Correlating surgical clerkship evaluations with performance on the National Board of Medical Examiners examination

Background

Evaluation of medical students during the surgical clerkship is controversial. Performance is often based on subjective scoring, whereas objective knowledge is based on written examinations. Whether these measures correspond or are relevant to assess student performance is unknown. We hypothesized that student evaluations correlate with performance on the National Board Of Medical Examiners (NBME) examination.

Methods

Data were collected from the 2011–2012 academic year. Medical students underwent a ward evaluation using a seven-point Likert scale assessing six educational competencies. Students also undertook the NBME examination, where performance was recorded as a percentile score adjusted to national standards.

Results

A total of 129 medical students were studied. Scores on the NBME ranged from the 52nd to the 96th percentile with an average in the 75th percentile (±9). Clerkship scores ranged from 3.2–7.0 with a mean of 5.7 (±0.8). There was a strong positive association between higher NBME scores and higher clerkship evaluations shown by a Pearson correlation coefficient of 0.47 (P < 0.001). Students clustered with below average ward evaluations (3.0–4.0) were in the 69.5th percentile of NBME scores, whereas students clustered with above average ward evaluations (6.0–7.0) were in the 79.2th percentile (P < 0.001).

Conclusions

A strong positive relationship exists between subjective ward evaluations and NBME performance. These data may afford some confidence to surgical faculty and surgical resident ability to accurately evaluate medical students during clinical clerkships. Understanding factors in student performance may help in improving the surgical clerkship experience.     

Development of a fresh cadaver model for instruction of ultrasound-guided breast biopsy during the surgery clerkship: pre-test and post-test results among third-year medical students

Background

The aim of our study was to determine if a fresh cadaver model is a viable method for teaching ultrasound (US)-guided breast biopsy of palpable breast lesions.

Methods

Third-year medical students were assessed both preinstruction and postinstruction on their ability to perform US-guided needle aspiration or biopsy of artificially created masses using a 10-item checklist.

Results

Forty-one third-year medical students completed the cadaver laboratory as part of the surgery clerkship. Eight items on the checklist were found to be significantly different between pre-testing and post-testing. The mean preinstruction score was 2.4, whereas the mean postinstruction score was 7.10 (P < .001).

Conclusions

Fresh cadaver models have been widely used in medical education. However, there are few fresh cadaver models that provide instruction on procedures done in the outpatient setting. Our model was found to be an effective method for the instruction of US-guided breast biopsy among medical students.     

A focused curriculum in surgical oncology for the third-year medical students

Background

Educating medical students in surgical subspecialty fields can be challenging, and the optimal timing and curriculum remain unknown. Despite advocacy for earlier exposure, competing core clerkship rotations often leave little time for subspecialty fields. We report our experience with a novel, short, and focused curriculum in surgical oncology for the third-year medical students.

Methods

A 2-wk (2009–2010) and a 4-wk (2010–2011) curriculum in surgical oncology were developed for the third-year students at a tertiary-referral cancer center, including formal didactics, rotation in clinical service of students' choosing (breast, gastrointestinal, endocrine, or melanoma), and case-based learning and presentation. Paired pre- and postrotation questionnaires were prospectively completed, including 20 items assessing knowledge and four items assessing experience. Grading was anonymous, and change in score was assessed by Wilcoxon signed-rank test.

Results

Paired questionnaires from 47 students (2-wk rotation, n = 26; 4-wk rotation, n = 21) showed a median improvement of three points (21.4%) from pre- to posttests (P < 0.001). The improvement did not differ by the length of rotation or by the specific clinical service. Nearly all (93%) reported a positive and inspiring experience. The most valuable avenue of learning was reported as the time spent with resident or fellow or attending (92%), followed by self-directed reading (62%) and didactic lectures (28%).

Conclusions

A short and focused curriculum in surgical oncology, including structured didactics and clinical rotation, had positive impact for the third-year students. Given the increasing work-hour limits, it is important to note that the time spent in the clinical setting continues to be ranked as the most educationally valuable by medical students.     

International surgical clerkship rotation: perceptions and academic performance

Background

Concerns about international training experiences in medical school curricula include the effect on student learning. We studied the educational effect of an international elective integrated into a traditional third-year (M3) surgical clerkship.

