Reviewing graduate medical education programs: a cancer center experience. Members of the Graduate Training Committee.

The Graduate Training Committee at Memorial Sloan-Kettering Cancer Center developed procedures for comprehensively reviewing the 32 graduate training programs at our institution. The methods used to carry out this review, the problems encountered, and the results of this review are presented. As this type of program review is now mandated by the Accreditation Council for Graduate Medical Education (ACGME), our method and experience should prove useful to other institutions planning a similar review process.

The teaching of cancer medicine by educational objectives.

In this paper, the authors review the findings of a survey of cancer education activities in 110 U.S. medical schools conducted by the American Association for Cancer Education. Problems documented through this survey include the need for more coordination of multidisciplinary teaching; more exposure of students to patients with common malignancies, especially in an outpatient setting; and more uniform instruction in fundamental diagnostic procedures, such as proctosigmoidoscopy, bone marrow aspiration/biopsy, and indirect laryngoscopy. The present authors review these problems, particularly as they relate to educational functions of departments of medicine, and discuss an approach to the teaching of cancer medicine that employs the definition of educational objectives and relates these objectives to departmental teaching responsibilities. The authors suggest that the departments of medicine are in a unique position to stimulate and coordinate clinical cancer education by this approach.

Studies on the pathogenesis of cancer hypercalcemia.

The pathogenesis of hypercalcemia in cancer continues to challenge the clinical investigator. Some aspects of this subject have been reviewed, notably with respect to the possible roles of prostaglandins and osteoclast activating factor, with particular reference to breast cancer. There is considerable evidence that the former humoral factor is operative and beginning evidence that the latter may be also. The hope in this continued work is that with better understanding of the mechanisms of hypercalcemia and bone loclization of tumors we will be in a far better position to control and interdict this localization.

Documented hyperparathyroidism of thirty-six years' duration.

The fascinating history of the first Memorial Hospital patient who was diagnosed as having hyperparathyroidism is reviewed. The illness presented as a cystic mass in a femur in 1929, which was treated with radiation. When the patient was first seen at Memorial Hospital in 1931, the diagnosis of osteitis fibrosa cystica was made; serum calcium was 14 mg/100 ml. In 1932, 6 years after Mandl performed the first parathyroidectomy ever for osteitis fibrosa cystica, this patient's neck was explored, and a right hemithyroidectomy was done, with removal of two normal parathyroid glands. The parathyroid tumor was finally located and partially removed in 1937 after a second failure at neck exploration in 1936. Correspondence between Dr. Edward D. Churchill at the Massachusetts General Hospital and Dr. Bradley Coley at Memorial Hospital indicated the concern at that time about uncontrollable tetany, which had been fatal in some contemporary cases and which had led to the practice of only partially removing the tumor. Following this, the patient was observed with documented hypercalcemia and chemical evidence of hyperparathyrodism until age 79. The physical and chemical abnormalities over the years up to and including her last exam are presented. The case is important not only from the historical viewpoint, but because it lends a perspective to long-term parathyroid disease, which is becoming less appreciated in this day of the routine serum calcium by SMA-12 screening. The question of partial parathyroidectomy for adenoma or hyperplasia is reviewed, and the question of observation of patients with mild hypercalcemia who probably have parathyroid tumors is discussed.