Loricaria cuffyi (Siluriformes: Loricariidae), a new species of loricariin catfish from the Guiana Shield.

Loricaria cuffyi n. sp. is described based on 36 specimens from the Essequibo and upper Negro River drainages in western Guyana and the upper Orinoco River drainage in Venezuela. The new species can be distinguished from sympatric and geographically proximate congeners by a postorbital notch that is inconspicuous, shallow and rounded, odontode ridges on the dorsum of head and predorsal weakly developed, abdominal plates tightly joined and completely covering the median abdominal space and pectoral girdle, higher anterior lateral plate counts, and coloration characteristics. The distribution of the new species adds to an interesting and well-documented biogeographical pattern exhibited by other Guiana Shield loricariids influenced by the proto-Berbice during the Cenozoic and recent configuration of drainages in the Guiana Shield. We present an update on the taxonomy of Loricaria, and discuss the biogeography and conservation status of the new species.

Predictors of medical school clerkship performance: a multispecialty longitudinal analysis of standardized examination scores and clinical assessments.

BACKGROUND: Evidence suggests that poor performance on standardized tests before and early in medical school is associated with poor performance on standardized tests later in medical school and beyond. This study aimed to explore relationships between standardized examination scores (before and during medical school) with test and clinical performance across all core clinical clerkships. METHODS: We evaluated characteristics of 435 students at Mayo Medical School (MMS) who matriculated 2000-2009 and for whom undergraduate grade point average, medical college aptitude test (MCAT), medical school standardized tests (United States Medical Licensing Examination [USMLE] 1 and 2; National Board of Medical Examiners [NBME] subject examination), and faculty assessments were available. We assessed the correlation between scores and assessments and determined USMLE 1 cutoffs predictive of poor performance (≤10th percentile) on the NBME examinations. We also compared the mean faculty assessment scores of MMS students vs visiting students, and for the NBME, we determined the percentage of MMS students who scored at or below the tenth percentile of first-time national examinees. RESULTS: MCAT scores correlated robustly with USMLE 1 and 2, and USMLE 1 and 2 independently predicted NBME scores in all clerkships. USMLE 1 cutoffs corresponding to poor NBME performance ranged from 220 to 223. USMLE 1 scores were similar among MMS and visiting students. For most academic years and clerkships, NBME scores were similar for MMS students vs all first-time examinees. CONCLUSIONS: MCAT, USMLE 1 and 2, and subsequent clinical performance parameters were correlated with NBME scores across all core clerkships. Even more interestingly, faculty assessments correlated with NBME scores, affirming patient care as examination preparation. USMLE 1 scores identified students at risk of poor performance on NBME subject examinations, facilitating and supporting implementation of remediation before the clinical years. MMS students were representative of medical students across the nation.

Loricaria luciae, a new species of whiptail catfish (Siluriformes: Loricariidae) from the Paraguay and lower Paraná River basins of southeastern South America.

Loricaria luciae, new species, is described from the the rio Paraguay basin of Bolivia, Brazil, and Paraguay, south to its confluence with the rio Paraná in Argentina. It is distinguished from all congeners by the following combination of characteristics: pectoral girdle entirely naked or with small isolated plates near base of pectoral fin, post-ural plate at base of caudal fin large (plate length 17.0-20.3% HL), and total lateral plates 32-33 (modally 32). The new species occurs in a variety of habitats ranging from small, seasonally intermittent streams with clear water to large, turbid rivers over sand and mud substrates. It is sympatric with at least three other species of Loricaria in the Paraguay and lower Paraná drainages, including L. apeltogaster Boulenger 1895, L. coximensis Rodriguez et al. 2012, and L. simillima Regan 1904. 

Distress and empathy do not drive changes in specialty preference among US medical students.

