Credentialing of surgical skills centers

Major imperatives regarding quality of patient care and patient safety are impacting surgical care and surgical education. Also, significant emphasis continues to be placed on education and training to achieve proficiency, expertise, and mastery in surgery. Simulation-based surgical education and training can be of immense help in acquiring and maintaining surgical skills in safe environments without exposing patients to risk. Opportunities for repetition of tasks can be provided to achieve pre-established standards, and knowledge and skills can be verified using valid and reliable assessment methods. Also, expertise and mastery can be attained through repeated practice, specific feedback, and establishment of progressively higher learning goals. Simulation-based education and training can help surgeons maintain their skills in infrequently performed procedures and regain proficiency in procedures they have not performed for a period of time. In addition, warm-ups and surgical rehearsals in simulated environments should enhance performance in real settings.Major efforts are being pursued to advance the field of simulation-based surgical education. New education and training models involving validation of knowledge and skills are being designed for practicing surgeons. A competency-based national surgery resident curriculum was recently launched and is undergoing further enhancements to address evolving education and training needs. Innovative simulation-based surgical education and training should be offered at state-of-the-art simulation centers, and credentialing and accreditation of these centers are key to achieving their full potential.     

Cutaneous lesions in new born

Five hundred unselected newborn babies delivered in the Department of Obstetrics and Gynaecology, Unit II of SGBT Hospital attached to Government Medical College, Amritsar during April 2000 to October 2000 were examined for cutaneous lesions daily for the first five days after birth. Different cutaneous lesions were seen in 474(94.8%) newborns. The physiological skin changes observed in order of frequency were Epstein pearls in 305(61%), Mongolian spot in 301(60.2%), superficial cutaneous desquamation in 200(40%), icterus in 128(25.6%), milia in 119(23.8%), sebaceous gland hyperplasia in 107(21.4%), occipital alopecia in 94(18.8%), lanugo in 72(14.4%), peripheral cyanosis in 47(9.4%), breast hypertrophy in 29(5.8%) and miniature puberty in 28(5.6%) newborns. Of the transient non-infective skin diseases, erythema toxicum neonatorum was observed most commonly in 105(21%), followed by miliaria rubra in 103(20.6%) and acne neonatorum in 27(5.4%) newborns. The naevi and other developmental defects in the descending order were salmon patch in 69(13.8%), congenital melanocytic noevi in 10(2%), accessory tragi in 3(0.6%), spina bifida in 2(0.4%), hydrocephalus in 1(0.2%) and poliosis in 1(0.2%) newborns. Cradle cap was the only dermatitis observed in 50(10%) newborns. One (0.2%) case each of Harlequin ichthyosis and labial cyst was seen.     

Direct laryngoscopic observations in progressive hoarseness of voice

Hoarseness is a common disorder of voice which indicates abnormality at the level of glottis. We present our study of forty cases of progressive hoarseness of voice who underwent direct laryngoscopy during a period of January 2003 to January 2004 in our hospital. The observations were recorded und the data was evaluated.     

The new paradigm of continuing education in surgery

Concerns regarding the shortcomings of traditional continuing medical education (CME) have led to widespread acceptance of the concept of continuous professional development (CPD). Continuous professional development focuses on the individual learning needs of physicians across the continuum of their professional careers and encompasses a broad range of educational activities. Continuous professional development activities of practicing surgeons should be integrated with the core competency of practice-based learning and improvement (PBLI), which involves a cycle of 4 steps-identifying areas for improvement, engaging in learning, applying new knowledge and skills to practice, and checking for improvement. The effectiveness of CPD and PBLI should be objectively evaluated by assessing their impact on surgeons' learning and performance and on patient care outcomes. A portfolio may be used to document CPD and PBLI activities and can serve as a valuable learning and assessment tool. It should contain information on the personal learning projects pursued by the surgeon. Continuous professional development of the entire surgical team and education of patients and their families need to be considered within the context of the surgeon's CPD efforts to positively affect patient care. Thus, a concept of global 360 degrees education should be embraced. Continuous professional development integrated with PBLI can help surgeons address their specific learning needs and play a pivotal role in surgeons' providing the best care to patients.