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The editors discuss updates with the journal

In Honor of Our Peer Reviewers

This editorial is our annual recognition of our peer reviewers

Effectiveness of iterative interventions to increase research productivity in one residency program.

BACKGROUND: The Accreditation Council for Graduate Medical Education requires residency programs to expose residents to research opportunities. OBJECTIVE: The purpose of this study was to assess the impact of a series of iterative interventions to increase scholarly activity in one internal medicine residency. METHODS: Retrospective analysis of the effectiveness of a series of interventions to increase resident and faculty scholarly productivity over a 14-year period was performed using quality improvement methodology. Outcomes measured were accepted regional and national abstracts and PubMed indexed manuscripts of residents and faculty. RESULTS: Initially, regional meeting abstracts increased and then were supplanted by national meeting abstracts. Sustained gains in manuscript productivity occurred in the eighth year of interventions, increasing from a baseline of 0.01 publications/FTE/year to 1.57 publications/FTE/year in the final year measured. Run chart analysis indicated special cause variation associated with the interventions performed. CONCLUSIONS: Programs attempting to stimulate research production among faculty and residents can choose among many interventions cited in the literature. Since success of any group of interventions is likely additive and may take years to show benefit, measuring outcomes using quality improvement methodology may be an effective way to determine success

The red hearing: swollen ear in a patient with ulcerative colitis

Relapsing polychondritis is a rare connective tissue disease of unknown etiology characterized by recurrent inflammation, degeneration and deformity of auricular cartilage. The autoimmune inflammation may also affect cartilage at other sites including nose, larynx, trachea and bronchi. Here, we present a case of relapsing polychondritis in a patient with ulcerative colitis. We also review the presentation, diagnosis and management of this condition

An unusual cause of hypoglycemia in a middle-aged female after bariatric surgery

Non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) is a disorder characterized by postprandial hypoglycemia and islet cell hypertrophy. It is an uncommon complication of weight-loss surgery. However, with the rising incidence of gastric bypass surgeries, it is important to be able to recognize the clinical picture of NIPHS and not to incorrectly ascribe the symptoms to late dumping syndrome

Design of a clinical competency committee to maximize formative feedback.

BACKGROUND: As the next phase in the roll-out of Next Accreditation System, US residency programs are to develop Clinical Competency Committees (CCCs) to formally implement outcome-based medical education objectives in the resident assessment process. However, any changes to an assessment system must consider balancing formative and summative tensions, flexibility and standardization tensions, fairness and transparency to learners, and administrative burden for faculty. OBJECTIVES/METHODS: In this article, one program discusses the approach one internal medicine residency took to create a developmental model CCC. In this model, a learner\u27s mentor presents the argument for competence to the CCC, while a second reviewer presents challenges to that argument to the rest of the committee members. The CCC members provide other insights and make recommendations. The mentor presents the final committee recommendations to that resident, who then works with the mentor to develop a plan for future action. RESULTS: CCC second reviewers spent an average of 30.4 min (SD: 11.4) preparing for each resident\u27s discussion, a duty performed 5-7 times every 6 months. Faculty development was associated with an increase in the number of action-oriented comments in the meeting minutes (3.2-4.1 comments per resident, CONCLUSION: Developmental model CCCs may be feasible for residency programs, but faculty development may be necessary

Rater Perceptions of Bias Using the Multiple Mini-interview Format: a Qualitative Study

Introduction The Multiple Mini-Interview (MMI) format appears to mitigate individual rater biases. However, the format itself may introduce structural systematic bias, favoring extroverted personality types.  This study aimed to gain a better understanding of these biases from the perspective of the interviewer. Methods A sample of MMI interviewers participated in a series of primary and follow-up one-on-one semi-structured interviews.   Interviews pursued subjects of perception of biases (including norming; applicant personality, appearance and behavior; and interviewer personality) associated with the MMI process.  Emergent qualitative data analysis was performed using the constant-comparative method. Results A number of perceived biases were identified by subjects, sub-grouped into cultural factors, personality factors, perception of prior preparation, concerns with norming, and biases associated with specific applicant characteristics. Discussion While the MMI appears to help mitigate individual rater biases, our analysis suggests that raters perceive structural systematic biases may be introduced by the question type and format of the MMI itself.  Whether rater awareness of these biases mitigates them, and whether these herald other unconscious biases is unknown

Interventions to increase research publications in graduate medical education trainees: a systematic review.

Introduction: Competency-based educational models recommend trainee exposure to research, but the best methods for Graduate Medical Education (GME) programs to accomplish this have not been clarified. The objective of this study was to quantify published interventions to generate resident research and compare effectiveness among those interventions. Material and methods: A systematic review of English-language articles of studies of GME programs was performed, describing resident research interventions and quantifying the number of publications as an outcome. Results: The search produced 13,688 potentially relevant articles, and included 47 articles in the final synthesis. Publication effectiveness was calculated as publications per year. The top ten programs for publication effectiveness were compared to others for interventions chosen. Interventions were characterized as research director, protected time, research requirement, research mentor, curricula, research assistant, biostatistician, information technology support, research fund, pay-for-performance plans, and celebration of accomplishments. Total number of different interventions was not significantly associated with primary outcome ( Conclusions: Leadership interventions (directors, curricula) are associated with successful GME research efforts

Cardiac sarcoidosis and ventricular arrhythmias. A rare association of a rare disease. A retrospective cohort study from the National Inpatient Sample and current evidence for management

Background: Sarcoidosis is an increasingly recognized multi-systemic condition. Cardiac sarcoidosis is associated with ventricular arrhythmias and higher mortality rates. Little epidemiological data is available regarding the disease and associated ventricular arrhythmias. Methods: Data from the National Inpatient Sample (NIS) database 2012–2014, were reviewed. Dis­charges associated with sarcoidosis were identified as the target population using relevant ICD-9-CM codes. Primary outcome was a diagnosis of ventricular tachycardia (VT) in the sarcoidosis population. Secondary outcomes include rate of ventricular fibrillation (VF) and cardiac arrest. Subgroup analyses were performed to examine the association of VT with multiple potential confounding clinical variables. Results: Of 18,013,878 health encounters, 46,289 (0.26%) subjects had a diagnosis of sarcoidosis. VT and VF were more prevalent among patients with sarcoidosis compared to those without a diagnosis of sarcoidosis (2.29% vs. 1.22%; p < 0.001 and 0.25% vs. 0.21%; p < 0.001, respectively). Sarcoidosis was also associated with a higher prevalence of cardiac arrest (0.72% vs. 0.6%; p < 0.001). In unadjusted analyses, all examined comorbidities were significantly more common in those with sar­coidosis, including diabetes mellitus (31.6% vs. 21.25%; p < 0.001), hypertension (65.2% vs. 51.74%; p < 0.001), chronic kidney disease (21.09% vs. 14.02%; p < 0.001), heart failure (24.87% vs. 15%; p < 0.001) and acute coronary syndrome (4.32% vs. 3.35%; p < 0.001). Conclusions: The present study showed that sarcoidosis was associated with increased rates of ven­tricular tachyarrhythmia, which can affect the overall disease morbidity and mortality