J Am Board Fam Med
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Cardiovascular disease is a leading cause of morbidity and mortality in the United States. Since their initial discovery, statins have become the first-line treatment for decreasing the risk of cardiovascular disease. Although they are typically well tolerated, side effects do occur and tend to affect the musculature. ⋯ This case report details the case of a 54-year-old woman who developed anti-HMGCR myopathy after several years of uncomplicated statin use. Differences between other reported cases and this 1 are discussed, including the patient's strong response to steroid therapy which resulted in the normalization of her serum creatinine kinase and alleviation of her muscle weakness. This case highlights the need for clinicians to be aware of anti-HMGCR myopathy and to consider it as a potential cause of proximal muscle weakness and persistent serum creatinine kinase elevations in patients exposed to statins even if they were previously well tolerated by the patient.
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American Boards of Medical Specialties have emphasized single point in time testing for summative assessment of cognitive expertise necessary for board certification. In 2016, the American Board of Anesthesiology introduced Maintenance of Certification in Anesthesiology (MOCA), a longitudinal assessment platform that provides diplomates formative feedback with continuous questions over time and adapts questions to areas of knowledge weaknesses over time. This paper describes the rationale, history, and early results of the American Board of Anesthesiology MOCA platform.
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Addressing professionalism is a key role of Certification Boards, but how best to do this is not clear. This article describes a 360° approach to monitoring and enhancing professionalism taken by the American Board of Urology (ABU). ⋯ As a part of its 10-year cycle, the Board requires peer evaluations from other urologists in the community. Finally, and most importantly, ABU uses a portfolio practice log to evaluate the candidates' use of procedures appropriate to their stated subspecialty area of expertise, evaluation of potential overuse or inappropriate use of procedures and a narrative that details any major complications associated with their procedures.
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Quality Improvement has gone from practice by practice piecework to an industry driven by expertise that lies within corporate offices rather than within patient care. Using for her 20 years of experience leading and teaching quality improvement as a lens, the author makes the case for quality improvement teams to ensure a key role for clinicians and direct care staff who are closest to the patients and the improvements that need to be made.