Competency-Based Medical Education and Breast Disease.

Description The future delivery of high quality, patient-centered breast care is fundamentally dependent on how we train the next generation of breast care providers. As medical educators, we have a tremendous opportunity to transform how clinical skills related to breast care are taught and assessed and thereby, improve breast patient outcomes. This article reviews the current state of education and ideas for implementing a learner-specific, competency-based curriculum to teach breast care skills.

Construct validity of a novel, objective evaluation tool for the basics of open laparotomy training using a simulated model.

BACKGROUND: We describe initial success in designing and implementing an objective evaluation for opening and closing a simulated abdomen. METHODS: (1) An assessment for laparotomy was created using peer-reviewed literature, texts, and the input of academic surgeons nationally; (2) the assessment was evaluated for construct validity, comparing the videotaped performance of laparotomy by surgical experts and novices on a viscoelastic model; and (3) the basics of open laparotomy training (BOLT) curriculum was piloted with junior residents to evaluate efficacy at improving performance. RESULTS: Experts performed better than novices opening (.94 vs .51; P < .001), closing (.85 vs .16; P < .001), and overall performance (.88 vs .27; P < .001). Novices caused bowel injury more frequently (5 vs 1; P < .05) and took longer to open the abdomen (6:06 vs 3:43; P = .01). After completing the BOLT curriculum, novices improved for opening (1.00 vs .50; P = .014), closing (.80 vs .10; P = .014), and overall score (.87 vs .23; P = .014). CONCLUSIONS: We demonstrate construct validity of an evaluation tool for simulated laparotomy, and pilot efforts with the BOLT curriculum have shown promise.

WISE-MD usage among millennial medical students.

BACKGROUND: E-learning is increasingly common in undergraduate medical education. Internet-based multimedia materials should be designed with millennial learner utilization preferences in mind for maximal impact. METHODS: Medical students used all 20 Web Initiative for Surgical Education of Medical Doctors modules from July 1, 2013 to October 1, 2013. Data were analyzed for topic frequency, time and week day, and access to questions. RESULTS: Three thousand five hundred eighty-seven students completed 35,848 modules. Students accessed modules for average of 51 minutes. Most frequent use occurred on Sunday (23.1%), Saturday (15.4%), and Monday (14.3%). Friday had the least use (8.2%). A predominance of students accessed the modules between 7 and 10 PM (34.4%). About 80.4% of students accessed questions for at least one module. They completed an average of 40 ± 30 of the questions. Only 827 students (2.3%) repeated the questions. CONCLUSIONS: Web Initiative for Surgical Education of Medical Doctors has peak usage during the weekend and evenings. Most frequently used modules reflect core surgical problems. Multiple factors influence the manner module questions are accessed.

A 5-year review of feedback on the Philadelphia-area mock ABS certifying examination.

OBJECTIVES: The American Board of Surgery Certifying Examination (ABSCE) is an oral examination designed to evaluate a resident׳s ability to apply their cognitive knowledge to manage a broad range of clinical problems. In this study, we analyze our 5-year experience with a Philadelphia-wide mock oral examination (PMOE). SETTING: The PMOE is organized by the Metropolitan Philadelphia Chapter of the American College of Surgeons and offered annually to all postgraduate year 4/5 residents from the 8 participating Philadelphia general surgery programs. Each examinee is scheduled for 3 consecutive 30-minute examinations given by 2 examiners per room. Overall performance is graded for each interaction using the ABSCE scoring method. Participants are given their "pass/fail" status, and they receive written examiner feedback. DESIGN: From 2008 to 2013, deidentified examinee scores from both the PMOE and the ABSCE were reviewed; overall pass/fail status was compared using the chi-square statistic for significance. Examinee feedback from 2009 to 2013 was reviewed by 3 independent raters and characterized as commenting upon cognitive knowledge, clinical management, or communication skills. This categorical data were then correlated with pass/fail status and examined using unpaired t tests for significance. RESULTS: From 2009 to 2013, 189 residents participated in the PMOE with an overall pass rate of 53%, compared with the ABSCE pass rate of 76% for 113 examinees from the Philadelphia area from 2008 to 2013 (χ(2) = 18.8, p < 0.01). A total of 2273 comments were reviewed and categorized from 2009 to 2013. Examinees who failed the PMOE received significantly more feedback pertaining to cognitive knowledge than examinees who passed the examination (p = 0.04). CONCLUSION: The PMOE provides residents an opportunity to receive feedback on their performance on a representation of the ABSCE that may be more rigorous than the actual certifying examination. Deficits in cognitive knowledge are a significant determinant of performance on a city-wide mock oral examination.

Role of robotic-assisted surgery in benign esophageal diseases.

Laparoscopic treatment of benign esophageal conditions is technically complex with several inherent limitations. Robotic-assisted surgery provides technical improvement and helps to overcome some of these limitations. We therefore report a single surgeon's experience in management of benign esophageal diseases by robotic-assisted surgery. Over a period of 8 consecutive years, a retrospective chart review was performed of 105 patients who underwent robotic-assisted surgery for benign esophageal diseases by a single surgeon. Demographic data and outcome measures were studied. The robotic-assisted procedures included 85 Nissen fundoplications with and without mesh repair, 12 Heller myotomies and eight para-esophageal hernia repairs. The mean total operating time was lowest for the Nissen group (94 min) and highest for the para-esophageal group (183 min). Operating time decreased from a mean of 105 min in the first 20 cases to 84 min in the last 20 cases for the Nissen group (P = 0.014). The mean length of stay was 1.3, 1.6, 1.5 and 4.8 days for the groups, respectively. Persistent symptoms of dysphagia/reflux/dysphonia requiring further investigation were seen in nine (8 %) of these patients. Two of these patients required repeat Nissen fundoplication in the mesh group. Our complication rate, total operating time and length of stay for robotic-assisted benign esophageal surgery are comparable to those reported in the literature. When performed by an experienced surgeon, robotic-assisted surgery is safe and effective in the management of benign esophageal diseases.

Squamous cell carcinoma in an African American with discoid lupus erythematosus: a case report and review of the literature.

Discoid lupus is an autoimmune disorder with primarily cutaneous manifestations. Carcinomatous changes in discoid lupus can lead to the development of squamous cell carcinoma. While this most often occurs in Caucasians, the presented patient is an African American. She developed numerous squamous cell carcinomas in areas of scarring from discoid lupus. This case illustrates the need for careful observation of discoid lupus for the development of squamous cell carcinoma in the African American patient.