Subspecialty Fields Research Articles

Recruitment of New Physicians, Part I

Organizations are judged largely by the quality of their people and their output. It is therefore critical to obtain the best possible new physicians in the recruiting process. However, getting the finest doctor for the job may mean looking for someone who brings more than expertise in a subspecialty field such as nuclear medicine. The group doing the hiring may also want an individual who has expertise in business, leadership, computers, or other areas. It may be the group wants someone who is a star in research or teaching or whose name is recognized internationally. Other groups may want someone who is very fast or is prepared to take much call. It is also important to pick a person who will be happy in the location and practice, and get along well with other people.

Reporting the results of diagnostic neuromuscular ultrasound: An educational report

Neuromuscular ultrasound (NMUS), an emerging diagnostic subspecialty field, has become an important extension of the electrodiagnostic examination. However, there are no formal guidelines on how to appropriately report NMUS results. The AANEM convened an expert panel to develop recommendations for reporting NMUS findings. Providers should describe the reason for referral, the nerves or muscles studied, and normal values as well as numerical values for the results of imaging. Muscle imaging reports should also include a description of how gray-scale values were calculated. NMUS-guided needle placement reports should include a description of the length and gauge of needle, the type of probe used, and an indication of how well the patient tolerated the procedure. All reports should clearly state whether the findings were normal or abnormal and include a definitive diagnosis. NMUS reports should provide comprehensive information along with a succinct conclusion, mirroring guidelines for electrodiagnostic reports.

Work-Home Conflicts Have a Substantial Impact on Career Decisions That Affect the Adequacy of the Surgical Workforce

To evaluate factors associated with work-home conflicts (W-HCs) of US surgeons and their potential personal and professional consequences. Cross-sectional study. Members of the American College of Surgeons. Burnout, depression, quality of life, alcohol use, career satisfaction, and career decisions (ie, reduce work hours or leave current practice). Of 7197 participating surgeons, 3754 (52.5%) had experienced a W-HC in the previous 3 weeks. On multivariate analysis, hours worked per week, having children, sex, and work location (Veterans Administration or academic center) were independently associated with an increased risk for W-HC (all P < .01), while some factors (increased age and subspecialty field) reduced the risk. Surgeons with a recent W-HC were more likely to have symptoms of burnout (36.9% vs 17.1%; P < .001), depression (50.9% vs 28.1%; P < .001), alcohol abuse/dependency (17.2% vs 14.4%; P = .003), and were less likely to recommend surgery as a career option to their children (46.0% vs 54.4%; P < .001). Work-home conflicts were also independently associated with surgeons reporting a moderate or higher likelihood of planning to reduce clinical work hours (odds ratio, 1.769) and leave their current practice in the next 24 months for a reason other than retirement (odds ratio, 1.706) after controlling for other personal and professional factors. Integrating personal and professional lives is a substantial challenge for US surgeons. Conflict in this balance appears to be a major factor in their decision to reduce work hours and/or move to a new practice, with potential substantive manpower implications for the surgical workforce.

Tactical Emergency Medical Support Programs: A Comprehensive Statewide Survey

Background. Specially trained tactical emergency medical support (TEMS) personnel provide support to law enforcement special weapons and tactics (SWAT) teams. These programs benefit law enforcement agencies, officers, suspects, and citizens. TEMS programs are increasingly popular, but there are wide variations in their organization and operation and no recent data on their prevalence. Objective. We sought to measure the current prevalence and specific characteristics of TEMS programs in a comprehensive fashion in a single southeastern state. Methods. North Carolina emergency medical services (EMS) systems have county-based central EMS oversight; each system was surveyed by phone and e-mail. The presence and selected characteristics of TEMS programs were recorded. U.S. Census data were used to measure the population impact of the programs. Results. All of the 101 EMS systems statewide were successfully contacted. Thirty-three counties (33%) have TEMS programs providing medical support to 56 local law enforcement agencies as well as state and federal agencies. TEMS programs tend to be located in more populated urban and suburban areas, serving a population base of 5.9 million people, or 64% of the state's population. Tactical medics in the majority of these programs (29/33; 88%) are not sworn law enforcement officers. Conclusions. Approximately one-third of county-based EMS systems in North Carolina have TEMS programs. These programs serve almost two-thirds of the state's population base, using primarily nonsworn tactical medics. Comparison with other regions of the country will be useful to demonstrate differences in prevalence and program characteristics. Serial surveillance will help track trends and measure the growth and impact of this growing subspecialty field.