Methods

A 1-week surgical elective in Haiti was available to M3 students during the conventional 8-week surgical clerkship each year for the 4 academic years 2008 to 2011. The authors collected student and surgeon perceptions of the elective using a mixed-methods web-based survey. Statistical analysis compared the academic performance of participating M3s relative to nonparticipating peers.

Results

Twenty-eight (100%) students (41 trip weeks) and 3 (75%) surgeons responded. Twenty-five (89%) students believed the elective provided appropriate clinical training. Surgeon responses were consistent with students' reported perceptions.Strengths included unique clinical experiences and close interactions with faculty. Criticisms included recurring overwhelming clinical responsibilities and lack of local provider involvement.Academic performance of participants versus nonparticipants in the same clerkship term were statistically insignificant.

Conclusions

This study demonstrates the feasibility of integrating global health experiences into traditional medical student clinical curricula. The effects on less tangible attributes such as leadership skills, fostering teamwork, and cultural competency require future investigation.     

Higher clinical performance during a surgical clerkship is independently associated with matriculation of medical students into general surgery

Background

The purpose of our study was to determine the predictive impact of individual academic measures for the matriculation of senior medical students into a general surgery residency.

Methods

Academic records were evaluated for third-year medical students (n = 781) at a single institution between 2004 and 2011. Cohorts were defined by student matriculation into either a general surgery residency program (n = 58) or a non–general surgery residency program (n = 723). Multivariate logistic regression was performed to evaluate independently significant academic measures.

Results

Clinical evaluation raw scores were predictive of general surgery matriculation (P = .014). In addition, multivariate modeling showed lower United States Medical Licensing Examination Step 1 scores to be independently associated with matriculation into general surgery (P = .007).

Conclusions

Superior clinical aptitude is independently associated with general surgical matriculation. This is in contrast to the negative correlation United States Medical Licensing Examination Step 1 scores have on general surgery matriculation. Recognizing this, surgical clerkship directors can offer opportunities for continued surgical education to students showing high clinical aptitude, increasing their likelihood of surgical matriculation.     

American College of Surgeons/Association for Surgical Education medical student simulation-based surgical skills curriculum needs assessment

Background

Simulation can enhance learning effectiveness, efficiency, and patient safety and is engaging for learners.

Methods

A survey was conducted of surgical clerkship directors nationally and medical students at 5 medical schools to rank and stratify simulation-based educational topics. Students applying to surgery were compared with others using Wilcoxon's rank-sum tests.

Results

Seventy-three of 163 clerkship directors (45%) and 231 of 872 students (26.5%) completed the survey. Of students, 28.6% were applying for surgical residency training. Clerkship directors and students generally agreed on the importance and timing of specific educational topics. Clerkship directors tended to rank basic skills, such as examination skills, higher than medical students. Students ranked procedural skills, such as lumbar puncture, more highly than clerkship directors.

Conclusions

Surgery clerkship directors and 4th-year medical students agree substantially about the content of a simulation-based curriculum, although 4th-year medical students recommended that some topics be taught earlier than the clerkship directors recommended. Students planning to apply to surgical residencies did not differ significantly in their scoring from students pursuing nonsurgical specialties.     

Students’ expectations on the surgery clerkship exceed those of residents and faculty

Purpose

The perceptions and expectations of students on the surgery clerkship were evaluated and compared with those of surgical residents and faculty.

Methods

A voluntary and anonymous survey was distributed to third year medical students, general surgery residents, and surgery faculty. Statistical analysis was performed using the χ² and Cochran-Mantel-Haenszel tests (P value <0.05 was significant).

Results

Medical students, surgery residents and faculty largely agreed on student responsibilities during morning rounds. However, more students (96.9%) than residents (86.2%) and faculty (77.3%) believed they should be writing progress notes, and fewer students (85%) than residents (100%) and faculty (95.5%) thought they should be taught during morning rounds (P < 0.01 and P = 0.04, respectively). The expected and actual educational experience on the surgical clerkship was similar. The amount of instruction provided each week by residents and faculty was similar to the amount expected by students; each group believed that surgical residents were good educators. Students, residents, and faculty agreed on many essential skills for a student to learn by the clerkship’s end; however, more students (85.8%) than residents (58.6%) and faculty (68.2%) viewed identifying surgical complications as an essential skill (P < 0.01).

Conclusions

Overall, the expectations of the medical students, surgical residents, and surgical faculty on the surgery clerkship were well matched. However, there were some instances where the students thought they should be more involved in patient care than did the residents and the faculty. It is important for surgical educators to be aware of these discrepancies to fully maximize the educational experience of medical students.     

