Bole, Raevti

Purpose The medical student performance evaluation (MSPE) summarizes a residency applicant’s academic performance. Despite attempts to improve standardized clerkship grading, concerns regarding grade inflation and variability at United States medical schools persist. This study’s aim was to describe current patterns of clerkship grading and applicant performance data provided in the MSPE. Method The authors evaluated Electronic Residency Application Service data submitted to a single institution for the 2016–2017 Match cycle. Clerkship grading characteristics regarding grading tiers, school rank, location, and size were obtained. Data regarding methods for summative comparisons such as key word utilization were also extracted. Descriptive statistics were generated, and generalized linear modeling was performed. Results Data were available for 137/140 (98%) MD-granting U.S. medical schools. Pass/fail grading was most commonly used during the preclinical years (47.4%). A 4-tier system was most common for clerkship grading (31%); however, 19 different grading schemes were identified. A median of 34% of students received the highest clerkship grade (range, 5%–97%). Students attending a top 20 medical school were more likely to receive the highest grade compared with those attending lower-rated schools (40% vs 32%, P < .001). Seventy-three percent of schools ranked students, most commonly using descriptive adjectives. Thirty-two different adjectives were used. Conclusions There is significant institutional variation in clinical grading practices and MSPE data. For core clerkships where most students received the highest grade, the ability to distinguish between applicants diminishes. A standardized approach to reporting clinical performance may allow for better comparison of residency applicants.

Abstract Background Glanular hypermobility (GH) or supersonic transporter (SST) deformity are occasionally encountered during penile prosthesis (PP) implantation, yet management strategies are underreported with minimal data available on surgical outcomes. Aim To describe a modified technique for glanulopexy to correct GH/SST in men undergoing PP placement and assess outcomes associated with this technique. Methods Glanulopexy was performed in men with GH/SST identified at the time of or following PP placement. A modification to previously described techniques was performed, whereby a suture is passed into the glans and secured to the tissue overlying the corpora through small incisions on the lateral aspects of the distal penile shaft. Outcomes Correction of the anatomic deformity (GH/SST), device infection, and changes in penile sensation were evaluated during post-operative follow-up. Results From 2014–2017, a total of 12 patients underwent modified glanulopexy for GH/SST. Nine (75%) were performed at the time of PP, while the remaining 3 were performed in a delayed fashion. At a median follow-up of 12 months (range 1–33 months), all patients with the device in situ demonstrated appropriate glanular positioning, and no patients reported changes in penile sensation. A single patient required device removal secondary to infection. Clinical Translation Glanulopexy with permanent suture successfully corrects severe GH or SST in men with inflatable PP without reduced penile sensation. Conclusions Strengths of the current study include the description of a simple, safe, and reproducible technique for GH/SST that adds minimal operative time and can be performed under local anesthesia when necessary. To our knowledge, this represents one of the largest reported series of glanulopexy outcomes reported in the literature. Limitations include that this is a single-surgeon series, there is limited follow-up, and lack of a comparison group. Further study with external validation is warranted to establish the optimal role for the procedure.