¿Está la virtud en el punto medio? La incertidumbre del CIN2 y el papel del VPH / Is virtue at the midpoint? The uncertainty of CIN2 and the role of HPV

Objetivo: La biopsia guiada por colposcopia (BGC) marca el manejo de la neoplasia intraepitelial cervical. El objetivo de este estudio fue evaluar la concordancia de los resultados entre la BGC y la escisión amplia de la zona de transformación (LLETZ, large loop excision of the transformation zone), y la utilidad del genotipado del virus del papiloma humano (VPH) para seleccionar a las pacientes con riesgo de lesión intraepitelial escamosa de alto grado/neoplasia intraepitelial cervical 3 (HSIL/CIN3). Método: Se compararon los resultados de la BGC y de la LLETZ, siendo esta última el método de referencia. Se evaluó la relación del genotipo del VPH con el diagnóstico final de HSIL/CIN3. Resultados: La precisión de la biopsia comparada con LLETZ fue del 61,4%. La tasa de concordancia fue del 64,4% para CIN1, del 31,4% para CIN2 y del 77,4% para CIN3. La tasa global de sobrediagnóstico fue del 18,68% y la de subdiagnóstico del 19,89%. En mujeres menores de 30 años, la concordancia fue del 62,79% (CIN1 65%, CIN2 39,58% y CIN3 73,08%), la tasa de sobrediagnóstico del 22,67% y la tasa de subdiagnóstico del 15,11%. La infección por VPH16 tuvo una odds ratio de 3,86 para el diagnóstico final de HSIL/CIN3+. Conclusiones: El diagnóstico de CIN2 por BGC parece insuficiente para seleccionar a las pacientes para tratamiento escisional, principalmente en mujeres jóvenes. El hallazgo de VPH16 es un factor de riesgo de HSIL/CIN3+ independientemente del resultado de la biopsia.

Objective: Colposcopy-guided biopsy (CGB) is a basic tool for the management of cervical intraepithelial neoplasia. The aim of this study is to evaluate the concordance of results between CGB and large loop excision of the transformation zone (LLETZ), and the usefulness of human papillomavirus (HPV) genotyping to select patients at risk of H-SIL/CIN3. Method: The results of colposcopy-guided biopsy and LLETZ were compared, with LLETZ being the gold standard. The relationship of HPV genotype to the final diagnosis of CIN3 was assessed. Results: The accuracy of CGB compared to LLETZ was 61.4%. The concordance rate was 64.4% for CIN1, 31.4% for CIN2 and 77.4% for CIN3. The overall overdiagnosis rate was 18.68% and underdiagnosis rate was 19.89%. In women under 30 years of age the concordance rate was 62.79% (CIN1 65%, CIN2 39.58% and CIN3 73.08%), and the rate of overdiagnosis and underdiagnosis was 22.67% and 15.11%, respectively. HPV16 infection had an odds ratio of 3.86 for the final diagnosis of CIN3+ and the result was significant regardless of the biopsy result. Conclusions: The CGB result as CIN2 is inaccurate and seems insufficient to select patients for excisional treatment, mainly in young women. HPV16 infection is a risk factor for CIN3+ regardless of the colposcopy-guided biopsy result.

Detection of Relevant Heavy Metal Concentrations in Human Placental Tissue: Relationship between the Concentrations of Hg, As, Pb and Cd and the Diet of the Pregnant Woman.

Heavy metals can cross the placental barrier and reach the fetal compartment, threatening fetal development. Pregnant women can acquire these through food, drinking water, toxic habits or simply by breathing polluted air. The placenta has been described as a biomarker of maternal and fetal exposure to different toxic elements. OBJECTIVES: The main objective of this study was to test the possible existence of heavy metal deposits (Pb, As, Cd and Hg) in the placentas of women who gave birth at term in our setting, analyzing the influence of daily life and dietary habits. METHODS: We studied 103 placentas, obtained by consecutive sampling, of women that delivered in the Regional Maternity Hospital of Malaga between March and June, 2021. As, Cd and Pb concentrations were analyzed using mass spectrometry techniques. Hg concentration was studied according to US EPA method 7473. Women also answered a questionnaire with epidemiological variables. RESULTS: Detectable concentrations were found in 14.56% [As], 44.6% [Cd], 81.5% [Pb] and 100% [Hg]. [Pb] and [As] correlated significantly (Spearman's Rho of 0.91 and <0.001), as did [Hg] and [Cd] (Spearman's Rho 0.256, p < 0.004). The [Pb] and [AS] concentrations were significantly higher in cases of tap water consumption. [Hg] concentrations predicted the birth weight of female newborns.

