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JOURNAL OF SHOULDER AND ELBOW SURGERY 2007年第4期16卷 438-442页

作者： Baumgarten, Keith M. Wright, Rick W. Univ Washington Sch Med Dept Orthopaed Surg Seattle WA 98195 USA

To date, there is no comprehensive study that determines which arthroscopic knots are easiest to learn to tie. In this study, 23 surgeons in training graded 10 orthroscopic knots with regard to ease of learning and tying using a 10-cm visual analog scale for No. 2 Ethibond and No. I polydioxanone (PDS) II suture. Statistical analysis was performed with analysis of variance and the Tukey Studentized range (HSD) test for post hoc analysis with a significant value of P < .05. The Tennessee slider, Duncan loop, Revo knot, and Nicky's knot were the easiest knots to tie by use of both Ethibond and PDS suture. The Field knot and double-twist knot were consistently the hardest knots to tie. Knots tied with Ethibond were easier to tie than knots tied with PDS. Novice surgeons should consider using the Revo knot when developing their arthroscopic knot-tying skills. Once they have mastered this knot, they can consider adding more difficult knots to their repertoire.

关键词： Arthroscopy Humans Internship and Residency Orthopedics Polydioxanone 关节镜检查实习医师和住院医师职务矫形外科学聚二恶烷酮聚对苯二甲酸乙酯类 Polydioxanone Ethibond Arthroscopy Tie Internship and Residency Orthopedics virtual value

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DOCTORS AND PATIENTS IN OBSTETRICS AND GYNECOLOGY - NEXT 15 YEARS

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AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY 1976年第3期125卷 361-367页

作者： PEARSE, WH Chicago Illinois USA

The major impact on the development of obstetrics-gynecology during the next 15 years will come from the substantially increased number of practicing physicians in the specialty and the less rapidly increasing patient population they will serve. Even at present record low fertility rates, the annual number of births in the United States will increase slowly to a level near 4 million by the early 1980's; children already born will contribute to a 16 per cent increase in the female population 15 to 44 years of age between now and 1990. Over the same time interval, the number of practicing specialists will increase dramatically, based on rising numbers of medical school graduates and more Ob-Gyn residents; there will be a 52 per cent increase in certified specialists per unit population over the next 15 years.

关键词：年龄因素出生率妇科学实习医师和住院医师职务产科学人口增长美国青少年成年人女(雌)性人类中年人

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Comparison of the first 100 coronary bypass patients of a supervised resident with his first 100 as an attending surgeon at the same institution

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AMERICAN JOURNAL OF SURGERY 1999年第4期178卷 348-350页

作者： Roberts, CS Bocanegra, NR Univ N Carolina Sch Med Div Cardiothorac Surg Chapel Hill NC 27599 USA

BACKGROUND: Although coronary artery bypass grafting (CABG) has been analyzed intensely for 30 years, little information is available on the characteristics and outcome of CABG patients operated upon by resident trainees or first-year attending surgeons in a public teaching hospital. METHODS: The first 100 CABG patients operated upon by a supervised resident were compared with the first 100 CABG patients under the cave of the same person as an attending surgeon at the same institution. In the first group, the resident was directly supervised by one of three different staff surgeons. In the second group, the same person, as an attending, performed 60 operations and directly supervised one of two trainees in 40. RESULTS: Comparing the resident group versus the attending group, mean age (62 versus 61 years), percentage of females (37 and 37), tobacco use (74 versus 77), obesity (43 versus 55), insulin-dependent diabetes mellitus (20 versus 17), ejection fraction less than or equal to 0.5 (29 versus 35), and previous myocardial infarction (56 versus 54) were similar. Three or move coronary anastomoses were performed in 83 patients in the first group and in 74 in the second group. Early mortality (in-hospital and/or less than or equal to 30 days) occurred in 2 patients in the resident group and 3 in the attending group;each patient had a low ejection fraction and severe narrowing of all three major epicardial coronary arteries. Morbidity in the two groups was similar. CONCLUSION: If properly supervised by experienced staff surgeons, a resident trainee can achieve satisfactory results in CABG in a heterogeneous group of patients. Furthermore, the transition to attending surgeon can be achieved with a good outcome for the patients. (C) 1999 by Excerpta Medica, Inc.

