Browsing by Author "Adams, William"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    Coprescription of Isotretinoin and Systemic Corticosteroids for Acne: An Analysis of the National Ambulatory Medical Care Survey
    (2019-06) Vasicek, Brooke; Adams, William; Steadman, Laryn; Reserva, Jeave; Swan, James; Dermatology, School of Medicine
    Introduction: Isotretinoin treatment has been linked to flares of severe acne, which can be managed by the coadministration of systemic corticosteroids or prevented by beginning with a low dose of isotretinoin. To our knowledge, there are no estimates in the literature on the frequency of coprescription of isotretinoin and systemic corticosteroids. Objectives: We sought to quantify the estimated frequency of coprescription of isotretinoin and systemic corticosteroids and assess trends of the use of isotretinoin with systemic corticosteroids for acne as they relate to age, sex, race, insurance, and provider specialty. Methods: Data from the National Ambulatory Medical Care Survey (NAMCS) from 2003 to 2015, National Hospital Ambulatory Medical Care Survey Hospital Outpatient Departments (NHAMCS-OPD) from 2003 to 2011, and National Hospital Ambulatory Medical Care Survey Hospital Emergency Departments (NHAMCS-ED) from 2003 to 2014 were aggregated for this analysis. The number of prescriptions for isotretinoin and/or systemic corticosteroids was estimated by specialty (for NAMCS) and by survey type (for NHAMCS-OPD and NHAMCS-ED). Results: Among all first visits to a physician for acne (n=18,914,096), approximately 3.9 percent prescribed isotretinoin, 0.24 percent prescribed corticosteroids, and the remaining 96 percent prescribed neither drug. This was comparable to estimates for first visits to a dermatologist for acne (n=13,920,913), where approximately 4.2 percent prescribed isotretinoin, 0.32 percent prescribed corticosteroids, and the remaining 95 percent prescribed neither medication. Conclusion: Currently, isotretinoin and systemic corticosteroids are rarely prescribed together.
  • Thumbnail Image
    Item
    The Impact of Internal Medicine Clerkship Characteristics and NBME Subject Exams on USMLE Step 2 Clinical Knowledge Exam Performance
    (Springer, 2022) Fitz, Matthew; Adams, William; Heincelman, Marc; Haist, Steve; Whelan, Karina; Cox, LeeAnn; Cao, Uyen-Thi; Hingle, Susan; Raff, Amanda; Houghton, Bruce; Fitzpatrick, Janet; Nall, Ryan; Foster, Jennifer; Appelbaum, Jonathan; Grum, Cyril; Donovan, Anna; Kiken, Stuart; Abraham, Reeni; Hlafka, Marti; Miller, Chad; Bansal, Saurabh; Paauw, Douglas; Lai, Cindy J.; Pincavage, Amber; Agarwal, Gauri; Burns, Cynthia; Holzer, Horatio; Lappé, Katie; John, Viju; Barker, Blake; Mingioni, Nina; Rao, Deepti; Zakowski, Laura; Chakraborti, Chayan; Williams, Winter; Kelly, William; Medicine, School of Medicine
    Background: Residency program directors will likely emphasize the United States Medical Licensing Exam (USMLE) Step 2 clinical knowledge (CK) exam more during residency application given the recent USMLE Step 1 transition to pass/fail scoring. We examined how internal medicine clerkship characteristics and NBME subject exam scores affect USMLE Step 2 CK performance. Design: The authors used univariable and multivariable generalized estimating equations to determine associations between Step 2 CK performance and internal medicine clerkship characteristics and NBME subject exams. The sample had 21,280 examinees’ first Step 2 CK scores for analysis. Results: On multivariable analysis, Step 1 performance (standardized β = 0.45, p < .001) and NBME medicine subject exam performance (standardized β = 0.40, p < .001) accounted for approximately 60% of the variance in Step 2 CK performance. Students who completed the internal medicine clerkship last in the academic year scored lower on Step 2 CK (Mdiff = −3.17 p < .001). Students who had a criterion score for passing the NBME medicine subject exam scored higher on Step 2 CK (Mdiff = 1.10, p = .03). There was no association between Step 2 CK performance and other internal medicine clerkship characteristics (all p > 0.05) nor with the total NBME subject exams completed (β=0.05, p = .78). Conclusion: Despite similarities between NBME subject exams and Step 2 CK, the authors did not identify improved Step 2 CK performance for students who had more NBME subject exams. The lack of association of Step 2 CK performance with many internal medicine clerkship characteristics and more NBME subject exams has implications for future clerkship structure and summative assessment. The improved Step 2 CK performance in students that completed their internal medicine clerkship earlier warrants further study given the anticipated increase in emphasis on Step 2 CK.
  • Thumbnail Image
    Item
    Which Internal Medicine Clerkship Characteristics Are Associated With Students’ Performance on the NBME Medicine Subject Exam? A Multi-Institutional Analysis
    (Wolters Kluwer, 2020-09) Fitz, Matthew M.; Adams, William; Haist, Steven A.; Hauer, Karen E.; Ross, Linette P.; Raff, Amanda; Agarwal, Gauri; Vu, T. Robert; Appelbaum, Jonathan; Lang, Valerie J.; Miller, Chad; Grum, Cyril; Medicine, School of Medicine
    Purpose To identify which internal medicine clerkship characteristics may relate to NBME Medicine Subject Examination scores, given the growing trend toward earlier clerkship start dates. Method The authors used linear mixed effects models (univariable and multivariable) to determine associations between medicine exam performance and clerkship characteristics (longitudinal status, clerkship length, academic start month, ambulatory clinical experience, presence of a study day, involvement in a combined clerkship, preclinical curriculum type, medicine exam timing). Additional covariates included number of NBME clinical subject exams used, number of didactic hours, use of a criterion score for passing the medicine exam, whether medicine exam performance was used to designate clerkship honors, and United States Medical Licensing Examination Step 1 performance. The sample included 24,542 examinees from 62 medical schools spanning 3 academic years (2011–2014). Results The multivariable analysis found no significant association between clerkship length and medicine exam performance (all pairwise P > .05). However, a small number of examinees beginning their academic term in January scored marginally lower than those starting in July (P < .001). Conversely, examinees scored higher on the medicine exam later in the academic year (all pairwise P < .001). Examinees from schools that used a criterion score for passing the medicine exam also scored higher than those at schools that did not (P < .05). Step 1 performance remained positively associated with medicine exam performance even after controlling for all other variables in the model (P < .001). Conclusions In this sample, the authors found no association between many clerkship variables and medicine exam performance. Instead, Step 1 performance was the most powerful predictor of medicine exam performance. These findings suggest that medicine exam performance reflects the overall medical knowledge students accrue during their education rather than any specific internal medicine clerkship characteristics.