Primary Care Residency Perspectives on Medical Student Performance Evaluations.

Introduction: With the transition of the United States Medical Licensing Examination (USMLE) Step 1 exam to pass-fail, residency directors are exploring alternative objective approaches when selecting candidates for interviews. The Medical Student Performance Evaluations (MSPE) portion of the application may be an area where objectivity could be provided. This study explored program directors' (PDs) perspectives on the utility of the MSPE as a discriminating factor for residency candidate selection. Methods: We invited PDs of primary care residencies listed in the American Medical Association FRIEDA database to participate in a mixed-methods study assessing opinions on the MSPE, and the importance of student skills and application components when considering a candidate for interview. We obtained summary statistics for Likert-scale responses. We used inductive thematic analysis to generate themes from open-ended comments. Results: Two hundred forty-nine PDs completed the survey (response rate=15.9%). Patient communication (83.6%) and teamwork (81.9%) were rated as very/extremely important skills, and being a graduate of a US medical school in the past 3 years (73.1%), no failures on board exams (58.2%), and MSPEs (54.8%) were rated as very/extremely important application components. Six hundred seventy-eight open-ended comments yielded themes related to desire for more transparency and standardization, importance of student attributes and activities, and other important components of applications. Conclusion: PDs place a high value on the MSPE but find it limited by concerns over validity, objectivity, and lack of standardization. The quality of MSPEs may be improved by using a common language of skill attainment such as the Association of American Medical Colleges' Entrustable Professional Activities and using the document to discuss students' other attributes and contributions.

Hyperlipidemia: An Evidence-based Review of Current Guidelines.

Cholesterol treatment guidelines have evolved in the United States from the 1988 Adult Treatment Panel (ATP) I, the ATP II guidelines, ATP III guidelines, the 2013 American College of Cardiology/American Heart Association guidelines, to the most recent 2016 recommendations from the United States Protective Services Task Force. The use of statins to treat hyperlipidemia has been widely accepted and recommended in adults aged 40-75 years old with at least one risk factor and a calculated 10-year cardiovascular disease risk of 10%. However, statin use is associated with myalgias, myopathy, musculoskeletal injury, liver injury, and increased diabetes risk. The evidence for non-statin treatments is mixed. Bile acid sequestrants and ezetimibe reduce cardiovascular events. There is no evidence that the addition of any fibric acid derivative to a statin improves cardiovascular outcomes. Available evidence suggests that the use of proprotein convertase subtilisin/kexin type 9 (PCSK9) enzyme inhibitors likely leads to little or no difference in mortality despite lowering lipid levels.