BACKGROUND: Although medical student specialty choices shape the future of the healthcare workforce, factors influencing changes in specialty preference during training remain poorly understood. AIM: To explore if medical student distress and empathy predicts changes in students' specialty preference. METHODS: A total of 858/1321 medical students attending five medical schools responded to surveys in 2006 and 2007. The survey included questions about specialty choice, burnout, depression, quality of life, and empathy. RESULTS: A total of 26% (205/799) changed their specialty preference over 1 year. Depersonalization--an aspect of burnout--was the only distress variable associated with change in specialty preference (OR, odds ratio 0.962 for each 1-point increase in score, p = 0.03). Empathy at baseline and changes in empathy over the course of 1 year did not predict change in specialty preference (all p > 0.05). On multi-variable analysis, being a third year (OR 1.92), being male (OR 1.48), and depersonalization score (OR 0.962 for each point increase) independently predicted a change in specialty preference. Distress and empathy did not independently predict students' losing interest in primary care whereas being a fourth-year student (OR 1.83) and being female (OR 1.83) did. CONCLUSION: Among those who did have a major change in their specialty preference, distress and empathy did not play a major role.

Group assessments of resident physicians improve reliability and decrease halo error.

BACKGROUND: Individual faculty assessments of resident competency are complicated by inconsistent application of standards, lack of reliability, and the "halo" effect. OBJECTIVE: We determined whether the addition of faculty group assessments of residents in an ambulatory clinic, compared with individual faculty-of-resident assessments alone, have better reliability and reduced halo effects. DESIGN: This prospective, longitudinal study was performed in the outpatient continuity clinics of a large internal medicine residency program. MAIN MEASURES: Faculty-on-resident and group faculty-on-resident assessment scores were used for comparison. KEY RESULTS: Overall mean scores were significantly higher for group than individual assessments (3.92 ± 0.51 vs. 3.83 ± 0.38, p = 0.0001). Overall inter-rater reliability increased when combining group and individual assessments compared to individual assessments alone (intraclass correlation coefficient, 95% CI = 0.828, 0.785-0.866 vs. 0.749, 0.686-0.804). Inter-item correlations were less for group (0.49) than individual (0.68) assessments. CONCLUSIONS: This study demonstrates improved inter-rater reliability and reduced range restriction (halo effect) of resident assessment across multiple performance domains by adding the group assessment method to traditional individual faculty-on-resident assessment. This feasible model could help graduate medical education programs achieve more reliable and discriminating resident assessments.

Patterns of distress in US medical students.

BACKGROUND: How multiple forms of psychological distress coexist in individual medical students has not been formally studied. AIM: To explore the prevalence of various forms of distress in medical students and their relationship to recent suicidal ideation or serious thoughts of dropping out of school. METHODS: All medical students at seven US schools were surveyed with standardized instruments to evaluate burnout, depression, stress, mental quality of life (QOL), physical QOL, and fatigue. Additional items explored recent suicidal ideation and serious thoughts of dropping out of medical school. RESULTS: Nearly all (1846/2246, 82%) of medical students had at least one form of distress with 1066 (58%) having ≥3 forms of distress. A dose-response relationship was found between the number of manifestations of distress and recent suicidal ideation or serious thoughts of dropping out. For example, students with 2, 4, or 6 forms of distress were 5, 15, and 24 fold, respectively, more likely to have suicidal ideation than students with no forms of distress assessed. All forms of distress were independently associated with suicidal ideation or serious thoughts of dropping out on multivariable analysis. CONCLUSIONS: Most medical students experience ≥1 manifestation of distress with many experiencing multiple forms of distress simultaneously. The more forms of distress experienced the greater the risk for suicidal ideation and thoughts of dropping out of medical school.

The problems program directors inherit: medical student distress at the time of graduation.

BACKGROUND: Distress is prevalent among residents and often attributed to rigors of training. AIMS: To explore the prevalence of burnout and depression and measured mental quality of life (QOL) among graduating medical students shortly before they began residency. METHOD: Pooled analysis of data from 1428 fourth year medical students who responded to 1 of 3 multi-institutional studies. Students completed the Maslach Burnout Inventory, PRIME MD, and SF-8 to measure burnout, depression, and low mental QOL (defined as mean mental SF-8 scores ½ a standard deviation below the population norm) and answered demographic items. RESULTS: Shortly before beginning residency, 49% of responding medical students had burnout, 38% endorsed depressive symptoms, and 34% had low mental QOL. While no differences in the prevalence of distress was observed by residency specialty area, there were subtle differences in the manifestation of burnout by specialty. Medical students entering surgical fields had lower mean emotional scores, students entering primary care fields had lower mean depersonalization scores, and students entering non-primary care/non-surgical fields reported the lowest mean personal accomplishment scores (all p ≤ 0.03). CONCLUSION: Our results indicate a high prevalence of distress among graduating medical students across all specialty disciplines before they even begin residency training.

