Medical education: Effectiveness of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks)

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To describe outcomes of two simulation teaching methods in developing intubation skills of year level six medical students (clinical clerks).<br /><strong>METHODS:</strong> Students were shown a 6-minute video on intubation. Students were exposed to video-assisted learning, video-assisted learning with instructor-guided simulation, and video-assisted learning with experiential learning. Each student was assessed by a non-graded 11 point objective structured clinical examination.<br /><strong>RESULTS AND DISCUSSION:</strong> The three learning strategies: 1. Video-assisted learning, 2. Video-assisted learning with instructor-guided simulation, 3. Video-assisted learning with experiential learning (self-discovery learning) simulation showed OSCE mean scores (standard deviations) of 5.76 (2.16), 7.21 (2.35) and 7.60 (1.72), respectively. Failure of intubation was 21% (8/38), 2% (1/40) and 0% (0/36), respectively. There is an absolute risk reduction of 27-30% in failure of intubation when either VGL or VEL is used. Students recognized the contribution of the simulation-based activities to the development of their intubation skills. They appreciated the opportunity to actually perform intubation in a rehearsal setting before doing the procedure on real patients.<br /><strong>CONCLUSION:</strong> Medical simulation enhanced student skills development. Experiential learning or self-discovery learning method may be as effective as instructor guided simulation.</p>

The effect of standardization on the reliability of the Philippine Board of Surgery oral examinations.

BACKGROUND: Cognizant of potential problems with validity and reliability, the Philippine Board of Surgery (PBS) undertook standardization of its oral examination procedures. This retrospective analytic study was conducted to determine and compare the reliability of the Philippine Board of Surgery oral examinations before and after standardization. METHODS: The records of oral examinations from June 29, 2003 to March 28, 2010 were reviewed and measures of reliability (intraclass correlation coefficient and kappa agreement) were computed and compared between the time periods before and after standardization and among different case content modules administered. The proportion of passers between time periods and different content areas were also compared. RESULTS: All measures of interrater reliability (intraclass correlation coefficient and kappa agreement) increased significantly overall and in all content areas and regardless of examinee outcome. There was also a trend to increased proportion of passers overall and significant improvement in passing rate in 4 out of 6 content areas. CONCLUSIONS: This study validates the role of standardization of the content and scoring in improving the reliability of the oral examination, which is crucial for high stakes certifying examinations.

A comparative study of surgical training in South East Asia, Australia and the United Kingdom.

OBJECTIVE: A survey of the current status of surgical training in Hong Kong, Malaysia, Singapore, Philippines and Thailand, in comparison with the UK and Australia, was done to explore the possibility of cross border training in South East Asia (SEA). METHODS: A comprehensive questionnaire on various aspects of surgical training was sent to the presidents of the surgical colleges from Australia, Hong Kong, Malaysia, Philippines, Singapore, Thailand and the Royal College of Surgeons of England (RCS England). The results were compiled and subsequently discussed at a meeting of the Presidents or their representatives in Malaysia. RESULTS: Aside from being patterned after two distinct surgical training models (British and American), extensive variability was observed among the training programs in the SEA region particularly in terms of direction, control and management. CONCLUSION: Quality of training can be improved by changing to a curriculum and competency based model, utilization of continuous assessment methods, reducing service requirements and better compensation for trainers. Southeast Asia has the potential to provide centres of excellence for surgical training. Surgical educators in SEA will find useful information in this paper to improve their programs which will hopefully evolve into a common core curriculum and enable cross border exchange of surgical trainees in SEA for broader exposure.

The rectal cancer program at the UP-PGH: Institutionalizing the multidisciplinary team paradigm

