RESUMO
Background: Near-peer teaching (NPT) involves teaching by peers who are at a close, but not the same, level of training. This study investigated whether a novel surgical NPT workshop, designed and delivered by junior doctors using simulation models for acute otolaryngology conditions, improved the knowledge and confidence level of senior medical students. Methods: A one-day NPT workshop was held for medical students in their third year of a four-year postgraduate medical degree at the University of Notre Dame, Sydney, Australia. Four acute otolaryngology/head and neck surgery problems that might be encountered by junior doctors and require prompt management were chosen. These were post-operative neck swelling, epistaxis, and tracheostomy management (obstruction and bleeding). Six junior doctors facilitated didactic tutorials and practical skills training using models. Multiple choice question mini-tests and questionnaires were administered before and after the workshop to assess changes in students' knowledge and confidence in assessment, management, and practical skills. Results: The most common reason for participation was to acquire knowledge and practical skills (93.2 %). Mean correct MCQ mini-test knowledge scores increased significantly from 60 % pre-workshop to 83.9 % post-workshop (p < 0.05). Students reported significantly increased confidence in recognition and management of all four conditions. All students favoured including the course in their curriculum and would recommend the course to others. The tutors subjectively reported valuable teaching experience. Conclusion: NPT is an effective method for teaching medical students how to assess and manage acute otolaryngology/ENT surgery conditions that may present as emergencies for junior medical officers on the ward.
RESUMO
BACKGROUND: Mastectomy for breast cancer treatment and prophylaxis has improved survival for patients. The advantage of implant reconstruction post mastectomy is that it avoids an additional donor site with its associated morbidity, which post-mastectomy autologous reconstruction necessitates. However, the deficiency of muscle coverage at the lower pole of the implant meant it relied on only skin envelope coverage, and thus has the established complication of implant exposure or infection should the skin break down. In 2006, Nava devised a technique for a single-stage reconstruction using definitive breast implants with two-layer coverage of the lower pole with a vascularized dermal layer, as well as the traditional skin envelope, in women with preoperative large ptotic breasts. We present our experience with single-stage implant breast reconstruction using this technique. METHOD: A retrospective review of the medical and operative records as well as patients' photographs was undertaken for consecutive patients from November 2009 to April 2011. These patients were selected for the procedure based on set criteria. We describe our surgical technique for this procedure. RESULT: In the 18-month period, 6 patients underwent 11 skin sparing reduction mastectomy (SSRM) implant reconstructions. Follow-up ranged from 5 to 19 months. The mean length of hospital stay was 7.2 days (range was 2-15 days). One breast out of 11 reconstructions developed an infected seroma 8 months post-operatively, requiring aspiration and intravenous antibiotics. One breast out of 11 developed T junction skin necrosis and associated cellulitis but the breast implant was protected by a visibly vascularized dermal flap and, thus, was not exposed. One breast developed a minor vertical wound dehiscence. CONCLUSION: In our initial experience, SSRM is a safe and effective method of immediate implant-based breast reconstruction.