Factors associated with resilience to and recovery from burnout: a prospective, multi-institutional study of US medical students.

CONTEXT: Burnout is prevalent among medical students and is a predictor of subsequent serious consideration of dropping out of medical school and suicide ideation. Understanding of the factors that protect against burnout is needed to guide student wellness programmes. METHODS: A total of 1321 medical students attending five institutions were studied longitudinally (2006-2007). The surveys included standardised instruments to evaluate burnout, quality of life, fatigue and stress. Additional items explored social support, learning climate, life events, employment status and demographics. Students who did not have burnout at either time-point (resilient students) were compared with those who indicated burnout at one or both time-points (vulnerable students) using a Wilcoxon-Mann-Whitney test or Fisher's exact test. Similarly, the differences between those who recovered and those who were chronically burned out were also compared in students with burnout at the first time-point. Logistic regression modelling was employed to evaluate associations between the independent variables and resiliency to and recovery from burnout. RESULTS: Overall, 792 (60.0%) students completed the burnout inventory at both time-points. No differences in demographic characteristics were observed between resilient (290/792 [36.6%]) and vulnerable (502/792 [63.4%]) students. Resilient students were less likely to experience depression, had a higher quality of life, were less likely to be employed, had experienced fewer stressful life events, reported higher levels of social support, perceived their learning climate more positively and experienced less stress and fatigue (all p < 0.05) than vulnerable students. On multivariable analysis, perceiving student education as a priority for faculty staff, experiencing less stress, not being employed and being a minority were factors independently associated with recovery from burnout. CONCLUSIONS: Modifiable individual factors and learning climate characteristics including employment status, stress level and perceptions of the prioritising of student education by faculty members relate to medical students' vulnerability to burnout.

Relationship between burnout and professional conduct and attitudes among US medical students.

CONTEXT: The relationship between professionalism and distress among medical students is unknown. OBJECTIVE: To determine the relationship between measures of professionalism and burnout among US medical students. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional survey of all medical students attending 7 US medical schools (overall response rate, 2682/4400 [61%]) in the spring of 2009. The survey included the Maslach Burnout Inventory (MBI), the PRIME-MD depression screening instrument, and the SF-8 quality of life (QOL) assessment tool, as well as items exploring students' personal engagement in unprofessional conduct, understanding of appropriate relationships with industry, and attitudes regarding physicians' responsibility to society. MAIN OUTCOME MEASURES: Frequency of self-reported cheating/dishonest behaviors, understanding of appropriate relationships with industry as defined by American Medical Association policy, attitudes about physicians' responsibility to society, and the relationship of these dimensions of professionalism to burnout, symptoms of depression, and QOL. RESULTS: Of the students who responded to all the MBI items, 1354 of 2566 (52.8%) had burnout. Cheating/dishonest academic behaviors were rare (endorsed by <10%) in comparison to unprofessional conduct related to patient care (endorsed by up to 43%). Only 14% (362/2531) of students had opinions on relationships with industry consistent with guidelines for 6 scenarios. Students with burnout were more likely to report engaging in 1 or more unprofessional behaviors than those without burnout (35.0% vs 21.9%; odds ratio [OR], 1.89; 95% confidence interval [CI], 1.59-2.24). Students with burnout were also less likely to report holding altruistic views regarding physicians' responsibility to society. For example, students with burnout were less likely to want to provide care for the medically underserved than those without burnout (79.3% vs 85.0%; OR, 0.68; 95% CI, 0.55-0.83). After multivariable analysis adjusting for personal and professional characteristics, burnout was the only aspect of distress independently associated with reporting 1 or more unprofessional behaviors (OR, 1.76; 95% CI, 1.45-2.13) or holding at least 1 less altruistic view regarding physicians' responsibility to society (OR, 1.65; 95% CI, 1.35-2.01). CONCLUSION: Burnout was associated with self-reported unprofessional conduct and less altruistic professional values among medical students at 7 US schools.

