ABSTRACT
Background: Gallbladder duplication can present a diagnostic challenge, particularly in patients who have had prior cholecystectomy with a missed duplicated gallbladder. Case Presentation: Presented is the case of a man with 16 years of recurrent, persistent right upper quadrant pain after cholecystectomy who was found to have a duplicated gallbladder. Conclusions: Gallbladder duplication can be difficult to diagnose and frequently evades preoperative visualization. In particular, patients who have had prior operations or infections that may lead to epigastric adhesions are at higher risk for a missed gallbladder duplication at time of operation. An intraoperative cholangiogram should be routinely performed when the inferior liver margin is poorly visualized due to scarring or patient habitus. Gallbladder anomalies should be considered in the differential preoperatively for all patients undergoing hepatobiliary procedures and for postoperative patients with persistent biliary symptoms.
ABSTRACT
BACKGROUND: Professionalism in academia requires surgical faculty to establish a safe clinical learning environment based on respectful behaviors that span the training and patient interface. National data reporting trainee mistreatment suggest that there are significant gaps between resident and medical student perceptions of attending behavior. It is unknown whether patient perceptions mirror those of surgical trainees. HYPOTHESIS: Based on triangulated ratings, patients, surgical residents, and medical students have similar perceptions of a surgeons' respectful behaviors. METHODS: Respect scores from end-of-rotation evaluations by surgical residents and rotating medical students were compared for 50 academic surgeons over the period of 2014 to 2018. Clinician and Group Consumer Assessment surveys were collected from patients of 36 of these surgeons and mined for respect and listening behavior ratings. Data were triangulated and analyzed for correlation and variability across the trainee and patient experiences. RESULTS: Resident respect ratings of faculty were consistently higher than those from medical students. Despite a wider variability, medical students still rated their surgical faculty as being respectful to themselves and others most often, almost always, and always 95% of the time. Patient scores were generally lower than trainee scores for an individual surgeon, particularly regarding listening skills. Triangulation of trainee data with patient data identified surgeons demonstrating strong respectful behaviors across the clinical environment as well as those with gaps in behavior toward trainees and patients. CONCLUSION: Triangulation of feedback from trainees and patients provides a unique opportunity to target interventions in professionalism across the clinical learning environment.
