Ishani Barai

The SCARE Statement: Consensus-based surgical case report guidelines

INTRODUCTION Case reports have been a long held tradition within the surgical literature. Reporting guidelines can improve transparency and reporting quality. However, recent consensus-based guidelines for case reports (CARE) are not surgically focused. Our objective was to develop surgical case report guidelines. METHODS The CARE statement was used as the basis for a Delphi consensus. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. A multidisciplinary group of surgeons and others with expertise in the reporting of case reports were invited to participate. In round one, participants stated how each item of the CARE statement should be changed and what additional items were needed. Revised and additional items from round one were put forward into a further round, where participants voted on the extent of their agreement with each item, using a nine-point Likert scale, as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. RESULTS In round one, there was a 64% (38/59) response rate. Following adjustment of the guideline with the incorporation of recommended changes, round two commenced and there was an 83% (49/59) response rate. All but one of the items were approved by the participants, with Likert scores 7-9 awarded by >70% of respondents. The final guideline consists of a 14-item checklist. CONCLUSION We present the SCARE Guideline, consisting of a 14-item checklist that will improve the reporting quality of surgical case reports.

Preferred reporting of case series in surgery; the PROCESS guidelines

INTRODUCTION Case series have been a long held tradition within the surgical literature and are still frequently published. Reporting guidelines can improve transparency and reporting quality. No guideline exists for reporting case series, and our recent systematic review highlights the fact that key data are being missed from such reports. Our objective was to develop reporting guidelines for surgical case series. METHODS A Delphi consensus exercise was conducted to determine items to include in the reporting guideline. Items included those identified from a previous systematic review on case series and those included in the SCARE Guidelines for case reports. The Delphi questionnaire was administered via Google Forms and conducted using standard Delphi methodology. Surgeons and others with expertise in the reporting of case series were invited to participate. In round one, participants voted to define case series and also what elements should be included in them. In round two, participants voted on what items to include in the PROCESS guideline using a nine-point Likert scale to assess agreement as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. RESULTS In round one, there was a 49% (29/59) response rate. Following adjustment of the guideline with incorporation of recommended changes, round two commenced and there was an 81% (48/59) response rate. All but one of the items were approved by the participants and Likert scores 7-9 were awarded by >70% of respondents. The final guideline consists of an eight item checklist. CONCLUSION We present the PROCESS Guideline, consisting of an eight item checklist that will improve the reporting quality of surgical case series. We encourage authors, reviewers, editors, journals, publishers and the wider surgical and scholarly community to adopt these.

A protocol for the development of reporting criteria for surgical case reports: The SCARE statement

INTRODUCTION Case reports have specific relevance within the surgical literature. The Case Report Guidelines (CARE) were developed in 2013 to provide a framework to support accuracy in the publication of case reports. As such, they have been adopted by multiple journals. However, they are not tailored to surgery. The objective of this research is to conduct a Delphi consensus exercise amongst experienced case report reviewers and editors to develop the Surgical CAse REport (SCARE) Guidelines. METHODS AND ANALYSIS The CARE statement will be used as the basis for this Delphi consensus exercise. The Delphi questionnaire will be administered via SurveyMonkey and conducted using standard Delphi Methodology. Surgeons and others with significant experience in reviewing case reports will be invited to participate. There is no pre-determined number of Delphi rounds, although the expectation is that at least three will be needed. Initially, interested parties will be invited to contribute further items for consideration. Then, in each subsequent round, the participants will rate the importance of reporting each outcome on a nine-point Likert scale as proposed by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) working group. This process will also be used to agree standard definitions for the outcomes. DISSEMINATION This work will be disseminated through publication and will be presented at national and international meetings. The findings will be disseminated to interested parties, and journals will be encouraged to endorse the reporting guideline.

Support for reporting guidelines in surgical journals needs improvement: A systematic review

INTRODUCTION Evidence-based medicine works best if the evidence is reported well. Past studies have shown reporting quality to be lacking in the field of surgery. Reporting guidelines are an important tool for authors to optimize the reporting of their research. The objective of this study was to analyse the frequency and strength of recommendation for such reporting guidelines within surgical journals. METHODS A systematic review of the 198 journals within the Journal Citation Report 2014 (surgery category) published by Thomson Reuters was undertaken. The online guide for authors for each journal was screened by two independent groups and results compared. Data regarding the presence and strength of recommendation to use reporting guidelines was extracted. RESULTS 193 journals were included (as five appeared twice having changed their name). These had a median impact factor of 1.526 (range 0.047-8.327), with a median of 145 articles published per journal (range 29-659), with 34,036 articles published in total over the two-year window 2012-2013. The majority (62%) of surgical journals made no mention of reporting guidelines within their guidelines for authors. Of the 73 (38%) that did mention them, only 14% (10/73) required the use of all relevant reporting guidelines. The most frequently mentioned reporting guideline was CONSORT (46 journals). CONCLUSIONS The mention of reporting guidelines within the guide for authors of surgical journals needs improvement. Authors, reviewers and editors should work to ensure that research is reported in line with the relevant reporting guidelines. Journals should consider hard-wiring adherence to them.

