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A personal narrative from David Muller, the dean for medical education at the Mount Sinai School of Medicine in New York, is presented, which explores his experience with an old patient in his nineties, who voluntarily stopped eating and drinking in order to have a hastened death.

The author reflects on the important issue of reforming premedical education in the U.S. He cites several reasons for enhancing, overhauling, or abolishing the traditional premedical education requirements. He mentions various solutions proposed to enhance premedical education. He also discusses lessons from the Humanities and Medicine Program (HuMed).

The author reflects on the trend towards sending U.S. medical students overseas for global health experiences that involve medical mission work. According to the author, there are several poor, marginalized and underserved people in the country that needs medical attention. He describes the case of a Haitian family living on the Upper West Side of Manhattan who faces several health problems but are not eligible for any medical care. He points out that passion is an important element in defining the concepts of altruism and service for medical students.

Purpose To evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of progressive keratoconus. Design Prospective, randomized, multicenter, controlled clinical trial. Participants Patients with progressive keratoconus (n = 205). Methods The treatment group underwent standard CXL and the sham control group received riboflavin alone without removal of the epithelium. Main Outcome Measures The primary efficacy criterion was the change over 1 year of topography-derived maximum keratometry value, comparing treatment with control group. Secondary outcomes evaluated were corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), manifest refraction spherical equivalent, endothelial cell count, and adverse events. Results In the CXL treatment group, the maximum keratometry value decreased by 1.6 diopters (D) from baseline to 1 year, whereas keratoconus continued to progress in the control group. In the treatment group, the maximum keratometry value decreased by 2.0 D or more in 28 eyes (31.4%) and increased by 2.0 D or more in 5 eyes (5.6%). The CDVA improved by an average of 5.7 logarithm of the minimum angle of resolution (logMAR) units. Twenty-three eyes (27.7%) gained and 5 eyes lost (6.0%) 10 logMAR or more. The UDVA improved 4.4 logMAR. Corneal haze was the most frequently reported CXL-related adverse finding. There were no significant changes in endothelial cell count 1 year after treatment. Conclusions Corneal collagen crosslinking was effective in improving the maximum keratometry value, CDVA, and UCVA in eyes with progressive keratoconus 1 year after treatment, with an excellent safety profile. Corneal collagen crosslinking affords the keratoconic patient an important new option to decrease progression of this ectatic corneal process. [ABSTRACT FROM AUTHOR]

Mission-based budgeting has been touted as the preferred method of assessing and assigning departmental budgets in academic medical centers. Mission-based budgeting in its simplest form is a methodology that allows an institution's finance department to align costs with actual activities (typically clinical care, administration, research, and teaching). Despite its intuitive appeal, a minority of the academic medical centers across the country have embraced it. Mount Sinai School of Medicine was among the first to incorporate this approach, and we have almost a decade of experience with its risks and benefits. This article focuses on the education component of mission-based budgeting. We review all aspects of mission-based budgeting, including (1) the many variables that must be factored into a metric and how those variables differ among institutions, (2) the metric itself and how it reflects institutional philosophy, (3) the impact of mission-based budgeting on faculty and chairs of departments, (4) existing processes that ensure the quality, reliability, and validity of the different mission-based budgeting systems, and (5) a comparative perspective. [ABSTRACT FROM AUTHOR]

The coming decades will see a dramatic rise in the number of homebound adults. These individuals will have multiple medical conditions requiring a team of caregivers to provide adequate care. Home-based primary care (HBPC) programs can coordinate and provide such multidisciplinary care. Traditionally, though, HBPC programs have been small because there has been little institutional support for growth. Three residents developed the Mount Sinai Visiting Doctors (MSVD) program in 1995 to provide multidisciplinary care to homebound patients in East Harlem, New York. Over the past 10 years, the program has grown substantially to 12 primary care providers serving more than 1,000 patients per year. The program has met many of its original goals, such as helping patients to live and die at home, decreasing caregiver burden, creating a home-based primary care training experience, and becoming a research leader. These successes and growth have been the result of careful attention to providing high-quality care, obtaining hospital support through the demonstration of an overall positive cost–benefit profile, and securing departmental and medical school support by shouldering significant teaching responsibilities. The following article will detail the development of the program and the current provision of services. The MSVD experience offers a model of growth for faculty and institutions interested in starting or expanding a HBPC program. [ABSTRACT FROM AUTHOR]