I couldn’t help but compare and see the analogy with physicians who become the best at their craft, becoming a doctor’s doctor. Having trained and taught at many top tier USA and Canadian medical schools, both allopathic and osteopathic, I have learned that many of the physicians who went on to become a “doctor’s doctor” did not graduate from ivy league schools, nor in the top ten percent of their class. Most did not have a privileged pedigree, come from wealth or score in the stratosphere on standardized exams such as MCAT or USMLE/COMLEX. Yet, they went on to become a trusted “doctor’s doctor.”
My response, the title of a lecture I deliver yearly is “it’s the doctor in you.” Seth Godin, American Author has stated, “our credential-obsessed society teaches high achievers to equate success with approval from an external authority. Unfortunately, this outlook undermines your ability to trust yourself.
It is a convenient place to hide from our own potential. Godin goes on to question, the fact that you have a degree doesn’t mean you have insight, experience, or concern. You’ve acquired a piece of paper, but that doesn’t mean you care.”
More significantly, are you willing to persevere and do you have compassion. “It’s the doctor in you,”
that will instill a desire, a drive to continue to learn, long after medical school is completed.
This brings to mind the adage, “What do you call the person who graduated last in your medical school class?” Doctor. Medical students and doctors early in their career do not need to be trapped in their past. As TIM Denning states. “The past in your default program.” And to beat the default program, you have to change.
Being a doctors’ doctor has been an enormous privilege and honor. Bearing witness to the relentless and pernicious stigma in the house of medicine and how that ravages the minds and souls of our brothers and sisters in medicine has been a driving force. Through my teaching and mentorship, I know that there are many young and early-career physicians taking up the reins and making a commitment to physician health.

Being a doctors’ doctor can be a worthwhile experience, however it can be a daunting encounter for some. Caring for doctors may for some manifest feelings of inferior professional competence and feel pressured, strained and insecure. There are some doctors who prefer and choose to avoid such encounters. Other qualities of a doctor’s doctor is the ability to listen and be a good communicator.

“Listen to your patient; he is telling you the diagnosis.” Sir William Osler
But what it does mean is that the patient will provide doctors with enough clues to make the diagnosis, sometimes even before we examine them. For years I have taught my medical students when exiting a patient’s room after taking a history, if you are left in a quandary as to what could be possibly wrong with the patient, you need to return to the patient’s bedside and explore the history further, as 80% of the diagnosis is discoverable in the history.
Dr. Lisa Sanders an internist and author stated:” in an interview on NPR about her book, “Every Patient Tells a Story,” she aptly points out that there are two conversations going on at once. One is with the person telling the doctor about their problem. The second is a simultaneous conversation going on in the doctor’s head when they are thinking, “what does it mean and what do I ask next?” This second conversation frequently fogs the patient’s message and leads to the doctor interrupting the patient.”
Over 30 years ago a landmark study published in the Annals of Internal Medicine (Nov. 1984) reported that on average, physicians interrupted their patients after only 18 seconds. It should be noted that not all interruptions are verbal, a knock on the door, beeper interruptions, and computer use all interfered with communication, and increased frequency of interruptions are associated with less favorable patient perceptions of the office visit.”
A more recent study published in the Journal of General Internal Medicine (online, July 2, 2018) assessed 112 doctor-patient interactions between 2008 and 2015. This study reported that the clinician interrupted the patient after a medial of 11 seconds. The authors of this study concluded:
“The medical interview is a pillar of medicine. It allows patients and clinicians to build a relationship. Ideally, this process is inherently therapeutic, allowing the clinician to convey compassion, and be responsive to the needs of each patient. Eliciting and understanding the patient’s agenda enhances and facilitates patient-clinician communication.”
“The good physician treats the disease; the great physician treats the patient with the disease.”
Sir William Osler
Osler’s 19th-century admonitions have enduring relevance even today. Osler’s maxim has been proposed to reflect the realities of modern healthcare:
“Engage the patient; she is not only telling you the diagnosis but is integral to all aspects of her health and healthcare.”

