"We Do Not Want Him Because He Is a Jew": The Montreal Interns' Strike of 1934.

Speeches by modern-day White supremacists often include such statements as "Jews will not replace us." In 1934, the French-speaking medical interns of Montreal's Roman Catholic hospitals went on strike because, they alleged, a Jew "replaced" a Roman Catholic French Canadian. Anti-Semitic social and economic boycotts and educational quotas were in existence in Canada from the 19th through the mid-20th century. There were particularly strong anti-immigrant and anti-Semitic feelings in the first half of the 20th century in Quebec, along with anti-Semitic pro-fascist political parties. In 1934, Montreal's Hôpital Notre-Dame (HND), a teaching hospital of the Université de Montréal (UM) medical school, was unable to hire a full complement of medical interns from among the newly graduated French-speaking Roman Catholic medical students. The hospital hired a French-speaking Jewish graduate of UM, Samuel Rabinovitch. The prospective interns at HND submitted a petition demanding that Rabinovitch be fired, stating, "We do not want him because he is a Jew." On 14 and 15 June 1934, HND's interns went on strike to prevent Rabinovitch from taking up his duties. The strike spread to multiple hospitals in Montreal. A Jewish urology trainee at the Hôtel Dieu hospital, Abram Stilman, was also targeted. Rabinovitch resigned in order to bring the strike to an end. The strike buttressed the case in the first half of the 20th century for American and Canadian Jewish hospitals and medical schools to ensure the education of Jewish physicians, reminds us of the origins of the slogans of modern White supremacists, and reinforces the historical basis of efforts to promote diversity and inclusion in medical education.

Current challenges facing pediatric radiation oncology viewed through an economics lens.

This commentary addresses two problems facing pediatric radiation oncology: workforce education and the cost of technology. The tools of economics can help us understand these problems. Because cancer in children is relatively infrequent and the role of pediatric radiotherapy (RT) is limited, there are a small number of cases of children requiring RT in the US compared to the number of radiation oncology trainees. This creates a paucity of necessary clinical training material. Proton RT, rather than photon RT, is being recommended in many situations when RT is indicated in children. Cost, however, is a significant concern. The arguments for and against proton RT continue and a consensus on this matter has not emerged.

The Impact on Medical Students of the 9/11 Attacks on New York's World Trade Center.

Phenomenon: Little is known about how participation in disaster relief impacts medical students. During the terror attacks of September 11, 2001, New York Medical College School of Medicine students witnessed the attacks and then became members of emergency treatment teams at St. Vincent's Hospital, the trauma center nearest to the World Trade Center. To date, only two reports describe how 9/11 influenced the lives of medical students. This study was designed to characterize the short- and long-term effects on NYMC students and to compare those effects between students assigned to St Vincent's Hospital and classmates assigned to rotations at facilities more remote from the attack site. We hypothesized that participation in direct relief efforts by students assigned to the St. Vincent's site might have long-lasting effects on their lives and these effects might vary when compared to classmates assigned elsewhere. Approach: This was a retrospective, survey-based, unmatched cohort study. Participants included all school of medicine graduates who were St. Vincent's rotators on 9/11 (N = 22) and classmates (N = 24) assigned to other sites who could be contacted and agreed to participate. Our primary measure was whether the 9/11 experience affected the participant's life, defined as an affirmative response to the item which asked whether the 9/11 experience affected the participant's "life thereafter, career choice, attitudes toward life or attitudes toward practice." Secondary measures included self-reported effects on career, life, attitudes, health, resilience, personal growth, personality features, and the temporal relationship between the attack and stress symptoms. Findings: Completed surveys were received from 16/22 (73%) St. Vincent's and 18/24 (75%) non-Saint Vincent's participants: 62% male, 82% had children, 74% identified as Caucasian/white and 76% employed full-time. Overall, slightly more than half (58%) of respondents reported an effect of 9/11 on their life, with a greater but non-significant proportion of St. Vincent's rotators reporting life impact (67% versus 50% for St. Vincent's versus other locations, respectively). High post-9/11 stress levels, current marriage, and ability to make and keep family and social relationships were associated with an effect on life which approached statistical significance. Participants reported positive or no post 9/11 effects on empathy and altruism (50%), resilience (47%), attitudes toward medical practice and career (32%), and charitable giving (24%), while positive, negative, or no effects were reported for attitude toward life, family and social relations, physical health, and conscientiousness. Mental health was the only domain in which all participants reported unchanged or negative effects. Two St. Vincent's rotators but no students assigned elsewhere believed they experienced 9/11-related post-traumatic stress disorder. Insights: Just over half of New York Medical College School of Medicine students rotating at St. Vincent's Hospital on 9/11 or elsewhere reported significant life-effects as a result of direct/indirect experiences related to the attack. Perceived stress may have been a more important driver of this life-change than other factors such as geographic proximity to the disaster site and/or direct participation in relief efforts. Further study of medical school interventions focused on stress reduction among students who participate in disaster relief is warranted.

