Assuring Integrity in the Residency Match Process

Integrity in medicine is essential. One of the most important competencies a medical student can master is to be honest at all times. Indeed, professionalism is a key competency in the identity formation and development of a medical student. At times, this competency becomes challenged during the resident matching process. The behavior of some students, faculty members, and program directors who participate in the residency program selection process (the Match) often falls short of this ideal when it comes to handling the process that will be most dispositive in directing the future careers of graduating medical students. Violations of both National Resident Matching Program (NRMP) rules and ethical norms have been reported in the literature and experienced by students. In this Invited Commentary, the authors recommend a series of reforms. Substantially more robust enforcement of NRMP rules should be considered, including the creation of an avenue for anonymous reporting by applicants who experience inappropriate pre-Match, post-interview communications

Predicting, Preparing for, and Creating the Future: What Will Happen to Internal Medicine?

It is the year 2025. During the past 20 years, internal medicine as a discipline continued to become less prestigious, less respected, and more fragmented. As fewer medical students chose internal medicine as a career, residency programs began to close. Those that remained open filled with fewer graduates of US medical schools but filled with more US citizens who graduated from international medical schools, more graduates of osteopathic medical schools, and more foreign graduates of international medical schools. Due to lack of adequate remuneration and a shift of primary care provision from generalist physicians to nurse practitioners and physician assistants, training in general internal medicine as a patient care specialty ceased. Generalist internal medicine careers have been replaced by tracks designed to foster health services research or academic careers; internal medicine training graduates subspecialty physicians. Although the projected collapse of Medicare in 2019 was avoided, severe cuts in federal funding for undergraduate and graduate medical education programs forced medical schools and residency programs to compete for federal funds. As a result, medical school tuition became prohibitive, for-profit health care systems viewed medical education as a significant cost center and chose to limit the size of their residency programs, and community-based training programs could not withstand the financial pressures and closed. The result was a reduced supply of internists. Furthermore, compliance with the regulatory burden imposed by accrediting organizations—such as the Accreditation Council for Graduate Medical Education—drove individuals from sustained careers in education, further impacting the viability of training programs

Interleukin-1 induced gene expression of neutrophil activating protein (interleukin-8) and monocyte chemotactic peptide in human synovial cells

We report here that human synovial cells stimulated by interleukin-1[alpha] and interleukin-1[beta] express mRNA for both IL-8 (neutrophil chemotactic peptide) and monocyte chemotactic protein. IL-1 stimulated synovial cells from both osteoarthritis and rheumatoid arthritis patients exhibited similar mRNA expression of interleukin-8 and monocyte chemotactic protein. A capacity to produce factors selectively chemotactic for neutrophils, lymphocytes and monocytes provides a mechanism whereby synovial cells can facilitate inflammatory arthritis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29493/1/0000579.pd

Creation of ultracold molecules from a Fermi gas of atoms

Since the realization of Bose-Einstein condensates (BEC) in atomic gases an experimental challenge has been the production of molecular gases in the quantum regime. A promising approach is to create the molecular gas directly from an ultracold atomic gas; for example, atoms in a BEC have been coupled to electronic ground-state molecules through photoassociation as well as through a magnetic-field Feshbach resonance. The availability of atomic Fermi gases provides the exciting prospect of coupling fermionic atoms to bosonic molecules, and thus altering the quantum statistics of the system. This Fermi-Bose coupling is closely related to the pairing mechanism for a novel fermionic superfluid proposed to occur near a Feshbach resonance. Here we report the creation and quantitative characterization of exotic, ultracold $^{40}$K$_2$ molecules. Starting with a quantum degenerate Fermi gas of atoms at T < 150 nanoKelvin we scan over a Feshbach resonance to adiabatically create over a quarter million trapped molecules, which we can convert back to atoms by reversing the scan. The small binding energy of the molecules is controlled by detuning from the Feshbach resonance and can be varied over a wide range. We directly detect these weakly bound molecules through rf photodissociation spectra that probe the molecular wavefunction and yield binding energies that are consistent with theory

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Accelerated Graduation and the Deployment of New Physicians During the COVID-19 Pandemic

The COVID-19 pandemic has presented unprecedented challenges and opportunities for medical schools in the United States. In this Invited Commentary, the authors describe a unique collaboration between the University of Massachusetts Medical School (UMMS), the only public medical school in the state; the University of Massachusetts Memorial Medical Center (UMMMC); and the Commonwealth of Massachusetts. Through this partnership, UMMS was able to graduate fourth-year medical students 2 months early and deploy them to UMMMC to care for patients and alleviate workforce shortages during the COVID-19 surge, which peaked in Massachusetts in April 2020. The authors describe how they determined if students had fulfilled graduation requirements to graduate early, what commencement and the accompanying awards ceremony looked like this year as virtual events, the special emergency 90-day limited license these new graduates were given to practice at UMMMC during this time, and the impact these new physicians had in the hospital allowing residents and attendings to be redeployed to care for COVID-19 patients

In Reply to Ramotshwana et al

Comment on: Accelerated Graduation and the Deployment of New Physicians During the COVID-19 Pandemic. Flotte TR, Larkin AC, Fischer MA, Chimienti SN, DeMarco DM, Fan PY, Collins MF. Acad Med. 2020 Oct;95(10):1492-1494. doi: 10.1097/ACM.0000000000003540 and: New Physicians, New Challenges: The Impact of Accelerated Graduation and Deployment Due to COVID-19. Ramotshwana B, Gupta A, Seth S, Shah H. Acad Med. 2021 May 1;96(5):e15. doi: 10.1097/ACM.0000000000003996