Medical Students' Perspectives on Careers in Hospital Medicine: A National Study.

This article was migrated. The article was marked as recommended. Purpose: Concerns over burnout and other factors may influence whether students pursue hospital medicine as a career. We investigate whether there are certain predictive factors that ultimately play a role in medical students' career interest in hospital medicine. Methods: In January 2011, 960 third-year medical students from 24 U.S. allopathic medical schools were surveyed at baseline, and six to nine months later when they became fourth-years at follow-up. Hospitalist-oriented students were categorized as those students who indicated interest in the specialties of family medicine, internal medicine, or pediatrics, and who indicated that they were "very likely" or "somewhat likely" to become a hospitalist. Respondents were also asked to respond to a list of seven factors that potentially influenced their specialty choice. Results: Adjusted response rate for the fourth-year survey was 50% (n=463/919). Medical students considering hospitalist careers were more likely to report that perceived burnout between various specialties played an important influential role in their specialty decision-making (49.7% [42.2-57.2%], vs. non-hospitalists 39.9% [32.8-47.0%], P=0.03). Conclusions: Given that students are reporting burnout as a factor in their decision-making in favor of hospitalist careers, further studies are needed to explore what aspects of a hospitalist career are appealing to students.

Upper extremity deep venous thrombosis and pulmonary embolus after ovarian hyperstimulation.

A healthy female presented with upper extremity (UE) swelling of several days duration. Admission laboratories were normal except for an elevated D-dimer. An UE ultrasound with Doppler revealed a thrombus in the right subclavian vein. A subsequent chest CT angiogram further characterised the subclavian vein thrombus and also identified a pulmonary embolus. A thorough history and laboratory evaluation showed that her only risk factors were long-time contraceptive pills and a recent cycle of ovarian hyperstimulation (OH) 7 weeks prior to presentation. Anticoagulation treatment was started and the patient's remaining outpatient work-up was negative for all other hereditary causes. A complete anatomic work-up showed bilateral thoracic outlet syndrome (TOS). A review of the literature on the occurrence of upper extremity deep venous thrombosis suggests that these usually occur in the presence of a predisposing factor, including catheters, indwelling devices and active malignancies. OH has been shown to precipitate venous thromboembolism events; however, the diagnosis of bilateral TOS as a predisposing risk factor has not been described in a patient who had recently undergone recent OH and in one who was not actively pregnant.