Differences in international medical graduates' letters of recommendation by gender in pulmonary and critical care medicine: a cohort analysis

BACKGROUND

International Medical Graduates (IMGs) encounter barriers as they seek to match into fellowship programs in the United States (US). This study's objective is to determine if there are differences in letters of recommendation written for IMGs compared to U.S. Medical Graduates (USMGs) applying to pulmonary and critical care medicine (PCCM) fellowship programs.

METHODS

All applications submitted to a PCCM fellowship program in 2021 were included in this study. The applicant demographics and accomplishments were mined from applications. The gender of letter writers was identified by the author's pronouns on professional websites. Word count and language differences in the letters were analyzed for each applicant using the Linguistic Inquiry and Word Count (LWIC2015) program. Multivariable linear regressions were performed controlling for applicant characteristics to identify if IMG status was associated with total word count and degree of support, measured by a composite outcome encompassing several categories of adjectives, compared to USMG status.

RESULTS

Of the 573 applications, most of the applicants were USMGs (72%, N = 334/573). When adjusting for applicant characteristics, IMG applicants had shorter letters of recommendation (87.81 total words shorter 95% CI: - 118.61, - 57.00, p-value < 0.01) and less supportive letters (4.79 composite words shorter 95% CI: - 6.61, - 2.97, p-value < 0.01), as compared to USMG applicants. Notably, female IMG applicants had the biggest difference in their word counts compared to USMG applicants when the letter writer was a man.

CONCLUSIONS

IMG applicants to a PCCM fellowship received shorter and less supportive letters of recommendation compared to USMG applicants.

An audit of the outcome of amblyopia treatment: a retrospective analysis of 322 children

BACKGROUND/AIMS

Little is known about the effectiveness of occlusion therapy in hospital settings. A retrospective analysis was conducted to assess modalities, outcome and hospital costs of children treated for amblyopia with patching in a UK clinic.

METHODS

Notes of 322 children with amblyopia discharged after occlusion treatment were selected consecutively and reviewed. Data collated included age at presentation, amblyopia type, visual acuity (VA; before/after occlusion and at discharge), number of prescribed hours of occlusion, duration of patching treatment, number of glasses prescribed and number of visits attended or failed to attend. Hospital treatment costs were estimated.

RESULTS

Mixed amblyopes were prescribed the longest amount of patching (mean 2815 h over 23 months) followed by strabismic (1984 h) and anisometropic (1238 h) amblyopes. 319 amblyopes received glasses and five atropine treatment. The percentage of patients reaching VA of 6/12 was best in the anisometropic and strabismic groups (>75%) and worse in mixed amblyopia (64%). Average hospital costs were estimated at pound1365.

CONCLUSION

Although the mean duration of treatment was long, involving many hospital visits, the visual outcome was variable, unsatisfactory (<6/9) and more expensive than necessary. As compliance has been identified as a major problem methods to improve amblyopia treatment are needed, possibly by using educational/motivational intervention.

Survey of management of acquired nystagmus in the United Kingdom

PURPOSE

To determine the current management of acquired nystagmus by ophthalmologists and neurologists.

METHODS

Questionnaires were sent to ophthalmologists (850) and neurologists (434) in the United Kingdom. Estimated numbers of patients seen with acquired nystagmus, treatment options used, and the results of treatment of the patients were collected.

RESULTS

Response rate was 37% for ophthalmologists and 34% for neurologists. The most common causes of acquired nystagmus were estimated to be multiple sclerosis and stroke. 58% of ophthalmologists and 94.5% of neurologists reported seeing patients with nystagmus. The most commonly used medical treatment was gabapentin and baclofen. Other drugs used were clonazepam, carbamazepine, benzhexol, ondansetrone, buspirone, memantine, and botulinum toxin (n=3). Eleven ophthalmologists and 52 neurologists noted symptomatic improvement with medical treatment. Eleven ophthalmologists and 44 neurologists noted improvement in visual acuity (VA). Occurrence of side effects noted with baclofen and gabapentin treatments were similar.

CONCLUSION

A variety of drugs are used to treat acquired nystagmus in the UK. Baclofen and gabapentin are the drugs most commonly used and are reported to cause significant improvement in symptoms and VA. Better knowledge of the action of drugs in nystagmus is needed to establish guidelines and to give patients wider access to treatment.

Shape analysis of hippocampal surface structure in patients with unilateral mesial temporal sclerosis

Structural hippocampal magnetic resonance (MR) imaging-based analysis is helpful in the diagnosis and treatment of mesial temporal epileptic seizures. Computational anatomic techniques provide a framework for objective assessment of three-dimensional hippocampal structure. We applied a previously validated technique of deformation-based hippocampal segmentations in 20 subjects with documented unilateral mesial temporal sclerosis (MTS) and temporal lobe epilepsy. Using composite images, we then measured shape differences between the epileptogenic, smaller hippocampus, and contralateral hippocampus. Final shape differences were projected on the contralateral "normal" side. We calculated results for the left MTS group (10 patients) and right MTS group (10 patients) separately. Both groups showed similar regions of maximal inward deformation in the affected hippocampus, which were the medial and lateral aspect of the head, and posterior aspect of the tail. These results suggest that there are specific three-dimensional patterns of volume loss in patients with mesial temporal epilepsy.

Magnetic resonance imaging deformation-based segmentation of the hippocampus in patients with mesial temporal sclerosis and temporal lobe epilepsy

We compared manual and automated segmentations of the hippocampus in patients with mesial temporal sclerosis. This comparison showed good precision of the deformation-based automated segmentations.