关键词：心脏病学/教育临床工作能力冠状动脉分流术/方法实习医师和住院医师职务医务人员医院治疗结果成年人老年人老年人 80以上人类中年人

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Attending, house officer, and medical student perceptions about teaching in the third-year medical school general surgery clerkship

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2004年第6期199卷 932-942页

作者： De, SK Henke, PK Ailawadi, G Dimick, JB Colletti, LM Univ Michigan Med Ctr Dept Surg Ann Arbor MI 48109 USA

BACKGROUND: There has been declining interest in surgery among medical students and one reason might be the third-year clerkship experience. The aim of this study was to clarify the perceptions and expectations of attendings, residents, and medical students on the clerkship experience. STUDY DESIGN: A survey was distributed to all general surgery attendings, the entire general surgery house staff, and an entire third year medical school class inclusive of the 2001-2002 academic year at a single institution. Statistic analysis consisted of chi-square and Kruskal-Wallis-ANOVA on ranks with Dunn's test for multiple comparisons. A p < 0.05 was significant. RESULTS: Responses were obtained from 59 attending surgeons (50%), 38 surgical residents (32%), and 107 medical students (66%). Of this student cohort, 35% were planning to choose a surgical specialty as a career. Agreement was high among faculty, students, and residents about factors considered important in evaluation, expectations of skills, and level of skills needed before the clerkship. Medical students desired more hours of instruction, believed they performed fewer procedures per week, and thought that feedback was poor compared with the opinions of faculty and residents (p < 0.002). Nearly 50% of medical students believed they were an inconvenience to the service;30% of house officers and 27% of faculty (p < 0.001) believed this also. Almost all faculty and residents, however, wanted medical students on the service ( > 95%). Faculty believed residents did a better job teaching than either the students or residents themselves did (p < 0.001), and students thought that residents were the primary source of education in patient care. CONCLUSIONS: Considerable differences exist between faculty, surgical resident, and medical student perceptions and expectations of medical student education. Structured direct faculty contact, definition of medical student roles on the surgical team, and more consistent feedback can

关键词： Attitude of Health Personnel Clinical Clerkship Internship and Residency 医务工作者的态度临床实习实习医师和住院医师职务医务人员医院学生医科 Students house officer medical student medical school General Surgery Attitude of Health Personnel Perception Internship and Residency Clinical Clerkship

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PHARMACY INTERNSHIP IN MINNESOTA - OUTGROWTH OF AN EXTENSIVE EVALUATION PROGRAM

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AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 1976年第1期40卷 28-33页

作者： GRUSSING, P STEWART, JE HOLSTROM, D FITCH, J MINNESOTA STATE BOARD PHARM MINNEAPOLISMN 55414

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Interactive instruction in otolaryngology resident education

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OTOLARYNGOLOGIC CLINICS OF NORTH AMERICA 2007年第6期40卷 1203-+页

作者： Schweinfurth, John M. Dept Otolaryngol & Commun Sci Jackson MS 39216 USA

Today's academic faculty was typically trained under an education system based entirely on didactic lectures. However, if the aim is to teach thinking or change attitudes beyond the simple transmission of factual knowledge, then lectures alone, without active involvement of the students, are not the most effective method of teaching. If the goals of teaching are to arouse and keep students' interest, give facts and details, to make students think critically about the subject, and to prepare for independent studies by demonstration of problem solving and professional reasoning, then only two of these purposes are suited to didactic lectures. The problem then is how to organize lecture material so that individual student's learning needs are better addressed. The education literature suggests that instruction include a variety of activities designed to stimulate individual thought. These activities include small group discussion, working problems during lecture time, questions included in the lecture, and quizzes at the end of lecture, among others. The current study was undertaken to examine the feasibility of using these types of interactive learning techniques in an otolaryngology residency program. Possibilities considered in the current study include standard interactive lecturing, facilitated discussion, brainstorming, small group activities, problem solving, competitive large group exercises, and the use of illustrative cliff hanger and incident cases. The feasibility of these methodologies being effectively incorporated into a residency curriculum is discussed.

