Clinical resources to teach components of a new Family Medicine Clerkship Curriculum.

BACKGROUND AND OBJECTIVES: This retrospective study was designed to determine the capacity of a 6-week distributed Family Medicine Clerkship to provide student documented patient encounters that could facilitate instructions on the acute illness and chronic disease components of the new Family Medicine Clerkship Curriculum (FMCC). The FMCC was developed to standardize core clinical education experiences in Family Medicine Clerkships in US medical schools. METHODS: Three years (FY06--FY08) of patient encounters documented by students and compiled in a Family Medicine Clerkship patient encounter database at the Medical College of Georgia were examined to determine the presence of patient experiences consistent with the acute illness and chronic disease presentations objectives of the new FMCC. The study cohort consisted of 537 students encountering 78,770 patients in 21 learning sites. RESULTS: Fifty-five percent of the FMCC acute illness presentations objectives (n=20) were encountered at least once by >90% of the students while 81% of the chronic disease presentations objectives (n=16) were encountered at least once by >90% of the students. All students encountered patients with multiple chronic diseases, with an average of 32.29 and 13.6 student patient encounters containing two and three chronic diseases respectively. Patient volumes for the FMCC acute illness and chronic disease objectives ranged from means of 0.37 to 10.37 and 2.24 to 57.47 per student respectively. CONCLUSIONS: The study suggests that a 6-week Family Medicine Clerkship could provide patient experiences to facilitate student instructions on most of the acute illness and chronic disease presentations objectives of the new FMCC.

Ulnar and tibial bending stiffness as an index of bone strength in synchronized swimmers and gymnasts.

The purpose of this study is to compare a mechanical property of bone in world-class female athletes with different loading histories. Bone bending stiffness or EI (E is the modulus of elasticity and I, the moment of inertia) was measured noninvasively with the mechanical response tissue analyzer, that analyzes the response of bone to a vibratory stimulus. We evaluated the ulna, ulnar width, wrist density and tibia in 13 synchronized swimmers (SYN), eight gymnasts (GYM) and 16 untrained women (UNT) of similar age. Muscle strength in the flexors and extensors at elbows and knees was measured in the athletes. SYN were taller than GYM or UNT (168 +/- 0.7 vs. 152 +/- 1.1 or 157 +/- 1.2 cm, P < 0.01). Ulnar EI, Nm(2), was similar in SYN and GYM (41 +/- 5.4 vs. 42 +/- 4.2, NS) and 50% higher than in UNT (27 +/- 2.1, P < 0.05). Ulnar EI, Nm(2) was related to ulnar width (r = 0.497, P < 0.002, n = 37) but not to wrist density. Tibial EI, Nm(2), in SYN and GYM (270 +/- 42 vs. 285 +/- 49, NS) was similar and more than twice as high as in UNT (119 +/- 6; p < 0.05). Knee flexor strength measured at 60 degrees s(-1) and elbow extensor strength at 200 degrees s(-1) correlated with tibial EI (r = 0.44 and 0.41, P < 0.05). In spite of different loading histories, the tibiae and ulnas of world-class athletes showed similar high values for bending stiffness that exceeded values in untrained women. EI in the ulna could be related to bone width and in the tibia, to muscle strength.