Principles of Rodent Surgery for the New Surgeon

For both scientific and animal welfare reasons, training in basic surgical concepts and techniques should be undertaken before ever seeking to perform surgery on a rodent. Students, post-doctoral scholars, and others interested in performing surgery on rodents as part of a research protocol may not have had formal surgical training as part of their required coursework. Surgery itself is a technical skill, and one that will improve with practice. The principles of aseptic technique, however, often remain unexplained or untaught. For most new surgeons, this vital information is presented in piecemeal fashion or learned on the job, neither of which is ideal. It may also make learning how to perform a particular surgery difficult, as the new surgeon is learning both a surgical technique and the principles of asepsis at the same time. This article summarizes and makes recommendations for basic surgical skills and techniques necessary for successful rodent surgery. This article is designed to supplement hands-on training by the user''s institution.     

Teaching technical skills: training on a simple, inexpensive, and portable model.

The purpose of this study was to determine whether surgical residents could significantly improve their performance on a specific surgical procedure after a brief practice session with feedback. Attending plastic surgeons, using valid and reliable checklists and global rating scales, objectively assessed 37 junior surgical residents while performing two-flap Z-plasties on pig thighs (one before and one after a one-on-one, 5-minute practice session with feedback). The total cost per resident was $1.00 (Canadian currency). After the practice session, total checklist scores improved from 7.3 (range, 1 to 9) to 7.9 (range, 5 to 9), and the total global rating scores improved from 29.1 (range, 13 to 41) to 31.9 (range, 19 to 43). Paired Student's t tests revealed significant improvement in both the mean total checklist scores (p < 0.05) and mean total global rating scores (p < 0.01). Also, the global rating score for appearance and quality of the final surgical product significantly improved from 2.7 to 3.3 after the practice session (p < 0.01). There were no significant differences in performance scores between men and women, between first-year and second-year residents, with residents' previous experience with the Z-plasty procedure, or with resident's base surgical specialties. The results of this prospective study indicate that training on a simple and portable model with very brief individualized practice and feedback is an effective and inexpensive way of improving resident performance. A 5-minute practice session with a surgical trainee before performing a procedure on a living patient may significantly improve the patient's surgical performance and produce a superior result.     

Medical students as medical educators: opportunities for skill development in the absence of formal training programs

All physicians, at some point in their career, are responsible for the education of their peers and junior colleagues. Although medical students are expected to develop clinical and research skills in preparation for residency, it is becoming clear that a student should also be expected to develop abilities as a teacher. A handful of institutions have student-as-teacher programs to train medical students in education, but most students graduate from medical school without formal training in this area. When such a program does not exist, medical students can gain experience in education through participation in peer teaching, course design, educational committees, and medical education scholarship. In doing so, they attain important skills in the development, implementation, and evaluation of educational programs. These skills will serve them in their capacity as medical educators as they advance in their careers and gain increasing teaching responsibility as residents, fellows, and attending physicians.     

针对医学微生物学实验教学中学生常见问题的思考与探讨

实验教学是高等医学院校教学的重要组成部分,对培养学生理论联系实际、动手能力、分析解决问题能力、科学思维等有重要意义。微生物学实验不仅综合性和操作性强,而且要求学生具备较强的无菌操作技能和生物安全意识。针对在医学微生物实验教学中学生常见的一些问题,从多方面思考和探讨如何提高实验教学质量和培养学生综合素质。     

Patient-reported outcome measures in plastic surgery: use and interpretation in evidence-based medicine

Understanding patients' perceptions of surgical results and their impacts on quality of life is of primary importance in plastic surgery, as procedures are largely performed to improve either appearance or function. Patient-reported outcome measures are questionnaires specifically designed to quantify aspects of health-related quality of life from the patient's perspective. This article presents an overview of patient-reported outcome measures. It also aims to provide plastic surgeons with the necessary critical appraisal skills to interpret and apply evidence from patient-reported outcomes research in their own clinical practice.     