OBJECTIVE: The paper aimed to described and document the multidisciplinary process being ascribed to in the care of the colorectal cancer patient at the UP-PGH as conducted by the UP-PGH Colorectal Cancer and Polyp Study Group.METHODS: A description of the multidisciplinary team (MDT) process is presented. Data supplementing the documentation of the MDT process were, likewise, presented.RESULTS: In 2008, 214 rectal cancer patients were admitted and managed by the Division of Colorectal Surgery. Of these, 52 patients with mid- to low-rectal tumors eventually underwent resection of the primary lesion. Forty-one (79%) underwent a sphincter-saving operation. Only 11 APRs were performed. Our APR rate was, thus, at 21 percent. Among the 52 patients, 18 underwent neoadjuvant treatment with 10 subjected to chemoradiotherapy prior to surgery, a pathologic complete response was observed in 4 patients.CONCLUSION: With the increasing incidence of colorectal malignancies and the continuing collection of evidence supporting multimodality approach, the role of multidisciplinary team in the management of these cancers has come to the fore. UP-PGH Colorectal Cancer and Polyp Study Group has shown that the multidisciplinary team approach may be implemented amidst institutional and financial limitations without compromising the delivery of quality and efficacious cancer management.

Randomized comparison of piperacillin/tazobactam versus imipenem/cilastatin in the treatment of patients with intra-abdominal infection.

OBJECTIVES: Treatment of intra-abdominal infections remains a challenge because of their polymicrobial nature and associated mortality risk. Broad-spectrum empiric coverage is usually required. This randomized study compared the efficacy and safety of intravenous piperacillin/tazobactam with those of intravenous imipenem/cilastatin in the treatment of 293 hospitalized patients with intra-abdominal infection. METHODS: A total of 149 patients received piperacillin/tazobactam 4 g/500 mg every 8 hours, and 144 patients received imipenem/cilastatin 500 mg/500 mg every 6 hours. Efficacy was evaluated by clinical and bacteriological response. Safety was evaluated by analysis of adverse events and physical and laboratory examinations. RESULTS: Clinical and bacteriological responses in both evaluable treatment groups were equivalent. The clinical success was 97% (108/111) for piperacillin/tazobactam and 97% (100/103) for imipenem/cilastatin. Bacteriological success was 97% (67/69) for piperacillin/tazobactam and 95% (61/64) for imipenem/cilastatin. The most common pathogens were Escherichia coli, Klebsiella pneumoniae, Enterobacter species and Pseudomonas aeruginosa. The frequencies of treatment-related adverse events were similar (16 with piperacillin/tazobactam and 19 with imipenem/cilastatin). CONCLUSIONS: These results suggest that the safety and efficacy of piperacillin/tazobactam administered every 8 hours are equivalent to those of imipenem/cilastatin administered every 6 hours for the treatment of intra-abdominal infections.

Double-blind, randomized, placebo-controlled trial to determine the efficacy of eutectic lidocaine/prilocaine (EMLA) cream for decreasing pain during local anaesthetic infiltration for out-patient haemorrhoidectomy.

OBJECTIVE: The study was undertaken to evaluate the efficacy of eutectic lidocaine/prilocaine (EMLA) cream for decreasing pain during local anaesthetic infiltration for outpatient haemorrhoidectomy. METHODS: Ninety-eight patients were randomly assigned either to receive EMLA or placebo. The creams were applied 45 minutes prior to injection of a lidocaine/bupivacaine mixture using a diamond-shaped perianal block. All participants were blinded to the specific medication received. They were asked to rate pain and levels of acceptability using a pre-validated pain scale and questionnaire. RESULTS: There were 49 patients in each group. The baseline characteristics between the two groups were similar. Forty patients (82%) in the EMLA group and 42 patients (86%) in the placebo group reported only mild pain during injection and infiltration of the lidocaine/bupivacaine mixture. The mean rank pain scores were 49.11 and 48.89, respectively (p = 0.886, not significant). CONCLUSION: While outpatient haemorrhoidectomy under local anaesthesia was generally well tolerated, there was no statistically significant difference between EMLA cream and placebo for decreasing pain during anaesthetic infiltration.

Surgical pathology of colorectal cancer in Filipinos: implications for clinical practice.

