Surgical Education and the Longitudinal Model at the Columbia-Bassett Program.

OBJECTIVE: The aim of this study is to evaluate a longitudinal medical student surgical curriculum. DESIGN: This is a case-controlled study of students who participated in a longitudinal surgical curriculum compared to students who participated in a standard 12-week surgical clerkship. This study evaluates qualitative data including exam scores as well as qualitative data regarding student experience. SETTING: All students were from Columbia College of Physicians and Surgeons in New York City. A portion of the students completed their clerkship at the main university campus and others performed their clerkship at an affiliate site including Bassett Health Network. The longitudinal curriculum was only at the Bassett Health Network. PARTICIPANTS: All medical students who completed their surgical curriculum from 2012 to 2015 were eligible. The survey response rate was 45% for a total of 128 students. RESULTS: The students receiving the longitudinal curriculum outperformed the block students on the national shelf exam (77 vs 71, p = 0.001). The longitudinal students were also more likely to learn directly from attending surgeons and were more likely to have a greater interest in a surgical career after their surgery experience. CONCLUSIONS: The longitudinal approach to teaching surgery to medical students achieves non-inferior or superior testing outcomes when compared to the block model, and superior outcomes in terms of students' own attitudes and perceptions.

Use of an ACE inhibitor or angiotensin receptor blocker is a major risk factor for dehydration requiring readmission in the setting of a new ileostomy.

PURPOSE: Diverting ileostomies help prevent major complications related to anastomoses after colorectal resection but can cause metabolic derangement and hypovolemia, leading to readmission. This paper aims to determine whether angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use increased the risk of readmission, or readmission specifically for dehydration after new ileostomy creation. METHODS: Retrospective analysis of patients undergoing diverting ileostomy at a tertiary-care hospital, 2009-2015. Primary outcome was 60-day readmission for dehydration; secondary outcomes included 60-day readmission for any cause, or for infection obstruction. RESULTS: Ninety-nine patients underwent diverting ileostomy creation, 59% with a primary diagnosis of colorectal cancer. The 60-day readmission rate was 36% (n = 36). Of readmitted patients, 39% (n = 14) were admitted for dehydration. Other readmission reasons were infection (33%) and obstruction (3%). The majority (64%, n = 9) of patients readmitted for dehydration were taking either an ACEi or an ARB. Compared to patients not readmitted for dehydration, those who were readmitted for dehydration were more likely to be on an ACEi or an ARB (11/85, 13% vs. 9/14, 64%). After controlling for covariates, ACEi or ARB use was significantly associated with risk of readmission (p < 0.0001, odds ratio = 13.56, 95% confidence interval 3.54-51.92,). No other diuretic agent was statistically associated with readmission for dehydration. CONCLUSIONS: ACEi and ARB use is a significant risk factor for readmission for dehydration following diverting ileostomy creation. Consideration should be given to withholding these medications after ileostomy creation to reduce this risk.