Surgery resident selection and evaluation. A critical incident study

This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.     

Educational effort and CQI program improves ordering of serum digoxin levels

In a 289-bed, acute-care, non-tertiary-care regional referral center, a continuous quality improvement educational effort successfully improved ordering of serum digoxin levels. Following a determination that physicians were not requesting serum digoxin levels correctly, the P & T Committee issued a letter describing appropriate wording of orders for serum digoxin levels. The number of incorrectly ordered serum digoxin levels requested dropped significantly over a 49-month period as a result of the intervention described below, which also resulted in cost savings.     

How a CQI program improved aminoglycoside use in a community hospital

The P & T Committee of our institution, a 285-bed, non-tertiary care regional medical center, undertook a study to evaluate the use of the aminoglycoside amikacin sulfate (Amikin). Results of an initial DUE, a follow-up to an educational effort, and the estimated annual cost savings that could be achieved with appropriate prescribing of aminoglycosides are presented.     

Learned suppression of stereotypy in amphetamine-treated rats: implications for understanding tolerance to amphetamine 'anorexia'

The purpose of this study was to determine whether amphetamine-treated rats can learn to suppress stereotyped movements in order to feed. Rats implanted with cannulae were reinforced with intraoral infusions of milk for holding their heads stationary within a narrow area of space defined by intersecting photobeams. Four of six rats given chronic injections of amphetamine (2mg/kg) learned the response. The amount of milk ingested as a result of the infusions increased over trials at a rate that was comparable to that of rats given milk in bottles. Despite the development of such 'tolerance', analysis of the temporal distribution of photobeam interruptions revealed residual effects of the drug. Specifically, amphetamine-treated rats had longer latencies to initiate infusions and displayed a more fragmented pattern of responding than did saline controls. These results demonstrate that rats can learn to inhibit amphetamine-induced sterotypy and support the view that tolerance to amphetamine 'anorexia' involves learning to suppress stereotyped movements that interfere with feeding. Parallels to the suppression of involuntary movements in humans are noted.     

Advance directives: the experience of health care professionals across the continuum of care.

This study explored the perceptions of health care providers across the continuum of care as to how effective advance directive arrangements were in assuring compliance with the patients' wishes, as well as their overall satisfaction levels with the process. The health care providers who responded to the survey indicated high levels of overall satisfaction with advance directives, despite low patient completion rates and, most significantly, low confidence levels that surrogate decision making accurately reflected the patient's wishes. A secondary analysis compared the perceptions of health care providers with consumers' reasons for failing to complete advance directives. The need for further education was perceived as a primary need by the health care professionals but not by the consumers. Recommendations for policy initiatives and further research are then presented.     

Cost effectiveness of danaparoid compared with enoxaparin as deep vein thrombosis prophylaxis after hip replacement surgery

Guidelines for prophylaxis of deep vein thrombosis (DVT) after hip replacement surgery suggest the use of twice-daily low-molecular-weight heparin as one treatment option. Danaparoid, a low-molecular-weight heparinoid, and once-daily enoxaparin are recently released dosage forms that have been evaluated as pharmacoprophylaxis for DVT after hip replacement surgery. Incremental cost-effectiveness ratio calculations using published efficacy and safety data suggest that enoxaparin (40 mg) daily is the more cost effective of these two agents as routine prophylaxis after hip replacement surgery.