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Faculty and resident opinions regarding the role of morbidity and mortality conference

AMERICAN JOURNAL OF SURGERY 1999年第2期177卷 136-139页

作者： Harbison, SP Regehr, G Allegheny Univ Hlth Sci Grad Div Dept Surg Allegheny Univ Hosp Philadelphia PA 19146 USA

BACKGROUND: The role of the surgical morbidity and mortality (M&M) conference as a forum for examination of surgical failure may remain unclear. This paper reports the results of a national survey of surgical faculty and trainees regarding the role and effectiveness of the M&M conference. METHODS: Based on focus groups and pilot studies from multiple institutions in one geographic area, a questionnaire addressing critical issues in attitudes toward the M&M conference was sent to 1,100 randomly chosen subjects nationwide: 500 residents and 600 staff. The survey includes individual and institutional demographic information, 15 statements answered using a Likert scale, and 2 open-ended questions. RESULTS: Faculty response rate was 501 of 600 (83%) and resident response rate was 166 of 500 (33%). Responses were generally positive in both groups, with staff showing small but significantly more positive attitudes than residents. A higher proportion of residents characterize the M&M conference as too defensive. CONCLUSION: The M&M conference is fulfilling its potential as a teaching tool but there may be room for improvement as residents view the experience slightly less positively than faculty. This questionnaire provides a perspective of expectations for the M&M conference, allowing educators to optimize its effectiveness. (C) 1999 by Excerpta Medica, Inc.

关键词：态度全体教工医学院校卫生保健调查实习医师和住院医师职务手术后并发症/流行病学问卷调查美国人类

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Survey of internal medicine residents' use of the fecal occult blood test and their understanding of colorectal cancer screening and surveillance

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AMERICAN JOURNAL OF GASTROENTEROLOGY 2000年第8期95卷 2068-2073页

作者： Sharma, VK Corder, FA Raufman, JP Sharma, P Fennerty, MB Howden, CW Univ Arkansas Med Sci Div Digest Dis Little Rock AR 72205 USA Univ Kansas Kansas City MO USA Oregon Hlth Sci Univ Portland OR 97201 USA Rush Presbyterian St Lukes Med Ctr Chicago IL 60612 USA

OBJECTIVE: Primary care physicians have imperfect understanding of current colorectal cancer screening guidelines and recommendations. Furthermore, compliance with colorectal cancer screening by internal medicine residents has been demonstrated to be poor. We sought to identify whether current trainees in internal medicine had adequate understanding of colorectal cancer screening and surveillance and test utilization. METHODS: We applied a structured questionnaire about colorectal cancer screening and the use of fecal occult blood tests to 168 internal medicine residents at four accredited programs in the U.S. They were also asked for recommendations about six hypothetical patients who may have been candidates for screening or surveillance. RESULTS: Seventy-one percent identified 50 yr as the currently recommended age to commence screening in an average-risk individual;64.3% would begin screening with fecal occult blood testing and flexible sigmoidoscopy and 4.8% with colonoscopy. Most perform fecal occult blood testing on stool obtained at digital rectal exam and without prior dietary restrictions. Many use fecal occult blood testing for indications other than colorectal cancer screening. Only 29% recommended colonoscopy to evaluate a positive fecal occult blood test. Most residents plan to be screened for colorectal neoplasia at the appropriate age;significantly more opted for colonoscopy than recommended it for their patients. CONCLUSIONS: Internal medicine residents have many misperceptions regarding colorectal cancer screening and the utility of the Fecal occult blood test. Educational efforts should be directed at internal medicine residents, many of whom plan careers in primary care, where most colorectal cancer screening is currently performed. (C) 2000 by Am. Cell. of Gastroenterology.

关键词：结肠镜检查结直肠肿瘤/诊断数据收集内科学/教育实习医师和住院医师职务潜血人群监测问卷调查成年人女(雌)性人类男(雄)性中年人

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System-based practice: Proposal for a comprehensive curriculum

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ACADEMIC RADIOLOGY 2008年第1期15卷 119-126页

作者： Otero, Hansel J. Weissman, Barbara N. Rybicki, Frank J. Harvard Univ Brigham & Womens Hosp Sch Med Dept RadiolAppl Imaging Lab Boston MA 02115 USA

Systems-based practice (SBP) is the sixth competency of the required ACGME core competencies in US-based residency programs. SBP aims to ensure that residents (1) are aware of a larger context and system of health care and (2) have the ability to effectively call upon system resources to provide care of optimal value (1). Therefore diagnostic radiology residency training programs must provide SBP *** core competencies were introduced in 1999 and implemented between 2001 and 2002 as part of the outcome project by ACGME (1). The outcome project is still ongoing, currently in its second phase that aims at \"sharpening the focus and definition of the competencies and assessment tools\" (1). The SBP competency has received far less attention than the other five competencies, mostly because of its less defined nature when compared to the others (2). Little has been published about this requirement in radiology, and its implications remain relatively unexplored (3). In a relatively recent report only 3% of senior medical students identified system-based practice as the most relevant competency during residency and later in their careers (4).