网络云交互技术辅助外科实践教学的创新应用探索

目的:探索传统教学模式结合网络云交互技术在外科实践教学中的应用效果。方法:于我校2011级五年制临床医学专业本科生中选取76人,随机平均分为两组,分别采取单纯传统大课教学模式、传统教学结合网络云交互技术教学模式;课程结束后进行闭卷理论考试和实践操作考试,综合两项成绩进行评定。同时向两组学员发放调查问卷,以此评价使用网络云交互技术辅助教学的效果。结果:采取传统教学结合网络云交互技术教学模式组的成绩优于采取单纯传统教学模式组,两组成绩差异具有统计学意义(P0.05)。结论:在传统教学模式的基础上添加网络云交互技术更能激发学生的学习兴趣,大大提高了学习效率,更有利于本科生外科实践的教学以及教学资源的整合及教学档案的建立。     

Medical Students’ Attitudes toward Abortion Education: Malaysian Perspective

Background

Abortion is a serious public health issue, and it poses high risks to the health and life of women. Yet safe abortion services are not readily available because few doctors are trained to provide such services. Many doctors are unaware of laws pertaining to abortion. This article reports survey findings on Malaysian medical students’ attitudes toward abortion education and presents a case for including abortion education in medical schools.

Methods and Results

A survey on knowledge of and attitudes toward abortion among medical students was conducted in two public universities and a private university in Malaysia in 2011. A total of 1,060 students returned the completed questionnaires. The survey covered about 90% of medical students in Years 1, 3, and 5 in the three universities. About 90% of the students wanted more training on the general knowledge and legal aspects of abortion, and pre-and post-abortion counseling. Overall, 75.9% and 81.0% of the students were in favor of including in medical education the training on surgical abortion techniques and medical abortion, respectively. Only 2.4% and 1.7% were opposed to the inclusion of training of these two methods in the curriculum. The remaining respondents were neutral in their stand. Desire for more abortion education was associated with students’ pro-choice index, their intention to provide abortion services in future practice, and year of study. However, students’ attitudes toward abortion were not significantly associated with gender, type of university, or ethnicity.

Conclusions

Most students wanted more training on abortion. Some students also expressed their intention to provide abortion counseling and services in their future practice. Their desire for more training on abortion should be taken into account in the new curriculum. Abortion education is an important step towards making available safe abortion services to enable women to exercise their reproductive rights.     

Advanced technologies in plastic surgery: how new innovations can improve our training and practice

Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. Reports on simulator applications in medicine now appear regularly in the medical, computer science, engineering, and popular literature. The goal of this article is to review the emerging intersection between advanced technologies and surgery and how new technology is being utilized in several surgical fields, particularly plastic surgery. The authors also discuss how plastic and reconstructive surgeons can benefit by working to further the development of multimedia and simulated environment technologies in surgical practice and training.     

Current Trainee and Workforce Patterns for Thyroid and Parathyroid Surgery in the United States

ObjectiveThyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to direct research, education, and quality improvement interventions.MethodsWe tabulated case numbers for privately insured patients undergoing thyroid and parathyroid surgery in Marketscan: 2010–2016 and trainee case logs for residents and fellows in general surgery and otolaryngology. Summary statistics and tests for trends and differences were calculated.ResultsMarketscan data captured 114 500 thyroid surgeries. The proportion performed by each specialty was not significantly different. Otolaryngologists performed 58 098 and general surgeons performed 56 402. Otolaryngologists more commonly performed hemithyroidectomy (n = 25 148, 43.29% of all thyroid surgeries performed by otolaryngologists) compared to general surgeons (n = 20 353, 36.09% of all thyroid surgeries performed by general surgeons). Marketscan data captured 21 062 parathyroid surgeries: 6582 (31.25%) were performed by otolaryngologists, and 14 480 (68.75%) were performed by general surgeons. The case numbers of otolaryngology and general surgery trainees completing residency and fellowship varied 6- to 9-fold across different sites. The wide variation may reflect both the level of exposure a particular training program offers and trainee level of interest.ConclusionThyroid surgical care is equally provided by general surgeons and otolaryngologists. Both specialties contribute significantly to parathyroid surgical care. Both specialties should provide input into and be targets of research, quality, and education interventions.     

