Donald B. Witzke

Impact of adjunctive testing on the diagnosis and clinical course of patients with acute appendicitis

The diagnosis of acute appendicitis is usually made from the history and physical examination. Recently, abdominal ultrasonography (US), laparoscopy, computerized tomography (CT), and barium enema (BE) have been used in the preoperative evaluation of patients with presumed appendicitis in order to improve the diagnostic accuracy. However, the usefulness of these tests in verifying the diagnosis of appendicitis has not been established. We reviewed the medical records of 203 patients who underwent appendectomy. One hundred patients were surgically treated before 1984 (group I) and 103 patients underwent surgery after 1988 (group II). Patients in group II were more likely to have preoperative US, laparoscopy, CT, or BE (24 in group II versus 3 in group I, p < 0.05). When groups I and II were compared, the rates of perforation (27% versus 20%), normal appendectomy (8% versus 11%), and the interval between admission and operation (12.2 hours versus 10.7 hours) and length of hospitalization (5.0 days versus 5.1 days) were not significantly different. We concluded that although adjunctive testing may be beneficial in selected patients, its routine use in patients suspected of having appendicitis cannot be advocated at present.

Characteristics influencing career decisions of academic and nonacademic emergency physicians.

STUDY OBJECTIVE To determine characteristics motivating physicians to choose careers in academic and nonacademic emergency medicine. DESIGN A written survey of 1,017 active members of the Society for Academic Emergency medicine and of a random sample of 2,000 members of the American College of Emergency Physicians was performed. Questions were asked regarding medical school, residency, and fellowship training; the importance of specific factors in influencing career decisions; and perceived obstacles to emergency medicine research. Responses from nonfaculty and adjunct, clinical, and research faculty were compared using chi 2 analysis for discrete variables and a four-group analysis of variance for continuous variables. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Responses were obtained from 1,203 physicians (41.3%). Those choosing academic careers were significantly more likely to complete a residency in emergency medicine or internal medicine and fellowship training in research or toxicology compared with nonacademic physicians. Nonfaculty and clinical faculty considered family obligations, leisure time, and personal income to be the most important factors influencing their career decisions; research faculty considered role models and the value of research to be most important. There was no difference in indebtedness among the groups. Finding time and funding, administrative obligations, and pressures to do clinical work were the most important obstacles to research productivity. CONCLUSION Factors influencing career decisions can be used to plan strategies to meet the future needs of academic emergency medicine.

Survey of undergraduate emergency medical education in the United States

To determine the status of undergraduate education in emergency medicine, questionnaires were sent to 141 medical schools. Of the 135 schools responding, 15.2% require emergency medicine courses in the fourth year (mean, 164 hours); 11.9% require these courses (average, 84 hours) in the third year. Emergency medicine is offered in 21.8% of second-year and 37.9% of first-year curriculums. Training in cardiopulmonary resuscitation is offered in 96% of the schools responding, and certification is required in 53%. Training in advanced cardiac life support is offered in 73% of schools, with 23% requiring it for graduation. Training in advanced trauma life support is offered in 17.2% of schools. Osteopathic schools require more time for emergency medicine in the clinical years but less time in formal lectures. Schools with a residency program in emergency medicine more frequently offer emergency medicine in the preclinical years. This survey provides some basic data on the status of undergraduate emergency medicine education in medical school curriculums, and it encourages medical educators to review the undergraduate curriculum to ensure that students receive adequate exposure to the essentials of emergency medicine.

Effects of electrocautery on midline laparotomy wound infection

This study compared the healing of midline fascial incisions made with either scalpel or electrocautery and inoculated with Escherichia coli in 57 Sprague-Dawley rats. At 7 days, tensile strength was significantly less when incisions were made with electrocautery than with a scalpel. Additionally, would strength was inversely related to the concentration of the inoculum of E coli. The use of electrocautery was also associated with more frequent bacteremia at 48 hours and higher mortality at 7 days. Our results suggest that the technique used to incise the abdominal fascia influences subsequent wound healing, particularly in contaminated wounds.

Factors influencing radiologists to choose research careers.

The future of radiology is threatened by the paucity of competent researchers who are radiologists. To determine what influences are most important in selecting and training potential radiology researchers, we conducted a survey of 5000 practicing radiologists, including all members of the Association of University Radiologists. We also surveyed 3000 randomly selected radiology trainees. A research career was empirically defined as 20% or more of a radiologists time being involved with research. Response to the practicing radiologists and radiology trainees surveys was 28% and 19%, respectively. Radiologists who attended medical school or trained in radiology at an institution among the top 20 for research funding more frequently chose careers in research than those who matriculated and trained elsewhere. Publishing at least one research article, having a dedicated radiology research fellowship, having access to grant funds, and using computers during medical school or radiology training were factors typifying radiologists who chose research careers. Research radiologists were more concerned about the value of performing research and less concerned about personal income than those choosing careers not focusing on research. These results suggest that it might be possible to select radiology trainees who are more likely to become researchers based on their backgrounds and attitudes. An appropriate milieu during training enhances the likelihood of radiologists choosing research careers.

