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Aim: The study aims to determine resident applicant metrics most predictive of academic and clinical performance as measured by the Council of Resident Education in Obstetrics and Gynecology (CREOG) examination scores and Accreditation Council for Graduate Medical Education (ACGME) clinical performance (Milestones) in the aftermath of United States Medical Licensing Examination Scores (USMLE) Step 1 becoming a pass/fail examination., Methods: In this retrospective study, electronic and paper documents for Wayne State University Obstetrics and Gynecology residents matriculated over a 5-year period ending July 2018 were collected. USMLE scores, clerkship grade, and wording on the letters of recommendation as well as Medical Student Performance Evaluation (MSPE) were extracted from the Electronic Residency Application Service (ERAS) and scored numerically. Semiannual Milestone evaluations and yearly CREOG scores were used as a marker of resident performance. Statistical analysis on residents (n = 75) was performed using R and SPSS and significance was set at P  < .05., Results: Mean USMLE score correlated with CREOG performance and, of all 3 Steps, Step 1 had the tightest association. MSPE and class percentile also correlated with CREOGs. Clerkship grade and recommendation letters had no correlation with resident performance. Of all metrics provided by ERAS, none taken alone, were as useful as Step 1 scores at predicting performance in residency. Regression modeling demonstrated that the combination of Step 2 scores with MSPE wording restored the predictive ability lost by Step 1., Conclusions: The change of USMLE Step 1 to pass/fail may alter resident selection strategies. Other objective markers are needed in order to evaluate an applicant's future performance in residency., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Background: Multiple tools including Accreditation Council for Graduate Medical Education (ACGME) standardized milestones can be utilized to assess trainee and residency program performance. However, little is known regarding the objective validation of these tools in predicting written board passage., Methods: In this retrospective study, data was gathered on n = 45 Wayne State University Obstetrics and Gynecology program graduates over the five-year period ending July 2018. United States Medical Licensing Examination (USMLE) scores, Council on Resident Education in Obstetrics and Gynecology (CREOG) in-training scores and ACGME milestones were used to predict American Board of Obstetrics and Gynecology (ABOG) board passage success on first attempt. Significance was set at p < 0.05., Results: Written board passage was associated with average CREOGs ( p = 0.01) and milestones ( p = 0.008) while USMLE1 was not significantly associated ( p = 0.055). USMLE1 <217 (Positive predictive value (PPV) = 96%). CREOGs <197 (PPV = 100%) and milestones <3.25 (PPV = 100%), particularly practice-based learning and systems-based practice milestones were most strongly correlated with board failure. Using a combination of these two milestones, it is possible to correctly predict board passage using our model (PPV = 86%)., Discussion: This study is the first validating the utility of milestones in a surgical specialty by demonstrating their ability to predict board passage. Residents with CREOGs or milestones below thresholds are at risk for board failure and may warrant early intervention., Competing Interests: Conflict of interest The authors declare no conflict of interest. MAR is on our Reviewer Board. Given the role on the Reviewer Board, has no involvement in the peer-review of this article and has no access to information regarding its peer-review.

Objective: To evaluate risk factors for cervical ectopic pregnancies., Methods: Retrospective, quasi-experimental case-control study of cervical ectopic pregnancy (CEP) cases from 2000-2013. Two groups were selected as controls, patients with tubal ectopic (TEP) and intrauterine pregnancies (IUP) without a history of TEP, matched by year of pregnancy and randomly sampled in a 1:3 case-control ratio per each study group., Results: 21 cases were identified and 126 controls included, 63 TEP and IUP each. A binary logistic regression model was used to analyze whether statistically significant preceding factors from a bivariate analysis could predict CEP. Compared to patients with IUP, CEP patients had a higher history of elective abortions, D&C and cervical excisional procedures, with a high effect size (>0.7). Compared to patients with TEP, CEP patients had a higher history of D&C and cervical excisional procedures, with a high effect size (>.7). The risk of CEP was significantly higher with a prior history of D&C compared to an IUP (aOR 1.4; 95% CI, 1.1-9.1; p=0.04) and a TEP (aOR 6.1; 95% CI, 1.8-21.2; p=0.04)., Conclusion: D&C is a strong risk factor for CEP when compared to pregnancies in other locations. These findings confirm previous associations described in case series., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Cathelicidins are a family of peptides thought to provide an innate defensive barrier against a variety of potential microbial pathogens. The human and mouse cathelicidins (LL-37 and CRAMP, respectively) are expressed at select epithelial interfaces where they have been proposed to kill a number of gram-negative and gram-positive bacteria. To determine if these peptides play a part in the protection of skin against wound infections, the anti-microbial activity of LL-37 and CRAMP was determined against the common wound pathogen group A Streptococcus, and their expression was examined after cutaneous injury. We observed a large increase in the expression of cathelicidins in human and murine skin after sterile incision, or in mouse following infection by group A Streptococcus. The appearance of cathelicidins in skin was due to both synthesis within epidermal keratinocytes and deposition from granulocyctes that migrate to the site of injury. Synthesis and deposition in the wound was accompanied by processing from the inactive prostorage form to the mature C-terminal peptide. Analysis of anti-microbial activity of this C-terminal peptide against group A Streptococcus revealed that both LL-37 and CRAMP potently inhibited bacterial growth. Action against group A Streptococcus occurred in conditions that typically abolish the activity of anti-microbial peptides against other organisms. Thus, cathelicidins are well suited to provide defense against infections due to group A Streptococcus, and represent an important element of cutaneous innate immunity.