Supresión de la visita de tercer trimestre en embarazo de bajo riesgo en la pandemia de SARS-CoV-2 / Third trimester suppression in low-risk pregnancy in the SARS-CoV-2 pandemic

Resumen Objetivo: La pandemia de SARS-CoV-2 ha obligado a una reorganización de las visitas presenciales, y por ese motivo se han minimizado hasta el punto de reconsiderar la realización de la visita del tercer trimestre. Nuestro centro suprimió dicha visita obstétrica y obtuvo datos propios para comparar los resultados perinatales logrados con dicho manejo. Método: Se realizó un estudio de cohortes retrospectivo, en marzo de 2020, con una cohorte con visita presencial única en la semana 40 de gestación (122 gestantes) frente a una cohorte con seguimiento convencional con visita presencial en la semana 36 de gestación (162 gestantes). Se evaluaron la restricción del crecimiento fetal, la edad gestacional al nacimiento, el peso neonatal y las tasas de inducciones, partos eutócicos y cesáreas urgentes en trabajo de parto. Resultados: Se encontraron diferencias leves en la tasa de nuliparidad (p < 0,04), sin hallarlas en el resto de las variables maternas. No hubo diferencias entre las dos cohortes en los resultados neonatales. Conclusiones: No hay diferencias entre los resultados materno-fetales obtenidos en gestantes con seguimiento gestacional con restricción de la visita del tercer trimestre respecto del seguimiento tradicional, excepto en el diagnóstico de las alteraciones de la estática fetal al término de la gestación.

Abstract Objective: The SARS-CoV-2 pandemic has forced a reorganization of face-to-face visits, for this reason they have been minimized to the point of reconsidering the completion of the third trimester visit. Our center eliminated the performance of this obstetric visit and obtained its own data to compare the perinatal results obtained with such management. Method: A retrospective cohort study was carried out in March 2020, with a cohort with a single face-to-face visit at 40th week of gestation (122 pregnant women), versus a cohort with conventional follow-up with face-to-face visit at 36th week of gestation (162 pregnant women). The following were evaluated fetal growth restriction, gestational age at birth, neonatal weight, rate of inductions, of eutocic deliveries, and of urgent cesarean sections in labor. Results: Slight differences were found in the nulliparity rate (p < 0.04), without finding them in the rest of the maternal variables. There were no differences between the two cohorts in neonatal outcomes. Conclusions: There were no differences between the maternal-fetal results obtained in pregnant women with gestational follow-up with restriction of the third trimester visit compared to traditional follow-up, except in the diagnosis of alterations in fetal statics at the end of pregnancy.

Exploring students' [pre-pandemic] use and the impact of commercial-off-the-shelf learning platforms on students' national licensing exam performance: A focused review - BEME Guide No. 72.

BACKGROUND: Commercial-off-the-shelf learning platforms developed for medical education (herein referred to as MedED-COTS) have emerged as a resource used by a majority of medical students to prepare for licensing examinations. As MedED-COTS proliferate and include more functions and features, there is a need for an up-to-date review to inform medical educators on (a) students' use of MedED-COTS outside the formal medical school curriculum, (b) the integration of MedED-COTS into the formal curriculum, and (c) the potential effects of MedED-COTS usage on students' national licensing exam scores in the USA. METHODS: Due to the limited number of studies published on either the use or integration of MedED-COTS, a focused review of literature was conducted to guide future research and practice. Data extraction and quality appraisal were conducted independently by three reviewers; with disagreements resolved by a fourth reviewer. A narrative synthesis was completed to answer research questions, contextualize results, and identify trends and issues in the findings reported by the studies included in the review. RESULTS: Results revealed consistent positive correlations between students' use of question banks and their licensing exam performance. The limited number of integration studies, combined with a number of methodological issues, makes it impossible to isolate specific effects or associations of integrated commercial resources on standardized test or course outcomes. However, consistent positive correlations, along with students' pervasive use and strong theoretical foundations explaining the results, provide evidence for integrating MedED-COTS into medical school curricula and highlight the need for further research. CONCLUSIONS: Based on findings, we conclude that students use exam preparation materials broadly and they have a positive impact on exam results; the literature on integration of MedED-COTS into formal curriculum and the use by students of resources outside of exam preparation is scant.

