Electronic learning can facilitate student performance in undergraduate surgical education: a prospective observational study.

BACKGROUND: Our institution recently introduced a novel internet accessible computer aided learning (iCAL) programme to complement existing surgical undergraduate teaching methods. On graduation of the first full cycle of undergraduate students to whom this resource was available we assessed the utility of this new teaching facility. METHOD: The computer programme prospectively records usage of the system on an individual user basis. We evaluated the utilisation of the web-based programme and its impact on class ranking changes from an entry-test evaluation to an exit examination in surgery. RESULTS: 74.4% of students were able to access iCAL from off-campus internet access. The majority of iCAL usage (64.6%) took place during working hours (08:00-18:00) with little usage on the weekend (21.1%). Working hours usage was positively associated with improvement in class rank (P = 0.025, n = 148) but out-of hours usage was not (P = 0.306). Usage during weekdays was associated with improved rank (P = 0.04), whereas weekend usage was not (P = 0.504). There were no significant differences in usage between genders (P = 0.3). Usage of the iCAL system was positively correlated with improvement in class rank from the entry to the exit examination (P = 0.046). Students with lower ranks on entry examination, were found to use the computer system more frequently (P = 0.01). CONCLUSION: Electronic learning complements traditional teaching methods in undergraduate surgical teaching. Its is more frequently used by students achieving lower class ranking with traditional teaching methods, and this usage is associated with improvements in class ranking.

Delayed discovery of diaphragmatic injury after blunt trauma: report of three cases.

Blunt diaphragmatic injury is an increasingly common occurrence, frequently associated with considerable comorbidity. This injury is often missed at the time of the initial event, but may present some time later. We report three cases of diaphragmatic injury diagnosed 3 weeks, 6 months, and 12 years after the original diaphragmatic injury, respectively. Two of the injuries resulted from side-impact road traffic accidents and one followed a fall from a height. Gastrointestinal obstruction and respiratory compromise were the major presenting symptoms. All three patients were managed with a thoracotomy and the defect was closed without the need for prosthetic mesh. They all recovered uneventfully and have remained well since.