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1.
Elena Brandford Brittany Hasty Janine S. Bruce Sylvia Bereknyei Merrell Edward S. Shipper Dana T. Lin James N. Lau 《American journal of surgery》2018,215(2):227-232
Background
Medical students experience more psychological distress than the general population. One contributing factor is mistreatment. This study aims to understand the mechanisms of mistreatment as perceived by medical students.Methods
Students completed anonymous surveys during the first and last didactic session of their surgery clerkship in which they defined and gave examples of mistreatment. Team-based thematic analysis was performed on responses.Results
Between January 2014 and June 2016, 240 students participated in the surgery clerkship. Eighty-nine percent of students completed a survey. Themes observed included (1) Obstruction of Students' Learning, (2) Exploitation of Student Vulnerability, (3) Exclusion from the Medical Team, and (4) Contextual Amplifiers of Mistreatment Severity.Conclusion
The themes observed in this study improve our understanding of the students' perspective on mistreatment as it relates to their role in the clinical learning context, which can serve as a starting point for interventions that ultimately improve students' experiences in the clinical setting. 相似文献2.
Andrew Adelsheimer Russell S. Berman H. Leon Pachter Mark S. Hochberg 《American journal of surgery》2018,215(2):304-308
Introduction
This study compares NBME surgical clerkship scores of students who completed their medicine clerkship before their surgical clerkship with the performance of those who had not previously completed their medical clerkship.Methods
The study included 815 New York University School of Medicine students from the years 2014–2018 (571 students took medicine first, while 244 took surgery first). Performance on the surgical clerkship was assessed using the NBME SHELF examination. Statistical comparisons were performed via 2-tailed, independent-samples, unequal-variance t-tests.Results
Mean NBME surgical SHELF scores of the students who had previously taken medicine were significantly higher than students who had not (mean 78.6 vs. 73.5, p < 0.001). Students who had solely medicine (as their first clerkship) before surgery also performed significantly better (mean 78.8 vs. 73.5, p < 0.001). Students who completed surgery later in the year did not perform better on the surgical SHELF, so long as both surgical clerkship cohorts had completed medicine.Conclusion
Students who completed their core medical clerkship prior to their surgical clerkship scored significantly better on the NBME surgical SHELF examination. 相似文献3.
Patrick E. Georgoff Gabrielle Shaughness Lisa Leininger Vahagn C. Nikolian Gurjit Sandhu Rishindra Reddy David T. Hughes 《American journal of surgery》2018,215(2):293-297
Background
Medical students often report dissatisfaction with the feedback they receive on their clerkships. This study evaluates the performance of the Minute Feedback System (MFS), a web-based tool designed to facilitate medical student acquisition of same day written feedback from surgery residents and faculty.Methods
System-generated data, targeted surveys, and end of clerkship questionnaires were used to evaluate MFS performance over a one-year period.Results
170 students made 3190 feedback requests and received 1978 responses (62% response rate). Students felt the system was easy to use (90%), provided useful feedback (74%), and allowed them to obtain more feedback than they would have in its absence (81%). Concerns were raised regarding the quality of electronic feedback and whether the data generated would be used for summative assessment.Conclusions
The MFS encourages same-day assessment and increases documented medical student feedback. Further development is required to improve feedback quality, response rates, and feedback application. 相似文献4.
Joanna K. Law Parker A. Thome Brenessa Lindeman Daren C. Jackson Anne O. Lidor 《American journal of surgery》2018,215(1):196-199
Background
We examined the types of technology used by medical students in clinical clerkships, and the perception of technology implementation into the curriculum.Methods
An online survey about technology use was completed prior to general surgery clinical clerkship. Types of devices and frequency/comfort of use were recorded. Perceptions of the benefits and barriers to technology use in clerkship learning were elicited.Results
125/131 (95.4%) students responded. Most students owned a smart phone (95.2%), tablet (52.8%), or both (50%); 61.6% spent > 11 h/week learning on a device at the Johns Hopkins School of Medicine for educational purposes. Technology use was seen as beneficial by 97.6% of students. Classes that used technology extensively were preferred by 54% of students, although 47.2% perceived decreased faculty/classmate interaction.Conclusions
Students use mobile technology to improve how they learn new material, and prefer taking classes that incorporate information technology. However, in-person/blended curricula are preferable to completely online courses. 相似文献5.
