ABSTRACT
Introduction: Recent changes in undergraduate medical curricula have resulted in time constraints that are particularly challenging, especially when students must learn large blocks of musculoskeletal anatomy content. Consequently, students have resorted to rote memorization to cope, which counteracts our established collaborative self-directed learning model. Methods: For a 6-week musculoskeletal anatomy course, two structured case-based review sessions are described, each following the completion of two five-hour lab sessions, two on the upper extremities and two on the lower extremities. These largely self-directed review sessions consisted of 6 students rotating through 7 to 8 stations every 10 minutes where clinical cases with follow-up questions were projected on large screens. The students were expected to work collaboratively to solve the cases utilizing the prosected specimens provided and discuss the accompanying answers at the end of each case. Results: Ninety-four per cent of the students who participated in this study agreed that the case-based review sessions provided a helpful overview of musculoskeletal anatomy content. Student performance on the open-ended, case-based musculoskeletal examination questions showed no significant difference in performance on shoulder, hand, hip, thigh, and leg questions. There was, however, a statistically significant decrease in the students' scores on a forearm question in 2021 compared to 2019. Conclusion: This paper describes our integrated, collaborative musculoskeletal course, including case-based review sessions, which was positively received by students as having value in reviewing the musculoskeletal content though it was not found to improve examination performance.
ABSTRACT
PURPOSE: The implementation of a multidisciplinary, pharmacy-led, thromboprophylaxis program that reduced the rates of venous thromboembolism (VTE) in total-joint arthroplasty patients is discussed. SUMMARY: The results from a 2005 VTE review led to the formation of a thromboprophylaxis team at Glen Cove Hospital that consisted of representatives from the departments of general surgery, orthopedic surgery, anesthesia, hematology, rehabilitative medicine, internal medicine, pharmacy, nursing, and quality management. The team created a thromboprophylaxis risk factor assessment/prescriber order sheet that reflected the American College of Chest Physicians guidelines for venous thromboprophylaxis for all patients. In 2005, 87% of total-joint replacement patients received epidural anesthesia and analgesia, while the remaining 13% received spinal anesthesia and nonepidural analgesia. With both unilateral and staged bilateral surgeries, the first dose of warfarin was administered the night of surgery and continued as the sole chemical prophylaxis during epidural analgesia. For staged bilateral procedures, the patient received warfarin monotherapy for five days after the first dose and was then discontinued. Once the second procedure was completed, warfarin was restarted the night of surgery and continued until six hours after the epidural catheter was removed. As recommended by the team, the practice of warfarin monotherapy was stopped after the first dose. By reducing warfarin monotherapy for thromboprophylaxis in total-joint replacement surgery, the team reduced rates of VTE by 60%. CONCLUSION: The formation of a thromboprophylaxis team led to the development and implementation of a thromboprophylaxis prescriber order sheet. A 48% reduction in overall VTE rates and a 60% reduction in pulmonary embolism rates were observed in patients undergoing total-joint replacement procedures.
