Giving feedback on clinical skills: are we starving our young?

BACKGROUND: Feedback to clinical learners about their performance is crucial to their development into competent clinicians. Most feedback is provided by clinicians who have little or no formal training for this aspect of their teaching role. METHOD: Narrative review. FINDINGS: Feedback is most effective if provided by clinical mentors based on observations of behavior, with emphasis on correctable deficiencies. The difference between feedback, which is formative, and evaluation, which is summative, needs to be understood by both the giver and receiver. The ability to self-assess is an important related concept, with studies showing that self-assessment skills are lowest in individuals found to be the least competent in external assessments and in individuals with a high level of confidence. CONCLUSIONS: Feedback is an important component in learners' development, and clinical faculty should be educated about the importance of providing feedback, and the means to do so effectively must be provided to them. Despite several decades of accumulated knowledge in this area, the evidence from learners is that we continue to starve them of this critical nutrient for their growth.

Cartilaginous symphysis pubis cysts: report of two cases, technique for removal, and review of the literature.

Cartilaginous symphysis pubis cysts are rare. There are 7 cases previously reported in the literature. Patients are commonly asymptomatic or may present with a slow-growing, painless vulvar mass, voiding difficulty, and/or dyspareunia. Two cases were managed at our center over 5 years. We present these 2 cases, a surgical technique for removal, a summary of all reported cases, and some perspectives on the pathophysiologic mechanisms for the origin of this lesion.

Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment.

OBJECTIVE: To review treatment recommendations for empiric therapy of uncomplicated urinary tract infection (uUTI) in light of evolving antibiotic resistance and to consider use of guidelines to promote optimal practice. QUALITY OF EVIDENCE: PubMed was searched and additional relevant references were identified by reviewing articles found in the search. Guidelines were identified through discussion with family practitioners. Level of evidence was assessed for recommendations. MAIN MESSAGE: Many women have uUTIs. The treatment approach is usually empiric antimicrobial therapy without obtaining pretherapy cultures. Trimethoprim-sulfamethoxazole is standard first-line empiric treatment. While resistance to this drug is increasing, it remains only about 10% in community-acquired Escherichia coli in Canada. Concerns about increased resistance have contributed to greater use of fluoroquinolones, but widespread empiric use of this class of medications might promote resistance to fluoroquinolones. Hence, fluoroquinolones should not be considered first-line therapy. While guidelines for treatment of uUTIs have been developed, their usefulness is compromised by their conflicting recommendations. CONCLUSION: Trimethoprim-sulfamethoxazole and nitrofurantoin remain first-choice empiric therapy for uUTIs. Development of guidelines relevant to family physicians and community education programs that incorporate local susceptibility patterns are important strategies for promoting optimal practice.

Congenital hydronephrosis who requires intervention?

PURPOSE: To analyze the predictive value of early postnatal ultrasonography in congenital hydronephrosis. SUBJECTS AND METHODS: A retrospective study was conducted of 77 affected infants at our institution. All postnatal ultrasound studies were evaluated using 2 classification systems, the Anterior-Posterior Diameter (APD) system and the Society for Fetal Urology (SFU) system. Each study was compared to subsequent ultrasound examinations, renal scans, and to clinical outcome. RESULTS: There were 115 dilated renal units. Fifteen (13%) underwent intervention; all initially had high grade hydronephrosis on both classification systems. One hundred renal units (87%) were managed conservatively; 47 had low grade hydronephrosis and only 18 had high grade hydronephrosis on both systems. CONCLUSIONS: Using both the APD and the SFU classification systems together on the initial postnatal ultrasound is superior to using either method on its own, and the combined system enables us to predict the outcome of infants with congenital hydronephrosis.