Faculty Bibliography

Medical residents, frontline clinical educators, must be competent teachers. Typically, resident teaching competence is not assessed through any other means than gleaning learner's comments. We developed, evaluated, and integrated into our annual objective structured clinical examination a resident teaching skills assessment using 'standardized' students. Faculty observers rated residents using a customized 19-item rating instrument developed to assess teaching competencies that were identified and defined as part of our project. This was feasible, acceptable, and valuable to all 65 residents, 8 students, and 16 faculty who participated. Teaching scenarios have potential as reliable, valid, and practical measures of resident teaching skills

OBJECTIVE: To describe the differential diagnosis of periurethral masses in a consecutive series extracted from a single tertiary urogynecologic practice database. METHODS: A patient database of a private urology and urogynecology practice with 1,950 women was searched for patients who were found to have a periurethral mass during the accrual dates of 1994 to 2002, and these records were reviewed for diagnostic testing and results. All women provided a history, completed a questionnaire, and underwent physical examination, voiding diary, cystoscopy, and videourodynamic testing; selected patients then underwent additional imaging. RESULTS: Seventy-nine (4%) patients aged 41.2 +/- 14 years were identified. Of these, 72 (91%) had been referred for evaluation of persistent irritative lower urinary tract symptoms or incontinence. Seven patients (9%) had been referred specifically because of a periurethral mass. Sixty-six patients (84%; 95% confidence interval [CI] 73%, 91%) had urethral diverticula, of which 4 (6%; 95% CI 2%, 14.8%) contained malignancies. Six patients (7%; 95% CI 3%, 15%) had vaginal cysts histologically identified as fibromuscular tissue, 4 (5%; 95% CI 1%, 12%) had leiomyomata, and 2 (2.5%; 95% CI 0.03%, 8.8%) had ectopic ureteroceles. Two patients had vaginal squamous cell carcinomas (2.5%; 95% CI 0.03%, 8.8%), and 1 had an infected granuloma. Masses were palpable in 42 patients (53.8%; 95% CI 42%, 64%) and in 37 patients either were encountered at surgery (n = 5) or were urethral diverticula diagnosed by voiding cystourethrogram (n = 32). CONCLUSION: Periurethral masses were encountered in less than 4% of our patient sample. Most masses were urethral diverticula; however, the differential diagnosis included leiomyoma, vaginal cysts, and malignancy. Masses were generally either palpable or seen at imaging studies performed during evaluation of lower urinary tract symptoms.

We describe a specific mentoring approach in an academic general internal medicine setting by audiotaping and transcribing all mentoring sessions in the year. In advance, the mentor recorded his model. During the year, the mentee kept a process journal. Qualitative analysis revealed development of an intimate relationship based on empathy, trust, and honesty. The mentor's model was explicitly intended to develop independence, initiative, improved thinking, skills, and self-reflection. The mentor's methods included extensive and varied use of questioning, active listening, standard setting, and frequent feedback. During the mentoring, the mentee evolved as a teacher, enhanced the creativity in his teaching, and matured as a person. Specific accomplishments included a national workshop on professional writing, an innovative approach to inpatient attending, a new teaching skills curriculum for a residency program, and this study. A mentoring model stressing safety, intimacy, honesty, setting of high standards, praxis, and detailed planning and feedback was associated with mentee excitement, personal and professional growth and development, concrete accomplishments, and a commitment to teaching

The Accreditation Council of Graduate Medical Education (ACGME) and the Residency Review Committee require a competency-based, accessible evaluation system. The paper system at our institution did not meet these demands and suffered from low compliance. A diverse committee of internal medicine faculty, program directors, and house staff designed a new clinical evaluation strategy based on ACGME competencies and utilizing a modular web-based system called ResEval. ResEval more effectively met requirements and provided useful data for program and curriculum development. The system is paperless, allows for evaluations at any time, and produces customized evaluation reports, dramatically improving our ability to analyze evaluation data. The use of this novel system and the inclusion of a robust technology infrastructure, repeated training and e-mail reminders, and program leadership commitment resulted in an increase in clinical skills evaluations performed and a rapid change in the workflow and culture of evaluation at our residency program

The latest outbreak includes four suspected cases of SARS. They are three relatives of a nurse, identified as Ms. Li, 20, who acquired the disease while caring for Ms. Song, and a person who had contact with Ms. Li in a hospital in Beijing. The outbreak also includes a potential second chain of transmission from a Mr. Yang. He is a graduate student who is suspected of having acquired SARS in the same laboratory in Beijing on April 17, nearly a month after Ms. Song acquired her infection there. So far, health officials have not traced any transmission from Mr. Yang to other people

There is also concern about the recent travels of one of the cases, a 26-year-old medical graduate student, surnamed Song, who studied at the SARS lab. She traveled on at least three trains; two of the trips came after she had developed a fever and other symptoms. Song's mother, who cared for her and traveled with her, fell ill with pneumonia symptoms in April and died on Monday. She has been posthumously identified as a suspected SARS case. Chinese officials, who were harshly criticized for their mismanagement of the original SARS outbreak, appeared to be responding swiftly. Efforts were under way to find people who had come into contact with the SARS patients. Officials also closed the Institute of Virology at China's Centers for Disease Control, where the infections originated, according to a statement on the Web site of the Ministry of Health. They are testing the lab and have put some employees under medical observation. Graph: 1. SARS UPDATE (TEXT, p.16); Map: 2. Countries with SARS cases/SARS deaths (p.16)

The cases involve two graduate students who worked at the Institute of Viral Disease Control of the Chinese Centers for Disease Control and who were reported to have become ill nearly a month apart. One was identified only as a Ms. Song, 26, who became ill about March 25; the other was identified as a Mr. Yang, 31, whose onset of illness was April 17. The other two cases involve Song's mother, identified as a Ms. Wei, who died on Monday, and a nurse, identified as a Ms. Li, who cared for Song. Questions immediately arose about the apparent breach in the Beijing laboratory and why doctors and health officials had not been more alert to the possibility that Song had SARS earlier in the course of her illness, particularly because she worked in the SARS laboratory that tests specimens sent from all over China and is a leader in research on the virus

There is also concern about the recent travels of one of the patients, a 26-year-old medical graduate student, surnamed Song, who studied at the SARS lab. She traveled on at least three trains; two of the trips came after she had developed a fever and other symptoms. Ms. Song's mother, who cared for her and traveled with her, fell ill with pneumonia symptoms this month and died Monday. She has been posthumously identified as someone suspected of having contracted SARS. At the hospital, one of Ms. Song's nurses was Ms. Li, the woman identified Thursday by Chinese officials as suspected of having SARS. On Friday, officials reclassified Ms. Li as a confirmed SARS patient. Ms. Li, 20, remains hospitalized in Beijing, but state media have reported that her temperature is now normal. The official New China News Agency reported that Ms. Song tested positive for SARS antibodies on Wednesday. Health officials from Beijing went to Anhui and tested her again. She again tested positive on Friday and was deemed a confirmed SARS patient. The news agency said that officials in Anhui cremated Mrs. [Wei]'s body on Friday after taking medical samples. Initial testing suggested that Mrs. Wei suffered from heart problems, but the report noted that more pathology testing was necessary to determine a specific cause of death. Dr. Hall, however, said she ''died of pneumonia of an unknown cause that is likely to be SARS.''

Questions immediately arose about the apparent breach in the Beijing laboratory and why doctors and health officials had not been more alert to the possibility that the patient in the first case, [Song], had SARS earlier in the course of her illness, particularly because she worked in the SARS laboratory that tests specimens sent from all over China and that is a leader in research on the virus