Many medical curricula now include programs that provide students with opportunities for scholarship beyond that provided by their traditional, core curricula. These scholarly concentration (SC) programs vary greatly in focus and structure, but they share the goal of producing physicians with improved analytic, creative, and critical-thinking skills. In this article, the authors explore models of both required and elective SC programs. They gathered information through a review of medical school Web sites and direct contact with representatives of individual programs. Additionally, they discuss in-depth the SC programs of the Warren Alpert Medical School of Brown University; the University of South Florida College of Medicine; the University of California, San Francisco; and Stanford University School of Medicine. The authors describe each program's focus, participation, duration, centralization, capstone requirement, faculty involvement, and areas of concentration. Established to address a variety of challenges in the U.S. medical education system, these four programs provide an array of possible models for schools that are considering the establishment of an SC program. Although data on the impact of SC programs are lacking, the authors believe that this type of program has the potential to significantly impact the education of medical students through scholarly, in-depth inquiry and longitudinal faculty mentorship.

As diabetes becomes more prevalent in younger women, diabetes and maternal-child health issues such as breastfeeding co-exist with increasing frequency. We sought to determine the relationship between breastfeeding and both type 2 diabetes and gestational diabetes (GDM) in a variety of clinical contexts, with a focus on prevention. The Medline database from 1966-2003, relevant references of selected articles, the Cochrane database, and the NIH Clinical Trials website were searched. Search terms included breastfeeding, infant nutrition, and diabetes. The search was restricted to the English language and human subjects. Each study was reviewed by at least two of the authors and included if it pertained to the relationship between type 2 diabetes or GDM and breastfeeding. Twelve of 15 identified studies (80%) met selection criteria. All studies were observational. Specific maternal-child health populations varied by study. Two of the authors abstracted information from each article on 1) study design, 2) target population, 3) sample size/power, 4) definition of breastfeeding, 5) definition of diabetes, and 6) confounders. Higher rates of pregnancy and neonatal complications among women with type 2 or gestational diabetes can pose significant challenges to breastfeeding. Low estrogen levels in breastfeeding women may have a protective effect on glucose metabolism and subsequent risk of diabetes. Having been breastfed for at least 2 months may lower the risk of diabetes in children. Initial research has begun on the long-term effects of diabetes during pregnancy on children. Breastfeeding may lower both maternal and pediatric rates of diabetes. Women with diabetes should be strongly encouraged to breastfeed because of maternal and childhood benefits specific to diabetes that are above and beyond other known benefits of breastfeeding.

This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women's questions about and opinions of perinatal care in Buffalo and on providers' experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women's many questions and concerns, and described how doula training empowered them as patients' advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women's seeming agreeability. Doulas/interpreters possess insider knowledge of women's concerns and facilitate communication between patients and the care team.

Graduating residents lacked confidence in their SDL skills and their ability to manage their learning, especially in clinical settings. Fostering SDL skills during residency will likely require training and guidance for SDL as well as changes in the structure and culture of residency.