Purpose With the change in Step 1 score reporting, Step 2 Clinical Knowledge (CK) may become a pivotal factor in resident selection. This systematic review and meta-analysis seeks to synthesize existing observational studies that assess the relationship between Step 2 CK scores and measures of resident performance. Method The authors searched MEDLINE, Web of Science, and Scopus databases using terms related to Step 2 CK in 2021. Two researchers identified studies investigating the association between Step 2 CK and measures of resident performance and included studies if they contained a bivariate analysis examining Step 2 CK scores’ association with an outcome of interest: in-training examination (ITE) scores, board certification examination scores, select Accreditation Council for Graduate Medical Education core competency assessments, overall resident performance evaluations, or other subjective measures of performance. For outcomes that were investigated by 3 or more studies, pooled effect sizes were estimated with random-effects models. Results Among 1,355 potential studies, 68 met inclusion criteria and 43 were able to be pooled. There was a moderate positive correlation between Step 2 CK and ITE scores (0.52, 95% CI 0.45–0.59, P < .01). There was a moderate positive correlation between Step 2 CK and ITE scores for both nonsurgical (0.59, 95% CI 0.51–0.66, P < .01) and surgical specialties (0.41, 95% CI 0.33–0.48, P < .01). There was a very weak positive correlation between Step 2 CK scores and subjective measures of resident performance (0.19, 95% CI 0.13–0.25, P < .01). Conclusions This study found Step 2 CK scores have a statistically significant moderate positive association with future examination scores and a statistically significant weak positive correlation with subjective measures of resident performance. These findings are increasingly relevant as Step 2 CK scores will likely become more important in resident selection.

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Introduction: Ischemia due to coronary microvascular dysfunction (CMD) may cause a loss of lusitropy and resultant elevated filling pressures which can worsen with exercise. CMD is prevalent in patients with heart failure with preserved ejection fraction (HFpEF) and exercise studies are useful in diagnosing early HFpEF. The relationship between CMD and early HFpEF is not well characterized. Hypothesis: CMD is prevalent in patients with elevated pulmonary capillary wedge pressure (PCWP) at rest and those with normal resting PCWP but elevated post-exercise PCWP. Methods: All patients without obstructive CAD who underwent cardiac catheterization with coronary physiology and exercise bicycle studies at the University of Chicago Medical Center between 2015-2021 were included. Elevated resting PCWP was defined as > 15 and elevated post-exercise PCWP was defined as > 25. Patients were separated into three groups: elevated resting PCWP (group 1), normal resting & elevated exercise PCWP (group 2), and normal resting and exercise PCWP (group 3). Results: A total of 22 patients (mean age 56 + 10 years, 77% female) were studied. There were 9 patients in group 1, 8 patients in group 2, and 5 patients in group 3. A diagnosis of HFpEF was present in all patients in groups 1 and 2 and no patients in group 3. There was a nonsignificant trend towards lower median CFR in groups 1 (2.1 IQR 1.6-2.8) and 2 (2.3 IQR 1.75-3.65) compared to group 3 (3.8 IQR 1.8-5.5; Figure 1). Similarly, there was a nonsignificant trend towards higher median IMR in groups 1 (23.2 IQR 16.9-41.3) and 2 (25.9 IQR 19.0-35.2) compared to group 3 (14.4 IQR 11-25; Figure 1). Conclusion: Like patients with elevated resting PCWP, patients with normal resting and elevated post-exercise PCWP tend to have lower CFR and higher IMR than those patients with normal pre and post-exercise PCWP. This may indicate that CMD plays a role in the development of early HFpEF though more patients are needed to further characterize this relationship.

Background Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear. Purpose We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone. Methods We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed. Results There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77). Conclusions The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy. Funding Acknowledgement Type of funding sources: None.