关键词： Curriculum Feasibility Studies Humans Internship and Residency Learning 课程可行性研究实习医师和住院医师职务学习动机耳鼻咽喉科学问题解决 education policy Group Discussion Internship and Residency Learning Residency Declarative Knowledge Students instruction Problem solving Curriculum Laryngology

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Global Health in General Surgery Residency: A National Survey

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2009年第3期208卷 426-433页

作者： Jayaraman, Sudha P. Ayzengart, Alexander L. Goetz, Laura H. Ozgediz, Doruk Farmer, Diana L. Hosp Sick Children Div Gen Surg Dept Pediat Surg Toronto ON M5G 1X8 Canada Univ Calif San Francisco Dept Surg San Francisco CA 94143 USA Kaiser Permanente Dept Surg Oakland CA USA

BACKGROUND: Interest in global health during postgraduate training is Increasing across disciplines. There are limited data from surgery residency programs on their attitudes and scope of activities in this area. This study aims to understand how global health education fits into postgraduate surgical training in the US. STUDY DESIGN: In 2007 to 2 008, we conducted a nationwide survey of program directors at all 253 US general surgery residencies using a Web-based questionnaire modified from a previously published survey. The goals of global health activities, type of activity (ie, clinical versus research), and challenges to establishing these programs were analyzed. RESULTS: Seventy-three programs responded to the survey (29%). Of the respondents, 23 (33%) offered educational activities in global health and 86% (n = 18) of these offered clinical rotations abroad. The primary goals of these activities were to prepare residents for a career in global health and to improve resident recruitment. The greatest barriers to establishing these activities were time constraints for faculty and residents, lack of approval from the Accreditation Council for Graduate Medical Education and Residency Review Committee, and funding concerns. Lack of interest at the institution level was listed by only 5% of program directors. Of the 47 programs not offering such activities, 57% (n = 27) were interested in establishing them. CONCLUSIONS: Few general surgery residency programs currently offer clinical or other educational opportunities in global health. Most residencies that responded to our survey are interested in such activities but face many barriers, including time constraints, Residency Review Committee restrictions, and funding. (J Am Coll Surg 2009;208:426-433. (C) 2009 by the American College of Surgeons)

关键词： Cross-Sectional Studies Curriculum Data Collection Forecasting General Surgery 横断面研究课程数据收集预测国际教育交流实习医师和住院医师职务美国 Supervisory programs Global Health Time constraints General Surgery Residency Review Committees Cross-Sectional Studies Curriculum

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Psychological well-being of surgery residents before the 80-hour work week:: A multiinstitutional study

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JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 2004年第4期198卷 633-640页

作者： Zaré, SM Galanko, J Behrns, KE Koruda, MJ Boyle, LM Farley, DR Evans, SRT Meyer, AA Sheldon, GF Farrell, TM Univ N Carolina Dept Surg Chapel Hill NC 27599 USA Univ N Carolina Dept Med Chapel Hill NC 27599 USA Georgetown Univ Hosp Dept Surg Washington DC 20007 USA Mayo Clin Rochester MN USA Washington Hosp Ctr Washington DC 20010 USA

BACKGROUND: Accreditation Council on Graduate Medical Education work-hour restrictions are aimed at improving patient safety and resident well-being. Although surgical trainees will be dramatically affected by these changes, no comprehensive assessment of their well-being has been recently attempted. STUDY DESIGN: A multicenter study of psychological well-being of surgical residents (n = 108) across four US training programs before implementation of the 80-hour work week was performed using two validated surveys (Symptom Checklist-90-R [SCL-90-R] and Perceived Stress Scale [PSS]) during academic year 2002-03. Societal normative populations served as controls. Primary outcomes measures were psychologic distress (SCL-90-R) and perceived stress (PSS). Secondary outcomes measures (SCL-90-R) were somatization, depression, anxiety, interpersonal sensitivity, hostility, obsessive-compulsive behavior, phobic anxiety, paranoid ideation, and psychoticism. The impact of personal variables (age, gender, marital status) and programmatic variables (level of training, laboratory experience, institution) was assessed. RESULTS: Mean psychologic distress was significantly higher in general surgery residents than in the normative population (p < 0.0001), with 38% scoring above the 90(th) percentile and 72% above the 50(th) percentile. Mean perceived stress among surgery residents was higher than historic controls (p < 0.0001), with 21% scoring above the 90(th) percentile and 68% above the 50th percentile. Among secondary outcomes, eight of nine symptom dimensions were significantly higher in surgical residents than in societal controls. In subgroup analyses, male gender was associated with phobic anxiety (p < 0.001) and anxiety (p < 0.05), and junior level of training (PGY 1 to 3) with anxiety (p < 0.05), obsessive-compulsive behavior (p < 0.05), and interpersonal sensitivity (p < 0.05). CONCLUSIONS: More than one-third of general surgery residents meet criteria for clinical psycholog

