Reflections on a Crisis in Graduate Medical Education: The Closure of Hahnemann University Hospital.

In June 2019, Hahnemann University Hospital (HUH) in Philadelphia became the largest U.S. teaching hospital to announce its closure and the closure of all of its graduate medical education (GME) programs, which displaced more than 550 residents, fellows, and other trainees.

Components of postgraduate competence: analyses of thirty years of longitudinal data.

Context: The conceptualisation and measurement of competence in patient care are critical to the design of medical education programmes and outcome assessment.

Objective: We aimed to examine the major components and correlates of postgraduate competence in patient care.

Methods: A 24-item rating form with additional questions about resident doctors' performance and future residency offers was used.

Use of critical incidents to develop a rating form for resident evaluation of faculty teaching.

Context: Monitoring the teaching effectiveness of attending physicians is important to enhancing the quality of graduate medical education.

Methods: We used a critical incident technique with 35 residents representing a cross-section of programmes in a teaching hospital to develop a 23-item rating form. We obtained ratings of 11 attending physicians in internal medicine and general surgery from 54 residents.

Do global rating forms enable program directors to assess the ACGME competencies?

Purpose: In 1999 the Accreditation Council for Graduate Medical Education (ACGME) mandated that GME programs require their residents to be proficient in six general competencies. The purpose of this study was to ascertain whether an existing global rating form could be modified to assess these competencies.

Method: A rating form covering 23 skills described in the ACGME competencies was developed.

Banana flakes control diarrhea in enterally fed patients.

Diarrhea occurs frequently in the critically ill tube-fed population and may result from a multitude of causes. Despite the availability of antidiarrheal medications, diarrhea associated with enteral feedings remains a problem for clinicians and for the patients affected by it. We tested the hypothesis that administration of banana flakes would control diarrhea in critically ill patients receiving enteral feedings.

Complications of laparoscopic cholecystectomy: the experience of a university-affiliated teaching hospital.

Background: In most published reports on laparoscopic cholecystectomy, the cases have been accrued from small community hospitals in a multicenter fashion. The purpose of this study was to compare the rate of complication following laparoscopic cholecystectomy performed at a single university-affiliated teaching hospital to those quoted in the literature.

Study Design: A retrospective review of the first 1300 laparoscopic cholecystectomies performed at the Videoscopic Surgery Center at Pennsylvania Hospital from May 1990 through January 1994 was undertaken.

Osteoclastic giant cell tumor of the pancreas: an immunohistochemical study.

A case of an osteoclastic giant cell tumor of the pancreas is presented. Immunohistochemical studies were performed, which showed keratin (CAM, AE1) and epithelial membrane antigen positivity in the tumor cells. The findings support an epithelial origin for this tumor.

Small bowel obstruction following endoscopic extraperitoneal-preperitoneal herniorrhaphy.

Laparoscopic hernia repair has a number of unique potential complications. These include complications of pneumoperitoneum, general anesthesia, trocar injuries and complications of small bowel obstruction related to trocar site fascial defects, intraabdominal adhesions, and reaction with the synthetic mesh. A totally extraperitoneal approach should, in theory, eliminate postoperative small bowel obstruction in that the peritoneal space is never entered.

Combined laparoscopic-endoscopic gastrostomy.

Since the first report of successful percutaneous endoscopic gastrostomy placement by Gauderer and Ponsky in 1981 [Surg. Gynecol. Obstet.

Granular cell tumor of the common bile duct.

Granular cell tumor most commonly appears in the tongue and skin, but has been found in varied locations (10). There are now 14 reported cases of the lesion occurring in the common bile duct. In most of these 14 cases, it has affected black females in their thirties.

Artificial pancreas as an aid during insulinoma resection.

Blood glucose control by an artificial pancreas facilitated the intraoperative management of two patients with insulin-secreting pancreatic islet cell tumors (one had a large adenoma, the other diffuse islet-cell hyperplasia). The artificial pancreas is a glucose-controlled insulin and dextrose infusion system uniquely suited for the control of blood glucose concentrations during surgery. The artificial pancreas produced a stable glycemic baseline before surgery, prevented hypoglycemia during palpation of the pancreas and manipulation of the tumor, and indirectly amplified small decreases in the blood sugar level with large increases in the rate of dextrose infusion.

Malignant fibrous histiocytoma: report of five cases and a review of the literature.

Five cases of malignant fibrous histiocytoma are presented and the relevant literature is reviewed. All the patients had locally extensive tumor or eventual recurrent or metastatic disease. Determining malignancy by histologic criteria is difficult.

Operative trauma to the spleen.

A patient is discussed in whom splenic rupture followed an elective uncomplicated cholecystectomy by two weeks. There was no known direct operative or postoperative trauma to the spleen and the spleen was microscopically normal with no evidence of organizing hematoma. Possible mechanisms of operative splenic injury to the spleen are reviewed and the importance of recognition of this entity by surgeons is emphasized.