Porcine wet lab improves surgical skills in third year medical students

Background

Medical students desire to become proficient in surgical techniques and believe their acquisition is important. However, the operating room is a challenging learning environment. Small group procedural workshops can improve confidence, participation, and performance. The use of fresh animal tissues has been rated highly among students and improves their surgical technique. Greater exposure to surgical procedures and staff could positively influence students' interest in surgical careers. We hypothesized that a porcine “wet lab” course for third year medical students would improve their surgical skills.

Methods

Two skills labs were conducted for third year medical students during surgery clerkships in the fall of 2011. The students' surgical skills were first evaluated in the operating room across nine dimensions. Next, the students performed the following procedures during the skills lab: (1) laparotomy; (2) small bowel resection; (3) splenectomy; (4) partial hepatectomy; (5) cholecystectomy; (6) interrupted abdominal wall closure; (7) running abdominal wall closure; and (8) skin closure. After the skills lab, the students were re-evaluated in the operating room across the same nine dimensions. Student feedback was also recorded. Fifty-one participants provided pre- and post-lab data for use in the final analysis.

Results

The mean scores for all nine surgical skills improved significantly after participation in the skills lab (P ≤ 0.002). Cumulative post-test scores also showed significant improvement (P = 0.002). Finally, the student feedback was largely positive.

Conclusions

The surgical skills of third year medical students improved significantly after participation in a porcine wet lab, and the students rated the experience as highly educational. Integration into the surgery clerkship curriculum would promote surgical skill proficiency and could elicit interest in surgical careers.     

A pilot study to integrate an immersive virtual patient with a breast complaint and breast examination simulator into a surgery clerkship

Background

We aimed to determine if an immersive virtual patient (VP) with a breast complaint and a breast mannequin could prepare third-year medical students for history-taking (HT) and clinical breast examination (CBE) on a real patient.

Methods

After standardized instruction in breast HT and CBE, students (n = 21) were randomized to either an interaction with a VP (experimental) or to no VP interaction (control) before seeing a real patient with a breast complaint. Participants completed baseline and exit surveys to assess confidence regarding their HT and CBE skills.

Results

Students reported greater confidence in their HT (Δ value = 1.05 ± 1.28, P < .05) and CBE skills (Δ value = 1.14 ± .91, P < .05) and less anxiety when performing a CBE (Δ value = −.76 ± 1.10, P < .05). The VP intervention group had a significantly higher mean HT confidence than the control group at the conclusion of the study (4.27 ± .47 vs 3.50 ± .71, respectively, P < .05).

Conclusions

A single interaction with a VP with a breast complaint and breast mannequin improves student confidence in breast HT during a surgery clerkship.     

Standardized and quality-assured video-recorded examination in undergraduate education: informed consent prior to surgery

Background

Communication skills combined with specialized knowledge are fundamental to the doctor–patient relationship in surgery. During a single-station video-recorded objective structured clinical examination (VOSCE), students were tasked with obtaining informed consent. Our aim was to develop a standardized and quality-assured assessment method in undergraduate education.

Methods

One hundred fifty-five students in their fifth year of medical school (78 videos) participated in a summative VOSCE within the framework of the teaching module “Operative Medicine.” They prepared for three clinical scenarios and the surgical procedures involved. The examination comprised participants having to obtain informed consent from simulated patients, video recording their performance. Students were assessed by two independent raters, the background of one of whom was nonsurgical. Results were statistically tested using SPSS.

Results

Students' scores were all beyond the pass mark of 70%, averaging 91.0% (±4.0%), 88.4% (±4.4%), and 87.0% (±4.7%) for the appendectomy, cholecystectomy, and inguinal hernia repair checklist, respectively. Most items (68%–89% of the checklists) were found to have fair to excellent discrimination values. Cronbach's α values ranged between 0.565 and 0.605 for the individual checklists. Interrater agreement was strong (Pearson correlation coefficient = 0.80, P < 0.01; intraclass correlation coefficient 2.1 = 0.78).

Conclusions

The VOSCE is both feasible and reliable as a method of assessing student communication skills and the application of clinical knowledge while obtaining informed consent in surgery. This method is efficient (flexible rating outside normal working hours possible with reductions in administrative load) and may be used for high-stakes evaluation of student performance.     

