Incorporating the fourth year of medical school into an internal medicine residency: effect of an accelerated program on performance outcomes and career choice.

BACKGROUND: To counter declining student interest in general internal medicine, New York Medical College and Saint Vincent's Catholic Medical Centers of New York implemented an experimental accelerated internal medicine curriculum that was provisionally approved by the American Board of Internal Medicine. DESCRIPTION: This accelerated program allowed selected 4th-year medical students to obtain credit for their 1st year of an internal medicine residency while completing requirements for the MD degree. EVALUATION: Career and performance outcomes for trainees in the accelerated and traditional internal medicine residency programs were compared for 6 classes of graduates. There were no statistically significant differences between the 2 groups in mean scores on the Intern Clinical Evaluation Exercise, standardized in-service exam, monthly attending evaluations, or in Board pass rates. However, graduates of the accelerated program were more likely to be in general internal medicine practice on completion of residency. CONCLUSIONS: The accelerated program successfully increased the number of trainees entering generalist practice a year earlier, and maintained academic standards.

Long-term renal survival in HIV-associated nephropathy with angiotensin-converting enzyme inhibition.

BACKGROUND: Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is the most common cause of end-stage renal disease (ESRD) in HIV-infected patients. Angiotensin-converting enzyme (ACE) inhibition has previously shown a short-term benefit in HIVAN. This study examines the long-term effects of ACE inhibition on renal survival in HIVAN. METHODS: In this single-center prospective cohort study, 44 patients with biopsy-proven HIVAN were enrolled prior to the onset of severe renal insufficiency (serum creatinine or=two antiviral drugs for >or=30 consecutive days, CD4 lymphocyte count, initial median serum creatinine concentration, or proteinuria. Risk of renal failure was reduced with ACE inhibitors (RR = 0.003, P < 0.0001). Exposure to antiretroviral therapy did not have a significant impact on the risk of renal failure. Of the ACE inhibitor-treated group, 87.5% survived compared with 21.4% of the control group (P < 0.001). CONCLUSION: ACE inhibition initiated prior to severe renal insufficiency may offer long-term renal survival benefits in HIVAN. Diagnosis should be sought early in patients with clinical signs suggestive of HIVAN.