[Evaluation of faculty members' and students' attitude towards ambulatory teaching quality]

Ambulatory medicine is one of the most important parts of medical education. Due to its profound relation with professional future of physicians, ambulatory medicine is especially under attention and many studies have been performed to survey its quality and to design some ways to promote it. There is obvious deficiency in our evidence about ambulatory medicine. The aim of this study was to survey the quality of teaching of the ambulatory medicine from the viewpoint of the faculty members and students of medical faculty of Mazandaran. This was a descriptive and cross-sectional study. The study's population consisted of students, residents and clinical faculty members who were included by simple sampling. Data collection was performed by a questionnaire with 22 questions about demographic and educational variables as well as respondents' opinions about environmental conditions, independent activities, instructors' supervision, and social training in the ambulatory clinics. The validity of the questionnaire was controlled by content validity with expertise consultation, and its reliability was controlled by test-retest[r=0.85]. Data were analyzed using spss13 software. Response rate was 79%, the mean age of 36 faculties was 43.6 +/- 8.7 years and 32% of them were female. The mean age of 146 students was 25 +/- 3.6 years and 61% were female. The attitude of the majority of the students [88.3%] towards the quality of ambulatory teaching was negative, but majority of faculties [66.7%] had positive attitudes. There was no significant difference among teaching departments. Attitude of junior trainees was even worse. Attitude of faculty members and students was similar towards inappropriate physical environment of ambulatory clinics, but it was significantly different from independent activities of trainees in clinics [p=0.000]; relational drugs prescription [p=0.000]; management [p=0.004], and supervision of faculty members [p=0.000]. The overall attitudes towards the current condition of ambulatory teaching [especially trainees] were negative because of the impossibility of independent activities for trainees, low supervision of faculties, absence of teaching for rational drug prescription, differential diagnosis and management

[Incidental breast cancer in reduction mammaplasty specimen; a case report]

Reduction mammaplasty is increasingly used for the treatment of discomfort associated with macromastia. Breast cancer is a tumor with the highest prevalence and incidence in women. As it can be expected, reduction mammaplasty specimens occasionally reveal breast cancer. So, before reduction mammaplasty, patients should be assessed for breast cancer risk and evaluated by physical examination and mammography. We report here the discovery of breast cancer in specimens from a patient who underwent elective breast reduction. Preoperative mammography showed no evidence of malignancy. But, final pathologic evaluation of reduction specimens revealed foci of "invasive ductal carcinoma" on the left side, therefore the patient underwent modified radical mastectomy. In conclusion, thorough preoperative clinical examination and mammography may reduce the rate of incidentally discovered cancer during reduction mammaplasty procedures. Pathologic examination of RM specimens is imperative, and sending all of them for pathologist is mandatory. These recommendations emphasize breast reduction as an opportunity for detection of occult potential fatal disease in higher risk groups