Matching Against Men: 5 Years of Residency Match Data Show Disparities Still Exist.

OBJECTIVES: Despite progress toward equal representation by sex in medical practice, women remain underrepresented in many specialties. This study sought to examine the current state of gender equality among recently graduated doctors in multiple specialties. METHODS: Deidentified demographics, standardized examination scores, and Match results were gathered for 829 graduates. Participants were selected from an allopathic medical school between 2016 and 2020. Nineteen students (2.29%) were excluded from the study. Descriptive statistics were calculated, and χ2 tests for independence were used to compare proportions between reported sex and specialty and program Match results. One-way analysis of variance was then performed to test for differences in US Medical Licensing Examination Step 1 and Step 2 scores between sexes. P < 0.05 was considered statistically significant. RESULTS: Of the 829 individuals studied, 44.6% were women. A significantly smaller proportion of women matched into the most competitive specialties, despite no significant difference in US Medical Licensing Examination Step 1 scores between sexes. Furthermore, there was an overall significant trend of women matching into more competitive programs for any given specialty. CONCLUSIONS: In this study, we found that men matched into more highly competitive specialties, whereas women matched into more competitive residency program locations. Further research is needed to determine why women matched into specific specialties at lower rates than their male peers and seek to understand how sex affects the narrative of specialty choice.

Anatomic Variations of Foramen Ovale as a Predictor of Successful Cannulation in Percutaneous Trigeminal Rhizotomies.

BACKGROUND AND OBJECTIVES: Percutaneous trigeminal rhizotomies are common treatment modalities for medically refractory trigeminal neuralgia (TN). Failure of these procedures is frequently due to surgical inability to cannulate the foramen ovale (FO) and is thought to be due to variations in anatomy. The purpose of this study is to characterize the relationships between anatomic features surrounding FO and investigate the association between anatomic morphology and successful cannulation of FO in patients undergoing percutaneous trigeminal rhizotomy. METHODS: A retrospective analysis was conducted of all patients undergoing percutaneous trigeminal rhizotomy for TN at our academic center between January 1, 2010, and July 31, 2022. Preoperative 1-mm thin-cut computed tomography head imaging was accessed to perform measurements surrounding the FO, including inlet width, outlet width, interforaminal distance (a representation of the lateral extent of FO along the middle fossa), and sella-sphenoid angle (a representation of the coronal slope of FO). Mann-Whitney U tests assessed the difference in measurements for patients who succeeded and failed cannulation. RESULTS: Among 37 patients who met inclusion criteria, 34 (91.9%) successfully underwent cannulation. Successful cannulation was associated with larger inlet widths (median = 5.87 vs 3.67 mm, U = 6.0, P = .006), larger outlet widths (median = 7.13 vs 5.10 mm, U = 14.0, P = .040), and smaller sella-sphenoid angles (median = 52.00° vs 111.00°, U = 0.0, P < .001). Interforaminal distances were not associated with the ability to cannulate FO surgically. CONCLUSION: We have identified morphological characteristics associated with successful cannulation in percutaneous rhizotomies for TN. Preoperative imaging may optimize surgical technique and predict cannulation failure.

No change in network connectivity measurements between separate rsfMRI acquisition times.

The role of resting state functional MRI (rsfMRI) is increasing in the field of epilepsy surgery because it is possible to interpolate network connectivity patterns across the brain with a high degree of spatial resolution. Prior studies have shown that by rsfMRI with scalp electroencephalography (EEG), an epileptogenic network can be modeled and visualized with characteristic patterns of connectivity that are relevant to both seizure-related and neuropsychological outcomes after surgery. The aim of this study is to show that a 5-min acquisition time provides reproducible results related to the relevant connectivity metrics when compared to a separately acquired 5-min scan. Fourteen separate rsfMRI sessions from ten different patients were used for comparison, comprised of patients with temporal lobe epilepsy both pre- and post-operation. Results showed that there was no significant difference in any of the connectivity metrics when comparing both 5-min scans to each other. These data support the continued use of a 5-min scan for epileptogenic network modeling in future studies because the inter-scan variability is sufficiently low as not to alter the output metrics characterizing the network connectivity.