关键词： Clinical Competence Costs and Cost Analysis Curriculum Education Medical Graduate 临床工作能力成本及成本分析课程教育医学研究生教育考核实习医师和住院医师职务 competence Clinical Competence Medical Costs and Cost Analysis graduate SHBG wt Allele medical student Residency Health Care Systems system resources Curriculum

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European neurosurgical education - The next generation

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ACTA NEUROCHIRURGICA 2000年第10期142卷 1081-1087页

作者： Brennum, J Rigshosp Univ Clin Dept Neurosurg DK-2100 Copenhagen Denmark

Questionnaires regarding neurosurgical training were sent to all participants of the EANS-training course in Barcelona 1999 and to all national neurosurgical societies of EANS. The completed questionnaires show a significant variation in 1) the demands for education prior to obtaining a neurosurgical training position, 2) in the theoretical training programme and 3) in the surgical experience obtained within the training period. The trainees express a need for improvement of the neurosurgical training programmes. The need for common guidelines for European neurosurgical training as well as regular evaluation of the training programmes are discussed.

关键词：课程数据收集教育医学/发展趋势欧洲实习医师和住院医师职务神经外科手术/方法专业能力成年人女(雌)性人类男(雄)性

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Impact of urologic resident training on patient pain and morbidity associated with office-based cystoscopy

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UROLOGY 2008年第5期71卷 782-786页

作者： Nguyen, Carvell T. Babineau, Denise C. Jones, J. Stephen Cleveland Clin Fdn Glickman Urol & Kidney Inst & Quantitat Hlth Sci Cleveland OH 44195 USA

OBJECTIVES To determine whether pain and morbidity experienced by patients undergoing cystoscopy were affected by whether a staff urologist or resident was the primary surgeon. METHODS Patients scheduled to undergo cystoscopy were assigned to either the staff urologist or a resident as the primary surgeon. After cystoscopy, patients were given a visual analogue scale WAS, 0 to 100 mm) to assess pain. A two-part model was fit to investigate the effect that staff or resident had on pain scores. Confounding factors, such as age, gender, viewing of the procedure on video, and resident training year, were accounted for with multivariable regression techniques. RESULTS There was no statistically significant difference between the VAS scores for patients undergoing cystoscopy regardless of whether staff or resident performed the procedure. Further comparisons indicated no statistically significant differences in the effect that resident training year had on pain scores. CONCLUSIONS Office-based cystoscopy can be performed by residents under staff supervision, with pain and morbidity comparable to when a staff urologist performs the procedure. The impact of urologic resident training on patient care is an area that is relatively unexplored in the literature.

关键词： Aged Cystoscopy Female Humans Internship and Residency Male Medical Staff Hospital 老年人膀胱镜检查实习医师和住院医师职务医务人员医院门诊就医疼痛

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Residency review committee for pediatrics : Its role and responsibilities

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JOURNAL OF PEDIATRICS 2001年第3期139卷 341-342页

作者： McGuinness, G Univ Iowa Dept Pediat Iowa City IA 52242 USA

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The In-Training Examination: An analysis of its predictive value on performance on the General Pediatrics Certification Examination

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JOURNAL OF PEDIATRICS 2008年第3期153卷 425-428页

作者： Althouse, Linda A. McGuinness, Gail A. Amer Board Pediat Inc Chapel Hill NC 27514 USA

Objective This study investigates the predictive validity of the In-Training Examination (ITE). Although studies have confirmed the predictive validity of ITEs in other medical specialties, no study has been done for general pediatrics. Study design Each year, residents in accredited pediatric training programs take the ITE as a self-assessment instrument. The ITE is similar to the American Board of Pediatrics General Pediatrics Certifying Examination. First-time takers of the certifying examination over a 5-year period who took at least 1 ITE examination were included in the sample. Regression models analyzed the predictive value of the ITE. Results The predictive power of the ITE in the first training year is minimal. However, the predictive power of the ITE increases each year, providing the greatest power in the third year of training. Conclusions Even though ITE scores provide information regarding the likelihood of passing the certification examination, the data should be used with caution, particularly in the first training year. Other factors also must be considered when predicting performance on the certification examination. This study continues to support the ITE as an assessment tool for program directors, as well as a means of providing residents with feedback regarding their acquisition of pediatric knowledge.

