The following report illustrates a case of a 36-year-old Caucasian male with intravenous drug use (IVDU) induced septic thrombophlebitis presenting with recurrent unilateral pneumothoraces from septic pulmonary embolism (SPE) without the presence of obvious right-sided valvular vegetation in infective endocarditis (IE), defined as tricuspid or pulmonary valve lesions. Pneumothorax (PTX) has been observed as a rare complication of SPE and is commonly associated with infective right-sided IE, IVDU, and intravascular indwelling catheters. However, this case is novel as it is the very rare documented case of recurrent, unilateral, spontaneous right PTX refractory to multiple chest tube placements in such a setting. Therefore, the absence of detectable right-sided valvular vegetation in IE does not obviate the risk of SPE-induced PTX in IVDU and further expands the realm of infectious and pulmonary consequences of SPE and IVDU.

Background: Medical education is known to be stressful. Thus, medical schools have begun amending curricula to incorporate holistic wellness and stress reduction. Assessing medical student stressors is key to curricula development as well as the selection of appropriate reliable measures. This study investigated reliability reporting for studies using the Medical Student Stressor Questionnaire (MSSQ), as no study of this kind currently exists via employing Reliability Generalization (RG). Methods: A meta-analytic method, RG, was used to analyze the reliability reporting practices and reliability coefficients, in the form of Cronbach’s alpha coefficient, for the MSSQ. While a total of 18 studies were initially isolated related to the MSSQ, only those studies reporting reliability based on their sample (n = 8) were included in the final analysis. Blind coding was utilized and percent agreement among raters was excellent (95.18%). Results: Reliability estimates reported for the total scale fell within the excellent range (Range alpha coefficient (?) = 0.800 – 0.970; Mean alpha coefficient (M?) = 0.933, Standard Deviation alpha coefficient (SD?) = 0.050). A larger percent of males was negatively correlated to academic stressors while the number of females in studies was negatively correlated with social, drive, group activities and inter/intrapersonal aspects of medical student stressors. Conclusions: Outcomes provide useful suggestions, implications, and future recommendations regarding the use and application of the MSSQ. Medical student stress is essential to assess via measures which demonstrate robust reliability. Insights into sources of stress can offer important feedback to making specific changes to medical school curricula.