The Role of Neurocritical Care: A Brief Report on the Survey Results of Neurosciences and Critical Care Specialists

Neurocritical care is a new subspecialty field in medicine that intersects with many of the neuroscience and critical care specialties, and continues to evolve in its scope of practice and practitioners. The objective of this study was to assess the perceived need for and roles of neurocritical care intensivists and neurointensive care units among physicians involved with intensive care and the neurosciences. An online survey of physicians practicing critical care medicine, and neurology was performed during the 2008 Leapfrog initiative to formally recognize neurocritical care training. The survey closed in July 2009 and achieved a 13% response rate (980/7524 physicians surveyed). Survey respondents (mostly from North America) included 362 (41.4%) neurologists, 164 (18.8%) internists, 104 (11.9%) pediatric intensivists, 82 (9.4%) anesthesiologists, and 162 (18.5%) from other specialties. Over 70% of respondents reported that the availability of neurocritical care units staffed with neurointensivists would improve the quality of care of critically ill neurological/neurosurgical patients. Neurologists were reported as the most appropriate specialty for training in neurointensive care by 53.3%, and 57% of respondents responded positively that neurology residency programs should offer a separate training track for those interested in neurocritical care. Broad level of support exists among the survey respondents (mostly neurologists and intensivists) for the establishment of neurological critical care units. Since neurology remains the predominant career path from which to draw neurointensivists, there may be a role for more comprehensive neurointensive care training within neurology residencies or an alternative training track for interested residents.

An Alternative Mechanism for Clinical Medical Subspecialties' Accreditation and Recognition in Iraq and Other Developing Countries

In many nations around the world there has been increasing demand for scientific research and high-quality graduate medical education in subspecialty areas of medicine, surgery, and hospital-based specialties to provide a high standard of patient care. In North America, subspecialties have been evolving since the beginning of the 20th century.1 This evolution has been due in part to the introduction of new technologies and treatment modalities and growing awareness of the needs of patients with chronic disorders. Common health problems and diseases with known therapies continue to be managed by generalists, but for patients with complex diseases access to subspecialty care is critically important. In addition, having trained subspecialists contributes to discovery and the scholarly application of knowledge to patient care, with subspecialists functioning as scholarly leaders and educators in their field. In North America, subspecialists have made major and unique contributions to health care by advancing medical knowledge and technology and promoting excellence in the management of complex illnesses.2In present-day Iraq, the infrastructure for various subspecialties has not yet been established, a “modern” subspecialty physician workforce does not exist,3 and the requirement for subspecialty training as in North America and Europe currently cannot be met. The delay in the introduction of modern technologies and advances in medicine and surgery has been largely attributed to a lack of qualified faculty, educators, and leaders in various subspecialty fields. This has resulted in delay in building subspecialty centers. Particularly, training and recognition of surgical subspecialties and subspecialists in Iraq is not possible without the presence of qualified faculty to teach in these fields. The purpose of this letter is to propose an alternative mechanism for recognizing subspecialty clinicians in Iraq and other nations in similar circumstances.Historical accounts of the establishment of subspecialties in North America and Europe have identified the following steps4,5:Given the absence of these components in Iraq, a research-based subspecialty program concluding with a doctorate in the given subspecialty field rather than formal subspecialty training and board certificate may be more applicable:This approach bases subspecialty recognition on the valid criteria accessible in Iraq. Recognition granted by unqualified boards and councils cannot be substantiated and may not be valid or useful for the community.Advantages to this approach for developing subspecialty recognition in Iraq include (1) subspecialists recognized via this approach will have better knowledge, research skills, and likely clinical skills in the subspecialty field than the cohort of general specialists; (2) the process of recognizing the subspecialists will stimulate research in the subspecialty fields that may contribute to addressing health problems specific to the geographic region; and (3) the approach will provide the seed for the formation of future academic subspecialty boards. The largest potential drawback of this approach is that it lacks formal training programs for the subspecialty, and it is thus not possible to guarantee that it will create significant improvements in the clinical practice of the subspecialty, particularly in surgical subspecialties. Due to this shortcoming, the proposed approach is more appropriate for medical rather than surgical subspecialties. The aim of this proposal is to promote better research and accumulation of knowledge in the subspecialty areas, leading to enhancements in patient care.

