Mark A. Levine

Validity of the in-training examination for predicting american board of internal medicine certifying examination scores

Objective:To determine whether the results of the Internal Medicine In-Training Examination (ITE) can predict subsequent performance on the American Board of Internal Medicine certifying examination (ABIMCE).Design:Retrospective data review.Setting:A mixture of six community hospital and university-based internal medicine training programs in the Eastern United States.Subjects:109 residents who first took the ABIMCE in 1988 or 1989, and who had also taken at least one ITE.Measurements:Scores for the composite and subspecialty sections of the ITE were compared with those for the ABIMCE. An R2was obtained to relate the scores on the two examinations. A cutoff score was derived to maximize the ability of the ITE to discriminate between residents who were likely to pass and those who were likely to fail the ABIMCE.Main results:ABIMCE scores were available for 109 residents who had also taken the ITE during PGY-2 (19), PGY-3 (50), or both years (40). Composite scores on the ABIMCE were highly correlated with those on the ITE-PGY-2 (R2=0.593) and the ITE-PGY-3 (R2=0.677) (p<0.0001 for each).Most of the subspecialty sections on the two examinations were significantly correlated, although less strongly (range of R2=0.041 to 0.32)than were the composite scores. An empirically derived cutoff score of the 35th percentile on the ITE-PGY-2 had a positive predictive value of 89% (probability of passing ABIMCE) and a negative predictive value of 83% (probability of failing ABIMCE).Conclusions:Performance on the ITE can accurately predict and is highly correlated with performance on the ABIMCE. ITE results may therefore be useful in counseling residents about their educational needs in preparation for the ABIMCE.

Enhancement of granulopoiesis by lithium carbonate in a patient with hairy cell leukemia

A 73-year-old patient with hairy cell leukemia and profound granulocytopenia both before and after splenectomy was treated with lithium carbonate. With serum lithium level maintained in the therapeutic range, granulocyte count steadily increased from a level below 200/mm3 to 800/mm3 over a two-week period. This trend reversed upon withdrawal of lithium. A second hematologic response occurred when the drug was reintroduced. The data support the contention that lithium carbonate may effectively stimulate granulopoiesis on a long-term basis, and this pharmacologic approach may be a useful adjunct to the management of hairy cell leukemia.

Dietary counseling of hypercholesterolemic patients by internal medicine residents

AbstractObjective:To assess the knowledge, attitudes, and practices of internal medicine residents concerning dietary counseling for hypercholesterolemic patients. Design:Cross-sectional, self-administered questionnaire survey.Setting:Survey conducted August 1989 in seven internal medicine residency programs in four southeastern and middle Atlantic states.Participants:All 130 internal medicine residents who were actively participating in outpatient continuity clinic.Interventions:None.Measurements and main results:Only 32% of the residents felt prepared to provide effective dietary counseling, and only 25% felt successful in helping patients change their diets. Residents had good scientific knowledge, but the degree of practical knowledge about dietary facts varied. Residents reported giving dietary counseling to 58% of their hypercholesterolemic patients and educational materials to only 35%. Residents who felt more self-confident and prepared to counsel reported more frequent use of effective behavior modification techniques in counseling. Forty-three percent of residents had received no training in dietary counseling skills during medical school or residency.Conclusion:Internal medicine residents know much more about the rationale for treatment for hypercholesterolemia than about the practical aspects of dietary therapy, and they feel ineffective and ill-prepared to provide dietary counseling to patients.

The Interdisciplinary Generalist Curriculum Project at the University of Vermont College of Medicine: The Vermont Generalist Curriculum (VGC) Experience.

The University of Vermont College of Medicine received its Vermont Generalist Curriculum (VGC) subcontract as one of the second-cycle Interdisciplinary Generalist Curriculum (IGC) Project schools from 1995 to 1998. The Vermont program was jointly codirected by the chairs of family practice and pediatrics and the program director for internal medicine on a rotating basis and was overseen by a multidisciplinary steering committee that included generalists, basic scientists, specialists, and students. This committee provided guidance and support in recruitment of preceptors, continuous assessment and improvement of the courses, development of a clinical correlation manual for students in clinical offices, and cooperation around a jointly sponsored annual primary care meeting that included a joint scientific program, a research forum, and a faculty development workshop. The VGC has provided a pilot for many innovative curricular changes that have served as models for the school-wide curriculum redesign process currently under way at Vermont. While the funding for this project ended in 1998, the changes, innovations, and collaboration born out of the project are valuable enough for the deans office to maintain the VGCs funding and its steering committee for the future.