Use of a geriatric home visit experience to teach medical students the functional status assessment.

INTRODUCTION: Functional status measures strongly predict hospital outcomes and mortality, yet teaching of these measures is often missing from medical schools' curricula. To address this deficiency, we developed a Geriatric Home-based Assessment (GHA) module for third-year medical students. The module was composed of a workshop and two to three home visits. OBJECTIVE: To determine whether the GHA module would improve students' knowledge and proficiency in the functional status assessment. PROGRAM EVALUATION: Students completed a validated questionnaire and evaluated a standardized patient in an Observed Structured Clinical Examination (OSCE). Scores from students completing the GHA were compared to the scores of students without this experience. RESULTS: Thirty-one students participated in the GHA module, and 19 students were in the control group. The mean score on the written assessment was 87% among GHA students vs. 46% in the control group (p < 0.001). The mean clinical examination score of the intervention group was also better than that of the control group (76% vs. 46%, p < 0.001). CONCLUSIONS: Our GHA module was effective in improving students' knowledge and proficiency in the functional status assessment. "Hands on" experiences like the GHA allow students to develop a solid foundation for assessing functional status and mobility.

The learning environment and medical student burnout: a multicentre study.

OBJECTIVES: Little is known about specific personal and professional factors influencing student distress. The authors conducted a comprehensive assessment of how learning environment, clinical rotation factors, workload, demographics and personal life events relate to student burnout. METHODS: All medical students (n = 3080) at five medical schools were surveyed in the spring of 2006 using a validated instrument to assess burnout. Students were also asked about the aforementioned factors. RESULTS: A total of 1701 medical students (response rate 55%) completed the survey. Learning climate factors were associated with student burnout on univariate analysis (odds ratio [OR] 1.36-2.07; all P < or = 0.02). Being on a hospital ward rotation or a rotation requiring overnight call was also associated with burnout (ORs 1.69 and 1.48, respectively; both P < or = 0.02). Other workload characteristics (e.g. number of admissions) had no relation to student burnout. Students who experienced a positive personal life event had a lower frequency of burnout (OR 0.70; P < or = 0.02), whereas those who experienced negative personal life events did not have a higher frequency of burnout than students who did not experience a negative personal life event. On multivariate analysis personal characteristics, learning environment and personal life events were all independently related to student burnout. CONCLUSIONS: Although a complex array of personal and professional factors influence student well-being, student satisfaction with specific characteristics of the learning environment appears to be a critical factor. Studies determining how to create a learning environment that cultivates student well-being are needed.

Lack of interaction between sensing-intuitive learning styles and problem-first versus information-first instruction: a randomized crossover trial.

BACKGROUND: Adaptation to learning styles has been proposed to enhance learning. OBJECTIVE: We hypothesized that learners with sensing learning style would perform better using a problem-first instructional method while intuitive learners would do better using an information-first method. DESIGN: Randomized, controlled, crossover trial. SETTING: Resident ambulatory clinics. PARTICIPANTS: 123 internal medicine residents. INTERVENTIONS: Four Web-based modules in ambulatory internal medicine were developed in both "didactic" (information first, followed by patient problem and questions) and "problem" (case and questions first, followed by information) format. MEASUREMENTS: Knowledge posttest, format preference, learning style (Index of Learning Styles). RESULTS: Knowledge scores were similar between the didactic (mean +/- standard error, 83.0 +/- 0.8) and problem (82.3 +/- 0.8) formats (p = .42; 95% confidence interval [CI] for difference, -2.3 to 0.9). There was no difference between formats in regression slopes of knowledge scores on sensing-intuitive scores (p = .63) or in analysis of knowledge scores by styles classification (sensing 82.5 +/- 1.0, intermediate 83.7 +/- 1.2, intuitive 81.0 +/- 1.5; p = .37 for main effect, p = .59 for interaction with format). Format preference was neutral (3.2 +/- 0.2 [1 strongly prefers didactic, 6 strongly prefers problem], p = .12), and there was no association between learning styles and preference (p = .44). Formats were similar in time to complete modules (43.7 +/- 2.2 vs 43.2 +/- 2.2 minutes, p = .72). CONCLUSIONS: Starting instruction with a problem (versus employing problems later on) may not improve learning outcomes. Sensing and intuitive learners perform similarly following problem-first and didactic-first instruction. Results may apply to other instructional media.

