Examining the Role of Gender and Ethnic Concordance in Medical Student Specialty Selection.

Introduction: Representation of female and minority physicians varies across specialties and may influence career selection by medical students. To investigate the effect of demographic concordance between medical students and clinical role models on specialty selection, we conducted a survey of graduating medical students to assess the perceived importance and influence of third-year clerkship experiences with demographically concordant preceptors on their choice of specialty for post-graduate training. Methods: An 11-question survey was shared nationally through AAMC Organizational Student Representatives to medical students in the Class of 2023. Information gathered included demographics; specialty of choice; extent of exposure to preceptors of the same gender, race, or ethnicity during clinical clerkships; and perceived importance and influence of those interactions (Likert 1-5, Low-High) on specialty selection. Results: A total of 84 students responded. Female students ascribed more importance to gender concordance with preceptors on the third-year clerkship most associated with their specialty of choice than males [3.4 (SD 1.2) vs. 1.3 (SD 0.8) respectively, p < 0.0001] and greater influence to gender concordance on final specialty selection [2.37 (SD 1.1) vs. 1.31 (SD 0.8) respectively, p < 0.0001]. Non-Caucasians ascribed more importance to race/ethnicity concordance than Caucasians [2.8 (SD 1.4) vs. 1.2 (SD 0.5) respectively, p < 0.0001] and greater influence to race/ethnicity concordance on final specialty selection [2.0 (SD 1.3) vs. 1.1 (SD 0.4) respectively, p < 0.0001]. Caucasian females ascribed the greatest importance to gender concordance (p < 0.001), non-Caucasian females ascribed the greatest influence of gender concordance (p < 0.001), and non-Caucasian females ascribed both the greatest importance (p < 0.001) and influence (p < 0.001) to race/ethnicity concordance. Conclusions: We found that gender and race/ethnicity concordance between students and clinical preceptors during third year clerkships is perceived as especially important and influential in specialty selection by minority and female medical students. These findings highlight the importance of diversity in gender and race/ethnicity representation by preceptors on clinical clerkships. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-024-02044-6.

Ileocecal Intussusception and Obstruction Secondary to Metastatic Melanoma: A Case Report.

Intussusception is an uncommon cause of bowel obstruction in adults. Most cases are associated with a pathologic lead point, commonly attributable to benign or malignant tumors. Malignant skin melanoma can metastasize to the gastrointestinal tract and lead to significant morbidity and mortality if left undiagnosed or untreated. In this article, we present the case of a 43-year-old Hispanic female with a history of stage III melanoma on her neck removed four years ago who presented with three weeks of lower abdominal pain, nausea, and vomiting. Abdominal and pelvic imaging showed a high-grade small bowel obstruction with a transition point at the mid-ileum. Diagnostic laparoscopy confirmed an ileocecal intussusception secondary to a 5 cm mass at the lead point. The patient underwent successful resection of the ileum 5 cm from the intussusception and the ascending colon due to the high risk of malignancy. Pathology of the mass was found to be malignant melanoma, but the resected lymph nodes and omentum did not contain any malignancy. The patient tolerated the procedure well and is currently undergoing chemotherapy. This case demonstrates metastatic melanoma as a rare cause of intussusceptions in adults. It emphasizes the importance of considering intussusception when evaluating adult patients with classic lower abdominal pain. Prompt surgical intervention is recommended in suspected cases to address the significant likelihood of malignancy, especially in patients with an oncological history.

Identification of α1,2-fucosylated signaling and adhesion molecules in head and neck squamous cell carcinoma.

Head and neck cancer is the seventh most common cancer in the world, and most cases manifest as head and neck squamous cell carcinoma. Despite the prominent role of fucosylated carbohydrate antigens in tumor cell adhesion and metastasis, little is known about the functional role of fucose-modified glycoproteins in head and neck cancer pathobiology. Inactivating polymorphisms of the fut2 gene, encoding for the α1,2-fucosyltransferase FUT2, are associated with an increased incidence of head and neck cancer among tobacco users. Moreover, the presence of the α1,2-fucosylated Lewis Y epitope, with both α1,2- and α1,3-linked fucose, has been observed in head and neck cancer tumors while invasive regions lose expression, suggesting a potential role for α1,2-fucosylation in the regulation of aggressive tumor cell characteristics. Here, we report an association between fut2 expression and head and neck cancer survival, document differential surface expression of α1,2-fucosylated epitopes in a panel of normal, dysplastic, and head and neck cancer cell lines, identify a set of potentially α1,2-fucosylated signaling and adhesion molecules including the epidermal growth factor receptor (EGFR), CD44 and integrins via tandem mass spectrometry, and finally, present evidence that EGFR is among the α1,2-fucosylated and LeY-displaying proteins in head and neck cancer. This knowledge will serve as the foundation for future studies to interrogate the role of LeY-modified and α1,2-fucosylated glycoproteins in head and neck cancer pathogenesis. Data are available via ProteomeXchange with identifier PXD029420.