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Discontinuation of the United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) exam and Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Level 2 Performance Evaluation (2-PE) raised questions about the ability of medical schools to ensure the clinical skills competence of graduating students. In February 2021, representatives from all Florida, United States, allopathic and osteopathic schools initiated a collaboration to address this critically important issue in the evolving landscape of medical education. A 5-point Likert scale survey of all members (n=18/20 individuals representing 10/10 institutions) reveals that initial interest in joining the collaboration was high among both individuals (mean 4.78, SD 0.43) and institutions (mean 4.69, SD 0.48). Most individuals (mean 4.78, SD 0.55) and institutions (mean 4.53, SD 0.72) are highly satisfied with their decision to join. Members most commonly cited a "desire to establish a shared assessment in place of Step 2 CS/2-PE" as their most important reason for joining. Experienced benefits of membership were ranked as the following: 1) Networking, 2) Shared resources for curriculum implementation, 3) Scholarship, and 4) Work towards a shared assessment in place of Step 2 CS/2-PE. Challenges of membership were ranked as the following: 1) Logistics such as scheduling and technology, 2) Agreement on common goals, 3) Total time commitment, and 4) Large group size. Members cited the "administration of a joint assessment pilot" as the highest priority for the coming year. Florida has successfully launched a regional consortium for the assessment of clinical skills competency with high levels of member satisfaction which may serve as a model for future regional consortia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Toonkel et al.)

To assess the impact of the National Cholesterol Education Program (NCEP) guidelines, the 7,347 primary care members of the Florida Medical Association received a confidential mailed questionnaire. A follow-up survey polling 5% of the nonresponders validated the initial observations. Of the 1,909 analyzed returns, 96% of the physicians' responses indicated that they believed cholesterol is an important factor in preventing atherosclerosis. However, responses to other questions were far less uniform. For example, 92% of general internists (n = 495) reported being aware of the NCEP guidelines versus 98% of cardiologists (n = 212) (p less than .01) and only 78.7% of OB/GYN specialists (n = 218) (p less than .0001). While 88.2% of general internists responded that the guidelines were relevant in treating their patients, 80.2% of OB/GYN physicians answered likewise (p less than .03). Moreover, only 54% of OB/GYN specialists reported routinely measuring serum cholesterol in their patients compared to 96.7% of general internists (p less than .0001). Most Florida primary care physicians are aware of the NCEP guidelines; however, the impact varies widely among practitioners.

To determine if subjects with phenylketonuria receiving diets significantly lower in cholesterol and saturated fat had serum lipid concentrations different from those of their family members, we measured serum concentrations of total cholesterol, high-density lipoprotein cholesterol, and total triglycerides in the probands with phenylketonuria, their parents, and their siblings. Eleven adults (seven women and four men) and 16 children (eight girls and eight boys) were studied. Ten subjects (four girls and six boys) had phenylketonuria. Subjects with phenylketonuria consumed less cholesterol (0.02 vs 0.41 mmol/d) and fat (median, 21% vs 39.5% of total calories), and their diets had a higher ratio of polyunsaturated to saturated fatty acids (median, 2.0 vs 0.2) than did their siblings without phenylketonuria. The diet of the parents was similar to that of their offspring without phenylketonuria. No differences were noted between the subjects with phenylketonuria (consuming a diet lower in saturated fat and cholesterol) and their siblings without phenylketonuria in serum concentrations of total cholesterol (median, 3.34 vs 3.07 mmol/L); high-density lipoprotein cholesterol (median, 1.44 vs 1.37 mmol/L); low-density lipoprotein cholesterol (median, 1.44 vs 1.09 mmol/L); or triglycerides (median, 0.89 vs 0.54 mmol/L). We conclude that previously reported lipoprotein abnormalities noted between unrelated subjects with and without phenylketonuria may not be due to differences in dietary intake, but rather due to a (genetic) predisposition of the population with phenylketonuria toward lower serum lipid concentrations.

The current cholesterol screening and management of Florida's pediatric population is evaluated utilizing a questionnaire mailed to 1,534 pediatric health care providers. Twenty percent of the physicians responded. Of the respondents, 65% do not routinely screen for the presence of hypercholesterolemia. Only 28% of the respondents obtain serum total cholesterol measurements in accordance with the American Academy of Pediatrics Committee on Nutrition recommendations. The serum total cholesterol concentration prompting treatment was 240 mg/dL (6.2 mM). Dietary counseling alone, or in combination with exercise, was the initial treatment approach recommended by 98% of the responding physicians. Dietary education for the hypercholesterolemic patient was provided by both dieticians (46%) and physicians (42%). If the initial dietary intervention was unsuccessful, 48% of the physicians would begin medical therapy. The most commonly prescribed medication was a bile acid sequestrant (70%), with the majority (52%) referring their patient to a subspecialist for evaluation and care.