Faculty Bibliography

OBJECTIVE: This pilot study assessed the opinions of medical students, residents, and attending physicians regarding the technical standards for medical school admission and the competencies required of graduates in the context of physical disability issues. DESIGN: Students, residents, and faculty from all specialties at a major academic medical center were surveyed regarding the concept of the 'undifferentiated graduate;' the relative importance of motor, sensory, observation, and communication skills; the importance of specific technical skills; and the use of physician extenders and other accommodations to fulfill technical standards. RESULTS: Respondents placed higher importance on observation and communication skills compared with motor skills. Of respondents, 69.8% either disagree or strongly disagree with the idea that a medical student should be an undifferentiated candidate possessing all the technical skills necessary to enter any specialty. CONCLUSIONS: Technical skills used in interpretation and observation were more important to respondents than those technical skills that are purely procedural. Respondents largely rejected the concept of the undifferentiated graduate. Although statistical analyses are of limited reliability because of low response rates, this study represents the most extensive sampling to date of medical professionals' opinions on these issues. Respondents' narrative comments also provided valuable perspectives

Characterized by chronic widespread joint and muscle pain, fibromyalgia is a syndrome of unknown etiology. The American College of Rheumatology's classification criteria for fibromyalgia include diffuse soft tissue pain of at least 3 months' duration and pain on palpation in at least 11 of 18 paired tender points. Symptoms are often exacerbated by exertion, stress, lack of sleep, and weather changes. Fibromyalgia is primarily a diagnosis of exclusion, established only after other causes of joint or muscle pain are ruled out. The initial workup for patients who present with widespread musculoskeletal pain should include a complete blood count, erythrocyte sedimentation rate, liver function tests, hepatitis C antibody, calcium, and thyrotropin. The musculoskeletal system, the neuroendocrine system, and the central nervous system, particularly the limbic system, appear to play major roles in the pathogenesis of fibromyalgia. The goal in treating fibromyalgia is to decrease pain and to increase function without promoting polypharmacy. Brief interdisciplinary programs have been shown to improve subjective pain. Fibromyalgia is a complex syndrome associated with significant impairment on quality of life and function and substantial financial costs. Once the diagnosis is made, providers should aim to increase patients' function and minimize pain. This can be accomplished through nonpharmacological ahd pharmacological interventions. With proper management, the rate of disability appears to be significantly reduced