Women's Health Curriculum for Medical Students.

OBJECTIVES: Knowledge of women's health is important for physicians in various specialties, but training often is inadequate. The objective of this project was to develop, implement, and evaluate a women's health curriculum for medical students at the University of Florida College of Medicine in Gainesville. METHODS: After reviewing previous pertinent literature and assessing institutional factors, we developed an interdisciplinary women's health elective for medical students. We present the curricular design for the course. The 2-week elective explores women's health topics such as disease prevention, screening, breast health, osteoporosis, and cardiovascular health. Teaching methodology includes case-based lectures, reading assignments, and clinic sessions at multiple sites. RESULTS: Senior medical students worked in a variety of clinical settings and were assigned a women's health project, a pretest before starting the elective, and a posttest after completion of the course. A statistically significant increase was seen in the students' mean posttest (98.8%) versus pretest (85.6%) scores (difference 13.1%; 95% confidence interval 7.3-19.0, P < 0.0001). CONCLUSIONS: Designing curricula that promote lifelong professional competency in the field of women's health can be challenging. At the University of Florida, we have successfully created and implemented a medical student elective in women's health using local resources and expertise. This elective satisfies important women's health training requirements, has been well received by our students, and has resulted in increased women's health-specific knowledge. The experience at our institution may be useful for other programs interested in developing a women's health curriculum geared toward medical students utilizing minimal resources.

Ultrasound-Guided Segmental Mastectomy and Excisional Biopsy Using Hydrogel-Encapsulated Clip Localization as an Alternative to Wire Localization.

BACKGROUND: Wire localization is currently the most widely used localization strategy for excision of nonpalpable breast lesions. Its disadvantages include patient discomfort, wire-related complications such as wire displacement/fracture, and operating room delays related to difficulties during wire placement. We have implemented the technique of intraoperative ultrasound-guided excision using hydrogel-encapsulated (HydroMARK) biopsy clips for lesion localization. We hypothesize that this method is as effective as wire localization for breast conserving therapy. METHODS: This is a retrospective review of 220 consecutive patients who underwent segmental mastectomy or excisional biopsy using wire localization or hydrogel-encapsulated clip localization from January 2014 to July 2015. Data were collected and analyzed. Statistical analyses for differences between groups were performed using t tests and Mann-Whitney rank-sum analyses. RESULTS: A total of 107 excisions were performed using hydrogel-encapsulated clip localization, and 113 excisions were performed using the traditional wire localization technique; 68 % of our patients underwent excision for malignant pathology. Wire placement took a mean of 46 minutes (range 20-180 min), compared with 5 minutes for ultrasound localization (p <  .001). Successful intraoperative ultrasound localization and excision was performed on 100 % of patients. There was no difference in re-excision rates for positive margins or overall specimen size between the two groups. CONCLUSIONS: Intraoperative ultrasound-guided excision of nonpalpable breast lesions using a hydrogel-encapsulated biopsy clip for breast conserving therapy is a safe and feasible alternative to the traditional preoperative wire localized excision. This technique will lead to improvement in patient experience, operative efficiency, and alleviate wire-related complications.

Sarcoidosis manifesting as a pseudotumorous renal mass.

A 53 year-old African American woman with a three-year history of pulmonary sarcoidosis had a follow-up computed tomographic scan to evaluate the status of her disease and response to treatment. On the scan, an abnormal, hypodense mass on the left renal superior pole, which was not present on previous scans, was incidentally discovered. The initial concern was of carcinoma, despite her lack of any urinary symptoms. She underwent further evaluation with magnetic resonance, and the enhancement pattern and the shape of the mass were more suggestive of lymphoma or infarction than a carcinoma. A review of literature revealed sparse case reports demonstrating sarcoidosis presenting as infiltrative granulomatous masses resembling tumors with nonspecific imaging qualities. This diagnosis was entertained and then proven by biopsy. Pseudotumorous renal sarcoid should be in the differential of renal masses, especially in patients with a history of sarcoidosis, as it alters clinical management.