Comparing clerkship sites in a community-based medical school by evaluating students' undergraduate and postgraduate performances.

BACKGROUND: Studies have generally found clinical training sites within the same clerkship to be comparable regarding students' performances--by using undergraduate measures in individual clerkships at medical schools with university hospitals. The present study examined performance comparability among sites within two clerkships in a community-based medical school and used both undergraduate and postgraduate measures. METHOD: The participants were the 349 graduates from the classes of 1988-1991 at Wright State University School of Medicine who took an internal medicine clerkship (332 of the graduates, in five principal combinations of sites) and a general surgery clerkship (349 at six sites). The undergraduate measures were final percent scores for the clerkships and subtest and total scores on the National Board of Medical Examiners (NBME) Part II examination. The postgraduate measures were supervisors' ratings from the first year of residency (210 graduates) and total score on the NBME Part III (212). Univariate analysis of variance and Tukey's multiple-range test were used for the comparisons. RESULTS: The only statistically significant difference among sites was for the medicine clerkship and involved only one undergraduate measure, the clerkship score (and the differences were slight, less than four percentage points). CONCLUSION: Virtually no differences in the students' performances on the undergraduate and postgraduate measures were found among sites for the two clerkships.

Potential influences of residencies' health risk policies on their rankings by Ohio applicants.

Residents' health risks constitute an area of increasing concern for hospitals and residencies. This study examined the importance of health risk policies in the context of students' selection of residencies. In 1991, all 836 fourth-year students in six Ohio medical schools were surveyed about their attitudes regarding residencies' policies on drug screening, HIV (human immunodeficiency virus) testing, and smoke-free workplaces. Of 763 surveys able to be delivered, 341 (45%) were returned. Substantial subsets of the students indicated that they would rank lower or not at all a program that required pre-residency drug screening (22%) or HIV testing (31%). Conversely, almost half the students (48%) responded that they would rank a program higher whose institution has a smoke-free policy. A discussion of potential factors affecting these findings is presented, with recommendations for hospitals, residencies, and residency applicants.

Medical management of Crohn's disease in adolescence.

The therapy of Crohn's disease in adolescence must balance the natural disease history of growth suppression, debilitation, and progression against possible drug-related adverse effects on growth and development. In contrast to published guidelines which usually suggest episodic and symptomatic treatment of relapses, we have attempted to suppress disease activity throughout adolescence. Sixteen consecutive adolescent patients treated with continuous medical therapy for a mean duration of 3.5 years are presented. Fourteen received long term prednisone therapy for maintenance of disease suppression. All 16 have been asymptomatic or have had only mild symptoms which did not interfere with regular activities. Only 1 subject had to be rehospitalized. He subsequently underwent bowel surgery. Aternate day corticosteroid administration has been attained in 11 patients; 10 are growing and developing at a normal rate. In total, 13 of 16 have achieved pubertal development appropriate for age. The 8 patients with distal ileal disease have had a consistently excellent response to medical therapy. There have been no major adverse effects from drug therapy. It is concluded that an effort to suppress disease activity continuously in adolsecents with Crohn's disease is warranted. Excellent symptomatic control and normal rate of growth can be expected in patients with primarily ileal disease.

Diagnostic use of luteinizing hormone releasing hormone in primary amenorrhea.

Thirty-eight patients with primary amenorrhea were evaluated by the administration of luteinizing hormone releasing hormone (LHRH). The LHRH stimulation test was not helpful in differentiating those patients who will proceed to normal menses from those who will continue to have prolonged dysfunction. Similar responses were observed in patients with different pathology, which indicates that the LHRH test must be utilized in conjunction with a carefully planned evaluation if it is to be useful in differentiating a hypothalamic from a pituitary defect. The finding of a patient with hypergonadotropism by serum radioimmunoassay and negative gonadotropins by bioassay suggests that the radioimmunoassay may detect a biologically inactive molecule and indicates that both assays are essential in the evaluation of primary amenorrhea.