Patient preferences for and satisfaction with methods of communicating test results in a primary care practice.

BACKGROUND: Appropriate and timely communication of test results is an important element of high-quality health care. Patients' preferences regarding and satisfaction with test result notification methods in a primary care practice were evaluated. METHODS: Some 1,458 consecutive patients were surveyed for whom routine blood tests were performed in the primary care internal medicine division at the Mayo Clinic Rochester (Minnesota) between January and March 2006. RESULTS: Among 888 respondents, test result notification occurred by telephone call (43%), return visit (35%), letter (3%), e-mail (0.1%), or a combination of methods (19%). Most (60%) telephone calls were handled by nurses. Patient preferences for notification method were telephone call (55%), return visit (20%), letter (19%), e-mail (5%), and automated answering mechanism (1%). Among patients reporting preference for telephone call, 67% wanted a call from a physician or nurse practitioner. Overall, 44% of patients received results by their preferred method; patients who did not were more likely to be dissatisfied with the communication method than those who did (10% vs. 5%, p = 0.01). A majority of patients were at least somewhat anxious to learn their test results, and patients greatly valued timeliness in test-result notification. DISCUSSION: The results describe primary care patients preferences for communication from their providers. Disparities exist between current practice and patient preferences in this important care delivery process. A telephone call from a physician or nurse practitioner was used to deliver test results for fewer than half of the patients who preferred to receive their results by this method. Future work should explore reimbursement of patient-preferred options and assess ways to improve resource-conscious test result communication methods.

Burnout and suicidal ideation among U.S. medical students.

BACKGROUND: Little is known about the prevalence of suicidal ideation among U.S. medical students or how it relates to burnout. OBJECTIVE: To assess the frequency of suicidal ideation among medical students and explore its relationship with burnout. DESIGN: Cross-sectional 2007 and longitudinal 2006 to 2007 cohort study. SETTING: 7 medical schools in the United States. PARTICIPANTS: 4287 medical students at 7 medical schools, with students at 5 institutions studied longitudinally. MEASUREMENTS: Prevalence of suicidal ideation in the past year and its relationship to burnout, demographic characteristics, and quality of life. RESULTS: Burnout was reported by 49.6% (95% CI, 47.5% to 51.8%) of students, and 11.2% (CI, 9.9% to 12.6%) reported suicidal ideation within the past year. In a sensitivity analysis that assumed all nonresponders did not have suicidal ideation, the prevalence of suicidal ideation in the past 12 months would be 5.8%. In the longitudinal cohort, burnout (P < 0.001 for all domains), quality of life (P < 0.002 for each domain), and depressive symptoms (P < 0.001) at baseline predicted suicidal ideation over the following year. In multivariable analysis, burnout and low mental quality of life at baseline were independent predictors of suicidal ideation over the following year. Of the 370 students who met criteria for burnout in 2006, 99 (26.8%) recovered. Recovery from burnout was associated with markedly less suicidal ideation, which suggests that recovery from burnout decreased suicide risk. LIMITATION: Although response rates (52% for the cross-sectional study and 65% for the longitudinal cohort study) are typical of physician surveys, nonresponse by some students reduces the precision of the estimated frequency of suicidal ideation and burnout. CONCLUSION: Approximately 50% of students experience burnout and 10% experience suicidal ideation during medical school. Burnout seems to be associated with increased likelihood of subsequent suicidal ideation, whereas recovery from burnout is associated with less suicidal ideation.

Letters of recommendation: rating, writing, and reading by clerkship directors of internal medicine.