Cutting too deep? Assessing the impact of a shorter surgery clerkship on students' clinical skills and knowledge

Background

The aim of this study was to compare the performance of students completing an 8-week versus a 6-week surgery clerkship on an objective structured clinical examination (OSCE) and the National Board of Medical Examiners (NBME) clinical science surgery examination.

Methods

One hundred fifteen students from the 8-week clerkship and 99 from the 6-week clerkship were included. Performance on a summative OSCE was assessed using behaviorally anchored checklists. NBME exams were graded using the NBME's standard scaled scores. Results were compared using 2-tailed, independent-samples, unequal-variance t tests.

Results

Mean OSCE scores for the 8-week and 6-week curricula were not statistically different. Mean NBME scores also did not statistically differ. Six-week students performed significantly better in the specific OSCE subdomains of blood pressure, orthostatic blood pressure, rectal exam, and fecal occult blood test.

Conclusions

Overall OSCE and NBME exam performance did not differ between 8-week and 6-week surgery clerkship students.     

Religiously affiliated intensive care unit patients receive more aggressive end-of-life care

Background

Previous studies among cancer patients have demonstrated that religious patients receive more aggressive end-of-life (EOL) care. We sought to examine the effect of religious affiliation on EOL care in the intensive care unit (ICU) setting.

Materials and methods

We conducted a retrospective review of all patients admitted to any adult ICU at a tertiary academic center in 2010 requiring at least 2 d of mechanical ventilation. EOL patients were those who died within 30 d of admission. Hospital charges, ventilator days, hospital days, and days until death were used as proxies for intensity of care among the EOL patients. Multivariate analysis using multiple linear regression, zero-truncated negative binomial regression, and Cox proportional hazard model were used.

Results

A total of 2013 patients met inclusion criteria; of which, 1355 (67%) affirmed a religious affiliation. The EOL group had 334 patients, with 235 (70%) affirming a religious affiliation. The affiliated and nonaffiliated patients had similar levels of acuity. Controlling for demographic and medical confounders, religiously affiliated patients in the EOL group incurred 23% (P = 0.030) more hospital charges, 25% (P = 0.035) more ventilator days, 23% (P = 0.045) more hospital days, and 30% (P = 0.036) longer time until death than their nonaffiliated counterparts. Among all included patients, survival did not differ significantly among affiliated and nonaffiliated patients (log-rank test P = 0.317), neither was religious affiliation associated with a difference in survival on multivariate analysis (hazard ratio of death for religious versus nonreligious patients 0.95, P = 0.542).

Conclusions

Compared with nonaffiliated patients, religiously affiliated patients receive more aggressive EOL care in the ICU. However, this high-intensity care does not translate into any significant difference in survival.     

Do medical student's surgical examination scores correlate with performance markers?

Background

Some medical school training consists of oral examinations.

Methods

We conducted a 9-year review of third-year medical student examinations including oral examinations, National Board of Medical Examiners Surgery Subject Examination (SSE, ie, shelf), and United States Medical Licensing Examinations Step 1 and Step 2.

Results

Step 1 showed a moderate to strong association with Period 1 orals (Somers' D = .297, P < .001), but not Period 2 orals (Somers' D = .048, P = .053). Period 1 orals (percentage) had a strong association with SSE (Somers' D = .356, P < .001) and Step 2 (Somers' D = .368, P < .001). Period 2 orals (pass/fail) suggested a positive, but not statistically significant, association with SSE (Somers' D = .334, P = .085) and Step 2 (Somers' D = .370, P = .055). Step 1 shows a strong association with SSE (Somers' D = .490, P < .001). SSE showed a strong association with Step 2 (Somers' D = .506, P < .001).

Conclusions

Orals can be used to identify students who may have difficulty passing the SSE. Step 1 can be used to identify students at risk of poor performance on the SSE, and SSE can be used to identify students at risk for poor performance on Step 2.     

Accuracy and content of medical student midclerkship self-evaluations

Background

Midclerkship self-evaluations (MCSEs) require students to reflect on their knowledge, skills, and behaviors. We hypothesized that MCSEs would be consistent with supervisor midpoint evaluations during a surgical clerkship.

Methods

MCSEs of 153 students who completed our surgery clerkship in 2 academic years were compared with supervisor midclerkship evaluations. The quantitative domains of the MCSE and supervisor evaluation were compared for accuracy. Identified areas of strengths and weakness were evaluated for thematic consistency.

