Assessing medical students' knowledge in differentiating the diagnosis and treatment of unipolar vs bipolar depression.

BACKGROUND: Depression is one of the leading causes of premature death and disability. However, both unipolar and bipolar depression are underdiagnosed and undertreated. The aims of this study were to assess medical students' level of confidence in and knowledge of diagnosing and treating depression before and after completing a psychiatry clerkship, and their knowledge of differentiating unipolar vs bipolar depression. METHODS: Third-year medical students at Augusta University (Georgia, USA) completed an online questionnaire to assess confidence in and knowledge of diagnosing and treating unipolar and bipolar depression. RESULTS: Students who completed a psychiatry clerkship were statistically significantly more comfortable/confident with diagnosing (P < .0001) and treating (P < .0001) unipolar depression. Regarding bipolar depression, 73% of students who completed a psychiatry clerkship correctly diagnosed bipolar disorder, vs 59% of students who did not complete a psychiatry clerkship. This difference was not statistically significant (P = .181). CONCLUSIONS: Students who completed a psychiatry clerkship were more confident in diagnosing and treating unipolar depression compared with those who did not complete a psychiatry clerkship. However, there was no statistically significant difference between students who had completed a psychiatry clerkship and those who had not completed a psychiatry clerkship in making the correct diagnosis of bipolar depression. Neither group had a very high rate of correct diagnosis.

A primary care guide to bipolar depression treatment.

Manage uncomplicated cases following guidelines on medical therapy and with adjunctive psychotherapy. Refer complicated and severe cases to Psychiatry.

Differences in Medical Students' Academic Performance between a Pass/Fail and Tiered Grading System.

OBJECTIVES: Medical school implementation of a pass/fail grading system offers the opportunity for a reduction in student stress and anxiety and the creation of a less competitive environment, leading to an improvement in overall well-being. Some critics of a pass/fail system have raised concerns of a decrement in academic performance. The purpose of this research project was to determine whether medical students at the Medical College of Georgia experienced a significant change in academic performance when graded using a pass/fail grading system rather than a tiered grading system in the year 1 curriculum. METHODS: This retrospective cohort study included a convenience sample of two cohorts of students: the first had tiered grading in the first year of medical school (classes of 2015 and 2016; n = 389) and the second cohort had pass/fail grading in the first year of medical school (classes of 2017 and 2018; n=385). Students' undergraduate grade point average and Medical College Admission Test scores in the two cohorts were compared. The first- and second-year averages and comprehensive finals, and the US Medical Licensing Examination step 1 scores were compared. Mann-Whitney U tests were calculated to compare the cohorts' grades. RESULTS: Overall, both cohorts performed similarly in the first and second year of medical school and on US Medical Licensing Examination step 1; however, there were a few unimportant but statistically significant differences of 1 to 2 points on a 100-point scale. In a few instances, the pass/fail cohort performed slightly better and in others, slightly worse. CONCLUSIONS: Overall academic performance was similar. The potential for an enhanced learning environment associated with pass/fail grading does not create an important decrement in academic performance.

Screening colonoscopies by primary care physicians: a meta-analysis.

PURPOSE: There is currently too few endoscopists to enact a national colorectal cancer screening program with colonoscopy. Primary care physicians could play an important role in filling this shortage by offering screening colonoscopy in their practice. The purpose of this study was to examine the safety and effectiveness of colonoscopies performed by primary care physicians. METHODS: We identified relevant articles through searches of MEDLINE and EMBASE bibliographic databases to December 2007 and through manual searches of bibliographies of each citation. We found 590 articles, 12 of which met inclusion criteria. Two authors independently abstracted data on study and patient characteristics. Descriptive statistics were performed. For each outcome measure, a random effects model was used to determine estimated means and confidence intervals. RESULTS: We analyzed 12 studies of colonoscopies performed by primary care physicians, which included 18,292 patients (mean age 59 years, 50.5% women). The mean estimated adenoma and adenocarcinoma detection rates were 28.9% (95% confidence interval [CI], 20.4%-39.3%) and 1.7% (95% CI, 0.9%-3.0%), respectively. The mean estimated reach-the-cecum rate was 89.2% (95% CI, 80.1%-94.4%). The major complication rate was 0.04% (95% CI, 0.01%-0.07%); no deaths were reported. CONCLUSIONS: Colonoscopies performed by primary care physicians have quality, safety, and efficacy indicators that are comparable to those recommended by the American Society of Gastrointestinal Endoscopy, the American College of Gastroenterology, and the Society of American Gastrointestinal Endoscopic Surgeons. Based on these results, colonoscopy screening by primary care physicians appears to be safe and effective.