James E. Coverdill Jeff Scott Shelton Adnan Alseidi David C. Borgstrom Daniel L. Dent Russell Dumire Jonathan Fryer Thomas H. Hartranft Steven B. Holsten M. Timothy Nelson Mohsen M. Shabahang Stanley R. Sherman Paula M. Termuhlen Randy J. Woods John D. Mellinger 《American journal of surgery》2018,215(2):222-226
Background
Nurse Practitioners and Physician Assistants – called non-physician practitioners or NPPs – are common, but little is known about their educational promise and problems.Methods
General surgery faculty in 13 residency programs were surveyed (N = 279 with a 71% response rate) and interviewed (N = 43) about experiences with NPPs. The survey documents overall patterns and differences by program type and primary service; interviews point to deeper rationales and concerns.Results
NPPs reduce faculty and resident workloads and teach residents. NPPs also reduce resident exposure to educationally valuable activities, and faculty sometimes round, make decisions, and operate with NPPs instead of residents. Interviews indicate that NPPs can overly reduce resident involvement in patient care, diminish resident responsibility and decision making, disrupt team dynamics, and compete for procedures.Conclusions
NPPs both enhance and hinder surgical education and highlight the need to more clearly articulate learning outcomes for residents and activities necessary to achieve those outcomes. 相似文献6.
7.
Background
Constructivist student-centered instructional models such as the flipped classroom (FC) have been shown to improve learning.Methods
A FC approach was implemented for the surgery clerkship. Data was collected in phase 1 to evaluate student learning and attitudes. Based on these results, questions for the phase 2 open-ended survey were developed to improve understanding of learner attitudes, and ascertain how well the FC aligns with constructivist principles.Results
There was no significant difference in shelf exam performance between the control and intervention groups. A majority of students agreed that they preferred the FC over lectures, and that their learning improved. Open-ended survey analysis demonstrated that the FC fostered self-directed, active learning, and that the in-class sessions facilitated application of concepts and deeper learning. Areas identified for improvement included better alignment with learning preferences through greater variety of pre-class learning options, improvement of podcast technical quality, and utilization of smaller in-class discussion groups.Conclusions
Students had a positive perception of the FC. The FC supports self-directed and more active and deeper in-class learning. 相似文献8.
Joachim Gülke Barbara Leopold Daniel Grözinger Björn Drews Stephan Paschke Nikolaus J. Wachter 《Journal of hand therapy》2018,31(1):20-28
Study Design
Prospective cohort randomized controlled trial.Purpose of the Study
Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures?Methods
Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively.Results
After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks.Conclusion
Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures.Level of Evidence
II. 相似文献9.
Background
Surgeons who work with trainees must address their learning needs without compromising patient safety.Methods
We used a constructivist grounded theory approach to examine videos of five teaching surgeries. Attending surgeons were interviewed afterward while watching cued videos of their cases. Codes were iteratively refined into major themes, and then constructed into a larger framework.Results
We present a novel framework, Intelligent Cooperation, which accounts for the highly adaptive, iterative features of surgical teaching in the operating room. Specifically, we define Intelligent Cooperation as a sequence of coordinated exchanges between attending and trainee that accomplishes small surgical steps while simultaneously uncovering the trainee's learning needs.Conclusions
Intelligent Cooperation requires the attending to accurately determine learning needs, perform real-time needs assessment, provide critical scaffolding, and work with the learner to accomplish the next step in the surgery. This is achieved through intense, coordinated verbal and physical cooperation. 相似文献10.
11.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献12.
S.-C. Yang H.-Y. Lee C.-L. Chen C.-J. Huang C.-H. Wang K.-W. Cheng S.-C. Wu T.-H. Shih C.-E. Huang Y.-E. Lee B. Jawan S.-E. Juang H.-F. Lu 《Transplantation proceedings》2018,50(9):2651-2653
Background
Opsite (Smith & Nephew, Hull, UK) is widely used in wound care but its use in eye protection against corneal abrasion during major surgery is rarely reported. The purpose of the current study is to compare the effectiveness of using Opsite in eye protection with either wet gauze alone or with wet gauze following application of eye ointment in patients undergoing living donor liver transplantation (LDLT).Methods
This is a prospective, double-blinded, randomized controlled trial. Forty-one patients undergoing liver transplantation were enrolled. One eye of each patient was protected with sterile gauze soaked with normal saline solution and covered with Opsite. Duratears (ALCON, Fort Worth, Tex, United States) ointment was applied to the other eye before covering it with sterile wet gauze and Opsite (ointment group). The corneal examination was carried out after fluorescein staining before and at the end of surgery by the same doctor. A Student t-test and a χ2 test were used for the statistical analyses.Results
Forty-one patients with 82 eyes were observed in this study. No corneal epithelial defects were found in either the normal saline group or the ointment group.Conclusion
Opsite combined with wet gauze with or without additional eye ointment provided 100% protection against corneal abrasion in patients undergoing LDLT. 相似文献13.
