Reflective Writing for Medical Students on the Surgical Clerkship: Oxymoron or Antidote?

Objectives: Reflective writing has emerged as a solution to declining empathy during clinical training. However, the role for reflective writing has not been studied in a surgical setting. The aim of this proof-of-concept study was to assess receptivity to a reflective-writing intervention among third-year medical students on their surgical clerkship.

Senior Surgical Resident Confidence in Performing Flexible Endoscopy: What Can We Do Differently?

Introduction: The American Board of Surgery endoscopy requirements for general surgery training are evolving. In 2006, the Residency Review Committee in Surgery increased the total number of endoscopy cases required before completion of general surgery residency training. This requirement is set to change further, given the new Flexible Endoscopic Curriculum that would be a requirement for applicants graduating surgical training during or after the 2017 to 2018 academic year.

Are graduating surgical residents confident in performing open vascular surgery? Results of a national survey.

Introduction: General surgical training has changed significantly over the past decade with work-hour restrictions, increasing use of minimally invasive techniques, and increasing specialization, leading to decreased resident exposure to open operative techniques. Furthermore, the presence of vascular surgery fellows and the advent of dedicated vascular surgery residencies have had the potential to diminish further the vascular surgery experience of general surgery residents. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing certain key open vascular maneuvers, approaches that might be required in a general surgery practice, and to determine factors associated with variations in reported confidence.

A comprehensive, simulation-based approach to teaching clinical skills: the medical students' perspective.

The purpose of this study was to determine if third-year medical students participating in a mandatory 12-week simulation course perceived improvement in decision-making, communication, and teamwork skills. Students participated in or observed 24 acute emergency scenarios. At 4-week intervals, students completed 0-10 point Likert scale questionnaires evaluating the curriculum and role of team leader.

Graduating general surgery resident operative confidence: perspective from a national survey.

Background: General surgical training has changed significantly over the last decade with work hour restrictions, increasing subspecialization, the expanding use of minimally invasive techniques, and nonoperative management for solid organ trauma. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing open surgical operations and to determine factors associated with increased confidence.

Methods: A survey was developed and sent to general surgery residents nationally.

The positive effect of immediate feedback on medical student education during the surgical clerkship.

Background And Aims: Feedback from faculty to medical students is vital in medical education. The objective of this study was to assess the feasibility and educational benefits of a program that incorporates seeking immediate feedback by students from their faculty during the third-year medical student core surgery clerkship.

Methods: Using a crossover model, students in the intervention group sought daily feedback from their faculty surgeons, whereas those in the nonfeedback comparison group did not seek feedback.

Operative confidence of graduating surgery residents: a training challenge in a changing environment.

Background: Given the recent changes in general surgical training, this study was undertaken to assess the confidence of graduating general surgery residents in performing open operations and to determine factors that are associated with increased confidence.

Methods: A survey was sent to the 5th-year general surgery residents in the Northeast. Respondents were queried regarding demographics, program characteristics and asked to rate their confidence in performing open operations.

Influence of race on the management of lower extremity ischemia: revascularization vs amputation.

Importance: Among patients presenting with critical lower extremity ischemia, it has been previously documented that white individuals are more likely to undergo revascularization than nonwhite individuals, with the disparity largely attributed to differences in resources and access to care.

Objective: To investigate the amputation disparity between white and nonwhite patients with critical lower extremity ischemia in more detail using a larger data set than previous studies, with a focus on the role of confounding factors such as access and hospital resources.

Design, Setting, And Patients: All hospital discharge records from the Nationwide Inpatient Sample of adult patients with the primary diagnosis of critical lower extremity ischemia from 2002-2008 were examined in detail using multiple logistic regression (n = 774,399).

Race as a predictor of morbidity, mortality, and neurologic events after carotid endarterectomy.

Objective: Racial disparities in the outcomes of patients undergoing carotid endarterectomy (CEA) have been reported. We sought to examine the contemporary relationship between race and outcomes and to report postdischarge events after CEA.

Methods: The American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were reviewed to identify all CEAs performed from 2005 to 2010 by vascular surgeons.

Open surgical simulation in residency training: a review of its status and a case for its incorporation.

Background: With the increase in minimally invasive approaches to surgical disease and nonoperative management for solid organ injury, the open operative experience of current surgical residents has decreased significantly. This deficit poses a potentially adverse impact on both surgical training and surgical care. Simulation technology, with the potential to foster the development of technical skills in a safe, nonclinical environment, could be used to remedy this problem.

Creating a surgery clerkship in a changing environment: reality, simulation, and the rules of engagement.

This review describes the current challenges associated with creating a successful surgical clerkship and the ways in which teacher-focused and curriculum-focused initiatives can address these challenges. The challenges are both systemic (reflected by changes in our health care system and training programs) and institutional (reflected by factors that affect curriculum design and faculty advancement). Particular attention is paid to residents as teachers, faculty as mentors, the educational impact of the operating room, and the role of simulation.

Limitations of online information on abdominal aortic aneurysm.

Background. Patients with AAA face a complex decision, and knowledge of the risks and benefits of each treatment option is essential to informed decision-making. Here we assess the current information on the internet accessible to patients regarding the management of AAA.

Pilot testing of a decision support tool for patients with abdominal aortic aneurysms.

Objective: Patients with abdominal aortic aneurysms (AAAs) who are surgical candidates have as many as three options: open surgery, endovascular surgery, or no surgery. As with all treatment decisions, informed patient preferences are critical. Decision support tools have the potential to better inform patients about the risks and benefits associated with each treatment option and to empower patients to participate meaningfully in the decision-making process.