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Dr. Penny’s thoughts for students seeking paths to overcome the obstacles’ faced during their medical education

“The Comeback is Greater than the Setback”

People enjoy a comeback story because it gives them hope that one day they can rise above an obstacle in their own personal struggles.  There is an overwhelming desire deep down that most people want to see redemption, a second chance.  Comebacks are possible and they happen all the time.  Life is full of setbacks, and many times it may seem impossible for you to emerge victoriously.  At one time or another, all people will experience some form of adversity, hardship, or a tough experience. How do people deal with these types of events that change their lives? The death of a loved one, a harrowing combat event, a loss of a job, serious illness, terrorist attacks and other traumatic events: these are all examples of very challenging life experiences

One of the greatest comebacks of all time is the career of Muhammad Ali.  After winning the gold medal in the 1960 Rome Olympic games for light heavyweight boxing, Ali went on to defeat Sonny Liston in February 1964.  Ali after having an initial streak of success was then struck with multiple setbacks.  In April 1967 he was found guilty of draft evasion and stripped of his title.  However, in June 1971 four years after being convicted and sentenced to five years in prison and stripped of his heavyweight championship by the boxing commission, the Supreme Court decided that Ali was improperly drafted in their first place.  This was not Ali’s only comeback, Ali lost his heavy weight championship fight to Joe Frazier in the “fight of the century” at Madison Square Garden in 1971. Once again, Ali overcame his setback and defeated Joe Frazier in January 1974.  After that, Muhammad Ali went on to beat George Foreman in the “Rumble in the Jungle” and finally Joe Frazier once again in 1975 in the “Thrilla in Manilla.”

The message gleaned from this story, you can overcome the obstacles you face, and those created currently by the pandemic.    Personal setbacks including financial, health, loss of loved ones, divorce and academic to name only a few.  With respect to the effects of the pandemic on medical education, it has caused an unprecedented disruption in medical education and healthcare systems worldwide. The disease can cause life-threatening conditions and it presents challenges for medical education, as instructors must deliver lectures safely, while ensuring the integrity and continuity of the medical education process.

As Provost and Dean of Clinical Affairs at the American University of Integrative Sciences, I have witnessed similar disruptions in the delivery of medical education of our students.  I have also communicated with many potential students interested in pursuing a medical education, yet reticent in making the commitment to apply.  My personal discussions with these students have identified many students who have had setbacks academically, past failures forced withdrawals and financial struggles to name a few.

My message to those students who are hesitant, a comeback will always begin with change.  91���� is a medical school that will allow you the chance for a Comeback.  A need to be willing to do things differently from what you have done in the past.  Change will always happen when you choose to be committed, this will result in a change of your future.  With proper personal mentoring, small class size and a successful track record,  91���� can turn it around and put you on the road to future success.

“I did the best I could at the time with what I knew”

The resilience of the human spirit speaks to the character of those who have been setback, it demonstrates their determination, creativity, and vigor.  At a basic level it resorts to what you want to achieve.  Many who have been successful have a strong belief in possibilities; Simon Sinek is one example who has stated:

“My goal is to live in a world where the vast majority of people wake up every single morning inspired to go to work and fulfilled by the work that they do.”

For those of you procrastinating on making the commitment to go to medical school, the time is right, and our next class will begin January 2022.  91���� is accepting students currently and the class is not yet complete.  If further information is required, our admissions officers are available to discuss options.

“We can’t undo, but we can rebuild.” Chaitanya Charon

The American University of Integrative Sciences is proud of our record in training physicians, including those that have been unsuccessful in the past and allowed a second chance.  Come join us and become the comeback that overcame your personal setback!  We would love to share this with you.

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Dr. Agnihotri and I are currently planning to make available a CS equivalent exam in February 2021 to meet ECFMG requirements. This exam does not replace the necessity that our graduating students preparing to enter residency, will still be required to take the USMLE Step 2 CS exam once testing has recommenced. The details of the exam and the optional preparatory course will be announced in mid-December. In order to fulfill ECFMG requirements, the 91���� exam will closely resemble the actual CS exam, with multiple patient encounters, employment of standardized patients, video recordings, and SOAP note preparation and grading of equal scrutiny to the CS exam. The difficulty in firmly announcing the date and format is the fact that COVID infections are continuing to increase along with hospitalizations and deaths. It is anticipated that a further “lockdown” will be announced by the federal government, which will ban all public gatherings?

Thomas Oppong posed the question in a recent article; “In our chaotic world, What’s the best way to live? How can I stay calm in turbulent times? What should I do to build resilience? How should I manage my emotions? “The one message I want to emphasize,” you are not alone.” As a professor at two other Stateside medical schools, I can share with you that medical students throughout the US and Canada are experiencing the same mental and emotional burden of uncertainty as to our own 91���� students. The positives are that hopefully you and your family are healthy and have not been hospitalized? You may have gathered that a number of our administrative faculty, me included have recovered from COVID.