BACKGROUND: A number of studies published in the Philippine literature have demonstrated certain peculiar clinicopathologic characteristics of colorectal cancer among Filipinos. This study presents the latest data and analyzes their implications for clinical practice. STUDY DESIGN: The pathology reports of all patients who underwent operation for colorectal cancer at the Philippine General Hospital over a period of 7 years were reviewed. RESULTS: One thousand two hundred seventy-seven patients were included. The male to female ratio was almost 1:1. The majority of patients were in the sixth and seventh decades of life, with a mean age of 55.3 years. Patients 40 years of age and younger made up 17% of the total. The site of cancer in order of frequency was rectum (49.8%), left colon (27.9%), and right colon (21.4%). Cancers of the right colon were more common in women, and rectal cancers were more frequent in men. Seventy-six percent of the tumors were well to moderately differentiated adenocarcinomas, and 6.7% were poorly differentiated. Mucinous and signet ring carcinomas were found in 11% and 1% of cases, respectively. Forty-four percent of patients had localized disease at the time of operation, 54% had regional disease, and 2% had disseminated disease. Associated predisposing conditions noted were polyps (4.7%), schistosomiasis (3%), and tuberculosis (1.5%). CONCLUSIONS: Colorectal cancer in Filipinos exhibits a number of unique clinicopathologic features, such as a higher proportion of early age of onset tumors, more advanced stage at presentation, an association with chronic granulomatous diseases, and relatively rare occurrence with polyps. This might suggest the possibility of a different pathway for tumor development of colorectal cancer in this population of patients. Also, current screening guidelines advocated for the Western population might not be appropriate for Filipinos.

Use of locally innovated radiopaque markers (MAKKO pills) for colonic transit study

Locally made radiopaque markers for colonic transit study are presented, specifically on how they were made, and how they compared radiographically with markers available abroad. These markers were produced using locally available materials like barium powder, a feeding tube, cyanoacrylate, and emptied drug capsules. They were then ingested and monitored by X-ray. They were found to be radiographically comparable with imported ones. No adverse events were noted when used in 5 patients: 2 patients with constipation secondary to chronic laxative abuse, 2 patients with reducible complete rectal prolapse, and 1 patient with constipation secondary to short segment Hirschsprungs' Disease. (Author)

Evidence-based clinical practice guidelines on some important aspects of the care of critically ill surgical patients Part II: Surgical intensive care units, implementation of guidelines

The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

The utility of Goodsall's rule among Filipino patients with anal fistula

This prospective cross-sectional study was conducted to determine the accuracy of Goodsall's rule in predicting the location of the internal opening of an anal fistula based on the location of the external opening among Filipino patients and the clinical factors that significantly influenced the accuracy of Goodsall's rule. From January 15, 1997 to April 15, 1998, 102 adult patients were analyzed by age, gender, fistula type, previous fistula surgery, symptom duration, location of the external opening, type of fistulous tract and distance of external opening from the anal verge. Overall, in 79 patients (77.5%), the locations of the internal opening were accurately localized according to Goodsall's rule. Univariate analysis showed that only the location of the external opening (posterior vs. anterior) and the distance of the external opening from the anal verge ((3 cm vs.> 3 cm) demonstrated a significant correlation with Goodsall's rule. Multivariate logistic regression analysis further demonstrated that anteriorly located external openings and distance of the opening greater than 3 cm from the anal verge were unlikely to comply with Goodsall's rule (odds ratio=0.008). Only 2 of 14 patients (14.3%) with anterior external openings greater than 3 cm from the anal verge had fistulous tracts which followed this rule. Thus, surgeons are advised to exercise caution during the surgical evaluation and treatment of anal fistula with these characteristics.

Injuries to the rectum and anus following radiation therapy in patients with cervical cancer: 5-year experience at the Philippine General Hospital

A five-year review of anorectal complications seen following radiotherapy for cervical carcinoma was done with the following objectives: 1) to present the profile of patients presenting with anorectal complications following radiation treatment for cervical cancer; 2) to describe the manifestations of these complications and findings on proctosigmoidoscopy with biopsy; and 3) to present the approaches in their management. A total of 116 patients, all with confirmed diagnosis of cervical cancer, were seen over this period. Mean age was 49.5 years. All received external beam cobalt and intracavitary radium. Complications were observed from 10 days to 20 months after treatment. Anal bleeding was the most common complaint (62%), followed by rectovaginal fistula (14%). Residual/recurrent malignancy was noted in seven patients (6%). Treatment modalities varied considerably, ranging from conservative and symptomatic treatment for bleeding, pain, constipation, and diarrhea, to major abdominal procedures for rectovaginal fistula