Rigorous Curricular Innovation: Development, Integration, and Evaluation of Anatomic Clinical Correlations Module.

OBJECTIVE: To develop an anatomy clinical correlations module utilizing modern instructional design techniques and theoretically structured student feedback for course improvements. DESIGN: A pre-experimental, single group post-test study. Eleven module sessions were structured using the 5-E instructional strategy (engage, explore, explain, elaborate, and evaluate). Learning impact was measured using Keller's ARCS framework (attention, relevance, confidence, and satisfaction) and narrative student feedback was collected to inform case alterations. The course was repeated the following year with the integrated feedback and year-on-year comparisons were drawn. SETTING: Single-institution study at the University of Central Florida College of Medicine. PARTICIPANTS: Medical students currently enrolled in the first-year anatomy course. RESULTS: Year-on-year comparisons for AY18-19 (n = 78) and AY19-20 (n = 118) yielded statistically significant improvements in attention (4.69-4.76, p = 0.01) and relevance (4.54 to 4.75, p ≤ 0.001) with high total combined survey response rates (n = 196/238, 82.4%). Internal consistency was good for attention and strong for the following scales: total scale, relevance, confidence, and satisfaction. Narrative feedback referenced the importance of applied anatomy, clinical context and decision-making, the format of the sessions. CONCLUSIONS: We structured a series of anatomic clinical correlations using an evidence-based instructional strategy, assessed its impact, and improved on the course to optimize the motivation to learn anatomy. Systematic use of structured student feedback is important to ensure case difficulty is within the zone of proximal development.

SARS-CoV-2 Infection and C-Section: A Prospective Observational Study.

Pregnant women are particularly vulnerable to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. In addition to unfavorable perinatal outcomes, there has been an increase in obstetric interventions. With this study, we aimed to clarify the reasons, using Robson's classification model, and risk factors for cesarean section (C-section) in SARS-CoV-2-infected mothers and their perinatal results. This was a prospective observational study that was carried out in 79 hospitals (Spanish Obstetric Emergency Group) with a cohort of 1704 SARS-CoV-2 PCR-positive pregnant women that were registered consecutively between 26 February and 5 November 2020. The data from 1248 pregnant women who delivered vaginally (vaginal + operative vaginal) was compared with those from 456 (26.8%) who underwent a C-section. C-section patients were older with higher rates of comorbidities, in vitro fertilization and multiple pregnancies (p < 0.05) compared with women who delivered vaginally. Moreover, C-section risk was associated with the presence of pneumonia (p < 0.001) and 41.1% of C-sections in patients with pneumonia were preterm (Robson's 10th category). However, delivery care was similar between asymptomatic and mild-moderate symptomatic patients (p = 0.228) and their predisposing factors to C-section were the presence of uterine scarring (due to a previous C-section) and the induction of labor or programmed C-section for unspecified obstetric reasons. On the other hand, higher rates of hemorrhagic events, hypertensive disorders and thrombotic events were observed in the C-section group (p < 0.001 for all three outcomes), as well as for ICU admission. These findings suggest that this type of delivery was associated with the mother's clinical conditions that required a rapid and early termination of pregnancy.

Stretched penile length at birth: a systematic review.

