Analysis of performance and predictors of success in the final fellowship examination of the College of Intensive Care Medicine.

OBJECTIVES: To analyse the performance and predictors of success in the final fellowship examination of the College of Intensive Care Medicine (CICM), and to compare the outcomes of international medical graduates (IMGs) attempting the CICM fellowship exam with those of local trainees, defined as those from Australia, New Zealand and Hong Kong (ANZ-HK). To compare the performance of IMGs from countries with comparable health care systems (CHS) with those from other countries (non-CHS). DESIGN, SETTING AND PARTICIPANTS: Analysis of six exam presentations collected prospectively between 2009 and 2011. MAIN OUTCOME MEASURES: Pass rates in the final fellowship exam. RESULTS: Between 2009 and 2011, 233 candidates presented to the exam 334 times, and 73% were IMGs. ANZ-HK trainees performed better at the exam (79% v 46%, P<0.0001). IMG trainees from CHS performed better than trainees from non-CHS (60% v 40%, P<0.01). Any candidate completing an ANZ primary exam performed better than non-ANZ primary candidates (74% v 41%, P<0.0001). IMG candidates successful at a postgraduate exam from a CHS country performed better than candidates from a non-CHS country (56% v 34%, P=0.005). The success rate of IMGs improved to 64% after obtaining an ANZ primary. Candidates taking the exam while working in an intensive care unit had a pass rate of 57% compared with 48% of candidates working in non-ICU posts (P=0.23). This was not statistically significant. CONCLUSIONS: A significant proportion of candidates appearing for the CICM fellowship examination are IMGs. Pass rates for trainees who have graduated from the ANZ- HK systems have a higher success rate in the fellowship examination. IMGs from a CHS country, or those who completed an ANZ primary have a much higher success rate compared with other IMGs.

Effect of adjuvant perioperative desmopressin in locally advanced canine mammary carcinoma and its relation to histologic grade.

Desmopressin (DDAVP) is a vasopressin peptide analog with hemostatic properties that has been successfully used during surgery in patients with bleeding disorders. Recently published experimental and clinical data indicate that perioperative administration of DDAVP can minimize spread and survival of residual mammary cancer cells. The central aim of this study was to explore the effect of perioperative DDAVP and its relation to histologic grade in bitches with locally advanced mammary carcinoma. Of the 32 dogs initially recruited, 28 intact bitches with mammary carcinoma tumors stage III or IV were ultimately included. These dogs were randomized to receive DDAVP at intravenous doses of 1 µg/kg (n=18) or saline solution as placebo (n=10). En bloc mastectomy of the affected gland(s) was performed. Tumor malignancy was graded by the method of Elston and Ellis into well-differentiated (grade 1), moderately differentiated (grade 2), or poorly differentiated (grade 3). DDAVP therapy significantly prolonged the disease-free survival (P<0.001) and overall survival (P<0.01) in bitches with grade 2 or 3 carcinomas compared with bitches in the control group. No significant difference in disease-free period or overall survival was found between treatment groups in bitches with grade 1 tumors. The present data suggest that DDAVP may be an excellent candidate as a surgical adjuvant in the management of aggressive cancers in small animals. More research in this field is warranted.