Vascular Surgery Curriculum for Medical Students: A National Targeted Needs Assessment.

Background: At present, neither the American College of Surgeons (ACS) nor the Society for Vascular Surgery (SVS) provides curriculum recommendations for medical students rotating on a vascular surgery service. We sent a targeted needs assessment to vascular surgeons across the country in order to investigate the need for a structured curriculum for medical students participating in a vascular surgery rotation during their clinical clerkships.

Methods: The survey was developed with input from medical students, vascular surgeons, and medical educators.

Resident Perspectives on Teaching During Awake Surgical Procedures.

Introduction: Residents learn technical and communication skills during training and practice both concurrently during awake surgical procedures. Patients have expressed mixed views on resident involvement in their surgical care, making this context challenging for residents to navigate. We sought to qualitatively explore resident perspectives on teaching during awake surgical procedures.

Bridging the Gap: Interdepartmental Quality Improvement and Patient Safety Curriculum Created by Hospital Leaders, Faculty, and Trainees.

Background: The Accreditation Council for Graduate Medical Education Clinical Learning Environment Review recommends that quality improvement/patient safety (QI/PS) experts, program faculty, and trainees collectively develop QI/PS education.

Objective: Faculty, hospital leaders, and resident and fellow champions at the University of Chicago designed an interdepartmental curriculum to train postgraduate year 1 (PGY-1) residents on core QI/PS principles, measuring outcomes of knowledge, attitudes, and event reporting.

Methods: The curriculum consisted of 3 sessions: PS, quality assessment, and QI.

Moving skills training closer to application: In-rotation skills curriculum is feasible and effective.

Purpose: Using simulation can help surgical trainees acquire surgical skills but at the expense of clinical learning time. We postulate an in-rotation skills curriculum is feasible and minimizes time away from clinical experiences.

Methods: Surgical residents (PGY2-5) were allotted two hours of weekly protected time for rotation specific simulation modules that included assessment, mentoring, and practice.

Surgeon-patient communication during awake procedures.

Background: Surgeons are increasingly performing procedures on awake patients. Communication during such procedures is complex and underexplored in the literature.

Methods: Surgeons were recruited from the faculty of 2 hospitals to participate in an interview regarding their approaches to communication during awake procedures.

Young surgeons on speaking up: when and how surgical trainees voice concerns about supervisors' clinical decisions.

Background: Poor communication is a known contributor to disasters in aviation and medicine. Crew members are trained to raise concerns about superiors' plans, yet literature exploring surgical trainees' responses to analogous concerns is sparse.

Methods: Surgical residents were interviewed about approaches to concerns about supervisors' clinical decisions using a semistructured guide.

Dissociation of somatic growth, time of sexual maturity, and life expectancy by overexpression of an RGD-deficient IGFBP-2 variant in female transgenic mice.

Impaired growth is often associated with an extension of lifespan. However, the negative correlation between somatic growth and life expectancy is only true within, but not between, species. This can be observed because smaller species have, as a rule, a shorter lifespan than larger species.

The RGD sequence present in IGFBP-2 is required for reduced glucose clearance after oral glucose administration in female transgenic mice.

Recent studies suggest that insulin-like growth factor-binding protein-2 (IGFBP-2) affects both growth and metabolism. Whereas negative growth effects are primarily due to negative interference with IGF-I, the mechanisms for metabolic interference of IGFBP-2 are less clear. As we demonstrate, overexpression of IGFBP-2 in transgenic mice is correlated with a decelerated clearance of blood glucose after oral administration.

Gender-specific effects on food intake but no inhibition of age-related fat accretion in transgenic mice overexpressing human IGFBP-2 lacking the Cardin-Weintraub sequence motif.

IGFBP-2 affects growth and metabolism and is thought to impact on energy homeostasis and the accretion of body fat via its heparin binding domains (HBD). In order to assess the function of the HBD present in the linker domain (HBD1) we have generated transgenic mice overexpressing mutant human IGFBP-2 lacking the PKKLRP sequence and carrying a PNNLAP sequence instead. Transgenic mice expressed high amounts of human IGFBP-2, while endogenous IGFBP-2 or IGF-I serum concentrations were not affected.

Complications of indwelling retrievable versus permanent inferior vena cava filters.

Objective: Retrievable inferior vena cava (IVC) filters are appealing because they are designed for either retrieval or long-term use. However, the long-term safety of indwelling retrievable compared with permanent filters is largely unknown. This study was undertaken to compare complication rates and types associated with indwelling retrievable and permanent filters.

A formative midterm test increases accuracy of identifying students at risk of failing a third year surgery clerkship.

Background: Providing midclerkship feedback to identify students at risk for failing is a Liaison Committee on Medical Education standard. Objective criteria for that feedback are critical. The investigators studied the value of a formative midterm (MT) test in identifying students at risk for failing a surgery clerkship.