Factors influencing resident career choices in emergency medicine

OBJECTIVE To assess the attitudes of residents in emergency medicine regarding a career in academics. DESIGN A 22-item questionnaire was administered to residents in conjunction with the yearly American Board of Emergency Medicine inservice examination. Demographic information and factors influencing career intent were elicited. Respondents were classified by intent on a career in emergency medicine. A three-way analysis of variance was used to address group differences for eight specific factors impacting on career decision. Chi-square analysis was used to address questions involving relationships among variables with dichotomous or categorical responses. RESULTS The survey was distributed to 1,654 residents, and 1,238 (75%) completed the questionnaire. Motivating factors demonstrating significant differences between those residents planning an academic career and those not interested in academe were a desire to do research, desire to teach, desire to make a contribution to medicine, and exposure to role models, with less emphasis on the need for free time for other interests and less concern regarding practice location. More than 80% of those not going into academic emergency medicine believed they were adequately exposed to research in residency compared with 65% of those intent on a career in academe (P less than .01). Research in medical school, residency, and authorship of a research paper were significantly more prevalent for those residents desiring a career in academe (P less than .01). Twenty-six percent of residents responded that their role models for research were less than adequate. Seventeen percent of residents intend to take fellowship training. The most popular fields for fellowships were toxicology (25%), emergency medical services (21%), pediatrics (15%), and research (9%). CONCLUSION The results of this survey address attitudes among residents toward a career in academic emergency medicine. Factors such as motivation, role models, and exposure to research may help academicians plan strategies to meet the future needs of academic emergency medicine.

Performances of underrepresented-minority students at the University of Arizona College of Medicine, 1987-1991

&NA; PURPOSE. To compare the academic performances of underrepresented‐minority (African American, Native American, and Hispanic) students and all other students at the University of Arizona College of Medicine. METHOD. The performances of 42 underrepresented‐minority and 368 other students who graduated between 1987 and 1991 were compared using the following variables: undergraduate science, non‐science, and overall grade‐point average (GPA); scores on the Medical College Admission Test (MCAT); subtest and total scores on the National Board of Medical Examiners (NBME) Part I and Part II examinations; and three types of evaluations from a required family practice clerkship. In addition, a comparison was made of scores on an objective structured clinical examination (OSCE) taken in the fourth year by 25 underrepresented‐minority and 165 other students. Data were analyzed using a three‐way analysis of variance and Pearson correlation analysis. RESULTS. The underrepresented‐minority students earned significantly lower GPAs and scored significantly lower on all standardized paper‐and‐pencil tests and the family practice clerkship final examination. There was no significant group difference in the family practice clerkship clinical evaluations or the majority of the OSCE scores. For both groups, overall GPAs and MCAT scores correlated equally well with NBME total scores but were not significantly corrected with OSCE scores or family practice clerkship clinical evaluations. CONCLUSION. While the underrepresented‐minority students entered medical school with significant educational disadvantages and continued to score lower than the other students on paper‐and‐pencil tests, their clinical performances on the OSCE and family practice clerkship were nearly equivalent to those of the other students.

Core content survey of undergraduate education in emergency medicine

One hundred forty-one medical schools were surveyed to determine the emergency medicine core content topics and skills being taught in the curricula. Responses were obtained from 96 schools through two mailings and a telephone followup. Most topics surveyed were offered in the vast majority of medical schools (greater than 92%) with the exception of emergency medical services (offered in 79% of schools). Emergency medicine topics were a required part of the curriculum in a much smaller percentage of schools. No subtopics in toxicology, ophthalmologic emergencies, or emergency medical services were required in more than 30% of schools. The survey showed a similar pattern of these skills being offered in most schools, but required in a smaller number. For example, while C-spine immobilization is taught in 90% of schools, it is required in only 46%. Educators must consider a coherent, interdisciplinary knowledge base and skills list for their medical school curricula.

Research and research training in academic radiology departments. A survey of department chairmen.

We surveyed 121 chairmen of academic radiology departments to assess how these departments select and educate their residents and fellows in research. Eighty-six chairmen responded (71%). The majority of their programs select at least some of their trainees for their potential as researchers and nearly all encourage trainees to perform research. The more the selection process focuses on research, the greater the percentage of residents and fellows that participate in research during training. Nonetheless, only about one-third of residents and half of the fellows perform and publish research. Only half the programs offer formal research seminars and few trainees opt for additional research training. These results may relate to the relatively small percentage of faculty performing prospective clinical and laboratory research. These findings are disappointing in the light of previous results suggesting that performing research, publication, and formal research education during training correlate highly with the development of successful research careers. Chairmen could increase the likelihood of trainees choosing research careers and being successful in publishing research by providing early exposure to research experiences and providing formalized research training.

Student fatigue as a variable affecting performance in an objective structured clinical examination.

No abstract available.