Whatʼs New in Sports Medicine

It is once again an honor and a privilege to be asked to present this update for the subspecialty of sports medicine. Sports medicine continues to be an expanding subspecialty field that crosses many boundaries. As mentioned in previous updates, however, our central mission remains the same—the care of the athlete. This update is based on scientific and organizational activities in sports medicine that took place from September 2003 to August 2004. It includes a summary of the Annual and Specialty Day Meetings of the American Orthopaedic Society for Sports Medicine (AOSSM), the Arthroscopy Association of North America (AANA), and the American Academy of Orthopaedic Surgeons (AAOS). These meetings featured more than 200 scientific presentations, including both clinical and basic-science studies, that focused primarily on sports medicine. The three most influential journals in our field will be reviewed again this year, specifically, The Journal of Bone and Joint Surgery, The American Journal of Sports Medicine, and Arthroscopy. ### Anterior Cruciate Ligament The optimum graft choice for anterior cruciate ligament reconstruction remains controversial. Several recent randomized, controlled studies showed equivalent results in association with both bone-patellar tendon-bone and quadrupled hamstring grafts, effectively endorsing a “double gold standard.” An additional randomized, prospective trial from Australia showed satisfactory functional outcomes in association with both types of grafts after three years of follow-up1. As in other studies, however, the authors noted increased kneeling pain in the bone-patellar tendon-bone group and slightly increased laxity and femoral tunnel widening in the hamstring group. Recent histological studies have shown that neither type of graft regenerates to a normal functional tendon. In two independent studies involving the use of magnetic resonance imaging and ultrasound examination following bone-patellar tendon-bone graft harvest, the patellar tendon had not normalized by six to ten years postoperatively2,3. Both groups of authors …

Cardiovascular magnetic resonance imaging - a pictorial review

Cardiovascular magnetic resonance imaging (CMR) is a powerful problem-solving tool and arguably offers the most comprehensive assessment of cardiac morphology and function, as well as the opportunity of rebuilding the bridge between cardiologists and radiologists. The role of CMR-trained imaging physicists is also valuable, and many CMR centres harmoniously incorporate these three sub-specialty fields.&#x0D; This paper comprises an overview of several CMR techniques, outlining both the strengths and limitations of the modality.

National Survey to Identify Subspecialties at Risk for Physician Shortages in Canadian Academic Radiology Departments

Purpose To identify subspecialty fields in Canadian academic radiology departments that are at risk for future manpower shortages. To determine reasons for the potential shortages and suggest potential solutions. Methods An anonymous online survey was sent by e-mail to radiology residents and academic radiology department heads in Canada. The survey was open from April 1 to August 1, 2006. Statistical analysis by using the SAS Frequency Procedure was performed on the results. Results Interventional radiology, neuroradiology, mammography, cardiac imaging, and pediatric radiology were identified as areas in which there will be increasing workforce demands. Mammography, pediatric radiology, and cardiac imaging were identified as areas in which there will be a potential decrease in supply. Of the residents, 65.83% intended on pursuing subspecialty training. Priorities were interesting work, job availability, and work schedule. Nuclear medicine, mammography, pediatric radiology, and interventional radiology were identified as the top 4 areas in which residents specifically did not want to pursue further subspecialty training. Only 15% of resident respondents received career counseling during residency, and only 50% of those residents thought it was adequate. Conclusions Our survey results indicate that mammography, cardiac imaging, and pediatric radiology are at risk for manpower shortages, and interventional radiology may be at risk. Increased efforts to recruit trainees may be necessary to ensure that these subspecialties maintain their presence in the future. Only 15% of the surveyed residents received career counseling during residency. This is a relatively untapped forum that academic staff could use to help recruit new trainees into these underserved subspecialties.