Implementing an excellence in teaching recognition system: needs analysis and recommendations.

Purpose: Teaching awards have been suggested to serve a variety of purposes. The specific characteristics of teaching awards and the associated effectiveness at achieving planned purposes are poorly understood. A needs analysis was performed to inform recommendations for an Excellence in Teaching Recognition System to meet the needs of surgical education leadership.

Foundations for teaching surgeons to address the contributions of systems to operating room team conflict.

Background: Prior research has shown that surgeons who effectively manage operating room conflict engage in a problem-solving stage devoted to modifying systems that contribute to team conflict. The purpose of this study was to clarify how systems contributed to operating room team conflict and clarify what surgeons do to modify them.

Methods: Focus groups of circulating nurses and surgeons were conducted at 5 academic medical centers.

Surgeons managing conflict in the operating room: defining the educational need and identifying effective behaviors.

Background: Developing an operating room conflict management educational program for surgeons requires a formal needs assessment and information about behaviors that represent effective conflict management.

Methods: Focus groups of circulating room nurses and surgeons were conducted at 5 participating centers. Participants responded to queries about conflict management training, conflict consequences, and effective conflict management behaviors.

Resection of intracaval leiomyomatosis using abdominal approach and venovenous bypass.

Background: Intravenous leiomyomatosis is the venous involvement of a histologically benign uterine tumor. This uncommon tumor can present contemporaneously with the primary uterine tumor or in a delayed fashion. Tumor extends up the venous system, via the iliac or ovarian veins, and can involve portions or all of the inferior vena cava and can extend into the heart as well.

Teaching operating room conflict management to surgeons: clarifying the optimal approach.

Context: Conflict management has been identified as an essential competence for surgeons as they work in operating room (OR) teams; however, the optimal approach is unclear. Social science research offers two alternatives, the first of which recommends that task-related conflict be managed using problem-solving techniques while avoiding relationship conflict. The other approach advocates for the active management of relationship conflict as it almost always accompanies task-related conflict.

Quiescent-interval single-shot unenhanced magnetic resonance angiography of peripheral vascular disease: Technical considerations and clinical feasibility.

We performed technical optimization followed by a pilot clinical study of quiescent-interval single-shot MR angiography for peripheral vascular disease. Quiescent-interval single-shot MR angiography acquires data using a modified electrocardiographic (ECG)-triggered, fat suppressed, two-dimensional, balanced steady-state, free precession pulse sequence incorporating slice-selective saturation and a quiescent interval for maximal enhancement of inflowing blood. Following optimization at 1.

Description and impact of using a standard-setting method for determining pass/fail scores in a surgery clerkship.

Background: Research on performance evaluation highlights the importance of using multiple measures to develop an accurate profile of students, yet we found no literature describing the use of a standard-setting method for determining a pass/fail cutoff for a clerkship based on multiple assessment methods.

Method: Steps in setting an absolute standard for a pass/fail grade are described. The new cut-off score was used to compare what decisions would have been made had it been applied in previous clerkships.

Questioning skills: the effect of wait time on accuracy of medical student responses to oral and written questions.

Background: Pauses (wait time) after asking questions in pre-college classes result in improved discussion and answer accuracy. The authors hypothesized that this would extend to medical students.

Method: Third-year surgery clerks were randomized to three-second or six-second wait times after questions asked of them during a scripted lecture.

Recognizing clinical faculty's contributions in education.

Objective: A faculty productivity profile system was designed to recognize faculty's contributions to administrative, educational, and research activities. It has long been recognized that clinical faculty receive little recognition or compensation for their efforts in education. Our surgery department previously had in place a recognition program for research achievements, but not for educational contributions.

Carotid endarterectomy with routine electroencephalography and selective shunting: Influence of contralateral internal carotid artery occlusion and utility in prevention of perioperative strokes.

Objective: Carotid endarterectomy (CEA) is associated with a risk of cerebral ischemia during carotid clamping, particularly in the face of contralateral internal carotid artery (ICA) occlusion. We examined the results of CEA with continuous electroencephalography in patients without and with contralateral ICA occlusion.

Design And Setting: We reviewed 564 primary CEAs with routine electroencephalography and general anesthesia performed between April 1, 1989, and March 31, 1999, in a community teaching medical center.

Melioidosis presenting as an infected intrathoracic subclavian artery pseudoaneurysm treated with femoral vein interposition graft.

We present the first case of in situ replacement of an infected subclavian artery using superficial femoral vein and the fourth reported case of an infected arterial pseudoaneurysm caused by pseudomonas pseudomallei. Sepsis and hoarseness developed in a 58-year-old man after recent travel to Borneo, Indonesia. Indirect laryngoscopy revealed a paralyzed right vocal cord.