RESUMO
BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires all residents participate in scholarly activity during residency. Case reports provide trainees an opportunity to engage in scholarly activities. This study assesses internal medicine residents' perceived benefits of writing and presenting case reports and barriers to this process. METHODS: A survey was disseminated to internal medicine residents at a tertiary academic center. The survey questionnaire aimed to assess residents' perceptions about benefits and barriers to writing and presenting case reports. Responses were obtained on a 5-point Likert scale, and the data were analyzed as respective frequencies and percentages. RESULTS: Forty-three (34%) of the 125 eligible internal medicine residents completed the survey. Fifty-eight percent reported never having presented a case report. Ninety-six percent believed that finding an interesting case was an important factor in facilitating writing a case report, while 81% perceived finding a good mentor as equally important. Perceived barriers to case report writing included lack of training in reviewing scientific literature (59%), lack of adequate time (58%), lack of formal training in identifying and writing case reports (56%), and lack of a mentor (54%). CONCLUSIONS: Our study showed that the majority of residents had not written or presented case reports. While case reports provide a myriad of educational value, various barriers exist that include lack of proper training, adequate time, and a mentor. Our findings suggest that additional institutional resources should be dedicated to designing a curriculum to address these perceived barriers.
Assuntos
Internato e Residência , Acreditação , Educação de Pós-Graduação em Medicina , Humanos , Percepção , RedaçãoRESUMO
BACKGROUND: Alvimopan has been shown to reduce length of stay after bowel resection. Use remains variable among institutions due to cost and efficacy concerns in laparoscopic surgery. Additionally, alvimopan's effects have not been isolated from other medications within enhanced recovery protocols. The aim of this study was to distinguish the relationship between alvimopan use, length of stay, and cost in both open and laparoscopic segmental colectomies. METHODS: The Vizient dataset was queried to identify patients undergoing open and laparoscopic colectomies from 2015 to 2017. Patient demographics and treatment details were collected. Primary outcomes of interest included duration of stay and total direct costs. RESULTS: In the study, 12,727 patients met inclusion criteria and 3,358 (26.4%) received alvimopan. For both open and laparoscopic groups, alvimopan was associated with decreased length of stay in unadjusted (4.0 vs 6.0 days, P < .01 and 3.0 vs 4.0 days, P < .01, respectively) and adjusted analysis (effect ratio 0.79, P < .01 and 0.85, P < .01, respectively). Alvimopan was associated with a 7% decrease in direct cost after adjustment (effect ratio 0.93, P = .04), with no cost difference in laparoscopic procedures (effect ratio 0.99, P = .71). CONCLUSION: Alvimopan use is associated with decreased length of stay for both open and laparoscopic colon resections, decreased cost in open procedures, and no cost difference for laparoscopic procedures.