Transorbital Surgical Corridor: An Anatomic Analysis of Ocular Globe Retraction and the Associated Exposure for the Transpalpebral Orbital Rim Preserving Endoscopic Orbitotomy (TORPEDO) Approach.

BACKGROUND AND OBJECTIVES: The transorbital approach varies by the extent of bony removal and the target. Orbital rim-sparing transorbital approach with removal of only the orbit's posterior wall provides optimal cosmetic results, without the need for reconstruction. The size of this corridor, limited by the medial globe retraction, has not yet been defined and is difficult to determine in cadavers because of postmortem tissue desiccation. By using patient-specific models in virtual reality, precise areas and degrees of surgical freedom (AOF and DOF, respectively) provided by globe retraction were calculated. These measurements define a potential maximum safe AOF and DOF, as well as the globe retraction, needed to achieve a sufficient surgical corridor. METHODS: Using a virtual reality system, transorbital rim-preserving craniectomies were performed. The axial and sagittal DOF as well as AOF were calculated lateral to the globe, limited by the orbital rim and globe, with an anterior clinoid target. The DOFs and AOFs were calculated for each degree of medial globe retraction and analyzed using paired t tests. RESULTS: With only 5 mm of retraction, the AOF was 886 mm 2 , while at 10 mm, the AOF was 1546 mm 2 . This increase between 5 and 10 mm allowed for the largest increase in surgical working corridor ( P = .02). At 15 mm of retraction (previously studied point at which intraocular pressure raises), the AOF averaged 2189 mm 2 and axial DOF averaged 23.1°. Eighteen DOF (a previously studied point needed to achieve sufficient working space for 2 instruments) was achieved at 11 mm on average, generating 1675 mm 2 AOF. CONCLUSION: Globe retraction of 11 mm is needed to achieve sufficient DOF for 2 surgical instruments, and 15 mm of retraction is a conservative limit that provides comparable AOFs with similar cranial approaches.

Clival-Meckel's Cave Angle: A Predictor of Glycerol Displacement in Percutaneous Glycerol Rhizotomy for Trigeminal Neuralgia.

BACKGROUND AND OBJECTIVES: Percutaneous glycerol rhizotomy successfully treats trigeminal neuralgia although failure rates and durability of the procedure are variable. Some of this variability in clinical outcome might be due to egress of glycerol from Meckel's cave (MC) because of surgical positioning and individual patient anatomy. In this article, we quantitatively analyzed the anatomic variances that affect glycerol fluid dynamics to better predict patients more amenable for percutaneous glycerol injections. METHODS: Computed tomography imaging of 11 cadaveric heads was used to calculate bilateral Clival-Meckel's cave (CMC) and sella-temporal (ST) angles. Twenty-two cadaveric percutaneous injections of dyed glycerol into the Meckel's cave were performed using Härtel's approach, and the fluid movement was documented at prespecified intervals over 1 hour. The relationship between the angles and glycerol migration was studied. RESULTS: Specimens with basal cistern involvement by 60 minutes had significantly greater CMC angles (median [IQR]: basal cistern involvement = 74.5° [59.5°-89.5°] vs no basal cistern involvement = 58.0° [49.0°-67.0°]), U = 6.0, P < .001. This model may predict which patients will experience glycerol migration away from the Gasserian ganglion (area under the curve: 0.950, SE: 0.046, CI: 0.859-1.041, P < .001). Increased ST angle was associated with lateral flow of glycerol (r s = 0.639, P = .001), and CMC angle was associated with total area of dispersion (r s = -0.474, P = .026). CONCLUSION: Anatomic variation in skull base angles affects glycerol migration. Specifically, a more obtuse CMC angle was associated with a higher risk of posterior migration away from the Gasserian ganglion. This may be a reason for differing rates of surgical success. These results suggest that anterior head flexion for 60 minutes may prevent percutaneous glycerol rhizotomy failures and some patients with large CMC angles are more likely to benefit from postinjection head positioning. However, this clinical effect needs validation in vivo.

