Anesthesiology Resident Performance on the US Medical Licensing Examination Predicts Success on the American Board of Anesthesiology BASIC Staged Examination: An Observational Study

BACKGROUND: Correlation has been found between the US Medical Licensing Examination (USMLE) Step 1 examination results and anesthesiology resident success on American Board of Anesthesiology (ABA) examinations. In 2014, the ABA instituted the BASIC examination at the end of the postgraduate year-2 year. We hypothesized a similar predictive value of USMLE scores on BASIC examination success. METHODS: After the Committee for the Protection of Human Subjects at UTHealth Institutional Review Board approved and waived written consent, we retrospectively evaluated USMLE Step examination performance on first-time BASIC examination success in a single academic department from 2014-2018. RESULTS: Over 5 years, 120 residents took the ABA BASIC examination and 108 (90%) passed on the first attempt. Ten of 12 first-time failures were successful on repeat examination but analyzed in the failure group. Complete data was available for 92 residents (76.7%), with absent scores primarily reflecting osteopathic graduates who completed Comprehensive Osteopathic Medical Licensing Examination of the United States level examinations rather than USMLE. In the failure cohort, all 3 USMLE examination step scores were lower ( CONCLUSIONS: In anesthesiology residency training, our preliminary single-center data is the first to suggest that USMLE Step 1 performance could be used as a predictor of success on the recently introduced ABA BASIC Examination. These findings do not support recent action to change USMLE scoring to a pass/fail report

Perioperative Acute Kidney Injury

Perioperative organ injury is among the leading causes of morbidity and mortality of surgical patients. Among different types of perioperative organ injury, acute kidney injury occurs particularly frequently and has an exceptionally detrimental effect on surgical outcomes. Currently, acute kidney injury is most commonly diagnosed by assessing increases in serum creatinine concentration or decreased urine output. Recently, novel biomarkers have become a focus of translational research for improving timely detection and prognosis for acute kidney injury. However, specificity and timing of biomarker release continue to present challenges to their integration into existing diagnostic regimens. Despite many clinical trials using various pharmacologic or nonpharmacologic interventions, reliable means to prevent or reverse acute kidney injury are still lacking. Nevertheless, several recent randomized multicenter trials provide new insights into renal replacement strategies, composition of intravenous fluid replacement, goal-directed fluid therapy, or remote ischemic preconditioning in their impact on perioperative acute kidney injury. This review provides an update on the latest progress toward the understanding of disease mechanism, diagnosis, and managing perioperative acute kidney injury, as well as highlights areas of ongoing research efforts for preventing and treating acute kidney injury in surgical patients

Specific or Nonspecific? There Is Very Little Light at the End of the Tunnel Competing Interests Competing Interests

1 is an interesting attempt in an everlasting quest to establish reliable markers for postsurgical recovery. The authors hypothesized that by testing presurgical immunologic parameters, individuals with expected delayed recovery can be identified. Whole blood was stimulated with several ligands aimed at mimicking an immunologic environment in blood during surgery followed by a correlational study linking the activation of several pathways to the psychosomatic measures of recovery (fatigue, pain, and functional impairment). In conclusion, the authors showed an impressive correlation between the activation of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and studied clinical endpoints. Activation of the immune system is often a nonspecific act. NF-κB is one of the most ubiquitous proteins activated by virtually any stressor or insult to the immune system. It would be expected that NF-κB-mediated pathway will be activated during surgery-induced stress. The study confirmed a pretty wellestablished link between psychosomatic markers of well-being and generalized systemic inflammatory response heralded by activation of NF-κB. However, the nature of the study precludes a final determination that suggested pathways are truly a cause, not a bystander, of the impaired recovery. Another important question is whether any manipulation lowering the activation of NF-κB benefits patients and speeds up postsurgical recovery? The authors also pointed out that most of the immunologic pathways are interconnected; thus, affecting one of them will have widespread consequences. Furthermore, how much can the activation of the immune system be decreased or increased by manipulation of NF-κB or Toll-like receptor (TLR) 4 system? 2 The authors described a three-to five-fold difference between individuals with respect to the level of activation. Such a wide range of responses can affect statistical correlational analysis and Future research should continue to explore the important drivers of earnings differences for physicians beyond what we were able to examine in our study. Competing Interests The authors declare no competing interests. (Accepted for publication January 26, 2016.) In Reply: We thank Pivalizza et al. for the valuable input based on their experiences that they provided on our original article. We are limited by the data we collected in the survey and are therefore unable to examine all of the potential explanations for the gender earnings gap. We also attempted to limit speculation on aspects of the gender wage gap we could not measure by noting that some of the gap may be driven by individual preferences or constraints female anesthesiologists have, while some of it may be employer-driven. We did try to account for the types of facilities in which hours were worked and the percentage of time allocated to various types of care to account for some of the potential difference in the value of the time anesthesiologists are working. Unfortunately, we did not collect data on the times of day or days worked, so we cannot directly test your hypothesis. While we understand that your hypothesis is focused on the timing of call hours rather than on the total number of hours, we do have average weekly call hours and average call hours spent actively providing care. A quick check indicates that including average weekly call hours in the wage regression does reduce the gender earnings gap by $329 (please refer to the coefficient shown in table 7 in our article 1 ) or 0.5% of the total earnings gap. reasons, the decreased compensation for female anesthesiologists in the study may have a plausible explanation that was not proffered in the article