Innovative partnerships to advance public health training in community-based academic residency programs.

Collaborative partnerships between community-based academic residency training programs and schools of public health, represent an innovative approach to training future physician leaders in population management and public health. In Kaiser Permanente Northern California, development of residency-Masters in Public Health (MPH) tracks in the Internal Medicine Residency and the Pediatrics Residency programs, with MPH graduate studies completed at the University of California Berkeley School of Public Health, enables physicians to integrate clinical training with formal education in epidemiology, biostatistics, health policy, and disease prevention. These residency-MPH programs draw on more than 50 years of clinical education, public health training, and health services research - creating an environment that sparks inquiry and added value by developing skills in patient-centered care through the lens of population-based outcomes.

Relationship Between Postinterview Correspondence From Residency Program Applicants and Subsequent Applicant Match Outcomes.

BACKGROUND: Studies show postinterview communication from applicants may affect their placement on the program's National Resident Matching Program (NRMP) rank order list. OBJECTIVE: To determine whether postinterview correspondence from applicants to a residency program is associated with the applicant's subsequent position on the program's rank list. METHODS: During 2 recruitment seasons, we collected postinterview correspondence from applicants to 1 residency program. Applicant characteristics and the content and timing of correspondence were compared with the applicant's position on the program's rank list. Data were analyzed using the Pearson χ(2) test. RESULTS: Of 470 applicants interviewed, 290 (61.7%) sent unsolicited correspondence to the program after interviewing. Ten percent (29 of 290) stated they planned to rank the program first, 11.7% (34 of 290) that they planned to rank it highly, and 78.3% (227 of 290) gave no indication of ranking intentions. Applicants who corresponded were no more likely to be ranked in the top 2 quartiles on the rank list than those who did not (P  =  .32) nor were applicants who communicated plans to rank the program "first" or "highly" ranked higher than other corresponding applicants (P  =  .34). Of the 16 applicants who planned to rank the program "first" and who were ranked in the program's match range, 5 did not match with the program, suggesting they may have misled the program. CONCLUSIONS: Postinterview correspondence by applicants was not associated with position on the rank order list. Correspondence does not benefit the applicant and can lead to misleading statements, which may violate the NRMP participation agreement.

Postoperative rhabdomyolysis following laparoscopic gastric bypass in the morbidly obese.

HYPOTHESIS: Laparoscopic approaches for weight reduction in the morbidly obese have become common with more than 50,000 bariatric surgical procedures being performed in 2001. The objective of this article is to raise awareness among surgeons of a new complication of rhabdomyolysis from this frequent procedure. DESIGN: Case series extracted from surgical database from January 2, 2001, through December 31, 2002. PATIENTS AND METHODS: We identified 5 cases of postoperative rhabdomyolysis in morbidly obese patients who underwent laparoscopic duodenal switch procedures with parietal gastrectomy. The cause, pathogenesis, and clinical features are reviewed and discussed. RESULTS: Postoperative rhabdomyolysis developed in 5 of 353 morbidly obese patients who underwent consecutive laparoscopic duodenal switch procedures, an incidence of 1.4%. All 5 patients were male, had a mean peak serum creatine kinase level of 19 680 U/L, and reported muscle pain in either the buttock, hip, or shoulder regions during the early postoperative period. CONCLUSIONS: We hypothesized that morbidly obese patients develop critical surface and deep tissue pressures during bariatric surgery, increasing their risk for tissue injury and rhabdomyolysis. Unexplained elevations in the serum creatinine level or reports of buttock, hip, or shoulder pain in the postoperative period should raise the possibility of rhabdomyolysis and prompt clinical investigation. We recommend routine preoperative and postoperative measurements of the serum creatine kinase and serum creatinine levels to aid detection. Surgeons need to keep a low index of suspicion because early diagnosis and treatment are the cornerstones of successful management of rhabdomyolysis.