Faculty Bibliography

INTRODUCTION:The United States Medical Licensing Examination (USMLE) Step 1 and Step 2 Clinical Knowledge (CK) are important for trainee medical knowledge assessment and licensure, medical school program assessment, and residency program applicant screening. Little is known about how USMLE performance varies between institutions. This observational study attempts to identify institutions with above-predicted USMLE performance, which may indicate educational programs successful at promoting students' medical knowledge. METHODS:Self-reported institution-level data was tabulated from publicly available US News and World Report and Association of American Medical Colleges publications for 131 US allopathic medical schools from 2012-2014. Bivariate and multiple linear regression were performed. The primary outcome was institutional mean USMLE Step 1 and Step 2 CK scores outside a 95% prediction interval (≥2 standard deviations above or below predicted) based on multiple regression accounting for students' prior academic performance. RESULTS:Eighty-nine US medical schools (54 public, 35 private) reported complete USMLE scores over the three-year study period, representing over 39,000 examinees. Institutional mean grade point average (GPA) and Medical College Admission Test score (MCAT) achieved an adjusted R2 of 72% for Step 1 (standardized βMCAT 0.7, βGPA 0.2) and 41% for Step 2 CK (standardized βMCAT 0.5, βGPA 0.3) in multiple regression. Using this regression model, 5 institutions were identified with above-predicted institutional USMLE performance, while 3 institutions had below-predicted performance. CONCLUSIONS:This exploratory study identified several US allopathic medical schools with significant above- or below-predicted USMLE performance. Although limited by self-reported data, the findings raise questions about inter-institutional USMLE performance parity, and thus, educational parity. Additional work is needed to determine the etiology and robustness of the observed performance differences.

Background: The growing opioid overdose epidemic has grappled the nation with the CDC now reporting that drug overdose deaths have become the most common cause of death for young people. Medical education has historically ignored substance use disorders, and though they generally require all medical students to learn basic life support, they have not taught how to respond to opioid overdoses. Further, medical education is moving towards modalities which utilize adult learning theory. One such modality are online modules. However, there are few studies comparing their outcomes with traditional lectures. Previously, the authors compared in-person and online training of medical students to respond to opioid overdoses using naloxone in a non-randomized controlled setting, which showed no meaningful differences in knowledge, attitudes, and preparedness outcomes for students. In this paper, the authors attempt to use a randomized controlled trial to compare the two educational modalities at a second urban medical school.
Objective(s): The author's primary objective was to demonstrate non-inferiority of online compared to in-person training for knowledge. Our secondary objective were to show non-inferiority of online compared to in-person training attitudes, and preparedness.
Method(s): Our study received IRB exemption as an education intervention. As a part of a transition to clinical clerkships curriculum used for second year medical students, second year medical students in an urban medical school were randomized into training sessions by the office of medical education without foreknowledge of the planned study. Students taking the online training were provided with a link to online modules with pre- and post-tests and video based lectures. Students randomized to the in-person training group took a pre-test just prior to receiving an oral lecture, and then immediately completed a post-test. Paired student's t-tests were used to compare measurements for each group in knowledge, attitudes, and preparedness, and Cohen's D was used to measure the effect size of the change. We calculated 99% confidence intervals for each measure and utilized a margin of non-inferiority of 5%.
Result(s): The in-person group demonstrated a statistically significant increase in knowledge, a non-statistically significant decrease in self-reported preparedness, and a small non-statistically significant increase in attitudes, see Table 1. The online group demonstrated a statistically significant increase in knowledge and self-reported preparedness, without a statistically significant change in attitudes, see Table 1. 99% CIs were [-0.20, 1.09] for knowledge, [6.51, 10.93] for preparedness, and [-2.32, 1.59] for attitudes, see Figure 1.
Conclusion(s): Online training for opioid overdose prevention training provided non-inferior outcomes for knowledge, preparedness, and attitudes. This study supports the use of online opioid overdose prevention training as a non-inferior alternative to in-person training

In this clinical vignette, we present a case of a 59-year-old woman with catastrophic antiphospholipid syndrome likely triggered by polymicrobial sepsis. The diagnostic criteria and clinical manifestations of catastrophic antiphospholipid syndrome are reviewed. We also compare diagnostic criteria and clinical manifestations with other clinical entities in the differential diagnosis, including thrombotic thrombocytopenic purpura-hemolytic-uremic syndrome, disseminated intravascular coagulation, sepsis, and inflammatory bowel disease. Catastrophic antiphospholipid syndrome is a rare, but lethal condition, and treatment recommendations are based on expert consensus and analyses of the international Catastrophic Antiphospholipid Syndrome Registry. Current management guidelines recommend triple therapy, with anticoagulation, glucocorticoids, and plasma exchange or intravenous immunoglobulins. This case brings this rare clinical entity to the attention of clinicians and emphasizes the need for more research to understand the best management. It also raises the question of whether high-dose steroids should be continued for treatment of catastrophic antiphospholipid syndrome in the setting of a severe sepsis.