关键词： Internship and Residency Stress Psychological Surgery Work Schedule Tolerance 实习医师和住院医师职务应激心理学外科学工作安排忍受 Phobic Disorders Compulsive Behavior Work Schedule Tolerance Patient Safety General Surgery Multicenter Study 90th Percentile Working time Internship and Residency Stressing Surgery

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Application of distance learning to interactive seminar instruction in orthodontic residency programs

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AMERICAN JOURNAL OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS 2007年第5期132卷 586-594页

作者： Bednar, Eric D. Hannum, Wallace M. Firestone, Allen Silveira, Anibal M. Cox, Thomas D. Proffit, William R. Univ N Carolina Sch Dent Dept Orthodont Chapel Hill NC 27599 USA Univ N Carolina Sch Educ Chapel Hill NC 27599 USA Ohio State Univ Coll Dent Dept Orthodont Columbus OH 43210 USA Univ Louisville Sch Dent Dept Orthodont Louisville KY 40292 USA Univ N Carolina Informat Technol Serv Chapel Hill NC USA

A series of experiments involving 3 orthodontic departments has shown that distance learning can be acceptable to residents and effective in teaching concepts that are fundamental to orthodontic practice. Methods: Residents in each department participated in distance seminars, clinical conferences, and clinical seminars via high-speed Internet connections. The acceptability of this form of instruction was judged from evaluation forms completed by the residents. Its effectiveness was judged from pretests and posttests on the seminar topics. Results: The improvement from pretest to posttest scores after observing a sequence of distance seminars was similar to that with direct instruction. Orthodontic residents rated the educational experiences positively. Live participation in seminars via video conferencing was preferred to live observation or later observation of a recording, but observation provided similar improvement in test scores. Conclusions: The acceptability of the distance seminars appeared to be influenced by the instructor's personality and teaching style in facilitating interaction, the seminar subject, the residents' comfort level in dealing with this technology, and the sequence for interaction vs observation. Further development of recorded seminars with live follow-up discussions has the potential to supplement instruction in graduate orthodontic programs and help with the impending shortage of experienced full-time orthodontic faculty.

关键词： Computer-Assisted Instruction Education Dental Graduate Distance 计算机辅助教学教育牙科研究生远程教育考核因特网实习医师和住院医师职务 Videoconferencing PRETEST graduate Residency Dentistry Distance learning instruction

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Epidemiology competencies and preventive medicine residencies: Do they mix and map?

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PUBLIC HEALTH REPORTS 2008年第Suppl.1期123卷 136-148页

作者： Boulton, Matthew L. Montgomery, JoLynn P. Beck, Angela Univ Michigan Sch Publ Hlth Ann Arbor MI 48109 USA

Objectives. This article maps the program requirements of the University of Michigan preventive medicine residency (PMR) to the newly established Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs) to determine the feasibility and utility of using these competencies to assess the training of physician epidemiologists. Methods. The academic and practicum requirements of the PMR are mapped against the 38 AECs for Tier 2, or mid-level epidemiologists. The process of mapping was done by reviewing academic course syllabi/content and practicum tasks to determine how closely they aligned with the AECs. This process allowed us to identify competencies that are relative training strengths and weaknesses of the residency. Results. Overall, the current program requirements of the PMR generally satisfy the AECs, although one competency was not met in either the academic or practicum year, and another was only met in a single, required academic course. The areas in which AECs were fulfilled by many activities in the residency were in domain 1 (assessment and analysis) and domain 2 (basic public health sciences). The areas in which competencies were met by few activities were primarily in domain 6 (financial and operational planning and management) and domain 7 (leadership and systems thinking). Conclusions. We found that the process of mapping an academically rigorous epidemiology training program (the PMR) to the AEC was feasible and useful. It permitted us to identify training strengths and gaps in our program and consider modifications that will strengthen the level of competency of our physician graduates.

关键词： Educational Measurement Epidemiology Humans Internship and Residency 教育考核流行病学实习医师和住院医师职务预防医学专业能力 proton nuclear magnetic resonance Residency Epidemiology competence Centers for Disease Control and Prevention (U.S.) Otolaryngologists Internship and Residency Educational Measurement

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