James J. Neutens

To the point: medical education review of the role of simulators in surgical training

Simulation-based training (SBT) is becoming widely used in medical education to help residents and medical students develop good technical skills before they practice on real patients. SBT seems ideal because it provides a nonthreatening controlled environment for practice with immediate feedback and can include objective performance assessment. However, various forms of SBT and assessment often are being used with limited evidence-based data to support their validity and reliability. In addition, although SBT with high-tech simulators is more sophisticated and attractive, this is not necessarily superior to SBT with low-tech (and lower cost) simulators. Therefore, understanding the types of surgical simulators and appropriate applications can help to ensure that this teaching and assessment modality is applied most effectively. This article summarizes the key concepts that are needed to use surgical simulators effectively for teaching and assessment.

Screening Mammography Utilization in Tennessee Women: The Association with Residence.

CONTEXT Approximately 70% of US women over age 40 report mammography screening within 2 years. However, rates are likely to vary by age, income, educational level, and residence. PURPOSE To describe the prevalence of screening mammography and associated factors in women living in rural and urban areas of Tennessee. METHODS Using pooled data from the Tennessee Behavioral Risk Factor Surveillance System (BRFSS; 2001 and 2003), utilization of screening mammography within a 2-year period was examined for a sample of 1,922 women, 40 years and older. Demographic, behavior, and health-related variables were used to examine associations with utilization. FINDINGS The prevalence of screening mammography utilization (71.3% 95% CI 67.4-75.2) in women living in rural areas of Tennessee was significantly lower than utilization among women living in urban areas (78.3% 95% CI 75.9-80.7). Higher utilization was associated with having attained at least a high school education, having health insurance, identifying a personal health care provider, being a nonsmoker, recent use of alcohol, having had a recent clinical breast exam or Papanicolau (Pap) test done, and meeting the Healthy People 2010 (HP 2010) recommendation for physical activity. After controlling for all other factors, rural residence was not associated with utilization. For rural women, identifying a personal health care provider was significantly associated with increased likelihood of utilization. CONCLUSIONS Lower income and lower education, each associated with lower screening utilization, were more common in rural Tennessee women. The significance of a personal health care provider for utilization in rural women is meaningful for service providers.

A comprehensive review to establish priority learning objectives for medical students in the obstetrics and gynecology clerkship

OBJECTIVE This study was undertaken to describe the process used to identify, externally validate, and establish the priority learning objectives for medical students on the obstetrics and gynecology clerkship. STUDY DESIGN We conducted a review of the APGO Medical Student Objectives in Obstetrics and Gynecology to establish which of these objectives should be given first priority. We used recommendations from external references to assess the validity of these selected objectives. We compared the distribution of objectives with levels of expected competency from Millers pyramid. RESULTS From a list of 267 unique learning objectives we identified 134 (50.2%) Priority 1 objectives students must master by the end of the clerkship. The recommendations from 17 external references were compared with this set of objectives, which demonstrated a significant correlation between the 2 (P < or = .001). Priority 1 objectives were associated with advanced levels of competency. CONCLUSION External sources validated and helped prioritize the learning objectives.