Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress. Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors, suggesting that perceived errors and distress may be related in a reciprocal cycle.

In this national study of internal medicine residents, suboptimal QOL and symptoms of burnout were common. Symptoms of burnout were associated with higher debt and were less frequent among international medical graduates. Low QOL, emotional exhaustion, and educational debt were associated with lower IM-ITE scores.

Modest outputs of graduates by relatively few medical schools and chronic emigration contribute to low physician presence in Sub-Saharan Africa (SSA).The Sub-Saharan African Medical School Study (SAMSS) examined the challenges, innovations, and emerging trends in medical education in SSA.SAMSS identified 168 medical schools and achieved a 72% survey response rate of the 146 schools surveyed. The Study found that countries are prioritizing medical education scale up as part of health system strengthening, and identified many innovations in pre-medical preparation, the use of expatriate faculty, and creative use of scarce research support. SAMSS also noted ubiquitous faculty shortages, weak scholastic infrastructure, and limited accreditation. Trends observed include the growth of private medical schools, community-based education, and international partnerships, and the benefit of research for faculty development.Ten recommendations provide guidance for efforts to strengthen medical education in SSA. BACKGROUND

Enzymes within the P450IIIA (CYP3A) subfamily appear to account for significant "first pass" metabolism of some drugs in the intestine. To identify which of the known P450IIIA genes are expressed in intestine, enterocyte RNA was hybridized on Northern blots with synthetic oligonucleotides complementary to hypervariable regions of hepatic P450IIIA4, P450IIIA5, and P450111A7 cDNAs. Hybridization was detected only with the P450IIIA4-specific oligonucleotide. The identity of the hybridizing mRNA was confirmed to be P45011IA4 by direct sequencing of a DNA fragment amplified from enterocyte cDNA by the polymerase chain reaction. To determine if enterocyte P450IIIA4 is inducible, biopsies of small bowel mucosa were obtained from five volunteers before and after they received 7 d of treatment with rifampin, a known inducer of P4501IIA4 in liver. Rifampin treatment resulted in a five-or eightfold mean increase (P < 0.05) in the biopsy concentration of P450IIIA4 mRNA when normalized for content of sucrase isomaltase or intestinal fatty acid binding protein mRNAs, respectively. Rifampin also induced P450II1A immunoreactive protein in enterocytes in each of the subjects, as judged by immunohistochemistry, and resulted in a 10-fold increase in P450IIIA4-specific catalytic activity (erythromycin N-demethylation) in the one patient studied. Our identification of inducible P450IIIA4 in enterocytes may in part account for drug interactions characteristic of P450IIIA4 substrates and suggests a strategy for controlling entry into the body of a major class of xenobiotics.