Implementation Of Hematology-Oncology Lecture Series For Housestaff

Abstract Abstract 4554 BACKGROUND Currently, the hospital has a floor dedicated to cancer patients. The housestaff taking care of these patients includes three interns and one hematology-oncology fellow. In addition, there is a consult service comprising another fellow, an intern, and a resident. There was a paucity of formal, didactic, teaching in place devoted to the subjects of hematology and oncology. OBJECTIVE the development of a monthly lecture series for housestaff rotating on a hematology-oncology rotation that would focus on three key areas: a. What housestaff need to know to manage the patients on the hematology-oncology service b. What housestaff are most likely to encounter in the practice of medicine, regardless of eventual subspecialty field. c. What housestaff need to know for American Board of Internal Medicine exams. METHODS Topics were chosen based on pertinence. These included: leukemia, lymphoma, multiple myeloma, stem cell transplantation (these first four comprising at least 50% of patients on the unit), coagulation, breast cancer, lung cancer, colon cancer, gynecological malignancies, and pain management/supportive care. Potential speakers included full-time faculty as well as private physicians affiliated with the cancer center. Emails and/or phone calls were placed to the physicians and announcements made at division meetings and schedules developed. The plan was also for the development of a series of questions testing the housestaff at the start of their one month rotation and at the end of the rotation. Lectures were scheduled for afternoons if possible to avoid conflicts with morning rounds. Occasional morning talks were necessary to accommodate lecturers. Format of lectures was flexible (power point, dry-eraser board). RESULTS Overall feedback was positive for the lecture series. The two conditions affecting optimal success of the program concerned scheduling, including intern and fellow schedules as they relate to rounds and housestaff clinics and availability of when speakers could lecture and recruitment of speakers appropriate to the relevant topics. In addition, repeating the topics every month proved challenging for finding lecturing participants. The question/answer testing is still early in testing and no conclusion can be made. CONCLUSION A didactic lecture series is an important aspect of hematology-oncology education for housestaff. Repeating lectures every month is a challenge for several reasons. Possible interventions in the future may include: a. Focusing lecturing duties to full-time faculty, with an emphasis on faculty currently on service b. Creating power point presentations and handouts on file for use by multiple people so that rotating faculty may use these materials for talks c. Statistical analysis of scores from pre-rotation and post-rotation exams Disclosures: No relevant conflicts of interest to declare.

Immunologic endocrine disorders

Autoimmunity affects multiple glands in the endocrine system. Animal models and human studies highlight the importance of alleles in HLA-like molecules determining tissue-specific targeting that, with the loss of tolerance, leads to organ-specific autoimmunity. Disorders such as type 1A diabetes, Graves disease, Hashimoto thyroiditis, Addison disease, and many others result from autoimmune-mediated tissue destruction. Each of these disorders can be divided into stages beginning with genetic susceptibility, environmental triggers, active autoimmunity, and finally metabolic derangements with overt symptoms of disease. With an increased understanding of the immunogenetics and immunopathogenesis of endocrine autoimmune disorders, immunotherapies are becoming prevalent, especially in patients with type 1A diabetes. Immunotherapies are being used more in multiple subspecialty fields to halt disease progression. Although therapies for autoimmune disorders stop the progress of an immune response, immunomodulatory therapies for cancer and chronic infections can also provoke an unwanted immune response. As a result, there are now iatrogenic autoimmune disorders arising from the treatment of chronic viral infections and malignancies.

Update on the Surgical Management of Craniopharyngiomas

Despite advances in microsurgical and skull base techniques, the surgical treatment of craniopharyngiomas continues to pose a challenge to surgeons. Controversy continues to exist between proponents of subtotal resection in conjunction with radiotherapy, who argue that this less aggressive approach can yield equivalent control rates with lower morbidity, and others who argue for the superiority of gross total resection. Regardless of whether gross total or subtotal resection is the goal, surgical planning must include a thorough endocrine and neuro-ophthamologic evaluation as well as imaging, and the approach, whether trans-sphenoidal or transcranial, must take into account the nature of the tumor and its location. In addition, optimal management of craniopharyngiomas must consist of individualized and multidisciplinary therapy including an array of subspecialty fields such as endocrinology, neuro-ophthalmology, neuropsychology, and radiation oncology.