Just as in past pandemics, conflict in the world, world wars, tornadoes, and hurricanes we as a nation have survived and, in the end, have more resolve, compassion, and tenacity. When you think of the personal hurdles you have overcome, to be where you are; you will prevail and will emerge stronger. Remember, “why you started.” The dream has not died, just delayed by a virus unknown to man that has created an unprecedented quagmire in which we will not only survive but will emerge more pertinacious as a society.

Seneca stated: “The greatest obstacle to living is expectancy, which hangs upon tomorrow, and loses today.” Fortunately, with advanced technology, and the ability to improvise; 91���� has been able to continue to offer medical education via a distant learning format. As a result, our pedagogical methods have transformed to meet the needs of 91���� undergraduate medical education and remain COVID compliant with State and Federal guidelines.

I encourage you in this period of reflection and thanksgiving, to appreciate the loved ones in your life, to reach out to those less fortunate with kindness and compassion, and to treasure your own health and remember “Why you Started.”

Don W. Penney MD.MSC.FACEP.FAAEM.
Neurological Surgeon
Provost, Dean Clinical Affairs. 91����
School of Medicine.

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The July 7th issue of Jama published a viewpoint article titled:” Potential Implications of COVID 19 for the 2020-2021 Residency Application Cycle.”   91���� students who have access to the journal, I strongly recommend they take time to review the article.  I have taken the liberty to summarize some of the key points made by its author, May M Hammound. 

It is expected that in the 2020-2021 academic year, more than 40,000 medical students and physicians will apply for residency positions in the United States. As a result of the COVID 19 pandemic, the process of applying will be “distinctly different” from previous years.  The pandemic will certainly stress an already stressful process, the author also suggested that this was an opportunity for change and possibly “systemic improvements.”

     “Sometimes the object in the path, becomes the path”

Prior to the COVID 19 pandemic, many have recommended reform in the residency selection process.  A topic that I have addressed in previous updates.   In the past, applicants for residency programs in the 2019-20 cycle applied to an average of 65 programs, and international medical graduates (IMGs) applied to an average of 137 programs. This number of applications does not improve match rates and results in significant cost burden to applicants as well as volume overload for program directors.  Hammound queries whether COVID 19 may spur an increase in the number of applications?  As a result of USMLE testing centers being closed, fulfilling the requirement for IMGs to pass Step 2 CK to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG) to apply to a US residency program becomes problematic.  Added to this conundrum, is the fact that many medical schools have shortened clerkships, shifted to virtual rotations, canceled rotations, and electives resulting in a reduction of student opportunities to obtain faculty evaluations, letters of recommendation, and communicate their interest in respective programs. 

Additionally, program directors will have potential difficulty in determining which applicants to interview without the use of traditional screening metrics.  Considering other logistic difficulties include travel disruptions, social distancing requirements and with recent increases in the infection rate, possible social isolation maybe implemented?

Temporary solutions have been proposed, including:

• Virtual interviews
• Waiving requirements for USMLE scores and letters of recommendation

Hammound points out that the number of interviews an applicant attends has in the past been limited by “time and travel expense.”  Many programs are known to overinvite the same pool of highly qualified applicants with just 7-21% of the applicant pool filling half of all interview slots in some specialties. (Lee et. Al. Laryngoscope 2019; 129 (3).

91���� students should be aware that despite the challenges, suggestions have been made to improve the process and may ultimately improve a much need overhaul of an antiquated system.  The following is a list of some of the proposals, I encourage our student body to review the article to further these suggestions in detail:

• Adjust the residency application timeline (allowing students more time of complete application requirements.)
• Modify Application requirements. ( Consider applications unable to receive USMLE Step 2 CK scores)
• Encourage holistic review (Consider applicant’s attributes, aptitudes, experiences?)
• Limit the number of applications (holistic only possible if applicants limit the number of applications)
• Improve the quality of information programs receive (standardizing the MSPE to address applicant’s integrity, reliability, motivation, professionalism)
• Temporarily make exceptions to the NRMP all-in-policy (consider accepting students outside of the match)
• Cap the number of interviews a student can accept (limiting the number of interviews a student can accept, preventing over interviewing and limiting the number of interview slots available for others.)
• Implement preference-signaling mechanisms (allow applicants to designate preferred programs could improve the process)

We the faculty and administration of 91����, strongly support our student body, stay current with frequent updates, and share in our graduating student’s consternation regarding the match.  As provost, and previous member of both neurological surgery and emergency medicine residency selection committee’s, will monitor recommendations and changes in this evolving situation.

