Experience and attitude of interns to pelvic and sensitive area examinations during their undergraduate medical course

To explore the experience of interns in sensitive area examination during their undergraduate medical course and identify factors interfering with such examinations. A cross sectional study was carried out from May to June 2010. Interns [n=315] at King Saud University College of Medicine were invited via email to complete a web-based questionnaire developed using surveymonkey.com. Out of 315 interns, 211 completed the questionnaire; 60% males and 40% females. The mean percentage of interns who never performed any of these examinations was 28.9% for digital rectal examination, 17.5% for breast, 43.1% for female pelvic examination, 13.3% for inguinal [hernia], and 34.6% for male external genitalia. Compared to females, male students conducted more rectal examinations [87 versus 63, p<0.005], and male external genitalia examinations [112 versus 26, p<0.001]. On the other hand, compared to male students, females conducted more pelvic examination [68 versus 52, p=0.03] and breast examinations [92 versus 82, p=0.27]. The most common reasons for not performing sensitive area examinations included patient's refusal [33.1%], and examining patients of opposite gender [27.6%]. Confidence in performance of these examinations was correlated to increased frequency of the examination. This study highlights that most common factors interfering with the students' conducting sensitive area examinations are patient's refusal and examining patients of the opposite sex. There is a strong correlation between increased frequency of conducting an examination and student's confidence in performance.

Surgical management of retrosternal goiter: local experience at a university hospital

Retrosternal goiter [RSG] is a term that has been used to describe a goiter that extends beyond the thoracic inlet. Surgery plays an important role in the treatment of these patients, but whether all or selected patients with RSG should undergo this operation remains controversial. Our aim is to look into the demographics, presentation, and treatment of patients with RSG and essentially to determine the role of surgery in its treatment. Retrospective study, teaching hospital-based. Retrospective analysis of 537 thyroidectomies performed at King Khalid University Hospital between 2003 and 2010. The twenty-six patients with RSG were analyzed further, with regard to demographics, presentation, indications, and outcome of surgical treatment. Statistical analysis was performed, where age was expressed as mean and range, and other variables were presented as numbers and percentage. There were 26 patients [4.8%] with RSG out of 537 thyroidectomies, who underwent an operation for removal of RSGs, in a seven-year period. The most common presentation was dyspnea [34.6%] and the surgical procedure predominantly used was total thyroidectomy. The RSGs were removed by collar incision in 96% of the cases. The final histological diagnosis revealed malignancy in 26.9% of the thyroid specimens. There was no mortality and minor complications occurred in nine patients. The presence of an RSG is an indication for surgery owing to the lack of effective medical treatment, the higher incidence of symptoms related to compression, low surgical morbidity, and the risk of malignancy

use of thoracoscopy to enhance medical students' interest and understanding of thoracic anatomy

To develop a video-based educational tool designed for teaching thoracic anatomy and to examine whether this tool would increase students' stimulation and motivation for learning anatomy. Our video-based tool was developed by recording different thoracoscopic procedures focusing on intraoperative live thoracic anatomy. The tool was then integrated into a pre-existing program for first year medical students [n = 150], and included cadaver dissection of the thorax and review of clinical problem scenarios of the respiratory system. Students were guided through a viewing of the videotape that demonstrated live anatomy of the thorax [15 minutes] and then asked to complete a 5-point Likert-type questionnaire assessing the video's usefulness. Apart from this, a small group of entirely different set of students was divided into two groups, one group to view the 15-minute video presentation of thoracoscopy and chest anatomy and the other group to attend a 15-minute lecture of chest anatomy using radiological images. Both groups took a 10-item pretest and post-test multiple choice questions examination to assess short-term knowledge gained. Of 150 medical students, 119 completed the questionnaires, 88.6% were satisfied with the thoracoscopic video as a teaching tool, 86.4% were satisfied with the quality of the images, 69.2% perceived it to be beneficial in learning anatomy, 96.2% increased their interest in learning anatomy, and 88.5% wanted this new teaching tool to be implemented to the curriculum. Majority [80.7%] of the students increased their interest in surgery as a future career. Post-test scores were significantly higher in the thoracoscopy group [P = 0.0175]. Incorporating live surgery using thoracoscopic video presentation in the gross anatomy teaching curriculum had high acceptance and satisfaction scores from first year medical students. The video increased students' interest in learning, in clinically applying anatomic fact, and in surgery as a future career

Mediastinal seroma post laparoscopic repair of type IV paraesophageal hernia

Laparoscopic repair of paraesophageal hernia is safe and feasible and can provide comparable results for patients with type IV paraesophageal hernia. We report a rare case of mediastinal seroma in an 80-year-old gentleman who had a giant type IV paraesophageal hernia and was eventually admitted to our hospital for elective laparoscopic repair and recovered very well after surgery with resolution of the atelectatic lungs and air-fluid collection in his chest