Reliability Study for Pediatric and Adolescent Gynecology Case-Based Learning in Resident Education

Objective To assess web-based teaching as a tool for resident education in pediatric and adolescent gynecology. Study Design Prospective Cohort involving 12 third year OB/GYN residents in a large university-based program. A second look reliability study on a previously utilized, web-based teaching case series in Pediatric and Adolescent Gynecology topics was evaluated. Residents' knowledge regarding the subject matter was assessed by pretest. After completion of the web-based teaching tool, a post test was administered. Residents were also given an opportunity to provide feedback regarding improvements to address future case series development for the tool and resident satisfaction in using this resource for resident education. Results The pre-test group mean score was 11.2 (58.9%), SD = 1.9. The post-test group mean score was 15.2 (80%), SD = 1.70. ( P = 0.0002). Resident participants universally reported the case series was a useful teaching tool. Pooled results from 2005–2006 and 2007–2008 also yielded statistically significant scores from pre test to post test (power of >80% at the 95% confidence interval). Conclusion A computer-based learning tool is an effective resource to improve baseline knowledge among ob-gyn residents in the subspecialty field of Pediatric and Adolescent Gynecology.

Factors Influencing Subspecialty Choice Among Radiology Residents: A Case Study of Pediatric Radiology

Persistent workforce shortages exist in some radiology subspecialties. Residents' motivations for selecting particular fellowships, as well as their perceptions of the subspecialty fields, heavily influence the supply of new radiologists to these areas. The authors investigated the factors residents consider most important in subspecialty choice, fellowship choice patterns between 1999 and 2008, and changes that might attract residents to one particular shortage field: pediatric radiology. An online questionnaire was developed and sent to 1,000 radiology trainees in the United States using contact information from the ACR's national resident database. Anonymized responses were evaluated using analysis of variance and logistic regression models. Leading factors for fellowship selection were "area of strong personal interest," "advanced/multimodality imaging," and "intellectual challenge." Compensation ranked low, 13th among 20 factors. Large shifts in subspecialty preference were seen between 1999 and 2008. Those with a pediatric radiology preference ranked "physician-physician interaction," "physician-patient contact," and "altruism" higher than respondents selecting other subspecialties. Respondents believed that pediatric radiologists make less money than other subspecialists ($325,000 vs $385,000 per year). There was no association between choosing pediatric radiology and gender, age, research plans, or parental status. Multiple factors account for subspecialty selection among residents, and it is useful to understand these factors when attempting to recruit residents to specific subspecialties. To ease the workforce shortage in pediatric radiology, advanced and varied imaging modalities, numerous job opportunities, and well-paid private practice positions should be emphasized to residents.

