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.     

National plastic surgery survey: face lift techniques and complications

The purpose of this study was to assess trends in technique and philosophy of face lifting, associated procedures, and the incidence and management of complications. Surveys were sent to 3800 members of the American Society of Plastic and Reconstructive Surgeons (ASPRS); 570 surveys (15 percent) were returned. Numerous very specific technique and philosophy questions were asked. Details of demographics, techniques, incidence of complications, management of complications, and basic philosophy are presented. Three basic conclusions can be gleaned from this study: (1) Surgeons perform more tried and true methods of aesthetic surgery, rather than the many new methods that seem to get the most attention in the media and at the meetings. (2) It seems that less-experienced surgeons tend to be generally more conservative in their approach to aesthetic surgery. (3) Complication rates reported by the plastic surgery community at large coincide with previous complication rates, as outlined in other nonsurvey studies. The authors expect to report additional data from the survey--on brow surgery (part II) and facility and ancillary procedures (part III)--in forthcoming publications.     

Survey research

SUMMARY: Survey research is a unique methodology that can provide insight into individuals' perspectives and experiences and can be collected on a large population-based sample. Specifically, in plastic surgery, survey research can provide patients and providers with accurate and reproducible information to assist with medical decision-making. When using survey methods in research, researchers should develop a conceptual model that explains the relationships of the independent and dependent variables. The items of the survey are of primary importance. Collected data are only useful if they accurately measure the concepts of interest. In addition, administration of the survey must follow basic principles to ensure an adequate response rate and representation of the intended target sample. In this article, the authors review some general concepts important for successful survey research and discuss the many advantages this methodology has for obtaining limitless amounts of valuable information.     

“线上线下混合式”微生物学课程教学改革与实践

为更好地响应教育部“金课建设”的号召,我们将“以学生为中心”作为教学改革的根本目标,将全面落实培养学生能力素质作为教学改革的根本任务,结合现代教育教学理念和方法,采用线上线下混合式教学模式对微生物学课程教学进行改革。线上：（1）依托超星泛雅网络教学平台提供课程教学相关的全部资源。主要有课程基本资源、辅助资源和拓展资源,供学生课外自学;章节教学设计,包括自学提纲、名师慕课、教学互动和作业练习等,供学生课前自学、课内互动和课后复习;阶段性调查问卷和意见建议,供学生进行教学评价和教师教学反思。（2）依托“学习通”手机APP实现教师和学生课内外实时互动交流,包括任务布置、学习检测、答疑质疑、教学互动、课程反馈等。线下：主要以课堂教学为载体,根据学生线上学习情况和教学设计,针对不同类型的知识进行分类教学,采用多种教学互动方法,巩固自学效果、加强重点、解析难点,在夯实基础的同时注重对学生多方面能力素质的培养。改革结果显示,学生对教学改革的方法和效果都非常认可,认为教学改革的目标明确、重点突出、手段优化,能够启发思维、激发兴趣,能够有效提高课堂参与度,提升主观能动性,使自身能力素质得到综合提升。     

Residency training in plastic surgery: a survey of educational goals

With the advent of integrative plastic surgical training programs, requirements for earlier specialization decisions, and an increasing subspecialization within the practice of plastic surgery, the educational goals of residency training may have changed. The duration and extent of training required are also currently being questioned. This study was performed to better understand the necessary roles of plastic surgery residencies and to determine how these demands might optimally be met. Of 151 practicing plastic surgeons in the Ontario, Canada, region, 81 (53.6 percent) responded to a survey. General agreement was that 2 years was an optimal length of time for core surgical training, which should then be followed by at least 3 years of plastic surgical training. Opinions on the ideal length of time training in specific medical and surgical disciplines are discussed. Overall, respondents thought that two thirds of training should occur in tertiary care centers, with the remaining time spent at smaller community centers and private clinics. Nearly half of respondents thought that research training should be a mandatory part of the residency, although the amount of protected time for this activity varied substantially. Most thought that unrestricted elective time should also be available. Academic plastic surgeons rated the importance of research training (p < 0.01), critical appraisal skills (p < 0.05), and teaching skills (p < 0.05) as significantly more important than did their nonacademic colleagues. The authors present results from the Ontario region and a template for determining optimal characteristics for training programs. Further investigation may be of timely importance during a foreseeable future transition from traditional to integrative plastic surgery residency training.     

