Due to shortage of time and limited availability of faculty surgeons to teach basic surgical skills during medical graduation, the search for alternative ways of simulated training with feedback is needed. The purpose of this study was to compare the simulated teaching of suture skills to novice medical students by senior medical students and by experienced faculty surgeons. Forty-eight novice medical students were randomly assigned to three practice conditions on bench model (n = 16): self-directed suture training (control), senior medical student-directed suture skills' training, or experienced faculty surgeon-directed suture skills' training. Pre- and post-tests were applied. Global Rating Scale with blinded evaluation and self-perceived confidence based on Likert scale were used to assess all suture performances in pre- and post-training. Effect size was also calculated. The analysis made after training showed that the students who received feedback from the instructors had better performance based on the Global Rating Scale (all p < 0.0000) and felt more confident to carry out sutures (all p < 0.0000) when compared to the control. There was no significant difference (all p > 0.05) between the student-directed teaching and faculty-directed teaching groups. The magnitude of the effect (instructor-directed training suture) was considered large (>0.80) in all measurements. The acquisition of suture skills after student-directed training was similar to the training supervised by faculty surgeon, and the increase in suture performances of trainees that received instructor administered training was superior to self-directed learning.
Due to ethical and medical-legal drawbacks, high costs, and difficulties of accessibility that are inherent to the practice of basic surgical skills on living patients, fresh human cadaver, and live animals, the search for alternative forms of training is needed. In this study, the teaching and learning process of basic surgical skills pertinent to plastic surgery during medical education on different inanimate bench models as a form of alternative and complementary training to the teaching programs already established is proposed.
PURPOSE:To propose a simulation-based ultrasound-guided central venous cannulation skills' training program, during residency.
METHODS:This study describes the strategies for learning the ultrasound-guided central venous cannulation on low-fidelity bench models. The preparation of bench models, educational goals, processes of skill acquisition, feedback and evaluation methods were also outlined. The training program was based on key references to the subject.
RESULTS:It was formulated a simulation-based ultrasound-guided central venous cannulation teaching program on low-fidelity bench models.
CONCLUSION:A simulation-based inexpensive, low-stress, no-risk learning program on low-fidelity bench models was proposed to facilitate acquisition of ultrasound-guided central venous cannulation skills by residents-in-training before exposure to the living patient.
Phytobezoar, a concretion of indigestible fibers derived from ingested vegetables and fruits, is the most common type of bezoar. Diospyrobezoar is a subtype of phytobezoar formed after excessive intake of persimmons (Diospyros kaki). We report the case of a diabetic man with a 5-day history of abdominal pain after massive ingestion of persimmons who developed signs of complicated small bowel obstruction. The patient had a previous history of Billroth II hemigastrectomy associated with truncal vagotomy to treat a chronic duodenal ulcer 14 years earlier. Since intestinal obstruction was suspected, he underwent emergency laparotomy that revealed an ileal obstruction with small bowel perforation and local peritonitis due to a phytobezoar that was impacted 15 cm above the ileocecal valve. After segmental intestinal resection, the patient had a good recovery and was discharged on the 6th postoperative day. This report provides evidence that diospyrobezoar should be considered as a possible cause of small bowel obstruction in patients who have previously undergone gastric surgery.
sion and pain upon palpitation over the lower abdominal area, and a large ecchymosis was noted over the left flank. Laboratory tests revealed hemoglobin of 4.9 mg/dL and PT of 56.2 seconds with an INR of 5.1. Computed tomography of the abdomen showed hemoperitoneum and left abdominal wall hematoma ( Figure 1). Because the diagnostic hypothesis was warfarin-induced hemoperitoneum and hematoma, she received component therapy with fresh frozen plasma and parenteral vitamin K for correction of bleeding. Her condition gradually improved, and she was discharged uneventfully 3 weeks later.This woman had received oral anticoagulant therapy for prevention of a thromboembolic event, and INR was maintained at approximately 2.5, but prolonged PT and a high INR with severe bleeding developed during hospitalization for pneumonia. The possible mechanism of unexpectedly high INR was the interaction between moxifloxacin and warfarin. Previous studies have demonstrated this rare clinical effect of the interaction between moxifloxacin and warfarin. 3,4 In contrast to previous reports that gastrointestinal bleeding was the most common complication, 3 the presentation of hemoperitoneum and abdominal wall hematoma found in the present case was rarely reported.Although moxifloxacin rarely interacts with warfarin, physicians should consider the potential drug interaction between moxifloxacin and warfarin in this era of their increasing use. 2,5,6 Monitoring of INR for individuals taking warfarin during use of moxifloxacin is needed to detect possible adverse effects and prevent further bleeding complications.
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