BACKGROUND: Micropenis is an endocrinological condition that is habitually observed at birth. Diagnosis is made by measuring the stretched penile length, a method established 80 years ago. Discrepancies in the normative data from recent studies raise the need for a current revision of the methodology. OBJECTIVES: The aims of this systematic review were to compare the different normative data of SPL at birth, to examine the methodological aspects of the technique and to evaluate the independent variables that may be involved. METHODS: Searches were performed using MEDLINE, EMBASE, Scielo, the Cochrane Library and Web of Science. A combination of the relevant medical terms, keywords and word variants for "stretched penile length", "penile length", "penile size", "newborn" and "birth" were used. Eligibility criteria included normative studies that used the stretched penile length (SPL) measurement on a population of healthy, full-term newborns during the first month of life. The outcomes studied included characteristics of the studies, methodological aspects and independent variables. RESULTS: We identified 49 studies comprising 21,399 children. Significant discrepancies are observed between the different studies. Methodological aspects seem to be consistent and similar. The main independent variables appear to be ethnic group and gestational age. Main limitations were the absence of studies of entire world regions such as Europe or South America, and the heterogeneity of the ethnic background that complicates the analysis. CONCLUSIONS: It seems advisable to suggest the creation of customized reference charts for each specific population instead of resorting to the classic cut-off points.

Sonographic evaluation of fetal scrotum, testes and epididymis.

External male genitalia have rarely been evaluated on fetal ultrasound. Apart from visualization of the penis for fetal sex determination, there are no specific instructions or recommendations from scientific societies. This study aimed to review the current knowledge about prenatal diagnosis of the scrotum and internal structures, with discussion regarding technical aspects and clinical management. We conducted an article search in Medline, EMBASE, Scopus, Google Scholar, and Web of Science databases for studies in English or Spanish language that discussed prenatal scrotal pathologies. We identified 72 studies that met the inclusion criteria. Relevant data were grouped into sections of embryology, ultrasound, pathology, and prenatal diagnosis. The scrotum and internal structures show a wide range of pathologies, with varying degrees of prevalence and morbidity. Most of the reported cases have described incidental findings diagnosed via striking ultrasound signs. Studies discussing normative data or management are scarce.

Open-legs axial plane: A standardized methodology and reference values for fetal genital biometry in mid-trimester ultrasound.

BACKGROUND: Evaluation of the external genitalia is an important part of prenatal ultrasound. However, there is no standardized methodology that includes biometric measurements and normative data to be able to carry out this evaluation. OBJECTIVE: To develop a standardized methodology for fetal genital biometry and obtain reference values for use in mid-trimester ultrasound. STUDY DESIGN: A prospective cross-sectional study was used. 273 male and 253 female fetuses of normal, singleton pregnancies at 18 to 22 weeks were included. Measurements of fetal penis length, penile width and transverse scrotal diameter in male fetuses and bilabial diameter in female fetuses were performed by transabdominal ultrasound. Reference values were calculated for each gestational week. RESULTS: Realization of the open-legs axial plane is described as a working methodology. Normative data for penile length, penile width, transverse scrotal diameter and bilabial diameter are defined, including mean, minimum and maximum values, range, and 5th, 10th, 90th and 95th percentiles. CONCLUSIONS: We have provided a standardized methodology using the open-legs axial plane, which would integrate the main measurements. In addition with the normative data constructed from their use, we hope to be able to improve the external genitalia assessment and diagnosis of genital anomalies in mid-trimester ultrasound.

Prediction model of success for external cephalic version. Complications and perinatal outcomes after a successful version.

AIM: External cephalic version (ECV) is an effective and safe technique for avoiding breech presentation at birth. However, it continues rejected by many women. The aim of this study is to develop a predictive model of success of external cephalic version, determine the safety of the technique and perinatal outcomes after successful version. METHODS: Data from 317 versions performed over a 6-year period were collected. Different clinical and ultrasound variables, complications, vaginal delivery after successful version and perinatal outcomes were analyzed. RESULTS: The overall success rate was 72% (229 of 317 versions). The variables most related to success were parity, placental location, amniotic fluid volume, fetal sex, fetal head palpation and descent of the presenting part. A model for calculating the probability of success was developed in which to input parity, placentation and amniotic fluid data. The model correctly classified 98.8% of successful technique and 74% of all women. Complications were very few and mostly mild. Of women who had success, 77% (163 of 212) had a vaginal birth. No differences between neonatal outcomes were found. CONCLUSION: External cephalic version is a successful, safe technique with a high rate of subsequent vaginal delivery. A success prediction model based on some very easily obtained variables can personalize the probability of success.

