke­mal Universitesi Tip Fakultesi Arastirma Hastanesi Uroloji poliklinigine basvuran hastalardan secildi. Kontrol grubu ise saglikli gonulluler arasindan secildi. Uroloji poliklini­ginde hastalar ejakulasyon suresine gore incelendi. Bir donem herhangi bir sikayeti olmadigi halde bir suredir ejakulasyon suresi bir dakikadan kisa olan ve bundan si­kayeti olan bireylerde PE oldugu kabul edildi. Toplam 30 katilimci PE grubu olarak, 30 saglikli gonullu de kontrol grubu olarak calismaya dahil edildi. Daha sonra bu kati­limcilar psikiyatr tarafindan degerlendirildi. Tum katilimci­lara Beck Ansiyete Olcegi ve Aile Degerlendirme Olcegi uygulandi. Bulgular: PE grubunda anksiyete duzeyi kontrol gru­bundan daha yuksekti (p=0.001). Aile degerlendirme ol­ceginde PE grubunda problem cozme (p=0.001), iletisim (p=0.022), duygusal cevap verebilme (p=0.011), davranis kontrolu (p=0.032), gereken ilgiyi gosterme (p=0.011) alt olceklerinde puanlar kontrol grubuna gore anlamli olarak daha yuksekti. Genel fonksiyonlar (p=0.217) ve roller (p=0.133) acisindan anlamli farkliliga rastlanmadi (p>0.05). Sonuc: PE hastalarinda ailesel islevlerde bozulma oldu­gu soylenebilir, dolayisiyla bu hastalarin tedavisinde aile­sel islevlere yonelik yaklasimlar fayda saglayabilir.

Fenestration of the internal carotid artery mimicking floating thrombus on CT and MR angiography

<h3>Background</h3> The Valsalva manoeuvre (VM) is used to treat supraventricular tachycardia (SVT) by inducing a vagal response (drop in HR). There is debate as to the best position in which to carry out the VM and how the strain should be delivered in practice. We aimed to compare vagal responses induced with supine and modified VMs using strains delivered with a standardised manometer or novel Valsalva Assist Device (VAD), a simple device to provide resistance to exhalation. <h3>Methods</h3> We conducted a repeated measures randomised trial of four VMs (two supine VM and two modified VMs), in healthy adult volunteers, with strains delivered using an adapted sphygmomanometer (manometer) or a VAD. Changes in HR, pressure and duration of strain and adverse events were monitored and compared between the techniques and devices. The trial was approved by the University of Exeter Medical School Research ethics committee. <h3>Results</h3> 75 healthy participants aged 19–55 years were recruited over a 4-month period. A mixed-effects linear regression showed the modified VM resulted in a 3.8 beats per min (bpm) greater drop in HR compared with the supine VM (p=0.002, 95% CI 2.2 to 5.4). VM strains produced by the VAD were of a similar pressure but of slightly shorter duration and resulted in a 1.9 bpm smaller drop in HR compared with the manometer (p=0.01, 95% CI 0.4 to 3.4). There were no differences in adverse events. <h3>Conclusions</h3> Modified VM was associated with a greater drop in HR than a supine VM with no increase in adverse events in healthy volunteers. The VAD can be used to safely generate the recommended VM strain pressure, but produced a smaller drop in HR compared with a manometer and requires modification to enable the recommended strain duration to be achieved consistently. <h3>Trial registration number</h3> NCT03298880.

A Comprehensive Research Curriculum to Prepare Physician-Investigators: Design, Implementation and Early Outcomes

The Cleveland Clinic Lerner College of Medicine (CCLCM) was established as one of three tracks in the Case Western Reserve University (CWRU) School of Medicine Program to prepare physician investigators through rigorous, comprehensive, longitudinal research training in a five-year undergraduate medical education setting. The curriculum includes specific research activities and dedicated research time, which culminates in a masterslevel thesis. The track has an administrative structure to facilitate student access to research-related opportunities. Basic scientists and clinicians participate in all curricular activities thereby fostering communication across the clinical medicine/research divide. The track features a centralized, portfolio-based assessment system. In this track, students submit portfolios to demonstrate their progress toward mastering nine competencies including research. A comprehensive program evaluation is in place to monitor the curricular impact on students. Results show that the CCLCM track has attracted a subset of students interested in research careers. Two cohorts of students (n = 56) have graduated. The Promotions Committee determined that all graduates successfully met the performance standards for the research competency. These graduates scored above mean USMLE Step 1 subscores in biostatistics and epidemiology. They successfully completed a research thesis where approximately 60% of the topics addressed basic science and translational research. Over 40% of graduates also obtained a masters degree concurrently with their medical degrees. Furthermore, 23% of CCLCM graduates received competitive awards to support their medical school research activities. Recommendations are included to expose students to research in multiple venues to create and sustain a passion for rigorous problem-solving Conclusions offer lessons learned from our experience.