Effectiveness of Near-Peer-Taught Case Reviews on Students' Confidence in National Board of Medical Examiners (NBME) Exams.

Introduction A key element to a first-year medical student's (MS1) education is guidance and practice in applying anatomy, pathophysiology, diagnosis, and treatment concepts to clinical vignettes. One potential solution to providing effective clinical reasoning training is the involvement of second-year medical students (MS2s) in small group sessions as teachers to provide more personalized instruction via case-based learning sessions. Near-peer teaching has been shown to benefit students' confidence in learning and improve test scores. Similarly, case-based learning is heavily associated with an improved understanding of complex topics. As such, this study assessed the efficacy of near-peer teaching with concomitant case-based style presentations on improving the comfort of MS1s with their understanding of the curriculum content and their comfort with applying their knowledge to clinical scenarios. Methods This randomized controlled crossover trial included several small-group study sessions, each consisting of five MS1s and led by an MS2 who reviewed selected clinical cases in a standardized slide decks. The control arm was provided the same slide decks but did not participate in the MS2-led sessions. During the first course, students were assigned to either the control or intervention group and then crossed over to the opposite group (control to intervention and vice versa) in every subsequent course. Comfort with the curriculum material was then assessed through pre and post surveys, with the post surveys administered after the MS1s took their final NBME examination for that course. Results The study was cut short due to COVID-19 precautions limiting in-person sessions. Nevertheless, the post survey demonstrated an increased understanding of pathological concepts for the intervention group compared to the control group. Conclusions Future work on near-peer group study sessions should enroll a larger sample size with measures to improve the response rate to better test whether near-peer-led case reviews had a significant effect on students' understanding of anatomical concepts and confidence during NBME examinations.

Incidental Metaplastic Primary Pulmonary Meningioma.

Primary pulmonary meningioma is a rare benign tumor usually presenting as a solitary pulmonary nodule or mass. It can be easily misinterpreted as a primary lung tumor or metastases on imaging studies. We present a 54-year-old woman with an incidentally discovered solitary lung nodule, which was diagnosed as metaplastic primary pulmonary meningioma following resection. Metaplastic meningioma is a rare WHO grade 1 meningioma subtype with focal or global mesenchymal differentiation. To the authors' knowledge, primary pulmonary meningioma with mesenchymal differentiation has not been described previously in the English literature.

Student-Produced Guides alongside First-Year Medical Curriculum: How Peer-Produced Textbooks Change Student Success within Neurology, Cardiopulmonary, and Mixed Systems Courses.

OBJECTIVES: In the United States, medical schools do not have a unified curricular plan that integrates basic sciences and organ-based systems in undergraduate medical education. Instead, institutions rely on independently created lecture material during the first-year medical school curriculum. The drawback to this approach is that no commercial or organizational resources cater to this individualized study plan. This study explored whether students who use student-produced "course guides" experience increased first-year success and improved skills. METHODS: First-year students at an allopathic medical school completed anonymous surveys about their reference guide usage, time management, organization, stress level, and examination scores. Statistical analysis was performed using Spearman's coefficient of correlation and χ2 tests. All of the tests were performed with a significance level of α = 0.05 and a 95% confidence interval. RESULTS: In total, 186 total students received the survey three times immediately after completing each organ system-based course. A total of n = 49 viable responses were received. One-fourth of the respondents used the guides for ≥3 hours/week. Respondents who used the reference guides reported improved time management, organization, self-confidence, and reduced student stress levels during the first year of medical school, but examination scores were unaffected. CONCLUSIONS: Access to student-produced guides increased confidence in self-rated measures of time management skills, organizational ability, and ability to balance medical course expectations. Because of the small sample size, future work will expand the survey population to increase the power to detect differences in these factors.