Financing U.S. Graduate Medical Education: A Policy Position Paper of the Alliance for Academic Internal Medicine and the American College of Physicians

In this position paper, the Alliance for Academic Internal Medicine and the American College of Physicians examine the state of graduate medical education (GME) financing in the United States and recent proposals to reform GME funding. They make a series of recommendations to reform the current funding system to better align GME with the needs of the nation's health care workforce. These recommendations include using Medicare GME funds to meet policy goals and to ensure an adequate supply of physicians, a proper specialty mix, and appropriate training sites; spreading the costs of financing GME across the health care system; evaluating the true cost of training a resident and establishing a single per-resident amount; increasing transparency and innovation; and ensuring that primary care residents receive training in well-functioning ambulatory settings that are financially supported for their training roles

Miliary tuberculosis and acquired immunodeficiency syndrome – ‘a cursed duet’

Tuberculous osteomyelitis is rare and usually involves the vertebrae but is seldom found in the foot. The uncommon site and ability to mimic other disorders clinically and radiographically leads to diagnostic and therapeutic delays. We report a case of a 40-year-old man who initially presented to his podiatrist with intermittent pain and swelling of his right ankle and foot that lasted for a year. He also started to exhibit significant weight loss and unexplained fevers and was subsequently hospitalized for cellulitis of his right foot. On further workup, patient was found to have miliary tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS). Patient was treated with anti-TB therapy for 9 months and highly active anti-retroviral therapy. Our patient presented with ongoing chronic right foot and ankle pain that was proven to be secondary to TB osteomyelitis of cuneiform bones of the right ankle in the setting of AIDS. The patient's clinical presentation was unusual due to symptom duration and lack of systemic characteristics. Like our case, reported incidence of osteomyelitis of bone/joint in extrapulmonary TB is estimated to be 10%, and out of all bones/joint TB cases, only 1% are found to be in the foot

Internal medicine resident perspectives on scoring USMLE as pass/fail

Background: The scoring rubric on the USMLE Step 1 examination will be changing to pass/fail in January 2022. This study elicits internal medicine resident perspectives on USMLE pass/fail scoring at the national level. Objective: To assess internal medicine resident opinions regarding USMLE pass/fail scoring and examine how variables such as gender, scores on USMLE 1 and 2, PGY status and type of medical school are associated with these results. Methods: In the fall of 2019, the authors surveyed current internal medicine residents via an on-line tool distributed through their program directors. Respondents indicated their Step 1 and Step 2 Clinical Knowledge scores from five categorical ranges. Questions on medical school type, year of training year, and gender were included. The results were analyzed utilizing Pearson Chi-square testing and multivariable logistic regression. Results: 4012 residents responded, reflecting 13% of internal medicine residents currently training in the USA. Fifty-five percent of respondents disagreed/strongly disagreed with pass/fail scoring and 34% agreed/strongly agreed. Group-based differences were significant for gender, PGY level, Step 1 score, and medical school type; a higher percentage of males, those training at the PGY1 level, and graduates of international medical schools (IMGs) disagreed with pass/fail reporting. In addition, high scorers on Step 1 were more likely to disagree with pass/fail reporting than low scoring residents. Conclusion: Our results suggest that a majority of internal medicine residents, currently training in the USA prefer that USMLE numerical scoring is retained and not changed to pass/fail

Extended ex vivo culture of fresh and cryopreserved whole sheep ovaries

We describe an original perfusion system for the culture of whole ovine ovaries for up to 4 days. A total of 33 ovaries were divided into six groups: control (n≤6), not perfused and fixed; Groups SM72 and SM72-FSH (n≤6 each), perfused with a simple medium for 72h with or without FSH; Groups CM96 and CM96-FSH (n≤6 each), perfused with a complex medium for 96h with or without FSH; Group CM96-FSH-cryo, (n≤3) cryopreserved and perfused for 96h with Group CM96-FSH medium. Depending on the medium used, morphological parameters of cultured ovaries differed from fresh organs after 72 (SM72, SM72-FSH) or 96 (CM96, CM96-FSH) h of perfusion. Oestradiol and progesterone were secreted in all groups but FSH had an effect only on Group CM96-FSH, stimulating continued oestradiol secretion 10 times higher than in all other groups. Morphological parameters and hormone secretion of cryopreserved ovaries were not different from fresh controls. This method enables the culture of whole ovaries for up to 4 days, the time required in vivo for 0.5-mm follicles to grow to 2.2mm and then for these follicles to reach the ovulatory size of 4mm or more. It could be used as a research tool or to complement current techniques for preserving female fertility