BACKGROUND: Letters of Recommendations (LORs) are used for applications to medical school and graduate medical education, but how they are used by current internal medicine educators is unknown. DESCRIPTION: In 2006, the Clerkship Directors of Internal Medicine conducted its annual, voluntary survey, and one section pertained to LORs. Survey items were categorized into questions regarding rating, writing, and reading LORs with answers on 3- to 5-point scales. EVALUATION: The response rate for the 110 institution members was 75%. When rating LORs, the most important factor was depth of understanding of the trainee (98% essential or important), followed by a numerical comparison to other students (94%), grade distribution (92%), and summary statement (91%). Although most (78%) agreed that reading LORs in general were important for trainee selection, few agreed that this was because of the ability to discern marginal performance (31%) or predict future performance (25%). CONCLUSIONS: LORs remain an important part of the application process for medical school and internal medicine residency. Letter writers should convey a great depth of understanding of the applicant, provide a numerical comparison with other students (including a denominator), and give a specific summary statement.

Medical informatics in the internal medicine clerkship: Results of a national survey.

BACKGROUND: Medical Informatics (MI) is increasingly a critical aspect of medical education and patient care. AIMS: This study assessed the status of MI training, perception of needs and barriers for the implementation of MI curricula and utilization of information technology (IT) in patient care and medical education. METHOD: The MI questionnaire was a part of the 2006 Clerkship Directors in Internal Medicine survey of 110 institutional members. Descriptive statistics were calculated using Statistical Package for the Social Sciences (SPSS), version 12 and all p-values are two-tailed. RESULTS: Eighty-three (75%) members responded. Out of this, 52, 32.5 and 12% report that students receive MI training for patient care activities during pre-clinical years, third-year internal medicine clerkship or intersession, respectively. House staff critiques (46.4%), patient billing (44.1%), radiographic imaging (40.8%), accessing clinical data (37.3%), and student evaluations (36.1%) were areas in which 35% of respondents use IT 'all the time.' Fifty-one percent of respondents rate the adequacy of training in MI as average. Cost, time and lack of trained faculty were primary barriers for the implementation. CONCLUSIONS: Significant variations exist in timing of MI curricula. IT is utilized more frequently for non-patient activities. Studies are needed to examine the needs, processes and outcomes of MI curricula.

Clinical informatics to improve quality of care: a population-based system for patients with diabetes mellitus.

BACKGROUND: The prevalence of diabetes mellitus is increasing in the USA. However, control of intermediate outcome measures remains substandard. Recently, significant emphasis has been placed on the value of electronic medical records and informatics systems to improve the delivery of health care. OBJECTIVE: To determine whether a clinical informatics system improves care of patients with diabetes mellitus. METHODS: In this quality improvement pilot initiative, we identified 48 patients with diabetes mellitus who were due for their annual haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and microalbumin tests. Through our newly developed clinical informatics initiative, patients were reminded to schedule tests and a physician appointment. Seventy-five patients without reminders served as controls. RESULTS: A significant improvement in LDL control was achieved in the intervention group (35.4% vs 13.3%; P=0.004). The intervention group had a greater percentage of patients who underwent the three tests, and members of this group also showed greater control of haemoglobin A1c, but these differences were not statistically significant. CONCLUSIONS: A clinical informatics system, used to deliver proactive, co-ordinated care to a population of patients with diabetes mellitus, can improve process and also quality outcome measures. Larger studies are needed to confirm these early findings.

Race, ethnicity, and medical student well-being in the United States.