Cutaneous human papillomavirus-related immune reconstitution-associated disease in human immunodeficiency virus: an under-recognized phenomenon

British Journal of DermatologyVolume 164, Issue 2 p. 458-459 Cutaneous human papillomavirus-related immune reconstitution-associated disease in human immunodeficiency virus: an under-recognized phenomenon Correction(s) for this article Erratum Volume 165Issue 1British Journal of Dermatology pages: 228-228 First Published online: June 24, 2011 R. Meys, R. Meys Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC. Macedo, C. Macedo Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorR. Jones, R. Jones Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorS. Day, S. Day Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorJ. Weir, J. Weir Department of Histopathology,Charing Cross Hospital,London W6 8RF, U.K.Search for more papers by this authorF.M. Gotch, F.M. Gotch Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC.B. Bunker, C.B. Bunker Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this author R. Meys, R. Meys Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC. Macedo, C. Macedo Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorR. Jones, R. Jones Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorS. Day, S. Day Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorJ. Weir, J. Weir Department of Histopathology,Charing Cross Hospital,London W6 8RF, U.K.Search for more papers by this authorF.M. Gotch, F.M. Gotch Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this authorC.B. Bunker, C.B. Bunker Departments of Dermatology,HIV and Genitourinary Medicine and Immunology,Chelsea and Westminster Hospital,London SW10 9NH, U.K.Search for more papers by this author First published: 29 October 2010 https://doi.org/10.1111/j.1365-2133.2010.10109.xCitations: 5 Christopher Bunker.E-mail: cbb@hamderm.demon.co.uk Funding sources: The Chelsea and Westminster Health Charity, the Westminster Medical School Research Trust and START (the Skin Treatment and Research Trust) generously provided funding that assisted in the generation of this item of correspondence. Conflicts of interest: none declared. 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 Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume164, Issue2February 2011Pages 458-459 RelatedInformation

Does the Duration of a Scholarly Concentration Affect Medical Studentsʼ Productivity?

To the Editor: In an insightful article discussing the research and scholarship experience at Duke and Stanford, Laskowitz et al1 highlight the challenge of ensuring that students have adequate time for scholarly concentrations (SCs), given multiple competing demands within the already dense medical school curriculum. For example, at Duke the time dedicated to research during year 3 has shortened from 10 to 12 months to less than 4 months. However, the consequences of abbreviating the SC experience are not discussed. Likewise absent from Bierer and Chen's2 otherwise excellent review is a discussion of the relationship between SC time and meaningful outcomes. Such information could help guide educators faced with the challenge of implementing or maintaining SCs. In a 2008 study,3 we evaluated the relationship between time allotted for an SC (in this case, a required medical school research experience) and research productivity, as determined by peer-reviewed full-length articles (retrieved from Medline) related to the student's required research experience, published abstracts, and extramural research presentations. Over the course of the study, the duration of the SC progressively shortened from 21 to 17 or 18 and then to 13 weeks. We found no differences across these varying durations in the proportion of students publishing an article or abstract or presenting at a scientific meeting. Our results suggest that shorter SCs may facilitate research productivity similar to that facilitated by longer SCs. As Bierer and Chen2 suggested, more rigorous research designs and greater use of conceptual frameworks will deepen our understanding of how SCs affect learners' behaviors. In addition, we must clarify how SC features such as duration, structure (e.g., focused blocks versus a longitudinal experience), and mentoring influence meaningful outcomes. Liselotte N. Dyrbye, MD, MHPE Associate professor of medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota; [email protected]. David Cook, MD, MHPE Professor of medicine and director, Office of Education Research, College of Medicine, Mayo Clinic, Rochester, Minnesota.

Quantitative assessment of somatosensory-evoked potentials after cardiac arrest in rats: Prognostication of functional outcomes*

High incidence of poor neurologic sequelae after resuscitation from cardiac arrest underscores the need for objective electrophysiological markers for assessment and prognosis. This study aims to develop a novel marker based on somatosensory evoked potentials (SSEPs). Normal SSEPs involve thalamocortical circuits suggested to play a role in arousal. Due to the vulnerability of these circuits to hypoxic-ischemic insults, we hypothesize that quantitative SSEP markers may indicate future neurologic status. Laboratory investigation. University Medical School and Animal Research Facility. : Sixteen adult male Wistar rats. None. SSEPs were recorded during baseline, during the first 4 hrs, and at 24, 48, and 72 hrs postasphyxia from animals subjected to asphyxia-induced cardiac arrest for 7 or 9 mins (n = 8/group). Functional evaluation was performed using the Neurologic Deficit Score (NDS). For quantitative analysis, the phase space representation of the SSEPs-a plot of the signal vs. its slope-was used to compute the phase space area bounded by the waveforms recorded after injury and recovery. Phase space areas during the first 85-190 mins postasphyxia were significantly different between rats with good (72 hr NDS >or=50) and poor (72 hr NDS <50) outcomes (p = .02). Phase space area not only had a high outcome prediction accuracy (80-93%, p < .05) during 85-190 mins postasphyxia but also offered 78% sensitivity to good outcomes without compromising specificity (83-100%). A very early peak of SSEPs that precedes the primary somatosensory response was found to have a modest correlation with the 72 hr NDS subscores for thalamic and brainstem function (p = .066) and not with sensory-motor function (p = .30). Phase space area, a quantitative measure of the entire SSEP morphology, was shown to robustly track neurologic recovery after cardiac arrest. SSEPs are among the most reliable predictors of poor outcome after cardiac arrest; however, phase space area values early after resuscitation can enhance the ability to prognosticate not only poor but also good long-term neurologic outcomes.