Wendell L. Hughes' life and contributions to plastic surgery

Wendell L. Hughes was a pioneer in ophthalmic plastic surgery and best known for the "Hughes flap," a tarsoconjunctival flap used for lower eyelid reconstruction. In 1937, Wendell L. Hughes sought to achieve the criterion standard of replacing "like with like" in his development of the tarsoconjunctival flap for lower lid reconstruction. This work was published in his ground-breaking thesis, Reconstructive Surgery of the Eyelids, the most comprehensive book on ophthalmic plastic surgery of its time. Although this flap has undergone many modifications, it has stood the test of time and is still used today. In addition, Dr. Hughes was heavily involved in surgical education, a founding member of the American Board of Plastic Surgery, and a leader in the development of sutures and microneedles. More importantly, he was a gracious humanitarian and inspiring mentor loved by peers and patients alike. Other authors have reviewed the intricacies of the Hughes flap; however, little attention has been given to the contributions of its creator.     

Basics of immune responses in transplantation in preparation for application of composite tissue allografts in plastic and reconstructive surgery: part I

Currently, composite tissue allografts are applied only occasionally as a reconstructive option in the field of plastic and reconstructive surgery. Composite tissue allografts offer a unique potential for coverage of large multitissue defects. However, compared with the relatively homogenous tissue of solid organ transplants, the heterogenicity of tissue components of composite tissue allografts may generate high immunologic responses. Modern immunosuppressive agents significantly improve successful allograft acceptance. However, chronic allograft rejection and immunosuppressive drug toxicity are still major problems in the clinical practice of transplantation. The major goals of transplantation immunology are (1) to develop tolerance to allograft transplants and (2) long-term drug-free survival. A number of experimental protocols were designed to develop tolerance; however, none of them has been proven to induce tolerance in clinical transplantation. In this article, the authors outline the mechanisms of allograft acceptance and rejection and barriers to transplantation tolerance. Novel immunosuppressive protocols are discussed in this review. This basic immunologic knowledge of allograft acceptance and rejection will allow plastic surgeons to apply composite tissue allograft transplants to plastic and reconstructive surgery.     

Systems-based practice: education in plastic surgery

The current Accreditation Council for Graduate Medical Education guidelines separate residents' education into six core competencies or subjects. The authors address the least intuitive of these, systems-based practice. In systems-based practice, educators and residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Plastic surgery is a specialty that is intimately involved with the economics, coordination of care, and real-life experience of resource allocation. It should be avant-garde in the development of a systems-based educational experience and be in the forefront in creating an appropriate and well-thought-out teaching agenda for graduate medical education. The authors explain and expand this definition to include objectives for plastic surgery training, programs, and individual learning goals. A series of didactic lectures, small group discussions, and grand round presentations are suggested to fulfill and facilitate the educational objectives. A potential time allotment and method of objective and subjective evaluations are offered.     

Fundraising and philanthropy in plastic surgery: an essential tool for academic excellence

In a time of multiple economic challenges in healthcare and society as a whole, academic plastic surgery units are also struggling to support teaching initiatives, research programs, and poorly remunerative patient care activities. A practical, available, and realistic solution is the establishment of formal fundraising and philanthropic efforts within plastic surgery divisions, sections, and departments. An understanding of donors and their motivations and how the fundraising process operates can lead to a successful long-term fundraising effort, benefitting various areas of the academic plastic surgery unit. Fundraising and philanthropic efforts are essential for the continued success and survival of academic plastic surgery units and will be requisite to ensure that education, research, and clinical programs flourish well into the future.     

“海洋微生物学实验”课程思政探索和实践

"海洋微生物学实验"课程是高等院校海洋科学类专业的重要基础课程,在海洋科学人才培养过程中发挥重要作用。开展"海洋微生物学实验"课程的思政建设,是落实高校全员全程全方位培养青年海洋微生物人才的重要途径。本文以"海洋微生物学实验"课程为例,挖掘提炼课程中蕴含的思政元素,从课程建设、教学理念、教学目标、教学方法、考核评价体系、教学反思等方面开展课程思政教育的探索和实践,旨在将专业知识和思政元素有机融合,实现知识传授和价值引领同频共振。     

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.     

Establishing a multidisciplinary academic cosmetic center

The demand for cosmetic services has risen rapidly in recent years, but has slowed down with the current economic downturn. Managed care organizations and Medicare have been steadily reducing their reimbursements for physician services. The payment for reconstructive surgical procedures has been decreasing and is likely to worsen with healthcare reform, and many plastic surgery residency programs are facing fiscal challenges. An adequate volume of patients needing cosmetic services is necessary to recruit and train the best candidates to the residency programs. Self-pay patients will help ensure the fiscal viability of plastic surgery residency programs. Attracting patients to an academic healthcare center will become more difficult in a recession without the appropriate facilities, programs, and pricing strategies. Setting up a modern cosmetic services program at an academic center has some unique challenges, including funding, academic politics, and turf. The authors opened a free-standing academic multidisciplinary center at their medical school 3 years ago. The center is an off-site, 13,000-sq ft facility that includes faculty from plastic surgery, ear, nose, and throat, dermatology, and vascular surgery. In this article, the authors discuss the process of developing and executing a plan for starting an aesthetic services center in an academic setting. The financing of the center and factors in pricing services are discussed. The authors show the impact of the center on their cosmetic surgery patient volumes, resident education, and finances. They expect that their experience will be helpful to other plastic surgery programs at academic medical centers.     

