Reporting Achievement of Medical Student Milestones to Residency Program Directors: An Educational Handover.

PROBLEM: Competency-based education, including assessment of specialty-specific milestones, has become the dominant medical education paradigm; however, how to determine baseline competency of entering interns is unclear-as is to whom this responsibility falls. Medical schools should take responsibility for providing residency programs with accurate, competency-based assessments of their graduates. APPROACH: A University of Michigan ad hoc committee developed (spring 2013) a post-Match, milestone-based medical student performance evaluation for seven students matched into emergency medicine (EM) residencies. The committee determined EM milestone levels for each student based on assessments from the EM clerkship, end-of-third-year multistation standardized patient exam, EM boot camp elective, and other medical school data. OUTCOMES: In this feasibility study, the committee assessed nearly all 23 EM milestones for all seven graduates, shared these performance evaluations with the program director (PD) where each student matched, and subsequently surveyed the PDs regarding this pilot. Of the five responding PDs, none reported using the traditional medical student performance evaluation to customize training, four (80%) indicated that the proposed assessment provided novel information, and 100% answered that the assessment would be useful for all incoming trainees. NEXT STEPS: An EM milestone-based, post-Match assessment that uses existing assessment data is feasible and may be effective for communicating competency-based information about medical school graduates to receiving residency programs. Next steps include further aligning assessments with competencies, determining the benefit of such an assessment for other specialties, and articulating the national need for an effective educational handover tool between undergraduate and graduate medical education institutions.

Injury patterns at Isle Royale National Park: an epidemiologic review of injuries and illnesses sustained in a remote environment.

OBJECTIVE: Isle Royale National Park is a remote island in northern Lake Superior that attracts 16,000 visitors annually. The epidemiology of injuries and illnesses sustained by Isle Royale׳s visitors has not been previously studied. The purpose of this study is to examine these data and evaluate them for injury patterns. METHODS: This is a retrospective observational study examining the epidemiology of injuries and illnesses sustained during the period from 2008 to 2012. Incident reports completed by park rangers were reviewed and the data sorted according to time of year, time of day, type of medical encounter, and whether the patient was stable, unstable, or required transport. RESULTS: Two hundred and seventy patient care reports were obtained from the National Park Service. Sixty-four percent of encounters occurred in July and August, and most patients sought care in the afternoon. Care was provided by park rangers, the majority of whom were trained to the level of emergency medical technician. Fifty-eight percent of cases were trauma related, and 20% of all cases were evacuated. CONCLUSIONS: The majority of incidents were trauma related. The majority of the rangers on the island are trained to the level of emergency medical technician-B and appear to offer appropriate care to the island's many visitors, utilizing the National Park Service treatment protocols and comprehensive medical kits. In addition, access to advanced medical care is readily available by air and water evacuation.

Sclerostin antibody improves skeletal parameters in a Brtl/+ mouse model of osteogenesis imperfecta.

Osteogenesis imperfecta (OI) is a genetic bone dysplasia characterized by osteopenia and easy susceptibility to fracture. Symptoms are most prominent during childhood. Although antiresorptive bisphosphonates have been widely used to treat pediatric OI, controlled trials show improved vertebral parameters but equivocal effects on long-bone fracture rates. New treatments for OI are needed to increase bone mass throughout the skeleton. Sclerostin antibody (Scl-Ab) therapy is potently anabolic in the skeleton by stimulating osteoblasts via the canonical wnt signaling pathway, and may be beneficial for treating OI. In this study, Scl-Ab therapy was investigated in mice heterozygous for a typical OI-causing Gly→Cys substitution in col1a1. Two weeks of Scl-Ab successfully stimulated osteoblast bone formation in a knock-in model for moderately severe OI (Brtl/+) and in WT mice, leading to improved bone mass and reduced long-bone fragility. Image-guided nanoindentation revealed no alteration in local tissue mineralization dynamics with Scl-Ab. These results contrast with previous findings of antiresorptive efficacy in OI both in mechanism and potency of effects on fragility. In conclusion, short-term Scl-Ab was successfully anabolic in osteoblasts harboring a typical OI-causing collagen mutation and represents a potential new therapy to improve bone mass and reduce fractures in pediatric OI.