Outcome-based residency education: teaching and evaluating the core competencies in plastic surgery

Through its oversight of residency education in the United States, the Accreditation Council for Graduate Medical Education has mandated new structural changes in resident education with its newly created core competencies and an emphasis on outcomes-based education. These core competencies represent the central areas in which the Accreditation Council for Graduate Medical Education believes a plastic surgery resident should receive adequate and appropriate education and training. In addition, as part of this outcomes-based education, residents are to be evaluated on their level of mastery in these core competencies. Increasingly, the Accreditation Council for Graduate Medical Education will assess the ability of residency programs to integrate the teaching and evaluating of the core competencies in their accreditation process of plastic surgery residency programs. This shift in residency evaluation initiated by the Outcomes Project by the Accreditation Council for Graduate Medical Education will have a significant impact in how plastic surgery residents are taught and, as importantly, evaluated in the coming years. The objectives of this work were as follows: (1) to outline the different methods available to foster a core competency-based plastic surgery training curriculum and (2) to serve as a primer to help both full-time academic and clinical faculty to further develop their curriculum to successfully teach and constructively evaluate their residents in the core competencies in accordance with the Accreditation Council for Graduate Medical Education guidelines. At the conclusion of this review, the reader should have a better understanding of what is necessary to formulate and help foster a plastic surgery core competency curriculum, particularly with an emphasis on the contemporary methods used for outcomes evaluations.     

Paint and Paper Creations

This article investigates generalist kindergarten teachers’ academic music training based on data collected from students undertaking an undergraduate degree in preschool (kindergarten) education (students aged 4–6 years) in Greece. The study was carried out through a questionnaire survey that addressed students’ aspirations when entering the university and the real learning outcomes by the end of their studies. This article seeks to find relationships between students’ academic experiences and their level of confidence and enthusiasm to teach music in kindergarten. The findings suggest that higher education provides students with most of the learning outcomes that they anticipate. However, students lack adequate practical experiences in terms of observing lessons in real educational settings, which can significantly affect their confidence levels. Finally, the author explores some implications for higher education policy and teaching practice.     

Creating long-term benefits in cleft lip and palate volunteer missions

The authors present their experience with 15 years of organizing cleft lip and palate surgical volunteer missions in Latin America. The history, basic principles, and objectives of Operation San Jose, a volunteer goodwill program from Christus St.Joseph Hospital in Houston, Texas, are covered. This report addresses the different problems encountered and solutions found. Following the principles set by Operation San Jose, CIRPLAST is a Peruvian foundation for plastic surgery that travels to remote areas in Peru, operating on patients with cleft lip and palate deformities. This report highlights the importance of working with local plastic surgeons and their residents, and emphasizes that the program should be organized by and the operations performed by accredited plastic surgeons and with the auspices and support of the national plastic surgery society and the local medical board. Operation San Jose promotes the creation of long-term benefits by offering a program to teach local surgeons cleft lip and palate repair techniques and to set up guidelines to organize local surgeons so that they can continue this effort by treating their own patients in their own countries.     

Contemplating a Constructivist Stance for Active Learning within Music Education

This article examines constructivist philosophies for learning with an emphasis on student-centered environments in education and the active involvement of students in learning as they relate new understanding to what they already know and refine previous skills in terms of newly acquired proficiencies. Active learning is explored from a constructivist perspective in which students adopt an analytic approach to questioning and problem solving. Through these processes, students extend their current understanding and emerge as independent musicians, actively engaged in their work as singers, players, composers, improvisers, and listeners. This approach is contrasted with student involvement in hands-on activities in which the focus is on the actions needed to fulfill a given task and limited awareness is devoted to the thinking required to complete the work. I examine the implications of this approach for educational practice and call on policymakers to re-envision music education with attention to engaged learning as perceived within constructivist ways of knowing.     

Informal educational interventions for caregivers of adult cancer survivors

This review study explores the available data relating to the informal education aspects of effective interventions applied in caregivers of adult cancer survivors to maintain their own health and quality of life (QoL) and as such to provide the optimal care to the cancer patient. The implications of these interventions in oncology practice are also discussed. Available data show that, over the last years, a significant proportion of caregivers of cancer survivors are increasingly offered informal education interventions towards the reduction of their burden. More specifically, educational, skills training, and therapeutic counseling interventions seem to positively affect caregivers' well-being and overall QoL. However, based on available data, one cannot generalize these interventions on improving caregivers' outcomes of daily living activities and QoL. As such, available intervention strategies should be further tested and validated in larger samples, whereas novel health promotion educational approaches are expected to be designed to effectively address and comply with the appropriate needs of caregivers of cancer patients.     