Don W. Penney MD.MSC.FACEP.

Neurological Surgeon

Provost/Dean of Clinical Affairs, 91����.

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A recent airline emergency at 30,000 feet, prompted the airline crew to request the assistance of any doctor on board. I have had this experience once in the past, in 1993 while traveling from Phoenix, AZ to Chicago, IL. I was traveling with my wife and family of two young toddler children. After ringing the call bell, the flight attendant questioned my background, including having to provide proof of state medical licenses, American Board of Emergency Medicine Certification, and employment status. After satisfying their scrutiny, I was allowed to spend the remainder of the flight on the floor with an elderly female who was suffering from a hypoglycemic episode.

The medical kit that was provided to me was scant. At that time there was no AED, there were an oxygen cylinder and face mask, an AMBU bag, some over the counter medications; Tylenol, Advil, a sphygmomanometer, a stethoscope, I.V. administration set: 1 tubing with 2 Y-site connectors, 2 alcohol-soaked sponges, a roll of 1-inch-wide adhesive tape, 1 pair of tape scissors, and 1 tourniquet.
Protective nonpermeable gloves or equivalent, 1 pair, 50% dextrose, epinephrine injection 1mg/ml, diphenhydramine injection and nitroglycerin tablets.
The Federal Aviation Administration (FAA) has required since 2004 an automated external defibrillator (AED) be present on board.
The FAA has also proposed a list of minimum contents for emergency medical kits to be included on all flights in 2001. Should be noted that these kits are much improved over what was provided to me in 1993.
It should also be recognized that medical professionals who volunteer to provide in-flight assistance, need to be qualified, active, licensed and sober. A recent publication noted that “more than 4 billion passengers are expected to fly in 2019, and more than 60,000 medical emergencies are anticipated.”
The current contents of an FAA Approved Emergency Medical Kit includes:
Sphygmomanometer
Stethoscope
Airways, oropharyngeal: 1 pediatric, 1 small adult, and 1 large adult or equivalent
Self-inflating manual resuscitation device with 1 pediatric mask, 1 small adult mask, and 1 large adult or equivalent mask
Cardiopulmonary resuscitation masks: 1 pediatric, 1 small adult, and 1 large adult or equivalent
V. administration set: 1 tubing with 2 Y-site connectors, 2 alcohol-soaked sponges, 1 standard roll of 1-inch-wide adhesive tape, 1 pair of tape scissors, and 1 tourniquet
Protective nonpermeable gloves or equivalent, 1 pair
Needles: 2 18 gauge, 2 20 gauge, and 2 22 gauge; or 6 needles in sizes necessary to administer required medications
Syringes: 1 5 cc and 2 10 cc; or 4 syringes in sizes necessary to administer required medications
Analgesic, nonnarcotic, 325-mg tablets, 4
Antihistamine, 25-mg tablets, 4
Antihistamine injection, 50-mg single-dose ampule or equivalent, 2
Atropine injection, 0.5-mg single-dose 5-mL ampule or equivalent, 2
Aspirin, 325-mg tablets, 4
Bronchodilator, metered-dose inhaler or equivalent
50% Dextrose injection, single-dose 50-mL ampule or equivalent
Epinephrine injection, 1:1000 (1 mg/mL) single-dose 1-mL ampule or equivalent, 2
Epinephrine injection, 1:10,000 (0.1 mg/mL) single-dose 2*-mL ampule or equivalent, 2
Lidocaine injection, 20-mg/mL single-dose 5-mL ampule or equivalent, 2
Nitroglycerin, 0.4-mg tablets, 10
9% Sodium chloride injection, 500 mL
Basic instructions for use of the drugs in the kit

One would ponder are there legal ramifications of providing medical assistance during a flight? Nable et al. reported in the New England Journal of Medicine,” that providing care creates a doctor-patient relationship with its attendant obligations and liability risk. Liability is usually determined under the law of the country in which the aircraft is registered. “Nable goes on to state;” U.S. health care providers traveling on registered U.S. airlines have no legal obligation to assist in the event of a medical emergency, ethical obligations often prevail. Some countries including Australia and other European countries impose a legal obligation to assist.