Desgarro perineal con mucosa vaginal íntegra tras primera relación sexual / Perineal tear with intact vaginal mucosa after first sexual intercourse

RESUMEN Las lesiones del tracto genital femenino tras relaciones sexuales son un problema frecuente en las urgencias de ginecología, pero poco estudiado salvo su aspecto médico-legal. Su incidencia es desconocida ya que muchas mujeres no llegan a consultar por miedo o pudor. El reconocimiento precoz de estas lesiones y su correcto tratamiento puede evitar la parición de secuelas que acompañarán a nuestra paciente durante el resto de su vida. Presentamos el caso de una paciente de 18 años con un desgarro perineal con mucosa vaginal íntegra tras su primera relación sexual.

ABSTRACT Injuries to the female genital tract after sexual intercourse are a frequent problem in gynecological emergencies, but little studied except for their medico-legal aspect. Its incidence is unknown since many women do not go to their specialist out of fear or embarrassment. Early recognition of these injuries and their correct treatment may prevent the appearance of sequelae that will accompany our patient for the rest of her life. We present the case of an 18-year-old patient with a perineal tear with intact vaginal mucosa after her first sexual intercourse.

Is large loop excision of the transformation zone depth a risk factor for affected endocervical margins?

OBJECTIVE: The aim of the study was to determine if the depth of large loop excision of the transformation zone (LLETZ) is a risk factor for presenting affected endocervical margins. METHODS: A cross-sectional retrospective study was performed on 353 patients that underwent LLETZ after presenting cervical biopsies with CIN grade 2 and grade 3 or persistent CIN grade 1 at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 2011 to December 2016. Automatized measurement of the LLETZ depth was performed in microns and added to cervical canal extensions when these were performed. Other variables studied in positive endocervical margins were age (under or over 35 years), premenopause/postmenopause, number of affected quadrants, CIN grading, the presence of HPV 16 before LLETZ, parity (nulliparous vs multiparous) and the location where the LLETZ was performed (operating room vs consultation room). RESULTS: Our multivariant analysis showed that LLETZ depth ≤ 10 mm did not increase the risk in affected endocervical margins (P = 0.366) and no statistically significant difference between the two groups (affected and nonaffected margins) was found. CIN grading and parity did prove a statistically significant association (P = 0.039 and P = 0.011, respectively). Age, menopause, number of affected quadrants, HPV 16 and the location did not show statistical association with positive endocervix margins. CONCLUSIONS: LLETZ depth equal to or lower than 10 mm was not proven to be a risk factor to have affected endocervical margins after the treatment. Therefore, higher LLETZ depth would not be justified to ensure oncological results.

The Physical-Virtual Patient Simulator: A Physical Human Form With Virtual Appearance and Behavior.

INTRODUCTION: We introduce a new type of patient simulator referred to as the Physical-Virtual Patient Simulator (PVPS). The PVPS combines the tangible characteristics of a human-shaped physical form with the flexibility and richness of a virtual patient. The PVPS can exhibit a range of multisensory cues, including visual cues (eg, capillary refill, facial expressions, appearance changes), auditory cues (eg, verbal responses, heart sounds), and tactile cues (eg, localized temperature, pulse). METHODS: We describe the implementation of the technology, technical testing with healthcare experts, and an institutional review board-approved pilot experiment involving 22 nurse practitioner students interacting with a simulated child in 2 scenarios: sepsis and child abuse. The nurse practitioners were asked qualitative questions about ease of use and the cues they noticed. RESULTS: Participants found it easy to interact with the PVPS and had mixed but encouraging responses regarding realism. In the sepsis scenario, participants reported the following cues leading to their diagnoses: temperature, voice, mottled skin, attitude and facial expressions, breathing and cough, vitals and oxygen saturation, and appearance of the mouth and tongue. For the child abuse scenario, they reported the skin appearance on the arms and abdomen, perceived attitude, facial expressions, and inconsistent stories. CONCLUSIONS: We are encouraged by the initial results and user feedback regarding the perceived realism of visual (eg, mottling), audio (eg, breathing sounds), and tactile (eg, temperature) cues displayed by the PVPS, and ease of interaction with the simulator.

