Competency in musculoskeletal and sports medicine: evaluating a PGY-1 curriculum.

BACKGROUND AND OBJECTIVES: The introduction of a prescribed curriculum and a clinical rotation in the PGY-1 year of family medicine training can enhance learning in musculoskeletal and sports medicine. Combining learning experiences in sports medicine and musculoskeletal medicine in the early stages of training establishes a base to master the required competencies by the completion of the training program. METHODS: All PGY-1 residents from 2006 to 2009 were assigned to a clinical rotation in sports medicine. Pretest and posttest were used to assess medical knowledge. The overall learning experiences were measured by the performance analysis by the resident for the rotation. RESULTS: The mean score for pretest was 51.9 (standard deviation [SD]=10.3), while the mean score for posttest was 63 (SD=7.2). Paired t tests were performed for posttest scores and pretest scores, stratified by year/gender. Overall or stratified by year, there is a significant difference between posttest and pretest scores. Across all 3 years, the mean score increase is 12.4, with 95% confidence interval (9.1, 15.7). Average performance analysis rated by the residents was 4.65 on a scale of 5. CONCLUSIONS: PGY-1 prescribed curriculum provides significant improvement in basic medical knowledge in musculoskeletal medicine, launches the learner toward the goal of competency, and fosters an appreciation for the role of musculoskeletal medicine in the practice of family medicine.

Preliminary results of the Australasian Regional Anaesthesia Collaboration: a prospective audit of more than 7000 peripheral nerve and plexus blocks for neurologic and other complications.

BACKGROUND AND OBJECTIVES: Peripheral nerve blockade is associated with excellent patient outcomes after surgery; however, neurologic and other complications can be devastating for the patient. This article reports the development and preliminary results of a multicenter audit describing the quality and safety of peripheral nerve blockade. METHODS: From January 2006 to May 2008, patients who received peripheral nerve blockade had data relating to efficacy and complications entered into databases. All patients who received nerve blocks performed by all anesthetists during each hospital's contributing period were included. Patients were followed up by phone to detect potential neurologic complications. The timing of follow-up was either at 7 to 10 days or 6 weeks postoperatively, depending on practice location and time period. Late neurologic deficits were defined as a new onset of sensory and/or motor deficit consistent with a nerve/plexus distribution without other identifiable cause, and one of the following: electrophysiologic evidence of nerve damage, new neurologic signs, new onset of neuropathic pain in a nerve distribution area, paresthesia in relevant nerve/plexus distribution area. RESULTS: A total of 6950 patients received 8189 peripheral nerve or plexus blocks. Of the 6950 patients, 6069 patients were successfully followed up. In these 6069 patients, there were a total of 7156 blocks forming the denominator for late neurologic complications. Thirty patients (0.5%) had clinical features requiring referral for neurologic assessment. Three of the 30 patients had a block-related nerve injury, giving an incidence of 0.4 per 1000 blocks (95% confidence interval, 0.08-1.1:1000). The incidence of systemic local anesthetic toxicity was 0.98 per 1000 blocks (95% confidence interval, 0.42-1.9:1000). CONCLUSIONS: These results indicate that the incidence of serious complications after peripheral nerve blockade is uncommon and that the origin of neurologic symptoms/signs in the postoperative period is most likely to be unrelated to nerve blockade.

First-line pharmacotherapy for tobacco use and dependence.

First-line pharmacotherapies for tobacco use and dependence (namely, nicotine patch, nicotine gum, nicotine inhaler, nicotine nasal spray, and sustained-release bupropion) are safe and have been empirically determined to be efficacious and should always be considered part of a tobacco treatment intervention program unless contraindicated. Studies published subsequent to the literature synthesized in TTUD support previously determined efficacy of first-line pharmacologic medications for treatment of tobacco use and dependence. Further studies will be necessary to define clearly the efficacy and relative safety of combination treatments.