Amanda Kupstas Warda Ibrar R. David Hayward David Ockner Cheryl Wesen Jeffrey Falk 《American journal of surgery》2018,215(3):400-403
Background
A single center retrospective chart review was performed examining the ability of a novel radiofrequency probe (Margin Probe; Dune Medical Devices, Caesarea, Israel) for intraoperative margin assessment to reduce the number of reexcisions in breast-conserving surgery.Methods
Reexcision rates were evaluated in one-hundred and twenty consecutive patients before and after the institution of the device. Utility of the device was evaluated by comparing intraoperative feedback with postoperative pathology reports.Results
Two hundred and forty patient subjects were reviewed in total. There was a significant decrease in the re-lumpectomy rate (50%, p = 0.039) in the device group without increasing the total volume of tissue resected.Conclusions
The use of the MarginProbe device as an adjunct to the standard of care resulted in reduction of positive margins after lumpectomy and the number of re-excisions, significantly improving outcomes in breast-conserving surgery at our institution. 相似文献14.
Barrett A. Kielhorn Anthony J. Senagore Theodor Asgeirsson 《American journal of surgery》2018,215(3):373-376
Background
Perioperative insulin resistance is associated with significant hyperglycemia-related morbidity in patients undergoing major surgery. We sought to assess the effect of preoperative loading with a low-dose maltodextrin/citrulline solution compared to a commercially available sports drink on glycemic levels in an established colorectal enhanced recovery program.Methods
Retrospective analysis was undertaken of elective non-diabetic colectomies and enterectomies from January 2016–March 2017. Cohorts included simple (SIM) and complex carbohydrate (COM) groups. Statistical analysis was performed with linear and logarithmic regression.Results
83 patients were included (42 SIM, 41 COM). SIM group was older (61.7 vs 52.7 p = 0.012) Glycemic variability was less in the COM group (7.6% vs 21.4% P = 0.034). The frequency of hyperglycemia, postoperative complications, and length of stay trended higher in the SIM group.Conclusions
This retrospective analysis identifies significant improvement in the perioperative glycemic variability with preoperative low dose complex carbohydrate loading compared to simple carbohydrate loading in colorectal surgery patients. 相似文献15.
16.
James E. Coverdill Adnan Alseidi David C. Borgstrom Daniel L. Dent Russell Dumire Jonathan Fryer Thomas H. Hartranft Steven B. Holsten M. Timothy Nelson Mohsen M. Shabahang Stanley R. Sherman Paula M. Termuhlen Randy J. Woods John D. Mellinger 《American journal of surgery》2018,215(2):326-330
Background
The study explores how residents and faculty assess the ACGME's 16-h limit on intern shifts.Methods
Questionnaire response rates were 76% for residents (N = 291) and 71% for faculty (N = 279) in 13 general surgery residency programs. Results include means, percentage in agreement, and statistical tests for 15 questionnaire items. Semi-structured interviews conducted with 39 residents and 43 faculty were analyzed for main themes.Results
Few view the intern shift limit as a positive change. Views differ (P < 0.01) for residents and faculty on 12 of 15 item means and across PGY levels on all 15 items. Interviews indicate concerns about losses with respect to education and professional development, difficulties when interns transition to their second year, and how intern shifts may be more fatiguing than expected.Conclusions
The 16-h limit on intern shifts has remained a source of concern and an educational challenge for residents and faculty. 相似文献17.
Omar A. Behery Sean M. Kearns Justin M. Rabinowitz Brett R. Levine 《The Journal of arthroplasty》2017,32(5):1510-1515
Background
The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.Methods
A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.Results
Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.Conclusion
It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components. 相似文献18.
Chema Strik Martijn W.J. Stommel Jeroen C. Hol Harry van Goor Richard P.G. ten Broek 《American journal of surgery》2018,215(1):104-112
Background
Adhesiolysis during abdominal surgery can cause iatrogenic organ injury, increased operative time and a more complicated convalescence. We assessed the impact of adhesiolysis and adhesiolysis-related complications on quality of life and functional status following elective abdominal surgery.Methods
Prospective cohort study, comparing patients requiring and not requiring adhesiolysis during an elective laparotomy or laparoscopy using the SF-36 and DASI questionnaire scores.Results
518 patients were included. Pre- and postoperative quality of life did not significantly differ between both groups. Patients with adhesiolysis had a significantly lower pre- and postoperative functional status (p < 0.01). Higher age, concomitant pulmonary disease, postoperative complications, readmissions and chronic abdominal pain 6 months after surgery were all associated with a significant and independent decline in quality of life and functional status six months after surgery.Conclusion
Adhesiolysis in itself does not affect functional status and quality of life six months after surgery. Postoperative complications, readmissions and chronic abdominal pain are associated with a lower health status. 相似文献19.
20.
Avinash Bhakta Owen Glotzer Ashar Ata Marcel Tafen Steven C. Stain Paul T. Singh 《American journal of surgery》2018,215(4):643-646