VR Simulation Leads to Enhanced Procedural Confidence for Surgical Trainees.

OBJECTIVE: Active learning techniques result in greater knowledge acquisition compared to passive methods. For medical students with limited hands-on operative experiences, virtual reality platforms represent active learning and may enhance procedural training. We hypothesize that virtual reality simulators like Toolkit for Illustration of Procedures in Surgery (TIPS) are a more effective modality in teaching laparoscopic surgical techniques to medical students when compared to passive learning tools like videos. DESIGN: In this crossover study, participants were randomly assigned to perform either a TIPS laparoscopic appendectomy followed by video of a laparoscopic cholecystectomy, or video of a laparoscopic appendectomy followed by TIPS laparoscopic cholecystectomy. A knowledge assessment followed each intervention. A postsurvey was used to gather feedback and subjective impressions of the learning experience. SETTING: University of Central Florida College of Medicine. PARTICIPANTS: Second, third, and fourth-year medical students (n = 37). RESULTS: Validation of the content assessments revealed strong internal consistency (Cronbach's α = 0.73). A 2-tailed Fisher's exact test revealed that the video had greater ease of use (p = 0.032), but TIPS had greater utility as a learning tool (p < 0.001) and instilled greater confidence in the ability to reproduce procedural steps (p < 0.001). A 2-tailed t test of the average content quiz scores revealed no significant difference in percentage correct between groups on the laparoscopic appendectomy quiz (p = 0.772), but a difference favoring video learning on the laparoscopic cholecystectomy quiz (p = 0.042) CONCLUSIONS: Video and TIPS both enhanced different aspects of student learning; however, the active TIPS platform produced greater confidence in the ability to reproduce the steps of the procedure and had greater utility as a learning strategy. Videos are simple to use and can serve a complementary role in curriculum design.

Does the trend toward less deep excisions in LLETZ to minimize obstetric risk lead to less favorable oncological outcomes?

OBJECTIVE: To analyze the relationship between large loop excision of the transformation zone (LLETZ) depth and the persistence of disease and human papillomavirus (HPV) infection in patients with cervical intraepithelial neoplasia grades 2 and 3. METHODS: A cross-sectional observational retrospective study included women with cervical intraepithelial neoplasia grades 2 and 3 who underwent LLETZ at Hospital Universitario Santa Lucía, Cartagena, Spain, from November 1, 2011, to December 31, 2016. Follow-up of cytology and HPV detection were performed at 6 and 12-18 months after surgery. RESULTS: In this study of 256 women, multivariate analysis revealed that conization depth of 10 mm or less did not indicate an increase of persistence/recurrence of pathological cytology at 6 months (P=0.094) and after 12-18 months (P=0.234), or infection by HPV at 6 months (P=0.675) and 12-18 months (P=0.938) after LLETZ. The affected endocervical margin at 6 months is the sole independent risk factor for persistence, both in the lesion (P=0.003) and HPV (P=0.004). CONCLUSION: Conization depth lower than 10 mm at LLETZ did not increase disease persistence or infection by HPV in an 18 month monitoring period. Therefore, higher depth conizations would not be justified to ensure favorable oncological results.

Evaluation of machine learning methods with Fourier Transform features for classifying ovarian tumors based on ultrasound images.

INTRODUCTION: Ovarian tumors are the most common diagnostic challenge for gynecologists and ultrasound examination has become the main technique for assessment of ovarian pathology and for preoperative distinction between malignant and benign ovarian tumors. However, ultrasonography is highly examiner-dependent and there may be an important variability between two different specialists when examining the same case. The objective of this work is the evaluation of different well-known Machine Learning (ML) systems to perform the automatic categorization of ovarian tumors from ultrasound images. METHODS: We have used a real patient database whose input features have been extracted from 348 images, from the IOTA tumor images database, holding together with the class labels of the images. For each patient case and ultrasound image, its input features have been previously extracted using Fourier descriptors computed on the Region Of Interest (ROI). Then, four ML techniques are considered for performing the classification stage: K-Nearest Neighbors (KNN), Linear Discriminant (LD), Support Vector Machine (SVM) and Extreme Learning Machine (ELM). RESULTS: According to our obtained results, the KNN classifier provides inaccurate predictions (less than 60% of accuracy) independently of the size of the local approximation, whereas the classifiers based on LD, SVM and ELM are robust in this biomedical classification (more than 85% of accuracy). CONCLUSIONS: ML methods can be efficiently used for developing the classification stage in computer-aided diagnosis systems of ovarian tumor from ultrasound images. These approaches are able to provide automatic classification with a high rate of accuracy. Future work should aim at enhancing the classifier design using ensemble techniques. Another ongoing work is to exploit different kind of features extracted from ultrasound images.