BACKGROUND: Little is known about the training experience of minority medical students. We explore differences in the prevalence of burnout, depressive symptoms, and quality of life (QOL) among minority and nonminority medical students as well as the role race/ethnicity plays in students' experiences. METHODS: Medical students (N = 3080) at 5 medical schools were surveyed in 2006 using validated instruments to assess burnout, depression, and QOL. Students were also asked about the impact of race/ethnicity on their training experience. RESULTS: The response rate was 55%. Nearly half of students reported burnout (47%) and depressive symptoms (49%). Mental QOL scores were lower among students than among the age-matched general population (43.1 vs 47.2; P < .001). Prevalence of depressive symptoms was similar regardless of minority status, but more nonminority students had burnout (39% vs 33%; P < .03). Minority students were more likely to report that their race/ethnicity had adversely affected their medical school experience (11% vs 2%; P < .001) and cited racial discrimination, racial prejudice, feelings of isolation, and different cultural expectations as causes. Minority students reporting such experiences were more likely to have burnout, depressive symptoms, and low mental QOL scores than were minority students without such experiences (all P < .05). CONCLUSIONS: Symptoms of distress are prevalent among medical students. While minorities appear to be at lower risk for burnout than nonminority students, race does contribute to the distress minority students do experience. Additional studies are needed to define the causes of these perceptions and to improve the learning climate for all students.

Immunization education for internal medicine residents: A cluster-randomized controlled trial.

PURPOSE: The aims of this study are to evaluate the impact of a novel immunization curriculum based on the Preferred Cognitive Styles and Decision Making Model (PCSDM) on internal medicine (IM) resident continuity clinic patient panel immunization rates, as well as resident immunization knowledge, attitudes, and practices (KAP). METHODS: A cluster-randomized controlled trial was performed among 143 IM residents at Mayo Clinic to evaluate the PCSDM curriculum plus fact-based immunization curriculum (intervention) compared to fact-based immunization curriculum alone (control) on the outcomes of resident continuity clinic patient panel immunization rates for influenza, pneumococcal, tetanus, pertussis, and zoster vaccines. Pre-study and post-study immunization KAP surveys were administered to IM residents. RESULTS: Ninety-nine residents participated in the study. Eighty-two residents completed pre-study and post-study surveys. Influenza and pertussis immunization rates improved for both intervention and control groups. There was no significant difference in immunization rate improvement between the groups. Influenza immunization rates improved significantly by 33.4% and 32.3% in the intervention and control groups, respectively. The odds of receiving influenza immunization at the end of the study relative to pre-study for the entire study cohort was 4.6 (p < 0.0001). The odds of having received pertussis immunization at the end of the study relative to pre-study for the entire study cohort was 1.2 (p = 0.0002). Both groups had significant improvements in immunization knowledge. The intervention group had significant improvements in multiple domains that assessed confidence in counseling patients on immunizations. CONCLUSIONS: Fact-based immunization education was useful in improving IM resident immunization rates for influenza and pertussis. The PCSDM immunization curriculum did not lead to increases in immunization rates compared with the fact-based curriculum, but it did significantly increase resident confidence in communicating with patients about vaccines.

Prolonged delays for research training in medical school are associated with poorer subsequent clinical knowledge.

BACKGROUND: Complementary degree programs and research training are important alternative tracks in medical school that typically interrupt the traditional MD curriculum. OBJECTIVE: Examine effects of such a break on clinical knowledge after reentry into the MD curriculum. DESIGN: Retrospective cohort study. PARTICIPANTS: Three hundred and two graduates of Mayo Medical School. MAIN MEASUREMENTS: Compared years of delay between the second and third years of medical school with third year clerkship grades, National Board of Medical Examiner's (NBME) Subject Examinations, and United States Medical License Exam (USMLE) Step 2. MAIN RESULTS: 258, 13, and 31 students spent 0, 1, or > or = 3 years pursuing research between the second and third year. Baseline measures of knowledge before matriculation and before the third year were similar between groups. Whereas a 1-year delay had no significant effect, a > or = 3-year delay was associated with fewer clerkship honors and lower NBME Medicine, Pediatrics, and Psychiatry percentiles compared to no delay (all p < .05). Students with a > or = 3-year delay had a 77% reduction in the odds of honors in Medicine. For each year of delay beyond 3, students' third-year NBME Medicine, Neurology, Obstetrics and Gynecology, and Psychiatry scores decreased as did USMLE Step 2 scores (r = -.38 to -.50, p < .05). CONCLUSIONS: Delays of > or = 3 years between the second and third years of medical school are associated with lower grades and scores on clinical knowledge tests. Further research is needed to determine the optimal timing of research training and develop effective interventions to facilitate reentry into the medical school curriculum.