ABSTRACT
BACKGROUND: Basic surgical skills (BSS) is a key bridging course for medical students to acquire basic surgical maneuvers and practice animal surgery before clinical rotation, but the complexity of operational procedures and high demands on asepsis may lead to poor performance and frequent error during practice. The current study intended to improve BSS teaching outcomes by implementing smartphone app-based competency and performance checklists for medical academy undergraduates. METHODS: WeChat-based checklists containing competency and performance modules were designed, distributed and collected via smartphone. One hundred seventy-six third-grade undergraduate cadets majoring in clinical medicine or anesthesiology were prospectively enrolled, with 92 set as study group and 84 as control group. Checklists were distributed for self-evaluation before and after each class throughout the semester of autumn 2021-2022. Student age, previous Grade Point Average (GPA), average grades of BSS (including grade-A rate and pass rate), operative time, error rate, and perioperative complications of intestinal anastomosis performed on Beagle dogs between the groups were compared to evaluate the efficacy of the checklists. RESULTS: The students aged 20.2 ± 0.63 in Group A and 20.3 ± 0.92 in Group B (P = 0.15), with a previous GPA of 2.9 ± 0.61 vs. 2.87 ± 0.58 (P = 0.61). The average operative time on their final lesson of intestinal anastomosis was 192.3 ± 27.18 min vs. 213.8 ± 29.48 min (P < 0.001). All students passed in BSS course, with a final grade of 89.45 ± 4.360 in Group A and 86.64 ± 4.026 in Group B (P < 0.001), in which grade-A rate was 46.7% vs. 26.2% (P = 0.005). For perioperative comorbidities, 4/23 (17.4%) animals in Group A and 5/21 (23.8%) in Group B recorded wound dehiscence or other incision-related complications; no animals died in Group A, and 2 died in Group B due to hemorrhagic shock or sepsis. CONCLUSIONS: The implementation of WeChat-based checklist is a reflection of improved quality of teaching in BSS course that may promote the students' competency and performance.
Subject(s)
Education, Medical, Undergraduate , Students, Medical , Animals , Dogs , Humans , Education, Medical, Undergraduate/methods , Clinical Competence , Checklist , Self-AssessmentABSTRACT
The number of regulatory T cells (Treg cells) and the expression of ectonucleoside triphosphate diphosphohydrolase 1 (ENTPD1; also known as CD39) and 5'-ectonucleotidase (NT5E; also known as CD73) on the Treg cell surface are increased during sepsis. In this study, to determine the factors leading to the high expression of CD39 and CD73, and the regulation of the CD39/CD73/adenosine pathway in Treg cells under septic conditions, we constructed a mouse model of sepsis and separated the Treg cells using a flow cytometer. The Treg cells isolated from the peritoneal lavage and splenocytes of the mice were treated with adenosine or the specific adenosine A2A receptor agonist, CGS21680, and were transfected with specific siRNA targeting E2F transcription factor 1 (E2F-1) or cyclic adenosine monophosphate (cAMP) response element-binding protein (CREB), which are predicted transcription regulatory factors of CD39 or CD73. The regulatory relationships among these factors were then determined by western blot analysis and dual-luciferase reporter assay. In addition, changes in adenosine metabolism were measured in the treated cells. The results revealed that adenosine and CGS21680 significantly upregulated CD39 and CD73 expression (P<0.01). E2F-1 and CREB induced CD39 and CD73 expression, and were upregulated by adenosine and CGS21680. Adenosine triphosphate (ATP) hydrolysis and adenosine generation were inhibited by the knockdown of E2F-1 or CREB, and were accelerated in the presence of CGS21680. Based on these results, it can be inferred that adenosine, the adenosine A2A receptor agonist, E2F-1 and CREB are the possible factors contributing to the high expression of CD39 and CD73 on the Treg cell surface during sepsis. Adenosine and its A2A receptor agonist served as the signal transducer factors of the CD39/CD73/adenosine pathway, accelerating adenosine generation. Our study may benefit further research on adenosine metabolism for the treatment of sepsis.
Subject(s)
5'-Nucleotidase/metabolism , Adenosine/analogs & derivatives , Adenosine/pharmacology , Antigens, CD/metabolism , Apyrase/metabolism , Cyclic AMP Response Element-Binding Protein/metabolism , E2F1 Transcription Factor/metabolism , Phenethylamines/pharmacology , T-Lymphocytes, Regulatory/drug effects , 5'-Nucleotidase/genetics , Adenosine/metabolism , Adenosine A2 Receptor Agonists/pharmacology , Adenosine Monophosphate/metabolism , Adenosine Monophosphate/pharmacology , Adenosine Triphosphate/metabolism , Adenosine Triphosphate/pharmacology , Animals , Antigens, CD/genetics , Apyrase/genetics , Blotting, Western , Cells, Cultured , Culture Media, Conditioned/metabolism , Cyclic AMP Response Element-Binding Protein/genetics , E2F1 Transcription Factor/genetics , Mice, Inbred BALB C , RNA Interference , Receptor, Adenosine A2A/metabolism , Sepsis/blood , T-Lymphocytes, Regulatory/metabolism , Up-Regulation/drug effectsABSTRACT
BACKGROUND: Very little is known of sex-related differences among medical students in the acquisition of basic surgical skills at an undergraduate level. The aim of this study was to investigate the sex differences in basic surgical skills learning and the possible explanations for sex disparities within basic surgical skills education. METHODS: A didactic description of 10 surgical skills was performed, including knot tying, basic suture I, basic suture II, sterile technique, preoperative preparation, phlebotomy, debridement, laparotomy, cecectomy, and small bowel resection with hand-sewn anastomosis. The students were rated on a 100-point scale for each basic surgical skill. Later during the same semester all the students took the final theoretical examination. RESULTS: A total of 342 (male = 317 and female = 25) medical students participated in a single skills laboratory as part of their third-year medical student clerkship. The mean scores for each of the 10 surgical skills were higher in female group. The difference in sterile technique, preoperative preparation, cecectomy, and small bowel resection with hand-sewn anastomosis reached the significant level. Compared with male medical students, the mean theory examination score was significantly higher in female medical students. Approximately 76% of the (19 of 25) female students expressed their interest in pursuing a surgical career, whereas only 65.5% (207 of 317) male students wanted to be surgical professionals (p = 0.381). CONCLUSIONS: Female medical students completed basic surgical skills training more efficiently and passed the theoretical examination with significantly higher scores than male medical students. In the future, studies should be done in other classes in our institution and perhaps other schools to see if these findings are reliable or valid or just a reflection of this 1 sample.
