A comparison of medical students and program directors\u27 perceived skill needs for internship\u27

Introduction: Stakeholders in the training of subinterns have varying perspectives on priorities for this important clinical experience. Existing assessments of student goals and internal medicine residency program directors opinions on expectations for readiness to function as an intern have not been compared. Research questions: What have previously gathered surveys indicated about student and program directors priorities for the subinternship rotation? What are the areas of difference and common ground between these assessments? Methods: Students starting internal medicine subinternship at the University of New Mexico between April 2010 and April 2012 and at Ohio State University between July 2012 and July 2013 were surveyed regarding their goals for the rotation. Responses were grouped and tabulated based on thematic analysis. In 2010, the Clerkship Directors in Internal Medicine (CDIM) subinternship task force performed a survey of internal medicine clerkship directors to identify skills expected in new interns. 36 items were scored to reflect perceived level of priority. Additionally, \u27free text\u27 responses could be entered. These were compiled into a separate list of common themes. Results: 40 students completed the survey at the University of New Mexico and 175 at Ohio State University. The goals most often written were increasing medical knowledge (n=186), management skills (105), radiology/EKG interpretation (52), procedures (46), pharmacology (43), efficiency (43), medical emergencies (30), laboratory usage (28), ordering (25) and physical exam skills (18). 282 of 377 program directors completed the 2010 CDIM subinternship task force survey. The highest overall priorities were: time management (n=345), knowing when to seek assistance (315), communicating with nurse/nurse triage (251), communicating in a culturally sensitive manner (227), information management (226), coordinating care with other health care workers (206), ethics of informed consent (204), providing an organized written sign-out (204), providing an organized verbal sign-out (200) and facility in using electronic databases (199). Discussion: Students\u27 and program directors\u27 goals for their subinternship rotation provides useful information about perceived gaps and areas of growth potential. Data gathered in 2013 suggests students mainly want to increase medical knowledge and develop skills in patient management, including operational tasks. Program directors ranked development of recognizing situations and communication skills as the most important domains for new internal medicine interns. These responses may reflect experience with problems borne from lack of these skills. Not surprisingly, both groups surveyed gave a moderate to high level of importance to efficiency.\u2

Ovarian Carcinoma With Isolated Spinal Cord Metastasis

Ovarian cancer metastasis to the spinal cord is quite rare, and few case reports have been published previously. Herein, we present a case of a patient who was treated for ovarian cancer and was thought to be disease free for 17 months, then presented with lower limb weakness. She was found to have a T11-T12 metastatic intramedullary spinal cord lesion. On pathology, the diagnosis of metastatic ovarian adenocarcinoma was made. This report highlights the importance of maintaining a low threshold for ovarian cancer metastases to the spinal cord when patients present with neurologic sequelae, even in the setting of normal laboratory values, as early detection can prevent permanent neurological consequences