A collaborative approach to wellness: diet, exercise, and education to impact behavior change.

PURPOSE: The purpose of this study was to evaluate an interdisciplinary Wellness Program developed to help patients implement behavior changes necessary to begin weight reduction. DATA SOURCES: A 12-week program was developed to offer a choice of three diets, education, behavior change, and support groups that would allow participants to work through their concerns. A total of 109 participants provided feedback throughout the program and had varying degrees of change. Measures included education, food diaries, support, exercise, and anthropomorphic measurements. CONCLUSIONS: Participants who attended the exercise classes showed the most positive results with weight loss, and the greater the number of times attending the exercise classes, the more weight was lost. Readiness and willingness to change and the degree of involvement in the program also proved to be major factors in the program. IMPLICATIONS FOR PRACTICE: While obesity and overweight continue to be major healthcare issues in the United States, a real positive approach to helping patients with this problem has not been found. Continued study and support are needed to help patients deal with the impact of weight on overall health and well-being.

Perceptions of obesity: Black and White differences.

To better understand similarities and differences in Black and White women's perceptions about obesity, we conducted race-matched focus groups with thirty physician-referred, obese women. Participants completed demographic questionnaires and body image assessments. Analysis yielded some common themes. Unique themes for Black women included disagreement with the thin ideal and their own and family members' satisfaction with their weight; dislike of physical activity because of perspiration and appearance; program access barriers; and difficulties with clothing. White women desired support during weight loss from other obese individuals. Results support education and intervention programs that respond to specific needs of each group.

Attitudes toward performance of endoscopic colon cancer screening by family physicians.

BACKGROUND AND OBJECTIVES: This study's purpose was to examine attitudes of family physicians and gastroenterologists toward family physician performance of lower endoscopy in general practice. METHODS: A mailed survey was sent to 1,563 board-certified physicians in Georgia (1,303 family physicians, 260 gastroenterologists). Respondents were asked to describe their practice of lower endoscopy procedures and colorectal (CRC) screening preferences. RESULTS: Fifty-one percent (801) of the surveys were returned. For CRC screening, family physicians recommend fecal occult blood testing most frequently (51.7%), while gastroenterologists recommended colonoscopy most frequently (89.5%). Most family physicians believe that family physicians should perform flexible sigmoidoscopy (FS) (81.4%) and colonoscopy (CS) (71.3%). A total of 71.2% of surveyed gastroenterologists believe that family physicians should perform FS, but only a minority (4.5%) believe that family physicians should perform screening CSs. Approximately 28% (186) of family physicians report performing FS (mean=.8 FS per month). Only 3.7 % (25) of family physicians reported performing CS (mean=8.2 CSs per month). CONCLUSIONS: Although most family physicians believe that they should perform lower endoscopy, only a minority of gastroenterologists believe family physicians should perform CS. Our results show that family physician performance of lower endoscopic CRC screening is limited in general practice. Future research might consider exploring these issues from both the gastroenterologist and family physician perspective.

Survey of student education in surgery.

