Faculty Bibliography

BACKGROUND: Medical schools must address the fact that students embarking on careers in medicine are idealistic but have a vague understanding of the values and characteristics that define medical professionalism. Traditionally, we have relied primarily on unsystematic role modeling and lectures or seminars on related topics to teach professionalism. METHODS: A committee of students and a faculty advisor created a curriculum, based on a needs assessment of the targeted learners, to raise students' awareness of professional tenets and provide them with the skills to recognize and analyze conflicts between the values of professionalism and the daily pressures of medical school training. The student-run professionalism curriculum begins during medical school orientation and is followed by three student-facilitated case-based workshops over the next two years. All of the workshops involve small group discussions led by trained upperclass student facilitators. The workshops address the application of professional values to both the preclinical and clinical situations and prepare students for self-reflection, self-assessment and peer evaluation. We evaluated students' satisfaction following each workshop and pre/post attitudes for the first workshop. RESULTS: Twenty five upper-class student facilitators were trained in the first year. Student attendance ranged from 80-100% of the class (N=160), the proportion of students who agreed or strongly agreed that the workshops were educationally useful ranged from 60-75% for each workshop. Certain student attitudes improved immediately after the first workshop. These workshops continue annually. CONCLUSIONS: Students have been a driving force behind this curriculum, which is a model for professionalism education. It was accepted by students and, although somewhat controversial, created a level of awareness and discussion regarding professional behavior in medical school that had previously been absent.

The TSH response to TRH administration (7 micrograms/kg) was measured in 68 infants (22 premature) who had abnormal thyroid screening tests by the filter paper method and whose serum thyroid function tests were only mildly abnormal. Twenty-eight infants (12 premature) had peak TSH values of 35 mU/L or less and were considered normal (group I). Forty infants (10 premature) had peak TSH values above 35 mU/L and were considered hyperresponsive (group II). The mean age at testing, screening T4, TSH levels that prompted the testing, as well as baseline T4, T3, and free T4 at the time of TRH testing were not different between the groups. The mean (+/- SD) baseline TSH value was greater in group II (6.8 +/- 2.3 mU/L) than in group I (4.4 +/- 2.2 mU/L; P < 0.001). However, there was a great deal of overlap in the individual TSH values (group I, 0.9-10 mU/L; group II, 1.9-10.6 mU/L). Mean peak TSH levels were significantly different in the two groups (group I, 24 +/- 7.7 mU/L; group II, 60.3 +/- 26.1 mU/L; P < 0.001). During long term follow-up, all 25 group I infants available for evaluation have been confirmed as clinically and biochemically normal. No infant diagnosed as normal was later found to have evidence of hypothyroidism. Fourteen infants in group II have had evidence of thyroid dysfunction. We conclude that the TSH response to TRH stimulation is a useful tool for the evaluation of infants suspected of having primary hypothyroidism. Whether hyperresponsiveness to TRH represents a form of neonatal hypothyroidism requiring treatment remains to be determined.