Congress passed the Aviation Medical Assistance Act (AMAA) in 1998. This provides protection to providers who assist in in-flight medical emergencies from liability. Although a number of caveats are important to recognize. The AMAA does allow liability of providers if the provider was grossly negligent or flagrantly disregarded the patient’s health safety.
It is recommended that the provider provide written documentation of the care provided.

The most common in-flight emergencies include chest pain, syncope, asthma attack, head injury secondary to overhead luggage falling from storage bins, psychiatric problems (anxiety/phobias), abdominal illnesses such as diarrhea and pain, diabetic-related emergencies, allergic reactions, obstetric and gynecological emergencies. Although not all doctors are trained to treat all possible emergencies, however, a good rule of thumb keeps in mind “primum non nocere.”

For our Canadian students in training, “there were 133.4 million airline passengers in 2015, a 27.3% increase from 2009.” Kodama ET. Al. In addition to the increase in passenger traffic, there has been a significant increase in the number of passengers taking longer flights, subjecting patients to physiologic stressors, relative hypoxia and lower humidity. Delaney et al. recently reported that respiratory viruses are not spread through recirculated air on commercial flights, only approximately 50% of the air is recirculated and that all air is HEPA filtered. (EM Practice 09/19)

Ground-based medical consulting companies exist and are often contracted by major airlines to provide consultation when needed. Their primary role is to assist in medical decision-making and advising. Estimates as high as $100,000 is the potential cost to an airline that is diverted because of an ill passenger. In addition, to the logistics of re-routing new flights for passengers, possible hotel and meal accommodation can be arduous.

For me, after spending almost 3 hours on the floor with my ill patient, who did well and was transported to hospital after arriving in Chicago. I was met at the door by the flight attendant when departing, and “was thanked for the help.” My wife who I abandoned with our two small children, was left to attend to their needs on her own.

Don W. Penney MD.MSC.FACEP.FAAEM.

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As Provost and Clinical Dean for the American University of Integrative Sciences, I would like to take this opportunity to update our faculty and student body, on the ramifications the COVID 19 pandemic has had on our undergraduate medical education curriculum. I would also like to inform you of our continuing efforts to adapt and develop new strategies to educate our medical students.

Let’s face it, COVID 19 has rocked our world as we knew it, the global economy, businesses, health care sector, and our educational system; to name a few. It is a medical education and the path forward I would like to update you on in this post.

In the past, the trajectory to residency after being accepted to a medical school was relatively straight forward. Complete the first two years of undergraduate pre-clinical basic sciences, sit for Step 1 of USMLE Step 1, complete two years of clinical clerkship and successfully taking the USMLE Step 2 CK and CS exams and apply to residency. As a result of the COVID 19 pandemic, this trajectory has been challenged by a number of factors. Classroom lectures have been canceled and replaced by an online lecture format, most clinical clerkships have been forced to be canceled as a result of hospitals attempting to minimize personal interactions and following recommended guidelines of social distancing. Likewise, this policy has also been implemented to minimize student exposure to patients who harbor a potentially lethal virus.

COVID 19 has proven itself as a formidable opponent. The science community is still learning the many aspects and manifestations of this viral disease. Initially, it was thought that patients could only be infected by contact with infected animals, a zoonotic disease, we now recognize that person to person contact is indeed the common mode of transmission. Originally, public health officials reported that infection could be transmitted by symptomatic patients, only to learn that up to 80% of patients with COVID are asymptomatic. Prior to the global outbreak, it was postulated that this was a respiratory virus leading to interstitial pneumonia and had a propensity for the elderly, particularly those with underlying co-morbidities. We now recognize that the COVID 19 virus also affects the GI tract, some with no respiratory symptoms, consistent with the early Chinese reported fecal-oral root of transmission. COVID 19 has been demonstrated to also cause hypercoagulability, associated with elevated d-dimer levels, thrombosis, stroke, cardiac arrhythmias, myocardial infarction, and congestive heart failure. We now understand that younger patients can acquire COVID and that it does not primarily affect only older patients. As this virus continues to wreak carnage, our understanding of the many clinical manifestations has and will continue to evolve.