Training and education of pediatric radiation oncologists: A survey from the 2019 Pediatric Radiation Oncology Society meeting.

To examine the educational background, clinical practice, and preferences regarding continuing medical education (CME) among radiation oncologists who attended the 2019 meeting of the Pediatric Radiation Oncology Society (PROS), a survey consisting of 20 questions was distributed asking for demographic and educational background, clinical practice, and preferences regarding pediatric radiation oncology CME. Of 188 participants, 130 (69.2%) returned the questionnaire. More than 80% reported access to CT simulation, three-dimensional radiotherapy, and general anesthesia while <30% had access to intraoperative radiotherapy, proton, and heavy particle therapy. After residency, 12.1% did further training in pediatric radiation oncology. When asked about further training in pediatrics after residency, 88.8% answered that there should be a formal training program beyond residency in order to treat children. More than 75% acquired knowledge in pediatric radiation oncology through journals, books, live meetings, and tumor boards. The results of this survey may help Pediatric Radiation Oncology Society (PROS) in creating guidelines and recommendations for improvement in pediatric radiation oncology training and practice support as well as the development of CME activities most likely to benefit practitioners.

Dose intensification of methotrexate and cytarabine during intensified continuation chemotherapy for high-risk B-precursor acute lymphoblastic leukemia: POG 9406: a report from the Children's Oncology Group.

PURPOSE: To determine the efficacy and toxicity of higher dose versus standard dose intravenous methotrexate (MTX) and pulses of high-dose cytosine arabinoside with asparaginase versus standard dose cytosine arabinoside and teniposide during intensified continuation therapy for higher risk pediatric B-precursor acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: From 1994 to 1999, the Pediatric Oncology Group conducted a randomized phase III clinical trial in higher risk pediatric B-precursor ALL. A total of 784 patients were randomized in a 2×2 factorial design to receive MTX 1 g/m versus 2.5 g/m and to cytosine arabinoside/teniposide versus high-dose cytosine arabinoside/asparaginase during intensified continuation therapy. RESULTS: Patients receiving standard dose MTX had a 5-year disease-free survival (DFS) of 71.8±2.4%; patients receiving higher dose MTX had a 5-year DFS of 71.7±2.4% (P=0.55). Outcomes on cytosine arabinoside/teniposide (DFS of 70.4±2.4) were similar to higher dose cytosine arabinoside/asparaginase (DFS of 73.1±2.3%) (P=0.41). Overall survival rates were not different between MTX doses or cytosine arabinoside/teniposide versus cytosine arabinoside/asparaginase. CONCLUSIONS: Increasing MTX dosing to 2.5 g/m did not improve outcomes in higher risk pediatric B-precursor ALL. Giving high-dose cytarabine and asparaginase pulses instead of standard dose cytarabine and teniposide produced nonsignificant differences in outcomes, allowing for teniposide to be removed from ALL therapy.

Anxiety in first year medical students taking gross anatomy.

To study anxiety levels in first-year medical students taking gross anatomy. Thirty medical students per year, for 2 years, completed the Beck Anxiety Inventory (BAI) 10 times during a 13-week gross anatomy course. In addition, behavioral observations were made by a psychiatrist during gross anatomy for demonstrations of assertive, destructive, neutral, or passive behavior. Additional qualitative outcome measures were group exit interviews with the faculty and students. The mean BAI for all 60 students per year, for 2 years, was 2.19 ± 3.76, 93% of the scores indicated minimal anxiety, and 89% of BAI values were less than five which confirmed a minimal level of anxiety. The low level of reported BAI contrasted sharply with verbal reports by the same students and face-to-face exit interviews with the psychiatrist. Symptoms of stress and anxiety emerged as a result of these conversations. The high levels of subjective stress and anxiety revealed by the interviews were unknown to the gross anatomy faculty. The low scores of students on the BAI's stand in sharp contrast to the BAI's reported for medical students in other published reports. Although it is possible that our students were truthfully devoid of anxiety, it is more likely that our students were denying even minimal anxiety levels. There have been reports that medical students feel that admitting stress, depression, or anxiety put their competitiveness for a residency at risk. We conclude that students may be in frank denial of experiencing anxiety and, if so, this behavior is not conducive to good mental health.

Preserving the humanities in medical education.

Patients are frequently unhappy with medical care because physicians fail to demonstrate humanistic qualities. Immersion in science is a necessary part of medical education but not sufficient. Courses in the history of medicine, the medical narrative in literature, bioethics, medicine and art, and spirituality and medicine will train physicians who will temper technological medicine with a humanistic touch. The rapid growth in biomedical knowledge and the growing demands upon medical students' time threaten to crowd out time for the humanities. Furthermore, the financing of medical humanities programmes is often tenuous. Medical students must come to understand that much of medical knowledge is a function of time and place, that medicine is a profoundly social enterprise and that the practice of medicine is a value-laden undertaking. The preservation of programmes in the medical humanities will reinforce the social responsibility that should be inherent in medical education.