医学专业学生确立自主学习观的必要性和重要性

目前,高等医学教育的主要任务是培养学生的综合能力,对于医学院校的学生来说,掌握扎实的医学基础知识至关重要。然而,大多医学专业的学生习惯于被动接受老师传授的知识,而严重缺乏主观能动性。医学知识涉及的内容广、难度大,初学者很难迅速掌握其精髓之处,因此确立一种高效的学习模式帮助医学生更好的理解并掌握专业理论是医学院校教育改革的重点。自主学习能力是现代教育学所提倡的相对于传统学习模式的一种现代化学习理念。自主学习的主体是学生,自主学习的过程要求主体发挥其主观能动性,自我督促、自我激励,以独立自主的方式完成高效的学习,帮助学生牢固地掌握专业理论,同时又可以灵活的运用在临床实践中。本文通过对自主学习的含义进行阐述,分析医学生确立自主学习观的必要性和重要性,并对如何确立自主学习观提出相应的建议,以推进我校教育体制改革的进度,进一步完善医学教育教学的质量。     

Educating Internists in Emergency Medicine

The education of internists in emergency medicine needs to be thoughtfully planned by those involved in their education. Objectives for their emergency medicine rotation include the recognition and initial treatment of true medical and surgical emergencies, clinical experience with and knowledge of common acute primary care problems, the ability to handle several patients with problems having different degrees of urgency, effective use of consultants in the follow-up and management of difficult patients and a knowledge of and clinical experience with the prehospital care system. A curriculum should be designed to give the resident a core of didactic material in addition to supervised clinical experience. The rotation should be evaluated by both residents and faculty from internal medicine and emergency medicine to determine if it is accomplishing the objectives set forth.     

Survey of antibiotic prophylaxis in gastrointestinal surgery in Scotland.

The current use of prophylactic antibiotics in gastrointestinal surgery in Scotland was established by postal questionnaire. Twenty-one per cent of surgeons used prophylactic antibiotics during cholecystectomy, 49% during appendicectomy, and 95% for elective colorectal surgery. Two-thirds of those surgeons who did not provide routine antibiotic cover considered that the incidence of wound sepsis in their surgical practice was too low to merit special measures. Most surgeons using prophylaxis chose an appropriate antibiotic. The parenteral route for administration of antibiotic was used by 93% of surgeons during cholecystectomy, 29% during appendicectomy, and 45% in elective colorectal surgery. Most did not prolong cover beyond 24 hours postoperatively. This survey shows that the concepts governing the use of antibiotic prophylaxis have been absorbed into current surgical practice. Most surgeons used appropriate antibiotic regimens; many prefer the parenteral route of administration; most do not prolong cover beyond 24 hours.     

Creating a surgery clerkship in a changing environment: reality, simulation, and the rules of engagement

This review describes the current challenges associated with creating a successful surgical clerkship and the ways in which teacher-focused and curriculum-focused initiatives can address these challenges. The challenges are both systemic (reflected by changes in our health care system and training programs) and institutional (reflected by factors that affect curriculum design and faculty advancement). Particular attention is paid to residents as teachers, faculty as mentors, the educational impact of the operating room, and the role of simulation. Strategies for engaging students, residents, and faculty are explored. The premise and impact of a comprehensive simulation course on the clinical education of medical students is detailed. Emphasis is placed on the educational validity of accountability and engagement of both the teachers and the learners.     

创新实践教学模式对大学生素质教育的作用

大学生素质教育要求新时代的大学生不仅要学习理论知识,更重要的是培养科学思维并掌握应用技能。我校微生物学课程教学中探索了以创新实践为主要内容的模式改革,其中"理论—技能—创新实践"同步训练的创新模式,是以将参与创新实践计入期末成绩的形式"强迫"学生进入实验室参与科研项目。实施中我们以"教师—研究生—创新小组"交互学习的方式,任课教师制定规则与目标,研究生帮助创新项目的选题、研究方案设计及实施指导,创新小组依照目标参与研究生的科研课题,最后完成创新实践并获得一定比例的成绩。实践证实创新实践教学对促进学生的理论课程学习、科学思维培养以及创新意识训练等方面都有积极的促进作用,是大学生素质教育的一种实用且高效的教学模式。     

Witnessing and the medical gaze: how medical students learn to see at a free clinic for the homeless

This article analyzes doctor-patient communication as it is taught to medical students in a student-run free clinic for the homeless. Moving beyond Foucault's concept of the medical gaze, it incorporates Byron Good's theorizing about the soteriological aspects of medicine and medical education as well as aspects of practice theory as illuminated by Anthony Giddens. Ethnographic examples illustrate the necessary tension between objectification and subject-making that exists in the specific practices engaged in by both students and preceptors at the clinic site.