Quality improvement teaching at medical school: a student perspective

Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school.

Cultural humility: treating the patient, not the illness

No abstract available. (Published: 3 February 2016) Citation: Med Educ Online 2016, 21: 30908 - http://dx.doi.org/10.3402/meo.v21.30908

Nipple sparing versus skin sparing mastectomy: a systematic review protocol

Introduction Breast cancer has a lifetime incidence of one in eight women. Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy (NSM). However, oncological safety remains unproven, and the benefits and indications have not been clearly identified. The objective of this systematic review will be to determine the safety and efficacy of NSM as compared with skin sparing mastectomy (SSM). Methods and analysis All original comparative studies including; randomised controlled trials, cohort studies and case–control studies involving women undergoing either NSM or SSM for breast cancer will be included. Outcomes are primary—relating to oncological outcomes and secondary—relating to clinical, aesthetic, patient reported and quality of life outcomes. A comprehensive electronic literature search, designed by a search specialist, will be undertaken. Grey literature searches will also be conducted. Eligibility assessment will occur in two stages; title and abstract screening and then full text assessment. Each step will be conducted by two trained teams acting independently. Data will then be extracted and stored in a database with standardised extraction fields to facilitate easy and consistent data entry. Data analysis will be undertaken to explore the relationship between NSM or SSM and preselected outcomes, heterogeneity will be assessed using the Cochrane tests. Ethics and dissemination This systematic review requires no ethical approval. It will be published in a peer-reviewed journal. It will also be presented at national and international conferences. Updates of the review will be conducted to inform and guide healthcare practice and policy.

Improving the quality of psychiatry teaching within the UK undergraduate medical curriculum

Dear editor We read with great interest the article by Shah,1 which outlines various approaches to increase the exposure of undergraduate medical students to specialties such as psychiatry. While Shah1 makes valid suggestions to tackle this issue without altering the undergraduate medical school curriculum, we believe that there is scope for significant improvements within the curriculum for psychiatry in particular. To initiate this process, the first step may be to acknowledge the intrinsic attitudes of medical students toward psychiatry. Misconceptions among medical students include perceiving psychiatry as emotionally challenging with difficult patients, being taught from an insufficient evidence base, and having a lack of prestige within the medical profession.2 The extracurricular exposure to psychiatry proposed by Shah1 would mainly target students with a pre-existing interest in psychiatry. In comparison, fundamental changes within the psychiatry curriculum of medical schools may have an impact on a larger proportion of the student body. Typically, psychiatry is taught in the later years of medical school. However, an early exposure to this vital specialty can be achieved via the integration of psychiatric components into teaching of other specialties. For example, medical students can be encouraged to adopt a more holistic approach during problem-based learning (PBL) sessions by considering the pertinent psychiatric aspects as learning objectives. McParland et al3 compared the effectiveness of PBL with traditional undergraduate psychiatry teaching at University College London and concluded that students showed better academic performance with the PBL course. In this case, although the attitudes of students toward psychiatry remained largely unchanged, the PBL teaching style enabled more effective learning of the subject, which translated into an improved clinical performance and knowledge base. Additionally, teaching of psychiatric conditions could be incorporated into the preclinical neuroscience course in order to explore the scientific basis of psychiatry. With the development of psychiatric neuroscience, residency training programs in the US have also started placing more importance on neuroscience education within psychiatry.4 Similar incorporation of psychiatry into neuroscience teaching in medical schools would allow students to appreciate the role of neuroscience in psychiatric practice early in their medical training. Importantly, this may also allow misconceptions about psychiatry to be dispelled early in medical school. Furthermore, Manassis et al5 highlighted that initial interest is a major factor influencing the choice of psychiatry as a specialty. Thus, early exposure to psychiatry in medical schools would also enable earlier identification of interested students, who can then be encouraged to pursue psychiatry. Other novel teaching techniques include the use of popular media such as clips from television programs6 to encourage discussion about the widespread presence of mental illness, alongside textbooks to consolidate learning. This was adopted in the development of a seminar program, at the University of Nebraska by McNeilly and Wengel,6 utilizing short vignettes from the television program “ER” to effectively demonstrate the practical applications of psychotherapeutic techniques and communication skills to medical students. Finally, an effective way to enhance the quality of psychiatry placements would be to involve teaching-oriented psychiatrists, without necessarily increasing the length of placements. To support this, a survey conducted among medical students reported that their attitudes toward psychiatry improved with encouragement from senior psychiatrists or if they were particularly inspired by a member of the psychiatric team during clinical attachments.7 Hence, practising physicians may be encouraged to reflect upon their impact on the attitudes of students and their future interest in pursuing psychiatry. We believe these suggestions would ultimately have minimal logistical and financial implications and can be easily incorporated into the curriculum of medical students. As junior doctors, we are highly likely to encounter patients with mental illnesses, as it affects over 25% of the population.8 Therefore, a solid understanding of psychiatry is crucial, regardless of the speciality that we ultimately pursue.

The importance of laboratory medicine in the medical student curriculum

(No abstract available) (Published: 17 December 2015) Citation: Med Educ Online 2015, 20: 30309 - http://dx.doi.org/10.3402/meo.v20.30309