Family medicine faces declining student interest and funding. Predoctoral directors will help lead efforts to overcome these challenges. Academic success will be important for predoctoral directors ...to be effective leaders in academic health centers. We therefore sought to describe predoctoral directors and factors associated with their academic success.
We carried out a cross-sectional survey of all family medicine predoctoral directors at US allopathic medical schools using a Web-based questionnaire. The response rate was 82%. We measured academic success using a variable combining rank and tenure status. We used bivariate analysis and multiple linear regression analysis to identify factors associated with academic success.
The mean age of predoctoral directors is 47, and 45% are women. Forty-two percent are assistant professors, 36% associate professors, 20% full professors, and 33% are on a tenure track. Sixty-four percent of predoctoral programs receive Title VII funding, and 63% of predoctoral directors believe that loss of Title VII funding will adversely affect student education. Factors associated with academic success include years since residency, total publications, years as predoctoral director, male gender, state funding for predoctoral family medicine programs, and participation in an academic fellowship. Involvement in educational research was associated with number of publications.
Providing predoctoral directors with the skills and support needed to study their educational undertakings and publish their findings may help them achieve academic success. Medical educators must assess the effects of loss of Title VII funding on predoctoral education while seeking new sources of funding.
Objective: Factors responsible for the exercise intolerance occurring in patients with peripheral arterial occlusive disease (PAOD) manifesting intermittent claudication (IC) and contributing to the ...observed improvements in walking capacity after exercise training have not been elucidated. The authors characterized the resting and exercise responses of high-energy phosphate species in affected calf skeletal muscle as detected by phosphorus (P)-31 magnetic resonance spectroscopy (MRS) to determine whether metabolic derangements were present in patients with mild to moderate PAOD and IC and whether these abnormalities could be altered by training.
Subjects: Thirteen patients evaluated for IC with resting ankle-brachial indices (ABIs) < 0.9 and positive exercise testing were enrolled in a supervised 10-week walking exercise program (IC training). Separate control groups were composed of (1) patients with PAOD and IC (IC control, n = 4) and (2) healthy, age-matched individuals (n = 4) without PAOD or IC who did not undergo exercise training.
Outcome Measures: Resting ABIs and constant-load treadmill testing were performed prior to and following exercise training. ABIs, ankle pressure drop, and calf muscle bioenergetic response (P-31 MRS) of the most symptomatic limb were measured during inmagnet, lowand high-intensity calf exercise done before and after training.
Results: Compared with healthy controls, patients with PAOD and IC before training had lower resting ABIs (0.66 ±0.11), larger ankle pressure drops (35 ±15%), shorter symptom-free walking distances during treadmill testing and significantly slower phosphocreatine recovery (Pcr t½) during in-magnet low-intensity (61 ±46 v. 36 ±40 sec, p=0.05) and high (119 ±93 v. 31 ±10 sec, p=0.003) exercise but had otherwise similar bioenergetic responses. Despite improved symptom-free walking distance (1,080 ±316 v. 498 ±367 ft, p < 0.001), patients with PAOD and IC exhibited no changes in resting ABI, ankle pressure drop or high-energy phosphate responses after training. Furthermore, no significant correlation was found between high-energy phosphate species and limb hemodynamics.
Conclusions: The relatively subtle abnormalities in high-energy phosphate muscle metabolism present in patients with PAOD and IC may only partially account for their marked exercise intolerance and do not appear to contribute to the observed improvement in walking capacity after supervised training.
