Is Academic Medicine a Financially Viable Career? Exploring Financial Considerations and Resources.

Introduction: As a result of the common belief that professionals in academic medicine make less money than their private practice counterparts, as well as the rising cost of medical school and subsequent loans, medical students and residents alike are dissuaded from pursuing careers in academia. However, with greater knowledge of loan repayment programs and financial planning, students can make informed decisions about entering the field of academia. Methods: Using the Kern model, a workshop was developed to educate medical students considering an academic career about financial resources, loan repayment, student debt, and the importance of budgets. The workshop also encouraged reflection on personal and financial factors that influence career choice. Results: The workshop was implemented at five regional conferences with a total of 113 participants. After participating in the workshop, survey data showed that participants were statistically less likely to agree with the statement "Student debt will hinder my ability to pursue an academic medicine career," and more likely to agree with the statement "Academic medicine is a financially viable career choice for me" and "A career in academic medicine will provide a comfortable salary." Over 95% of respondents agreed or strongly agreed that each objective was met. Discussion: This workshop provided an interactive and reflective method to increase participants' awareness of factors that influence financial considerations when considering postgraduate career choices. It highlighted factors that may be particularly relevant for an academic career choice and of resources available, especially loan repayment programs, to ensure a financially viable academic career.

An Introduction to Research Work, Scholarship, and Paving a Way to a Career in Academic Medicine.

Introduction: Despite high faculty attrition and challenges to expanding the number of clinician-researchers, career development to heighten trainees' pursuit of an academic research career remains a relatively understudied topic. Completing peer-reviewed publications during medical school increases a trainee's likelihood of becoming a future faculty member. There is a lack of educational content to guide trainees in selecting research activities, publishing, and gaining self-efficacy to pave a path towards a clinician-researcher track. Methods: The Kern model was applied to create a multimodal workshop that would heighten trainee awareness of various research opportunities, skills for conducting research, best practices in publishing, and also help them develop a personal plan to pursue research. The workshop included a presentation, reflection exercises, and a case scenario. The workshop was implemented among trainees attending professional development conferences at nine medical schools. A questionnaire assessed participants' change in self-efficacy in completing research scholarship and pursuing an academic research career. Results: Sixty medical students and seven residents participated in the workshops. Paired-sample t tests indicated a statistically significant increase in participants' perception that academic medicine would allow them to engage in research work, and in their self-efficacy to publish and succeed along a clinician-researcher track. Discussion: The workshop not only exposed participants to a variety of research activities but also provided a sense that all research types are valid, aiding some participants to identify new research opportunities. In addition, participants gained clarity on how to publish and develop a research path, which may help maintain interest in a clinician-researcher track.

A bacteriophage endolysin that eliminates intracellular streptococci.

PlyC, a bacteriophage-encoded endolysin, lyses Streptococcus pyogenes (Spy) on contact. Here, we demonstrate that PlyC is a potent agent for controlling intracellular Spy that often underlies refractory infections. We show that the PlyC holoenzyme, mediated by its PlyCB subunit, crosses epithelial cell membranes and clears intracellular Spy in a dose-dependent manner. Quantitative studies using model membranes establish that PlyCB interacts strongly with phosphatidylserine (PS), whereas its interaction with other lipids is weak, suggesting specificity for PS as its cellular receptor. Neutron reflection further substantiates that PlyC penetrates bilayers above a PS threshold concentration. Crystallography and docking studies identify key residues that mediate PlyCB-PS interactions, which are validated by site-directed mutagenesis. This is the first report that a native endolysin can traverse epithelial membranes, thus substantiating the potential of PlyC as an antimicrobial for Spy in the extracellular and intracellular milieu and as a scaffold for engineering other functionalities.

Complications of adenotonsillectomy in patients younger than 3 years.

OBJECTIVE: To evaluate the complication rate for adenotonsillectomy in children younger than 3 years, without a diagnosis of severe obstructive sleep apnea, to assess the necessity for postoperative inpatient admission. DESIGN: Retrospective medical record review (January 1, 2003, through October 31, 2009). SETTING: Tertiary care academic medical center. PATIENTS: Retrospective medical record review of 105 patients younger than 3 years who underwent adenotonsillectomy performed by a single surgeon. Nineteen patients were excluded from our review because of incomplete medical records or severe underlying disease, leaving a total of 86 patients with medical records available for inclusion in our study. Patient medical records were deidentified and reviewed for age, sex, indications for surgery, intraoperative and perioperative interventions, and postoperative complications. One child with a diagnosis of severe obstructive sleep apnea was excluded from the study. MAIN OUTCOME MEASURES: Complications, including bleeding, dehydration requiring admission, and airway intervention, during the intraoperative or perioperative period were recorded. RESULTS: The mean age of the study population was approximately 27.5 months (range, 13-35 months), with most children (76.5%) between 23 and 31 months of age. Among the patients whose records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Dehydration was the most common complication and was the cause of all documented readmissions (4.7%) in our patients who ranged in age from 14 to 30 months. Two patients had other complications, reactive airway disease (n=1) and postoperative fever (n=1), which were identified and treated in the postanesthesia care unit, resulting in same-day discharge. No airway complications were noted in our study. CONCLUSIONS: Our study reveals a low complication rate in children younger than 3 years. The recommendations for mandatory admission for children younger than 3 years should be reexamined. Criteria for inpatient admission for children younger than 3 years should be based on preoperative and postoperative clinical evaluation of the patient and an evaluation of the family resources for adequately caring for young children at home in the postoperative period. These recommendations apply only to otherwise healthy children (American Society of Anesthesiologists classifications I and II) without a diagnosis of severe obstructive sleep apnea syndrome.

Commentary: the building the next generation of academic physicians initiative: engaging medical students and residents.

Data from the 2010 U.S. Census are a reminder of the diverse patient population in the United States and the growing health care needs of Americans. Academic health centers are tasked with reforming the system to expand its capacity for care and with cultivating innovation to generate the teaching, training, and research prowess needed to eliminate health disparities. At the center of this reform is enhancing the system that produces the human capital, including the physicians who care for the patients and the educators who train those physicians. Institutions and foundations have committed to the development of pipeline programs, from kindergarten through college, to create a diverse clinical workforce, but they have limited their direct promotion of diversity in the academic medicine workforce to faculty development programs. Despite faculty efforts, shortcomings in diversity persist, including a paucity of female full professors and deans, an insignificant increase in the proportion of underrepresented racial and ethnic minority faculty, and a lack of knowledge on the cultivation of the lesbian and gay faculty perspective. Furthermore, underrepresented racial and ethnic minority students in particular lose interest in academic medicine careers during medical school, and overall students lose interest in academic medicine careers during residency. The Building the Next Generation of Academic Physicians Initiative is designed to develop interest and promote achievement in pursuing academic medicine careers. This initiative is needed to increase the pool of diverse faculty down the road and elicit their perspectives to more effectively address health care disparities.