Background Clinical skill training (CST) is indispensable for first-year surgical residents. It can usually be carried out through video-based flipped learning (FL) within a web-based learning environment. However, we found that residents lack the process of reflection, blindly imitating results in losing interest and passion for learning in the traditional teaching pattern. The teaching method of "spot the difference" (SDTM), which is based on the fundamentals of the popular game of "spot the difference," is designed to improve students' participation and reflective learning during skill training. This study aimed to evaluate this novel educational model's short-term and long-term effectiveness for surgical residents in China. Methods First-year residents who required a three-month rotation in the head and neck surgery department were recruited to participate in a series of CSTs. They were randomized into SDTM and traditional FL (control) groups. Clinical skill performance was assessed with validated clinical skill scoring criteria. Evaluations were conducted by comparing the scores that contain departmental rotation skill examinations and the first China medical licensing examination (CMLE) performance on practical skills. In addition, two-way subjective evaluations were also implemented as a reference for the training results. Training effects were assessed using t tests, Mann–Whitney–Wilcoxon tests, chi-square tests, and Cohen’ s effect size (d). The Cohen’ s d value was considered to be small (<0.2), medium (0.2-0.8), or large (>0.8). Results The SDTM group was significantly superior to the control group in terms of after-department skill examination (t=2.179, p<0.05, d=0.5), taking medical history (t=2.665, p<0.05, d=0.59), and CMLE performance on practical skill (t=2.103, p<0.05, d=0.47). The SDTM members rated the curriculum more highly than the control on the items relating to interestingness and participation (p < 0.05) with large effect sizes (d >0.8). There were no significant differences between the two groups on clinical competence (t=0.819, p=0.415, d=0.18), the first-time pass rate for CMLE (χ2 =1.663, p=0.197, d=0.29), and short-term operational skills improvement (t=1.747, p=0.084, d=0.39). Conclusions SDTM may be an effective method for enhancing residents' clinical skills, and the effect is significant both short- and long-term. The improvement effect seemed to be more significant in the peer-involved SDTM than training alone. However, despite positive objective results, SDTM still risks student learning burnout. Trial registration ISRCTN registry, ISRCTN10598469, 02/04/2022,retrospectively registered.
Background: To characterize the environment of deep underground laboratory (DUGL) with a rock cover of 1470m and observe the effect of the DUGL environment on the growth and metabolism of Chinese hamster V79 cells. Results: Six environmental parameters in the DUGL and an above ground laboratory (AGL; control) were monitored. Compared to the AGL, O2 concentration was not significantly different, total γ ray dose rate was significantly lower (p=0.005), and relative humidity (p<0.001), air pressure (p<0.001), and concentration of CO2 and radon gas (p<0.001) were significantly higher in the DUGL. The growth curves of cultured V79 cells showed cell proliferation was slower in the DUGL. Tandem mass tag (TMT) proteomics analysis was performed to identify differentially abundant proteins (DAPs) in V79 cells cultured in the DUGL and AGL. Parallel Reaction Monitoring (PRM) was conducted to verify TMT results. TMT detected 980 DAPs, defined as proteins with a ≥1.2-absolute fold change in relative abundance (p <0.05) between V79 cells cultured in the DUGL and AGL. Of these, 576 proteins were up-regulated and 404 proteins were down-regulated in V79 cells cultured in the DUGL. GO term enrichment analysis of up-regulated proteins revealed enrichment of proteins involved in translation, ribosome, proton-transporting ATP synthase activity, oxygen binding, and oxygen transporter activity et al. GO term enrichment analysis of downregulated proteins demonstrated enrichment of proteins involved in the endoplasmic reticulum lumenand respiratory chain. KEGG pathway analysis revealed that ribosome (p<0.001), base excision repair (p<0.001), RNA transport (p=0.009), Huntington's disease (p=0.023), and oxidative phosphorylation (OXPPL) (p=0.035) pathways were significantly enriched. Conclusion: Proliferation of V79 cells was inhibited in the DUGL, likely because cells were exposed to reduced cosmic ray muons flux. There were apparent changes in the proteome profile of the V79 cells cultured in the DUGL, which affected proteins related to the ribosome, RNA transport, translation, energy metabolism, and DNA repair.These proteins may have induced cellular changes that delayed proliferation but enhanced survival, making the V79 cells adaptable to the changing environment. Our findings provide insight into the cellular stress response that is triggered in the absence of normal levels of radiation.
Pleomorphic adenoma (PA) is primarily found in the salivary glands, and is extremely rare in the subglottic region. Here we present a subglottic PA that presented with symptoms of dry cough and dyspnea. A submucosal mass was found in the subglottic region under laryngoscopy, occluding approximately 40% of the lumen. The patient underwent the transoral endoscopic CO2 laser microsurgery under high-frequency jet ventilation for mass resection, and the pathology report supported the diagnosis of PA. At the 2-year follow-up, there was no evidence of recurrence, and the patient is currently under regular long-term monitoring. Dyspnea and dry cough are nonspecific respiratory symptoms. When no findings discovered in the regular site, it should be noted that the subglottic area is often a blind spot for both pulmonologists and otolaryngologists, and as such, requires careful examination. Transoral endoscopic CO2 laser microsurgery under high-frequency jet ventilation was found to be an effective and less invasive method for treating subglottic PA. This approach helped avoid tracheostomy and resulted in better postoperative recovery.
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