Pre-clerkship medical students' perceptions of medical professionalism.

BACKGROUND: Professionalism instruction and assessment is a core component of medical education, and essential for professional identity formation (PIF). Thus, understanding the socialization of medical students to the values of the profession (i.e., medical professionalism), and how these may evolve, warrants continued understanding. METHODS: The purpose of this study was to examine and compare pre-clerkship (first and second year) medical students' perceptions of professionalism. First and second year medical students participate in this study. This was a two-phase mixed-methods cohort study conducted across two academic years (2014-2015 and 2015-2016). In Phase I, first and second year medical students participated in a nominal group technique (NGT) session. NGT data was analyzed qualitatively to generate a card-sorting exercise of professionalism attributes for Phase II. In Phase II, data from the sorting task was analyzed using Principle Component Analysis (PCA). RESULTS: The PCA for first year students derived a 7-factor solution. Factors (i.e., professionalism domains) identified were: Self-management and patient-centeredness, ethics and professional reputation, dependability, self-awareness and self-improvement, image, proficiency and lifelong learning and integrity. The PCA for second year students derived a 5-factor solution; factors identified were: "Good Doctor" attributes, responsibility, ethics, innovation and self-improvement and unbiased. CONCLUSIONS: Identification and organization of attributes into an overarching professionalism mental model provide a window into the active reconstruction of students' professional identity during the nascent stages of medical education. M1 professionalism domains were more consistent with the conventional professional image of the physician (e.g. Ethics and Professional reputation, Dependability, Integrity), whereas, M2 domains reflected a more global view (e.g., "Good Doctor" attributes, Responsibility, Ethics). This study provides a lens into the dynamic nature of students' PIF and encourages educators to evaluate PIF pedagogy at their own institutions.

Increasing Students' Publication Productivity: Could Launching a University Scientific Journal be a Catalyst?

Our institution established an online medical journal to promote publication opportunities and to foster a culture of scholarship. In two years of activity, there was an increase in the proportion of students reporting authorship of peer-reviewed publications at our institution suggesting an increase in students' scholarly interest and output.

Using Assessment Point Accumulation as a Guide to Identify Students at Risk for Interrupted Academic Progress.

PROBLEM: Interruptions in academic progress (IP) are problematic for students and educational programs alike. Early identification of students at risk for IP, to provide remediation, could be beneficial. APPROACH: Considering the clinically familiar pediatric growth curve as a metaphor, researchers hypothesized they could identify students at risk of IP. They organized course-related examination performance data for 518 students in five classes (2013-2014 through 2017-2018), adding students' percentage scores cumulatively over time. At every examination point, they analyzed the data for dis-tribution and calculated a mean class score. They plotted each student's accumulated points and accommodated a linear fit. Using the mean of the class as the horizontal axis, students gaining points against the mean show a positive slope; conversely, students losing points reveal a negative slope. The authors compared their findings against students who had faced IP-those who had repeated at least one course or an academic year, or who had left medical school. OUTCOMES: Using a receiver operating characteristic approach, the authors identified a slope of -5 as an excellent screening test with 85% accuracy (sensitivity = 82%, specificity = 86%, area under curve = 0.917). Of 38 students facing IP, 25 would have been identified at risk for IP as early as the fifth assessment using a slope of -5. NEXT STEPS: Given the outcomes of this innovative, inexpensive, highly accurate approach to identifying students at risk of IP, the authors have plans to optimize interventions and to validate the approach at other programs.