Gaps in exposure to essential competencies in hand surgery fellowship training: a national survey of program directors

Background

Graduate medical education has moved towards competency-based training. The aim of this study was to assess hand surgery program directors’ opinions of exposure gaps in core competencies rated as essential for hand surgery training.

Methods

We surveyed the 74 ACGME hand surgery fellowship program directors. Respondents rated their opinion of 9 general areas of practice, 97 knowledge topics, and 172 procedures into one of three categories: essential, exposure needed, or unnecessary. Program directors also rated trainee exposure of each component at their respective program. Moderate and large exposure gaps were respectively defined as presence of at least 25 and 50 % of programs rating trainees as not having proficiency in the component at the end of training.

Results

Sixty-two of 74 program directors (84 %) responded to the survey. For the 76 knowledge topics and 98 procedures rated as essential, a majority of the knowledge topics (61 %; n = 46) and procedures (72 %; n = 71) had at least a moderate exposure gap. In addition, 22 % (n = 17) of the essential knowledge topics and 26 % (n = 25) of the essential procedures had a large exposure gap.

Conclusion

This study illuminates the discrepancies between what is believed to be important for practicing hand surgeons and graduates’ proficiency as perceived by program directors. The field of hand surgery must work to determine if program directors have unrealistic expectations for what is essential for practicing hand surgeons or if reforms are needed to improve exposure to essential skills in hand surgery training.     

医学生营养知识-态度-行为现状调查分析

目的调查某医学院校医学生营养知识-态度-行为（KAP）现状,为针对性对其进行营养教育和干预提供依据,增强医学生日后在医疗工作中的营养治疗意识。方法采用分层随机抽样的方法,对某医学院校800名医学生的KAP现状进行调查分析。结果医学生中女性的营养知识（K）、态度（A）、行为（P）得分及KAP总分均高于男生,差异有统计学意义（,分别为2．272,2．035,2．435,3．096,均P〈0．05）;高年级医学生K、A得分及KAP总分优于低年级学生（f分别为6．017,2．018,4．441,均P〈0．05）,不同年级学生间P得分差异无统计学意义（t=0．153,P=0．2265）;城市生源地间学生K、A得分及KAP总分高于农村生源学生（f分别为2．138,11．561,2．800,均P〈0．05）,不同生源地问学生P得分差异无统计学意义（t=0．061,P=0．0585）;营养知识与吃零食、在外就餐和每天吃早餐的食用行为存在相关性（P〈0．05）,营养态度与每天吃早餐的行为存在相关性（火0．05）。结论医学生营养知识缺乏,营养行为较差,但营养态度较为积极,应加强对医学生尤其是男生、低年级、农村学生的营养教育。     

Psychiatric trainees in Finland 2001

This study examined Finnish psychiatric trainees’ views on their education. This was a survey study of nationwide data on Finnish psychiatric trainees in 2001. The quality of training was considered at least moderate by 84% of the respondents. Training on epidemiology, on taking history and status, and on psychopharmacology was considered the best. Quality was rated bad for training in leadership and administration, and educating the community. Research was done by 20%, and a personal clinical supervisor was appointed to 52% of the respondents. Offensive treatment had been experienced by 49% of the trainees in this study. Generally, studies of training also reflect strengths and weaknesses of the profession. Based on our results, it seems especially that training in leadership and in educating the community need to be improved; both of these are quintessential skills to survive in the struggle for economic and human resources. Furthermore, treatment of the trainees could still be better; attention should be paid to supervision of all trainees. Moreover, research must become more attractive. Psychiatry can be developed by the development of psychiatric training.     

Temporary Health Impact of Prostate MRI and Transrectal Prostate Biopsy in Active Surveillance Prostate Cancer Patients

PurposeTo assess the temporary health impact of prostate multiparametric MRI (mpMRI) and transrectal prostate biopsy in an active surveillance prostate cancer population.MethodsA two-arm institutional review board–approved HIPAA-compliant prospective observational patient-reported outcomes study was performed from November 2017 to July 2018. Inclusion criteria were men with Gleason 6 prostate cancer in active surveillance undergoing either prostate mpMRI or transrectal prostate biopsy. A survey instrument was constructed using validated metrics in consultation with the local patient- and family-centered care organization. Study subjects were recruited at the time of diagnostic testing and completed the instrument by phone 24 to 72 hours after testing. The primary outcome measure was summary testing-related quality of life (summary utility score), derived from the testing morbidities index (TMI) (scale: 0 = death and 1 = perfect health). TMI is stratified into seven domains, with each domain scored from 1 (no health impact) to 5 (extreme health impact). Testing-related quality-of-life measures in the two cohorts were compared with Mann-Whitney U test.ResultsIn all, 122 subjects were recruited, and 90% (110 of 122 [MRI 55 of 60, biopsy 55 of 62]) successfully completed the survey instrument. The temporary quality-of-life impact of transrectal biopsy was significantly greater than that of prostate mpMRI (0.82, 95% confidence interval [CI] 0.79-0.85, versus 0.95, 95% CI 0.94-0.97; P < .001). The largest mean domain-level difference was for intraprocedural pain (transrectal biopsy 2.6, 95% CI 2.4-2.8, versus mpMRI 1.3, 95% CI 1.1-1.5; P < .001).ConclusionTransrectal prostate biopsy has greater temporary health impact (lower testing-related quality-of-life measure) than prostate mpMRI.