Noninvasive Radioablation of Ventricular Tachycardia.

Ventricular tachycardia (VT) occurs most commonly in the presence of structural heart disease or myocardial scarring from prior infarction. It is associated with increased mortality, especially when it results in cardiac arrest outside of a hospital. When not due to reversible causes (such as acute ischemia/infarction), placement of an implantable cardioverter-defibrillator for prevention of future sudden death is indicated. The current standard of care for recurrent VT is medical management with antiarrhythmic agents followed by invasive catheter ablation for VT that persists despite appropriate medical therapy. Stereotactic arrhythmia radioablation (STAR) is a novel, noninvasive method of treating VT that has been shown to reduce VT burden for patients who are refractory to medical therapy and/or catheter ablation, or who are unable to tolerate catheter ablation. STAR is the term applied to the use of stereotactic body radiation therapy for the treatment of arrhythmogenic cardiac tissue and requires collaboration between an electrophysiologist and a radiation oncologist. The process involves identification of VT substrate through a combination of electroanatomic mapping and diagnostic imaging (computed tomography, magnetic resonance imaging, positron emission tomography) followed by carefully guided radiation therapy. In this article, we review currently available literature describing the utilization, efficacy, safety profile, and potential future applications of STAR for the management of VT.

Why Did the United States Medical School Admissions Quota for Jews End?

At the end of World War II anti-Semitism was pervasive in the United States. Quotas to limit the number of Jewish students were put in place at most U.S. medical schools in the 1920s and were well-entrenched by 1945. By 1970 the quota was gone. Why? Multiple factors contributed to the end of the quota. First, attitudes toward Jews shifted as Americans recoiled from the horrors of the Holocaust and over half a million Jewish GIs returned home from World War II. Many entered the higher education system. Second, governmental and private investigations in New York City, New York State and Philadelphia exposed the quota. Third, New York State, led by Governor Thomas E. Dewey, established 4 publicly supported nondiscriminatory medical schools. These schools adsorbed many New York Jewish applicants. Fourth, from the 1920s through the 1960s some medical schools consistently or intermittently ignored the quota. Finally, the federal and several state governments passed nondiscrimination in higher education legislation. The quotas ended because of a combination of changing societal attitudes and government and private social action. This remarkable social change may be instructive as higher education now grapples with allegations of a quota system for Asian-Americans.

"This is a Christian institution and we will tolerate no Jews here": The Brooklyn Medical Interns Hazings.

Anti-Semitic quotas to restrict access to medical school, graduate medical education and hospital privileges were common in the United States from the 1920s to the 1960s. In Brooklyn, New York, medical education prejudice resulted in violence. In 1916 a Jewish intern at Kings County Hospital, Matthew Olstein, was bound and gagged by Christian interns, put on a train at Grand Central Station, and warned that if he returned he would be thrown in the East River. Olstein died in combat in World War I as an Army physician. In 1927 3 Jewish interns at Kings County Hospital were assaulted, bound, dumped in tubs of water and covered in black fluid. Six gentile physicians were charged with assault. Criminal proceedings and public investigations followed. These attacks are the only known episodes of violence associated with American medical education anti-Semitism.

Efficacy and Safety of Low-Dose Iodine Plaque Brachytherapy for Juxtapapillary Choroidal Melanoma.

PURPOSE: To evaluate low- vs high-dose plaque brachytherapy for juxtapapillary choroidal melanoma. DESIGN: Retrospective interventional case series. METHODS: Setting: Single institution. STUDY POPULATION: Forty-seven patients with juxtapapillary choroidal melanoma. INTERVENTION: Iodine-125 plaque brachytherapy. Eyes were divided into apex low-dose (LD) and high-dose (HD) groups (≤ or > median apex dose 84.35 Gy). Main outcome measures were time to distant failure, local failure, death, enucleation, radiation retinopathy, optic neuropathy, and best-corrected visual acuity (BCVA). RESULTS: Freedom from distant failure rates were 96% and 95% in apex LD and HD groups at 5 years and 77% and 95% at 10 years, respectively (P = .84). Freedom from local failure rates were 90% in the apex LD group vs 89% in the HD group at 5 and 10 years (P = .96). Apex LD and HD groups did not differ for time to death or enucleation. Five- and 10-year freedom from radiation retinopathy and optic neuropathy rates were higher in the apex LD than HD group. Loss of ≥3 BCVA lines, final BCVA 20/40 or better, and final BCVA 20/200 or worse were more favorable in the 5 mm LD compared to HD group. Visual acuity outcomes did not differ between apex LD and HD groups. CONCLUSIONS: Low-dose iodine-125 plaque brachytherapy (67.5-81 Gy at tumor apex) provides safe and effective tumor control for juxtapapillary choroidal melanoma and may be associated with reduced radiation toxicity. Larger trials are needed to determine the optimal therapeutic dose for juxtapapillary choroidal melanoma.