Attracting surgical clerks to surgical careers: role models, mentoring, and engagement in the operating room.

Background: Declining interest in careers in surgery among medical students has contributed to growing concerns about the surgical workforce. Although the medical student clerkship is likely to play an important role in shaping students' impressions of careers in surgery, little is known about the nature of this process. This study was designed to identify those aspects of the clerkship that are associated with medical students expressing an interest in surgery at the end of the clerkship.

Informed consent for abdominal aortic aneurysm repair: The patient's perspective.

Objective: Whether or not to undergo surgery for abdominal aortic aneurysm (AAA), and whether to have open or endovascular repair (EVAR), is a complex decision that relies heavily on patient preferences, and yet little is known about the patient perspective on informed consent in this context. This study explores patients' views on their decision-making processes and the quality of surgeon-patient communication during informed consent for AAA repair.

Design Of Study: We conducted in-depth interviews with AAA patients (n = 20) who underwent open AAA repair, endovascular repair, or declined surgery.

Intravenous lobular capillary hemangioma originating in the iliac veins: a case report.

Intravenous lobular capillary hemangioma is a rare benign lesion that can mimic other intravascular lesions encountered by vascular surgeons, such as angiosarcoma, papillary endothelial hyperplasia, and deep vein thrombus. These lesions have been described originating in the veins of the head, neck, and upper extremities. To our knowledge, there are no reported cases of intravenous capillary hemangioma arising from within a pelvic vein.

Urgent carotid endarterectomy is safe in patients with few comorbid medical conditions.

Recent reports from single institutions have confirmed the efficacy of carotid endarterectomy (CEA) performed in the urgent or emergent setting, although with higher perioperative mortality and morbidity. We determined the results of urgently performed CEA in academic and community hospitals and whether patient or hospital factors affected outcome. The records of patients undergoing CEA in all nonfederal hospitals in the state of Connecticut between 1992 and 2002 were reviewed, and symptomatic patients who presented in an urgent or emergent fashion were compared to patients treated electively.

Prosthetic vascular graft infection: a multi-center review of surgical management.

A multi-center retrospective review of major prosthetic graft infection outcomes was undertaken to determine graft preservation and limb salvage rates. The management of infected prosthetic vascular grafts continues to be controversial. The purpose of this study was to review the surgical management of major extracavitary prosthetic vascular graft infections and to correlate the outcomes on the basis of bacteriology and grade.

Informed consent for abdominal aortic aneurysm repair: assessing variations in surgeon opinion through a national survey.

Objective: Informed consent discussions for elective abdominal aortic aneurysm (AAA) repair should reflect appropriate risks of the open or endovascular repair (EVAR), but few guidelines exist describing what surgeons should discuss. This study examines expert opinion regarding what constitutes informed consent.

Methods: Design.

Beyond fusiform and saccular: a novel quantitative tortuosity index may help classify aneurysm shape and predict aneurysm rupture potential.

While saccular abdominal aortic aneurysms (AAAs) are thought to be more prone to rupture than fusiform aneurysms, attempts to validate this observation have been limited by the inability to quantitatively define the three-dimensional shape of an aorta. A quantitative three-dimensional shape model may distinguish among shape classes and ultimately be useful in identifying aneurysms at risk for rupture. Three-dimensional luminal surface data of AAAs were generated from computed tomographic (CT) images of 15 patients with small aneurysms (< or =5.

Malnutrition after vascular surgery: are patients with chronic renal failure at increased risk?

Background: The deleterious effects of perioperative malnutrition on recovery after general surgery are established. Since the effects of perioperative malnutrition on recovery after vascular surgery are not known, we examined the effects of nutritional status, and risk factors predictive of malnutrition, on outcome after vascular surgery.

Methods: The records of all open index vascular cases (abdominal aortic aneurysm [AAA] repair, carotid endarterectomy [CEA], lower extremity bypass) performed at the Veterans Affairs (VA) Connecticut between July 2004 and June 2005 were reviewed.

Safety of carotid endarterectomy in a high-risk population: lessons from the VA and Connecticut.

Background: The safety and efficacy of carotid endarterectomy (CEA) have been demonstrated in randomized trials, but these studies excluded patients thought to be at higher risk for poor outcomes. We sought to determine whether patients undergoing CEA in Veteran Affairs Hospitals (VA) were at higher risk and had different outcomes, compared with patients in nonfederal hospitals.

Study Design: Records of all CEA performed in the VA Connecticut Healthcare System between October 1997 and September 2002 were examined and compared with CEA performed in all nonfederal Connecticut hospitals (CT).

Hospital-based factors predict outcome after carotid endarterectomy.

Objective: Patient, hospital, and surgeon factors affect outcome after carotid endarterectomy (CEA). The nature and importance of hospital-specific factors, especially those unrelated to procedural volume, that affect post-CEA outcome remains poorly defined. We used a statewide database to determine the impact of several hospital-associated factors on outcome after CEA.

Use of N-acetylcholine and sodium bicarbonate to protect renal transplant function during endovascular renal artery aneurysm exclusion.

We describe the successful use of hydration with sodium bicarbonate and N-acetylcholine to prevent contrast-induced nephrophathy in a patient with a kidney transplant undergoing endovascular native renal artery aneurysm exclusion. The implications for surveillance studies for endovascular procedures are discussed.