As a learning institute, faculty at 91���� have explored different educational and learning platforms in our efforts to provide continued medical education to our undergraduate students both preclinical and clinical. Like other stateside medical schools, the number of on-line programs has expanded to meet the need. Many senior medical students are concerned by the disruption and uncertainty of applying for residency. Without rotations in different specialties and have the first-hand experience in that particular discipline, it poses a difficulty for students to be comfortable with a designated area for residency specialization. The following chart illustrates the factors that Residency Program Directors utilize to select students for interviews. Factors were deemed most important if a minimum of 70% of program directors said they used them.

Perusing this list, one can recognize that many factors used in the past for selection are currently not available.  Examples include letters of recommendation in the specialty are not possible if rotations with preceptors are not feasible, generating an MSPE likewise is not possible without completing both core and elective clerkships, USMLE Step 2 CS testing has been put on hold for 12 to 18 months.  In addition, the change of making USMLE Step 1 a pass/fail exam has removed another determinant used in the past in choosing residents based on numerical grade.  However, 91���� students need to be reassured you are not in this alone, and what you are experiencing has permeated all medical schools and universities.  As medical researchers are aggressively attempting to produce a vaccine and bring it to market, likewise educators are identifying and developing educational products that will meet the demands of licensing boards, and residency directors, while abiding federal, state and local laws, obeying guidelines of social distancing and attempting to flatten the curve.  Some are predicting a second wave that could emerge as early as the fall.  As

an educational institute, we need to prepare for a marathon and not a sprint, as I foresee this virus and its many manifestations to continue to alter our life as we previously knew it. 

As Shadi Hamid in the Atlantic reports:

 “In moments of crisis and civil unrest, people always say that things will never be the same.  But the act of living is a bit more circular than we give it credit for.  Things might never be exactly the same as they once were, but they do tend to at least return to some previous and somehow tolerable baseline.  Human beings, facing crisis, find ways to adapt, sometimes ingeniously.  Life, otherwise would be unbearable.” 

Students at 91���� should consider that the US health care system has depended on IMGs to fill residency positions since the 1970s.  Today, 1 in 4 physicians practicing in the US is an IMG.  The changes we are experiencing in medical education are applicable to all stateside schools as well as international medical schools.  The bottom line, there is job security in knowing that the US health care system is heavily dependent on your services and with the retirement of the “baby boomer” generation of physicians there is increased need for physicians, especially in rural locations.

Students should consider that many schools, in fact, the majority of medical students no longer attend preclinical classes in person, but rather watch lectures online. (JAMA 05/2020)  Ultimately, the COVID pandemic will further accelerate the application of this platform of education and even improve its application.  What I am excited about is the fact that medical students are on the cusp of a sweeping overhaul of medical education as we previously knew it. Software developers, educators, and entrepreneurs are rapidly exploring and developing online educational programs that will enhance and not hinder medical education.

91���� is pleased to inform our student body that we are in the final stages of launching a new virtual on-line emergency medicine elective to run over a month for credit, involving multiple virtual case simulations with debriefing and feedback by our Clinical Dean.  This elective will be credited as satisfying one elective rotation in the 80 weeks of required clerkship rotations.

On the horizon, 91���� is exploring other avenues and platforms to provide medical education to our student body.  This includes utilizing social media, particularly Twitter to keep up with biomedical literature and to evaluate clinical practice in the configuration of a medical journal club.  The administration is anticipating and preparing for the USMLE Step 2 CS to begin rescheduling students to take this exam at a future date.   We acknowledge that during periods in which clinical exposure to patients has been curtailed, that student will need to hone their clinical skills and SOAP note writing in preparation for this exam.   We will be offering weekend refresher courses in Atlanta for students to tweak and revivify their clinical skill sets prior to taking the exam.  The format will include a two-day intensive course in our simulation lab with one on one critiquing and training with our clinical dean, Dr. Penney.  Since instituting the Advanced Clinical Medicine program at 91����, we have been successful in reducing the failure rate to less than 1% on this important exam.  More information will be available once FSMB has released a date for scheduling.   

For those students who prefer to maintain their clinical skills throughout the Pandemic period, a two-day weekend course is available for a limited number of students. Following strict guidelines for social distancing and mandatory mask protection, this course will be limited to 6 students or less and held in our Atlanta Simulation Lab.  

Once clearance is obtained from the NIH/CDC to resume classroom teaching the ACM course will be available for the one-month intensive pre-clerkship program with advanced training for the USMLE Step 2 CS exam.