共生菌Cardinium对朱砂叶螨的生殖调控作用

为了了解共生菌Cardinium对朱砂叶螨Tetranychus cinnabarinus (Boisduval)的生殖调控作用,从检测到感染Cardinium的种群中选取山西运城和甘肃兰州2个感染率较高的种群作为实验材料,对Cardinium在寄主生殖调控方面的作用进行研究。通过人工培养100%感染Cardinium的种群和100%不感染的种群,并从中挑取不同感染类型的雌雄螨单独进行杂交实验,设立感染Cardinium(♀)×感染Cardinium(♂),感染Cardinium(♀)×不感染(♂),不感染(♀)×感染Cardinium(♂),不感染(♀)×不感染(♂) 4种杂交组合。结果发现,抗生素处理后不感染的雌螨和受感染雄螨的交配表现出了单向的胞质不亲和,而且2个种群表现出了2种类型：在山西种群不亲和的组合中,CI表现为卵孵化率显著降低,多数雌螨都产生出F₁雌螨后代,但是F₁代雌螨数量相对于其他3种组合明显减少; 而在甘肃种群不亲和的组合中则表现为卵全部孵化且幼螨100%存活,但全部为雄螨后代。2个种群中Cardinium的亲缘关系非常相近,而它们却能够在不同的地理种群中表现出不同的CI表型,这提示亲缘关系非常接近的品系也可以产生不同的表型。研究结果为深入揭示Cardinium的感染机制和生殖调控作用提供重要基础。     

谢氏宽漠王β-actin基因cDNA克隆、序列分析及表达量检测

β-actin是actin家族的一员,在维持细胞结构、运动和分裂等细胞生理活动方面发挥着重要作用,是基因定量实验中最常用的内参之一。本实验采用同源克隆和RACE技术扩增得到谢氏宽漠王Mantichorula semenowi β-actin基因。序列分析结果表明,该基因cDNA全长1 372 bp,开放阅读框长1 131 bp,编码376个氨基酸,5′和3′末端非翻译区域(UTR)分别为66 bp和175 bp;该序列与其他动物β-actin基因核苷酸序列具有96%～99%高度同源性。β-actin表达量检测结果显示热激后不同恢复时间其表达量无明显变化,且与未经热激处理的对照相比无显著差异。表明β-actin是研究受外界环境胁迫作用下昆虫体内不同基因表达水平的可靠内参基因。     

A new educational role for plastic surgery in the fourth year of medical school

At most medical schools, students are offered limited or sporadic experiences in plastic surgery. This is unfortunate because all physicians need to possess the knowledge and skills to evaluate skin lesions and participate in wound management. Also, students who are considering a career in plastic surgery do not have adequate information to make informed decisions. With the restructuring of plastic surgery training programs, career decisions of individuals interested in plastic surgery are being made earlier than ever before in the education continuum, and the aforementioned problem assumes greater magnitude both for the students and the faculty. At MCP-Hahnemann School of Medicine, basic plastic surgery experiences have been integrated into the third-year surgery clerkship as a requirement for all students, and a Plastic Surgery Pathway has been designed in conjunction with the school's pathway system for fourth-year students. The Pathway provides a framework for the student to select a combination of rotations that will best provide an appropriate broad-based education in preparation for training in plastic surgery, and it provides extensive guidance by faculty members in the discipline to assist with career decisions, rotation selection, and preparations for the residency application process. Students in the Plastic Surgery Pathway are required to take rotations in medicine, neurology, and plastic surgery. The remaining rotations are selected from a list of options based on the student's individual learning needs, interests, and career aspirations. Early experience with the Plastic Surgery Pathway has shown that it has been well received by students and faculty, has assisted students with their career decisions, and has led to an increased student awareness of the importance and relevance of the specialty.     

Is Agrammatism an Anomaly?

Kolk, van Grunsven, and Keyser (1985) and Kolk and Hofstede (1987) answer "No" to the question posed in the title of this article. Let us consider instances when normal subjects use "telegraphic style." The authors mentioned above point to dialogue markers, talking to foreigners and children as such cases. However, the offered list seems incomplete and may be enlarged; in doing so, it is important to define the structure and function of agrammatical utterances in normal language users. A Russian author has an advantage in solving this because in the Russian scientific tradition the problem has been approached from both the linguistic (Potebnia, 1888; Iakubinsky, 1923; Zemskaia, 1973; Zemskaia, Kitaigorodskaia, and Shir'aev, 1981) and psychological (Vygotsky, 1934) perspectives.     