关键词： Certification Child Educational Measurement Humans Internship and Residency 证明儿童教育考核实习医师和住院医师职务儿科学可重复性结果回顾性研究 Statistical Validity Pediatrics Predictive certification Internship and Residency Educational Measurement Child

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Using endoscopy to teach cataract surgery

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JOURNAL OF CATARACT AND REFRACTIVE SURGERY 2006年第10期32卷 1606-1610页

作者： Henderson, Bonnie An Ali, Rasha Kim, Jae Yong Ament, Christine Shortsleeve Harvard Univ Massachusetts Eye & Ear Infirm Sch Med Boston MA 02114 USA Univ Illinois Coll Med Chicago IL USA

Current methods of teaching cataract surgery include lectures, wet-lab sessions, and participation in real surgery. We describe a new method using a microendoscopic cyclophotocoagulation device during phacoemulsification cataract extraction and posterior chamber intraocular lens (IOL) implantation in 4 eyes of 4 patients. Endoscopic visualization during surgery aided in construction of the corneal incision, location of the capsulorhexis edge, and estimation of the lens groove depth. It also demonstrated clinical findings not observable with the surgical microscope such as misplaced IOL haptics and residual lens cortex. Use of the endoscope enhanced the educational value of the surgery and the final surgical outcome.

关键词： Education Medical Graduate Endoscopy Internship and Residency Ophthalmology 内窥镜检查实习医师和住院医师职务眼科学超声乳化白内障吸除术教学 operating microscope Medical posterior chamber intraocular lens graduate Intraocular Lymphoma Endoscopy Internship and Residency Endoscopes Cataract Extraction Surgery Ophthalmology

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Transmission of live laparoscopic surgery over the Internet2

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AMERICAN JOURNAL OF SURGERY 1999年第5期178卷 415-417页

作者： Damore, LJ Johnson, JA Dixon, RS Iverson, MA Ellison, EC Melvin, WS Ohio State Univ Med Ctr Dept Surg Columbus OH 43210 USA Ohio State Univ Med Ctr Tech Serv Columbus OH 43210 USA

BACKGROUND: Video broadcasting of surgical procedures is an important tool for education, training, and consultation. Current video conferencing systems are expensive and time-consuming and require preplanning. Real-time Internet video is known for its poor quality and relies on the equipment and the speed of the connection, The Internet2, a new high-speed (up to 2,048 Mbps), large bandwidth data network presently connects more than 100 universities and corporations. We have successfully used the Internet2 to broadcast the first real-time, high-quality audio/video program from a live laparoscopic operation to distant points. METHODS: Video output of the iaparoscopic camera and audio from a wireless microphone were broadcast to distant sites using a proprietary, PC-based implementation of H.320 video conferencing over a TCP/IP network connected to the Internet2. The receiving sites participated in two-way, real-time video and audio communications and graded the quality of the signal they received. RESULTS: On August 25, 1998, a laparoscopic Nissen fundoplication was transmitted to Internet2 stations in Colorado, Pennsylvania, and to an Internet station in New York, On September 28 and 29, 1998, we broadcast laparoscopic operations throughout both days to the Internet2 Fall Conference in San Francisco, California. Most recently, on February 24, 1999, we transmitted a laparoscopic Heller myotomy to the Abilene Network Launch Event in Washington, DC. CONCLUSIONS: The Internet2 is currently able to provide the bandwidth needed for a turn-key video conferencing system with high-resolution, real-time transmission. The system could be used for a variety of teaching and educational programs for experienced surgeons, residents, and medical students.

关键词：因特网实习医师和住院医师职务腹腔镜检查/方法外科学/教育远程医学录像人类

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Disaster medicine and the emergency medicine resident

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ANNALS OF EMERGENCY MEDICINE 2003年第6期41卷 865-870页

作者： Kaji, AH Waeckerle, JF Harbor UCLA Med Ctr Dept Emergency Med Torrance CA 90509 USA Univ Missouri Sch Med Dept Emergency Med Kansas City MO 64108 USA

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