Results

Student MCSE scoring was accurate across evaluated domains most of the time; when students were inaccurate, they tended to underrate themselves. Students and supervisors most often identified cognitive skills as areas for improvement and noncognitive skills predominated as student strengths.

Conclusions

Medical students can accurately identify their strengths and weaknesses in the context of an MCSE. Based on these findings, knowledge acquisition and application by medical students in the clinical setting should be emphasized in undergraduate medical education.     

The effect of supplemental parenteral nutrition on outcomes of necrotizing enterocolitis in premature,low birth weight neonates

Background

We hypothesized that supplemental parenteral nutrition (PN) decreases the need for surgery and mortality associated with necrotizing enterocolitis (NEC).

Methods

Single institution retrospective review of all premature, low birth weight infants with NEC from January 2006 to December 2013 was conducted.

Results

NEC was identified in 114 premature, low birth weight infants, 59 (51.8%) of which required surgical management. Surgical NEC infants were born younger (25.8 ± 4.0 vs 27.8 ± 3.3 weeks, P = .005) and weighed less at birth (829 ± 281 vs 938 ± 271 g, P = .038) than those managed medically. There was no difference in the use of PN (37.7% vs 31.4%, P = .541) between surgical and medical NEC patients. There was no statistically significant difference in mortality at discharge between patients who had PN at NEC onset and those who did not (31.4% vs 42.6%, P = .294)

Conclusion

In this single-center study, supplemental PN at NEC onset does not appear to significantly improve outcomes as demonstrated by rates of surgical intervention and in-hospital mortality.     

Do laparoscopic skills transfer to robotic surgery?

Background

Identifying the set of skills that can transfer from laparoscopic to robotic surgery is an important consideration in designing optimal training curricula. We tested the degree to which laparoscopic skills transfer to a robotic platform.

Methods

Fourteen medical students and 14 surgery residents with no previous robotic but varying degrees of laparoscopic experience were studied. Three fundamentals of laparoscopic surgery tasks were used on the laparoscopic box trainer and then the da Vinci robot: peg transfer (PT), circle cutting (CC), and intracorporeal suturing (IS). A questionnaire was administered for assessing subjects' comfort level with each task.

Results

Standard fundamentals of laparoscopic surgery scoring metric were used and higher scores indicate a superior performance. For the group, PT and CC scores were similar between robotic and laparoscopic modalities (90 versus 90 and 52 versus 47; P > 0.05). However, for the advanced IS task, robotic-IS scores were significantly higher than laparoscopic-IS (80 versus 53; P < 0.001). Subgroup analysis of senior residents revealed a lower robotic-PT score when compared with laparoscopic-PT (92 versus 105; P < 0.05). Scores for CC and IS were similar in this subgroup (64 ± 9 versus 69 ± 15 and 95 ± 3 versus 92 ± 10; P > 0.05). The robot was favored over laparoscopy for all drills (PT, 66.7%; CC, 88.9%; IS, 94.4%).

Conclusions

For simple tasks, participants with preexisting skills perform worse with the robot. However, with increasing task difficulty, robotic performance is equal or better than laparoscopy. Laparoscopic skills appear to readily transfer to a robotic platform, and difficult tasks such as IS are actually enhanced, even in subjects naive to the technology.     

Long-Term Outcomes of Orthotopic Heart Transplantation for Hypertrophic Cardiomyopathy

Background

Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease characterized by asymmetric or symmetric ventricular hypertrophy in the absence of an obvious clinical cause. Orthotopic heart transplantation (OHT) has been performed in patients who have refractory symptoms despite medical therapy and surgical septal myectomy. However, there is a paucity of data on outcomes of HCM patients who undergo OHT.

Methods

Data on 462 consecutive patients who underwent OHT at UCLA Medical Center from 1996 to 2004 were retrospectively collected. The clinical data on the 11 patients with HCM were identified.

Results

The majority of the HCM patients were male (64%). The mean age of the patient was 45 ± 8 years, and the mean donor age was 35 ± 18 years. The mean ischemia time was 226 ± 60 minutes. There was 1 in-hospital death secondary to septic shock. At a median duration of follow-up of 4.5 years (mean, 4.4 ± 3.2 years), there were 3 additional deaths. Compared with the 451 OHT patients who did not have HCM, there was no difference in survival (P = .13), development of cardiac allograft vasculopathy (P = .46), or rejection (P = .71). There was no evidence of HCM recurrence in biopsies from the donor heart.