As Hamid reported:

“Things might never be exactly the same as they once were, but they do tend to at least return to some previous and somehow tolerable baseline”

It is my belief and understanding that once the nidus of this pandemic has abated, 91���� will evolve and be stronger, offering medical educational content in multiple formats, allowing for distance learning as well as classroom instruction.  Essentially, COVID 19 has catalyzed a transformation of pedagogical methods, to guide us into the future.

Don W. Penney MD.MSC.FACEP.

Neurological Surgeon

Provost/Dean Clinical Affairs, 91����.

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 The article titled: “The Great Big Lie That Will Destroy Your Career Success”

Was especially relevant considering my familiarity with the topic with reference to my role as provost for 91���� School of Medicine?

We all indulge in “self-talk;” the internal dialogue influenced by our subconscious mind, revealing our thoughts, beliefs, questions, and ideas.  Self-talk can be both negative and positive. It can be encouraging and it can be depressing, it also can be truthful and it can take the form of a lie.  As the provost, I have interviewed students considering a career in medicine that have been victims of their own self-sabotage.  Those who are victims of deluding themselves, chipping away at their self-confidence.  Many who desire a different life or career success are doomed by their negative self-talk.  Students have confided in me that they don’t have choices and unable to fulfill life-long goals.  It is easier to continue to believe they have no choices, rather than believe they are afraid to make the change. 

Many students blame their career failures on a lack of choices or options in life.  Unfortunately, they remain in jobs and careers because they don’t like the choices they have; more as a result of the potential cost to them, forcing them to leave their “comfort zone.”  As a result, the status quo holds and they never experience their dreams and career success. 

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In a follow-up to my most recent post, I wanted to bring to the attention of our student body the on-going dialogue and consideration of converting the USMLE exam to a pass/fail score.

As noted in the accompanying viewpoint/opinion article from JAMA: July 19, 2019, “the official purpose of the examination is to assist state authorities in granting medical licenses, but it also reassures various groups ….. that licensed physicians have attained a minimum standard of medical knowledge.”

Currently, these examinations (Step 1, Step2 Clinical Knowledge, and Step 3) are reported in a 3 digit format.  As Swalis et al. reports: “The federation of State Medical Boards and National Board of Medical Examiners has released joint preliminary recommendations, which suggest consideration of a move to pass-fail score reporting.”

Of particular importance to our 91���� student body, the article states: “Application inflation is especially prominent for programs evaluating international medical graduates, who fill approximately 20% of position in US residency programs.  To manage this volume, program directors use filters in the Electronic Residency Application Service.  Filters exclude application below a requested standard, leaving fewer to be evaluated. 

Interestingly enough, Swalis states:” the narrow differences in examination scores used by some program to exclude many applicants are arbitrary with neither clinical, nor statistical meaning.”

Changing the USMLE exam to a pass-fail score would require residency program directors to utilize other criteria to adequately assess a student’s candidacy for residency?  Swalis rightfully points out, “programs might identify outstanding applicants who would have been overlooked based on a numerical cutoff”

It is well known, that medical students seeking residencies in much sought-after high demand programs are selected based on higher USMLE scores.  In particular, neurosurgery, plastic surgery, dermatology, radiology, and emergency medicine are very difficult to match- in because of their popularity.

Of particular concern, Swalis states: “solitary test preparation, which is inconsistent with the important skill of collaborative patient care, can replace class attendance.  Some students become isolated from each other and potential faculty mentors. They may focus exclusively on testable material. The stakes could be higher for international medical graduates, who may not match in US-based residency programs without exceptional scores.”

As many of our 91���� students come from backgrounds that are already underrepresented in medicine, potentially resulting in a significant lack of diversity in competitive postgraduate specialties.  As reported by Swalis: ”evidence suggests the USMLE may exhibit bias against racial/ethnic minority students, emphasis on USMLE scores during resident selection may contribute to this phenomenon and affect the specialty decisions of medical students from backgrounds that are underrepresented in medicine.”

91���� students are encouraged to follow the on-going dialogue and be familiar with residency match requirements.  In addition, in choosing a residency students should be realistic in their choice selection; based on USMLE scores, GPA, letters of reference, and clerkship performance.  

Don W. Penney MD.MSC.FACEP.

Provost, Dean of Clinical Affairs, 

91���� School of Medicine.

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