BACKGROUND: Few data exist comparing medical student surgical education programs across the US and Canada. We conducted a 30-question, Web-based survey of 142 medical schools in the US and Canada about the administration of undergraduate surgical education programs at their institutions. STUDY DESIGN: From October 2005 to January 2006, 142 Association of American Medical Colleges (AAMC) medical schools in the US and Canada were asked to complete a 30-item, Web-based questionnaire. Descriptive statistics were compiled for all responses and data were analyzed using Student's t-test. RESULTS: One hundred two medical schools responded to the survey (90 of 125 US and 12 of 17 Canadian schools, overall response rate,=72%). The majority of surgical clerkships have between 16 and 30 students rotating at a time through 2 to 4 teaching sites. The most frequent overall clerkship duration was 8 weeks, divided most frequently between a 4- to 6-week general surgery rotation and a 4-week subspecialty rotation. There was no consensus about what services constitute general surgery rotations, although the most common subspecialty rotations were urology (68%) and orthopaedics (66%). American medical schools were more likely to use the National Board of Medical Examiners (NBME) subject examination for student assessment (90.9% US versus 50.0% Canadian, p < 0.05); Canadian medical schools were more likely to use an Objective Structured Clinical Examination (69.2% Canadian versus 37.7% US, p < 0.05) and other written examinations (69.2% Canadian versus 37.7% US, p < 0.05). CONCLUSIONS: There is wide variation in the structure and administration of medical student surgical education programs in the US and Canada. These findings underscore the need for a clerkship directors committee and a national dialog about a core student curriculum to ensure consistency in the quality of student education in surgery.

The prevalence of dysphagia in primary care patients: a HamesNet Research Network study.

PURPOSE: A number of disorders cause dysphagia, which is the perception of an obstruction during swallowing. The purpose of this study was to determine the prevalence of dysphagia in primary care patients. METHODS: Adults 18 years old and older were the subjects of an anonymous survey that was collected in the clinic waiting room before patients were seen by a physician. Twelve family medicine offices in HamesNet, a research network in Georgia, participated. RESULTS: Of the 947 study participants, 214 (22.6%) reported dysphagia occurring several times per month or more frequently. Those reporting dysphagia were more likely to be women (80.8% women vs 19.2% men, P = .002) and older (mean age of 48.1 in patients with dysphagia vs mean age of 45.7 in patients without dysphagia, P = .001). Sixty-four percent of patients with dysphagia indicated that they were concerned about their symptoms, but 46.3% had not spoken with their doctor about their symptoms. Logistic regression analyses showed that increased frequency [odds ratio (OR) = 2.15, 95% CI 1.41-3.30], duration (OR = 1.91, CI 1.24-2.94), and concern (OR = 2.64, CI 1.36-5.12) of swallowing problems as well as increased problems eating out (OR = 1.72, CI 1.19-2.49) were associated with increased odds of having talked to a physician. CONCLUSIONS: This is the first report of the prevalence of dysphagia in an unselected adult primary care population. Dysphagia occurs commonly in primary care patients but often is not discussed with a physician.

Students assigned to community practices for their pediatric clerkship perform as well or better on written examinations as students assigned to academic medical centers.

BACKGROUND: Medical schools are increasingly using community practice sites (CPS) for clerkship training. PURPOSES: We compared the test performance of all students assigned to CPS with all students trained at an academic medical center (AMC) for their pediatric clerkship for the past 5 years. METHODS: Baseline comparability of both groups was established by the group mean scores on 1st and 2nd year medical school grade point average (GPA) and the United States Medical Licensing Examination (USMLE) Step 1 and Step 2. Performance outcome was compared by group mean scores on a written clerkship exam and the National Board of Medical Examiners Pediatric Subject Examination. RESULTS: There was no statistical difference between the two groups with regard to GPA or USMLE scores. Standardized test performance results: [table: see text] CONCLUSION: The CPS-trained students performed as well or better on standardized written tests compared with AMC-trained students. Community pediatric practices can provide a quality clerkship experience for junior medical students.