The Flame Photometer as Engine of Nephrology: A Biography

In the 1940s, the flame photometer made possible for the first time relatively simple and quick measurements of sodium and potassium in serum and urine. During World War II, it unexpectedly fell into the hands of John P. Peters of Yale University, who sought to understand water and electrolyte physiology and apply such knowledge to patient problems. Pupils and young associates of Peters would seed the early nephrology divisions and training programs in the United States; the flame photometer was essential to their work and that of their trainees, both Americans and international visitors. Hyponatremia and the syndrome of inappropriate antidiuretic hormone secretion became the "attribute" disorders of nephrologists. Invention of a microflame photometer fostered the revival of micropuncture and transport studies. In the 1960s, the flame photometer was linked to Leonard Skeggs' sequential automated analysis system, leading to enormous numbers of routine measurements of electrolytes. The growing number of nephrologists, then based mostly at teaching hospitals, thus found plentiful instances of sodium and potassium abnormalities to address. The autoanalyzer also catalyzed use of the anion gap, another emblem of nephrology in its early decades. Not only ideas and theories, but also the usually invisible machinery, enable the growth of a knowledge base and formation of a scientific discipline or medical specialty. Of course, the flame photometer did not itself shape the agenda of nephrology, but it allowed the most influential group of progenitors and their progeny to explore normal function and bring a strongly physiologic imperative to their daily work with patients.

Promoting pain resolution

Harvard Medical School researchers have shown that resolvins could help treat inflammatory pain at least as effectively as and more safely than, opioids or COX-2 inhibitors. The findings could open up a new indication for Resolvyx Pharmaceuticals Inc., which is developing resolvins to treat inflammatory indications.

The Generalist Disciplines in American Medicine One Hundred Years Following the Flexner Report: A Case Study of Unintended Consequences and Some Proposals for Post-Flexnerian Reform

Abraham Flexner's analysis of U.S. medical education at the turn of the 20th century transformed the processes of student selection and instruction, the roles and responsibilities of faculty members, and the provision of resources to support medical education. Flexner's report also led to the nearly universal adoption of the academic medical center as the focal point of medical school teaching, research, and clinical activities. In this article, the authors describe the effects of the dissemination of this model and how the subsequent introduction of public funding for research and patient care transformed academic health centers and altered the composition of the physician workforce, resulting in the proliferation of specialties. They also describe how these workforce changes, along with the evolution of health care financing during the late 20th century, have led to a system that affords the most scientifically advanced and potentially efficacious care in the world, yet so profoundly fails to ensure affordability and equitable access and quality, that the system is no longer sustainable. The authors propose that both health care system reform and medical education reform are needed now to restore economic viability and moral integrity, and that a key element of this process will be to rebalance the generalist and specialist composition of the physician workforce. They conclude by suggesting that post-Flexnerian reform of medical education should include broadening the scope of criteria used to select medical students and reshaping the curriculum to address the evolving needs of patient care during the 21st century.

Targeting platelets in RA

Harvard Medical School researchers have identified a collagen receptor on platelets, GPVI, as a target in rheumatoid arthritis. Inhibiting the target would represent a new approach for treating RA, but local delivery could be required, as blocking platelets systemically could carry a risk of bleeding.

A survey on the attitudes towards research in medical school

BackgroundAn observed decrease of physician scientists in medical practice has generated much recent interest in increasing the exposure of research programs in medical school. The aim of this study was to review the experience and attitudes regarding research by medical students in Canada.MethodsAn anonymous, cross-sectional, self-report questionnaire was administered to second and fourth year students in three medical schools in Ontario between February and May of 2005. Questions were primarily closed-ended and consisted of Likert scales. Descriptive and correlative statistics were used to analyze the responses between students of different years and previous research experience.ResultsThere was a 47% (327/699) overall response rate to the questionnaire. Despite 87% of respondents reporting that they had been involved in some degree of research prior to medical school, 43% report that they have not been significantly involved in research activity during medical school and 24% had no interest in any participation. There were significant differences in the attitudes towards research endeavors during medical school between students in their fourth year compared to second year. The greatest barriers to involvement in research in medical school appear to be time, availability of research mentors, formal teaching of research methodology and the perception that the student would not receive appropriate acknowledgement for work put towards a research project.ConclusionThe results of this self-report survey outline the significant differences in attitudes towards mandatory research as a component of critical inquiry and scholarship in the undergraduate curriculum in Ontario medical schools.