Impact Factor Wars: Episode V—The Empire Strikes Back

T oo bad it is not ‘‘A long time ago in a galaxy far, far away . . . ’’ Instead, it is the 21st century and European, Canadian, and American scientists are now in the grips of a menace that threatens their livelihood: the journal impact factor (a proprietary calculation based on journal citations and produced by the monolithic news and information empire Thomson Reuters) is being used in many places to determine academic employment, rank, tenure, and funding. In the past, few voices have protested the abusive power associated with journal impact factor, and publishers generally shrank in terror at the prospect of their journals being subjected to the ‘‘death penalty’’—removal from the Thomson Reuters journal impact factor listing. However, in 2007, the Executive Director of the powerful Rockefeller University Press, along with the Executive Editors of the Journal of Experimental Medicine and the Journal of Cell Biology, courageously questioned the validity and reliability of the journal impact factor calculations. These editorials (by Mike Rossner, Heather Van Epps, and Emma Hill) emboldened others to voice concerns about the use of an unverifiable and proprietary metric—journal impact factor—to evaluate the quality of scientific work. In the initial 1977 film (now designated ‘‘Episode IV’’) of the epic Star Wars movie series by George Lucas, the Galactic Empire uses a lethal show of force (the Death Star) to destroy the relatively insignificant planet Alderaan in order to frighten the rest of the galactic inhabitants (particularly those on the larger planets) into submission. Apparently, Thomson Reuters has decided to use a similar tactic: wielding its enormous power in a show of force against a tiny journal. As has been widely described, the journal impact factor is calculated by summing the total citations during a given year to articles published in the previous 2 years and dividing this by the number of ‘‘items’’ (a number derived secretively by Thomson Reuters) published in the journal during that same 2-year period. The ability of journal editors and publishers (particularly large and influential ones) to manipulate (and negotiate) the journal impact factor to achieve higher values has been well documented. Unfortunately, journals from small subspecialty fields are at a distinct disadvantage with fewer articles for possible citation, a smaller population of investigators, and little leverage to finagle higher journal impact factor values. Nonetheless, 2 clever scientists, Harm K. Schutte and Jan G. Svec, who work in a small scientific field published in the year 2007 an editorial in the official organ of the International Association of Logopedics and Phoniatrics (IALP)—Folia Phoniatrica et Logopaedica (published by S. Karger AG, Basel)—in which they cited all 66 articles published in that journal during the years 2005 and 2006. This strategy of self-citation raised the journal impact factor from a value of 0.655 for 2006 to 1.439 for 2007 and jumped the journal’s ranking by 9 places in the subject category of ‘‘Rehabilitation’’ (which only contains 27 journals). For investigators whose only scholarly outlet is publishing in this journal, such changes in journal status could profoundly affect their ability to compete for an academic livelihood. This permutation probably would have gone unnoticed but for a letter published in the September 11, 2008, issue of Nature. Subsequent reaction by Thomson Reuters was swift: just 4 weeks later on October 9, 2008, in Nature, James Testa reported that self-citation is ‘‘reviewed each year’’ and that journals will be removed from Journal Citation Reports until the ‘‘problem of excessive self-citation resolves and we can publish an accurate impact factor.’’ One strategy by journal editors to manipulate the journal impact factor has been to demand that authors cite articles from recent years of the journal (ie, self-citation). Thomson Reuters does not provide any criteria for acceptable self-citation, although it has been reported that up to 20% self-citation is common in most journals listed in the Journal Citation Reports. Received December 29, 2008. Accepted for publication December 29, 2008.

APEP - Anesthesiology Preceptorship Enrichment Program: A curriculum for first and second year medical students…an early look

The purpose of this educational innovation was to create a program for first and second year medical students (MS1s and MS2s) that would: (1) Provide students with early clinical exposure to the subspecialty field of anesthesiology, (2) Expose MS1s and MS2s to dedicated anesthesiologists serving as preceptors, (3) Enrich the students' basic science knowledge in a practical way using an integrated curriculum with clinical correlates and (4) Convey an accurate depiction of anesthesiology as a possible career choice. The Anesthesiology Preceptorship Enrichment Program (APEP) was designed for MS1s and MS2s as a seven month curriculum for each level, integrated with basic science course content. APEP students shadowed faculty from the Department of Anesthesiology (APEP preceptors). Guided by handouts, preceptors reviewed basic science concepts with clinical correlates. APEP encounters from October 2006-April 2007, October 2007-April 2008, and October 2008-April 2009 were documented and students completed a questionnaire about their experience. After three years, APEP has become a successful program, as evidenced by the increasing numbers of interested incoming students, active students and returning students. According to the end of program questionnaire, 38-68% of the APEP students used the APEP handouts to guide discussions with their preceptor, enhance intra-operative teaching, and/or refer to while studying for basic science course exams. According to the questionnaire, 71-80% of the APEP students were more interested in the field of anesthesiology after participating in APEP, 10-16% were neither more or less interested, and 4-19% were less interested. Early clinical exposure to anesthesiology with APEP was viewed as a very positive experience, increasing interest in anesthesiology at the MS1 and MS2 level. The APEP handouts were deemed a useful aid for discussion and created opportunities for teaching clinical correlates of basic science knowledge.