Calibration of nitric oxide flux generation from diazeniumdiolate NO donors

The 1-(secondary amino) diazen-1-ium-1,2-diolates (NONOates) are the most commonly utilized nitric oxide (NO, nitrogen monoxide) donor because of the ability of different NONOates to spontaneously break down liberating NO at different rates, which can be utilized to control NO fluxes. However, the parameters that determine these fluxes of NO generation, half-lives and stoichiometry of NO per donor, can vary significantly with specific experimental conditions in addition to the donor chosen. Here we report straightforward methods that can be used to determine these parameters. For donors of intermediate half-life (10–80 min) a real-time oxymyoglobin (oxyMb) assay can be analyzed to simultaneously determine both the half-life and the total amount of NO liberated, from which the NO flux can be obtained for any given donor concentration. The half-lives obtained by oxyMb assay are very similar to those obtained by following NONOate decomposition kinetics spectrophotometrically, and a survey of several NONOates from different commercial sources show consistent results. These data provide validation for the methodologies employed. In addition, procedures are described for calibration of donors with shorter (<10 min) and longer (>80 min) half-lives. These procedures can be used to reproducibly and routinely calibrate NO fluxes for a variety of donors under any specific condition.     

“趣味教学法”在微生物学课堂中的应用及探讨

微生物学属于生命科学的重要分支,是生物、食品科学、临床医学等大学专业一门重要的基础课。该课程综合性强、知识涉及面广,所以如何有效调动学生的学习兴趣将直接影响课堂效果。为达到良好的教学效果,教师可在微生物学教学过程中综合运用多种方式提高学生学习兴趣与学习质量。因此,我们采用“趣味教学法”进行教学设计,并针对连续3个不同年级的相同专业班级做出教学改革,通过学生期末闭卷成绩、过程考核（签到率、课堂参与度、注意力集中程度等）成绩与学生反馈评语对教学成果进行验证。结果表明,采用“趣味教学法”进行教学改革的班级学生期末闭卷成绩中不及格率低于未改革的班级,“良好”与“优秀”学生比例均高于未改革的班级,过程考核成绩远高于未改革的班级,说明“趣味教学法”教学改革有效调动了学生的学习兴趣。我们认为,在大学微生物学课堂上,教师可在教学设计中适当引入趣味教学内容并适时展开,有助于改善教学气氛,调动学生学习积极性与主动性,提高教学质量。     

三株烟草天蛾新细胞系的生长特性及重组蛋白表达

从尚未涉及的昆虫种类中建立新的细胞系能为基础研究和生物技术应用提供重要资源。本实验通过细胞培养技术, 建立了3株来源于鳞翅目昆虫烟草天蛾Manduca sexta卵组织的新细胞系, 分别命名为QB-Ms1-8, QB-Ms2-2和QB-Ms2-7。这3株细胞已经培养在TNM-FH培养基中, 28℃条件下传代培养了约50代, 大部分细胞呈梭形, 细胞群体倍增时间分别为51, 31和49 h。虽然这3株细胞系对苜蓿银纹夜蛾核型多角体病毒（Autographa californica multiple nuclear polyhedrosis virus, AcMNPV）不够敏感, 侵染后96 h感染率在33%~40%之间, 但是QB-Ms2-2细胞与BTI-Tn5B1-4细胞比较, 分泌型碱性磷酸酶（SEAP）活性表达更高。本研究从建立的3株烟草天蛾新细胞系中筛选出SEAP高表达的细胞系QB-Ms2-2, 为进一步细胞克隆和筛选提供了新资源。     

羟基香茅醛缩醛类化合物的合成及对蚊虫的驱避活性

为了寻找新的萜类驱避剂, 以羟基香茅醛为原料, 合成羟基香茅醛二甲缩醛、 羟基香茅醛乙二醇缩醛、 羟基香茅醛1, 3-丙二醇缩醛和羟基香茅醛1, 2-丙二醇缩醛, 用红外光谱IR、 质谱MS分析其结构, 对羟基香茅醛1, 2-丙二醇缩醛还进行了¹H NMR及¹³C NMR分析。按国标GB/T 13917.9-2009测定了它们对白纹伊蚊Aedes albopictus、 中华按蚊Anopheles sinensis及淡色库蚊Culex pipiens的驱避活性。结果表明: 10%（质量分数）羟基香茅醛二甲缩醛和羟基香茅醛1, 2-丙二醇缩醛对中华按蚊的驱避时间均达到国标B级; 羟基香茅醛1, 2-丙二醇缩醛还对其他的蚊虫具有驱避作用, 20%（质量分数）羟基香茅醛1, 2-丙二醇缩醛对白纹伊蚊的驱避时间超过国标B级; 10%（质量分数）羟基香茅醛1, 2-丙二醇缩醛对淡色库蚊的驱避时间超过国标A级。这些结果说明它们对不同蚊种驱避活性的差别, 为不同场合的驱蚊需要提供了理论基础。