Conclusions

OHT is a viable treatment option for patients with end-stage HCM refractory to standard therapies.     

How prepared are your interns to take calls? Results of a multi-institutional study of simulated pages to prepare medical students for surgery internship

Background

This study evaluated a simulated pages curriculum that was developed to assess communication and clinical decision making in medical students and interns.

Methods

A curriculum consisting of 14 simulated pages was administered across 5 institutions to 150 senior medical students. A 3-case subset was administered to interns who did not participate in the curriculum. Six expert surgeons identified critical fails and set passing scores for case-specific assessments using the Graphical Hofstee Method.

Results

Participants in the curriculum demonstrated superior clinical decision making compared with non-participants across all cases scenarios (P < .01). Average medical student scores for clinical decision making were 46.9%. Global ratings averaged 6.0 for communication and 5.2 for patient care. Passing rates averaged 46%.

Conclusions

Participation in a mock page curriculum improved performance. The performance of participants based on expert standards set for simulated page performance highlight the need for innovative approaches to improve interns' preparedness to take calls.     

Physical Activity in Daily Life Assessed by an Accelerometer in Kidney Transplant Recipients and Hemodialysis Patients

Background

Sedentary lifestyle is a problem among hemodialysis (HD) patients, potentially attenuated after kidney transplantation. However, the effect of kidney transplantation on physical activity has not been thoroughly investigated.

Objective

This study sought to evaluate the physical activity in daily life in kidney transplant recipients (KTRs) compared with HD patients and to explore its relationship with clinical variables.

Methods

A cross-sectional study enrolled KTRs who received transplants at least 6 months before the study (N = 23; 48.3 ± 10.3 years) and patients undergoing HD for at least 6 months (N = 20; 47.3 ± 12.6 years). Time spent in different activities (walking, standing, sitting, and lying down) and number of steps taken, measured by a multiaxial accelerometer used for 12 h/d on 2 consecutive days for KTRs and on 4 consecutive days for HD patients, were evaluated.

Results

KTRs engaged in more active time per day (sum of walking and standing time) than HD patients (311 ± 87 vs 196 ± 54 min/d; P = .001), with longer walking (106 ± 53 vs 70 ± 27 min/d; P = .008) and standing time (205 ± 55 vs 126 ± 42 min/d; P < .001). Sixty-five percent of KTRs were classified as active (>7500 steps/d) compared with only 20% of the HD group (P < .05). The multivariate analysis showed that time posttransplantation was significantly associated with walking time and active time.

Conclusions

By using an accelerometer, a precise method, this study showed that KTRs are significantly more active in daily life than HD patients, and that daily physical activity increases with time since transplantation.     

Effect of Platelet-rich Plasma Therapy Associated With Exercise Training in Musculoskeletal Healing in Rats

Background

Muscle healing is a time-dependent process associated with an increase in the total amount of local collagen fibers. Platelet-rich plasma therapy (PRPT) associated with exercise may improve this healing process. The aim of this study was to demonstrate the regenerative effect of PRPT in association with exercise training on musculoskeletal healing.

Methods

Male Wistar rats were submitted to an injury in the vastus lateralis muscle and randomly divided into 4 groups (n = 5/group): sedentary sham-operated (SSO); sedentary group submitted to PRPT (SPR); swim-trained (SWT); and swim-trained group submitted to PRPT (SWP). Serum lactate level was used to confirm the training protocol effectiveness to increase aerobic fitness. The collagen fiber concentration was measured by the polarization colors in picrosirius red-stained tissue sections.

Results

Lactate levels decreased in both training groups (SWT and SWP; P < .05) after training (SWT: from 6.2 ± 0.44 to 4.7 ± 0.22 mmol/L; SWP: from 5.5 ± 0.99 to 4.0 ± 0.78 mmol/L). There were less type 1 collagen fibers in SWP group compared with other groups (SSO = 31.8 ± 10.3, SSP = 32.3 ± 13.5, SWT = 14.6 ± 13.4, SWP = 5.7 ± 4.7, P < .05), while there were more type 3 collagen fibers on SWP (SSO = 68.7 ± 9.8, SSP = 71.2 ± 12.2, SWT = 85.4 ± 13.4, SWP = 94.4 ± 4.6, P < .05) in the injured region.

Conclusion

Exercise in association with PRPT enhances the skeletal muscle-healing process.