Whatʼs New in Sports Medicine

1Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22908-0159. E-mail address for M.D. Miller: [email protected]

Radiology in Israel: What Is Happening?

951 months of clinical rotation, and a 6-month basic science project. Radiology residents complete compulsory rotations through the imaging subspecialties. A committee of the Scientific Council of the Israel Medical Association supervises training facilities, and participating departments must conform to strict requirements. Small hospitals that are unable to provide all the required rotations are not granted full recognition and must send their residents for supplementary training in major medical centers. Currently, 19 medical centers and hospitals in Israel have partial or complete radiology training programs. Every training radiologist completes two certification examinations: a written examination halfway through the residency program and an oral examination during the final year of training. The written examination is offered annually and includes 160 multiple-choice questions covering nine subspecialty fields: cardiothoracic, musculoskeletal, pe di atric, gastrointestinal, genitourinary, and breast imaging and neuroradiology, inter ventional radiology, and sonography as well as a physics section. The oral examination is a standardized, structured examination offered biannually that includes nine stations according to the required subspecialty fields listed previously [4]. The radiology examination board has recently introduced a computerized Web-based system for preparation of the oral examination by expert radiologists from around the country. A similar system is now being developed for preparation of the written examination. Both the written and oral examinations are computer-based and use specialized software developed in Israel. A two-semester postgraduate course in radiology is offered by the Faculty of Medicine of the Tel Aviv University. Radiology residents from around the country attend this course, which covers most aspects of radiology in Radiology in Israel: What Is Happening?

Neurosurgery, “neurospine,” and neuroscience: a vital synergy?

A fundamental dilemma that faces both neurosurgery in general and the subspecialty field of spine surgery is the question of whether those who trained in the former and now work in the latter should maintain their links with their origins and remain under the broader umbrella of neurosurgery, or whether they should develop their own organizational structure and identity separate from organized neurosurgery. This challenge raises many questions with respect to future potential for growth and development, professional identity, and collegiality. This paper is an edited version of an invited speech to the 2007 Annual Meeting of the Joint Section on Disorders of the Spine and Peripheral Nerves. It uses the concept of synergy to review relevant history and explore possible future options for neurosurgery, neurospine, and neuroscience. An example from medical politics is used to illustrate the importance of perspective in approaching these questions, and examples of current therapeutic cutting-edge endeavors highlight the need for team-based behavior that takes a broad view. The premise of the paper is that while individual and specialty aspirations need to be acknowledged, considered, and managed, the results from truly working together will be greater than the sum of the individual efforts-synergy.

Internal Medicine Resident Perceptions of Optimal Training Duration

To describe internal medicine residents' opinions regarding the optimal duration of internal medicine residency training, and to assess whether these opinions are associated with specific career interests. A national cohort study was conducted during the 2005 Internal Medicine In-Training Examination (IM-ITE), which involved 382 of 388 (98.5%) U.S. internal medicine programs. A sample of 14,579 residents enrolled in three-year categorical or primary care training programs in the United States reported their opinions regarding optimal residency training duration on the IM-ITE 2005 Residents Questionnaire. Reported optimal training duration was assessed by postgraduate training year, sex, medical school location, program type, and reported career plan. Among the residents surveyed, 78.1% reported a three-year optimal length of internal medicine residency training, 15.3% preferred a two-year training duration, and 6.7% preferred a four-year duration. Residents planning careers in general medicine, hospital medicine, and subspecialty fields all preferred a three-year training duration (83.8%, 82.6%, and 75.9%, respectively). Residents planning subspecialty careers were more likely than those planning general or hospital medicine careers to prefer a two-year program (18.7% versus 7.4% and 8.3%). Residents planning generalist or hospitalist careers were more likely to favor a four-year program (8.9% and 9.1%, respectively) compared with residents planning subspecialty careers (5.4%). Most internal medicine residents endorse a three-year optimal duration of internal medicine residency training. This perspective should be considered in further national discussions regarding the optimal duration of internal medicine training.