BACKGROUND Learning from medical errors and near-misses based on retrospective, single-case outcomes is an ubiquitous part of medical training, so much so that morbidity and mortality (M&M) conferences are a required component of graduate medical education in the United States and have been since 1983. 1 Despite widespread use of the M&M conference, its format remains heterogenous with significant variation between programs. 1,2 The origin of the M&M conference can be traced to the early 20th century when Ernest Codman, a surgeon and outspoken reformer at Massachusetts General Hospital, introduced the end-results system, which employed end-result cards to publicly document individual surgeon's outcomes. 2 While this system of blame assignment was met with intense opposition at the time, it largely informed the initial iteration of the M&M conference. 2 Despite over a century of shared experience with M&M conferences among medical centers, many of the limitations of the primitive M&M conference still exist today. These include haphazard retrospective collection of data, focus on isolated and anecdotal events without consideration of previous similar events, recall bias, lack of meaningful audit, narrow focus on individual performance, lack of systems-based thinking, and lack of

This study demonstrates the effectiveness of surgical therapy in patients with lesions identified by clinical examination without electrodiagnostic testing. After the completion of this study, an additional 87 patients were treated (18 bilateral) with cubital tunnel release. The data from these patients confirm the effectiveness of surgical treatment of ulnar entrapment neuropathy based on provocative clinical testing.

Study objective: We determine whether interpolated questions in a podcast improve knowledge acquisition and retention.Methods: This double-blinded controlled trial randomized trainees from 6 emergency medicine programs to listen to 1 of 2 versions of a podcast, produced de novo on the history of hypertension. The versions were identical except that 1 included 5 interpolated questions to highlight educational points (intervention). There were 2 postpodcast assessments, 1 within 48 hours of listening (immediate posttest) and a second 2 to 3 weeks later (retention test), consisting of the same 15 multiple-choice questions, 5 directly related to the interpolated questions and 10 unrelated. The primary outcome was the difference in intergroup mean assessment scores at each point. A sample size was calculated a priori to identify a significant interarm difference.Results: One hundred thirty-seven emergency medicine trainees were randomized to listen to a podcast, 69 without interpolated questions (control) and 68 with them (intervention). Although no significant difference was detected at the immediate posttest, trainees randomized to the interpolated arm had a significantly higher mean score on the retention test, with a 5.6% absolute difference (95% confidence interval 0.2% to 10.9%). For the material covered by the interpolated questions, the intervention arm had significantly higher mean scores on both the immediate posttest and retention tests, with absolute differences of 8.7% (95% confidence interval 1.6% to 15.8%) and 10.1% (95% confidence interval 2.8% to 17.4%), respectively. There was no significant intergroup difference for noninterpolated questions. Conclusion:Podcasts containing interpolated questions improved knowledge retention at 2 to 3 weeks, driven by the retention of material covered by the interpolated questions. Although the gains may be modest, educational podcasters may improve knowledge retention by using interpolating questions. [

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Frostbite injuries have traditionally been treated with expectant observation. With the exception of early blister aspiration tissues are allowed to demarcate before definitive debridement is accomplished. Triple-phase bone scanning has been used to define the extent of fatally damaged tissues in an attempt to allow for early debridement and wound closure. We suggest extending this technology to assess injury and direct debridement in patients for whom early aggressive salvage attempts are indicated. We present two cases in which triple-phase scanning was used to direct early debridement for aggressive limb salvage with flap reconstruction. Bone, ligament, tendon, and nerve were preserved and covered with vascularized tissue before the onset of frank necrosis. Postoperative scans reveal revascularization of these tissues. An algorithm incorporating triple-phase scanning for the evaluation and treatment of frostbite is presented.

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Twiddler’s syndrome refers to a rare condition in which a pacemaker or automatic implantable cardioverter-defibrillator (AICD) malfunctions due to coiling of the device in the skin pocket and resultant lead displacement. This image is the chest radiograph (CXR) of a 54-year-old male who presented to the emergency department with chest pain five months after his AICD was placed. The CXR shows AICD leads coiled around the device and the absence of leads in the ventricle consistent with Twiddler’s syndrome. Patients with twiddler’s syndrome should be admitted for operative intervention.